Wednesday, October 7, 2009

Telesurgery Successful in Iraq

According to a story appearing in MC4’s September newsletter issue of “The Gateway”, LTC T. Sloane Guy IV, M.D., a cardiothoracic surgeon, found that he was not always doing run-of-the-mill procedures in his specialty. However, as Chief of Clinical Services with the 249th General Hospital in Afghanistan until 2006, he successfully completed all of his procedures but he would have been happy with another specialist or two by his side. He could see the need especially in his case to contact with operating rooms in the U.S. to talk to other specialists and to help him assist with his procedures from afar.

LTC Guy thought about the need and came up with an original concept that included a camera system configured in the OR with one camera worn on the head of the surgeon and another camera mounted in the overhead light fixture. This configuration would offer different views of the operative field all connected in real-time over the internet.

In 2007, LTC Guy met with Colonel Ronald Poropatich, Medical Informatics Consultant to the Army Surgeon General and the leadership at TATRC to ask for assistance. In 2008, the project received funds and the next step was to develop the software. The project leaned on SRI International to provide the solution based on their expertise in telesurgical projects.

SRI was able to provide the ability to perform telestration on images. Doctors in the U.S. can now freeze-frame live footage and write instructions or details on an image and then send it to the deployed OR.

At this point, the Medical Communications for Combat Casualty Care (MC4) provided the configuration and technical support for LTC Guy. After resolving firewall issues and inserting the technology into the OR in theater, MC4 provided the hardware to Brooke Army Medical Center and was then able to link LTC Guy with providers stateside.

LTC Guy’s telesurgery mentor system vision took years to germinate from an idea formed in a treatment facility in Afghanistan to a working prototype tested on the Battle field in Iraq. In August 2009, LTC Guy, now Chief of Surgery with the 47th Combat Support Hospital has successfully tested the new telesurgery initiative to connect stateside specialists with the Combat Support Hospital in Iraq.

The surgeon was able to perform a complex and rare surgical procedure. At the same time, LTC P. William “Chance” Conner, a specialist at Brooke Army Medical Center in Fort Sam Houston, Texas peered over his shoulder to view live video footage of the procedure and was able to offer real-time guidance when requested. MC4 enabled the live consult to take place through rugged laptops armed with new technology.

Colonel Poropatich believes the system can be used in any deployed setting whether in Iraq, Afghanistan, Kosovo, or Honduras. It is possible for calls for assistance to go into a central consult routing system and then go to the Tripler Army Medical Center in Hawaii, Landstuhl Regional Medical Center in Germany, or to the 121st Combat Support Hospital in Korea.

“The system can also be used to help during hurricanes in the U.S. and can be of value to help smaller civilian hospitals lacking surgical expertise to handle some of the difficult cases that might come in. In addition, the system could also better prepare new surgeons for the realities of theater trauma care. Surgeons graduating from military programs and preparing to deploy for the first time would be able to watch live procedures from the battlefield. Stateside medical personnel just do not see the same type of cases that are handled in theater”, reports Colonel Poropatich.