3D adds extra dimensions in telemedicine
Professor Wilko Grolman from the University Medical Center Utrecht has long been at the forefront of high-resolution telemedicine, and his latest project, using 3D, is no different. Paul Milligan reports.
I’ve always had a big interest in technology, people used to joke that anything with a plug would draw my attention,” laughs Professor Wilko Grolman.
Based in the Netherlands, Grolman is the head of the department of Otorhinolaryngology and Head and Neck surgery at the University Medical Center Utrecht (UMC Utrecht). He has dedicated his professional career to patient care, surgery, research, and training. Nothing new there in the world of medicine you might say, but Grolman is also at the forefront of using high resolution video to help him (and others around the world) learn ever more about the world of ENT (ear, nose and throat) surgery.
Grolman was one of the ﬁrst in the Netherlands to adopt 4K, when he was involved in a project transmitting 4K video from the UMC to another university four years ago. Using broadband internet and 4K monitors that cost €20,000 each, it was a very different 4K environment to the one we inhabit now.
Grolman has long been an exponent of video conferencing, “To become a great surgeon, you have to watch the same operation being performed many times, preferably by different surgeons. Two surgeries are rarely identical.”
Grolman takes his teaching responsibilities very seriously, as he is in charge of 18 ENT residents at the UMC, as well as an additional 14 interns who pass through his department every two weeks. To help assist the education programme, the UMC links with a hospital in France, the Causse Ear Clinic, every Tuesday where a specialist in one ﬁeld of ENT surgery leads an interactive session, where students can ask questions via video conferencing. Every Thursday the UMC also links with a hospital in the UK , Wexham Park Hospital, to teach another specialism of ENT surgery.
To help create a network of knowledge sharing, Grolman was involved in setting up LION (Live Interactive Otolaryngology Network) in 2006. LION is a group of ear surgeons based around the world (its members range from Sao Paulo to Sydney), whose aims are to learn from each other and provide a continuous educational network, in which members can provide consultation to others when needed. Nearly ten years on from its inception LION hosts multiple live ear-surgery events every year, using video conferencing. The transmissions are publicly available and aimed at Otolaryngology residents and specialists.
In its early days it was all done over ISDN, which although signiﬁcantly faster than regular broadband services at the time, had huge associated running costs. “It was a hassle to get four ISDN lines in one OR. The phone bill was huge from just a one-day event.” Now the internet is far more stable and reliable around the globe, costs have shrunk dramatically, making it far more widely available. “Since we moved to IP we can now transmit in 1080p in 30Hz or 60Hz. We transmit in two different qualities, so even mobile devices can watch live surgeries.” The UMC now has the ability to stream via 4G as well.
Professor Grolman is constantly searching for ways to improve his surgeries and his teaching. His next big challenge was to be able to broadcast in stereoscopic 3D, as he knew it would make a signiﬁcant difference.
“I was already intrigued by 3D, when I look at surgeries though an endoscope or a microscope I see depth, proportion and dimensions,which you don’t see when you use a video camera, and that is the added value of stereoscopic images. Surgery is all about what you feel with your hands, but also what you see with your eyes; the colour of things, the dimensions, Is it big? Is it small? Is it deep? Is it shallow? These dimensions are added when you add stereoscopic to the images you see. Try driving with one eye closed, it’s much harder to estimate the speed you are driving and the distance of people to you. I wouldn’t recommend it but it does give you an idea of how important dimensions and speed are. It’s the same for surgery. 3D doesn’t necessarily give you more detail, what it does do is give you more information about the dimensions and orientation and size and location.”
Grolman began planning a 3D broadcast in the Spring of 2015, and was able to fully realise his dream in late October using a Polycom RealPresence video conferencing system with a 3D lab kit. The surgery, which was a stapedotomy, was performed by the Professor on two patients suffering from otosclerosis, (a bone growth in the ear that causes hearing loss). Grolman used a Zeiss Trenion HD 3D operating microscope to perform the surgery. For the ﬁrst time, residents learnt how to perform the surgery by receiving the identical stereoscopic 3D view as the surgeon.
This system also makes it easier for a resident to perform the surgery under supervision, as the supervisor is able to guide him/her while looking at a 3D screen in the OR with a reliable representation of what the resident sees through the microscope.
In combination with a regular 3D display, any viewer is able to have the same orientation as the surgeon. Being such an enthusiast of live streaming, and through his work with LION, much of the infrastructure at the UMC was already in place, including the vital element of a 3D stereoscopic microscope. The ﬁnal piece was waiting on a video conferencing manufacturer to offer a 3D system to meet his needs.
Now it’s all in place, has Grolman seen any resistance to the technology within the surgical community? “No,not at all. What makes this different than most is that we are able to combine the IP and the codec and MCUs and bandwidth technology with the desires of the surgeon.” The 3D broadcasts have proved so effective it’s now being used for most live transmissions.
So what’s next for the professor? He is hoping to get 3D surgical procedures posted on YouTube to extend its global range, and sees a lot of potential for the footage to be shown on VR headsets such as Zeiss VR One or the Oculus Rift.