Novel real-time image tracking annotation system for facilitating telementoring in surgery

Surgeries can improve the quality of life and save the lives of patients, which telementoring could help with when on-site expert surgeons are unavailable. The prevalence of laparoscopic and robotic surgery has led to increasing attention on telementoring, which involves real-time, remote, intraoperative image-based guidance from surgeons. However, the communication tools and equipment used can cause significantly various quality of telementoring, and no clear consensus exists; brief image shifts can cause miscommunication between local and remote surgeons. This study aimed to develop a novel system to improve the reliability of telementoring. We developed a novel real-time image-tracking annotation system (RITAS) using the MedianFlow algorithm, an object-tracking algorithm available as an external module within the OpenCV image-processing library. Using this system, three laparoscopic surgeries were performed at Beppu Hospital with telementoring support from Kyushu University. Surgical videos were transmitted through a secured optical fiber network, and a remote mentor annotated the video using a tablet device. These annotations tracked the surgical field and were simultaneously sent back to Beppu Hospital, allowing the local surgeon to refer to them during the procedure. One of the three RITAS-based telementoring sessions was conducted under a blinded protocol in which the tracking feature was alternately enabled and disabled every 10 min to assess annotation effectiveness. In this exploratory interval-level analysis, RITAS showed a higher effective annotation rate than non-tracking annotation. All three RITAS-based laparoscopic surgeries were completed without observed intraoperative or postoperative complications. In this pilot technical feasibility study, RITAS was clinically implemented in laparoscopic telementoring and showed improved annotation stability compared with non-tracking annotation in a preliminary blinded comparison. Further studies are required to evaluate technical robustness, usability, educational value, safety, and clinical impact.