SickKids surgeons use “smart glasses” to telementor in low-resource countries

Imagine sharing specialized skills in real time with a surgeon on the other side of the globe while they perform an operation, without physically being in the operating room with them.

Dr. Maryse Bouchard, a Paediatric Orthopaedic Surgeon at The Hospital for Sick Children (SickKids), has done so multiple times.

Bouchard is a member of the International Medical Advisory Board of Steps2Walk, a global humanitarian non-profit organization educating and training orthopaedic surgeons who lack access to ongoing and advanced training in the foot and ankle specialty. A pilot mentoring program was established through Steps2Walk and funded by a SickKids Centre for Global Child Health Catalyst Grant. Each year, the SickKids Centre for Global Child Health Catalyst Grant aims to support innovations that benefit children and their families in resource constrained settings to help realize SickKids vision of Healthier Children. A Better World.

“There are many skilled orthopaedic surgeons in low-resource areas who have excellent general knowledge when it comes to broken bones or joint replacements, but they lack expertise in less common sub-specialties, namely foot and ankle,” Bouchard says. “I have a strong interest in foot and ankle, as well as expertise in paediatrics, and I was invited to join the Advisory Board of Steps2Walk.”

When the pandemic shut down travel and surgical centres, the organization had to improvise and joined forces with Ohana One, an organization that utilizes “smart glasses” technology coupled with a mentor/mentee relationship to improve surgical training in developing countries and, in turn, treat more patients.

The augmented reality smart glasses create a virtual interactive presence, allowing a mentor not only to see what the mentee sees, but to make gestures and annotations to help the mentee during surgery. Dr. Bouchard was paired with an experienced surgeon in Sri Lanka, Dr. Dimuthu Tennakoon, and together they have performed more than a dozen surgeries using the smart glasses technology. 

“Even though we’re in two different countries about 14,000 kilometres apart, it’s like being there together,” Bouchard explains. “There’s a camera on the glasses frame that sends images to the person not wearing the glasses. The software allows me to zoom in and out, alter contrast, and draw on the screen. It takes phone a friend to the next level.”

Bouchard visited Sri Lanka in November to speak at the annual meeting of the Sri Lankan Orthopaedic Association. There, she conducted a two-day live surgery course in paediatric foot and ankle, with lectures and in-person surgeries with her mentee that were broadcast to a small group in an auditorium.

“The smart glasses technology can also be effective within a country or region, not just halfway around the world,” she says. “Dr. Tennakoon has already begun training his colleagues in the new techniques he’s learned, which is the ultimate goal.” Their work was been presented at annual meetings of the Pediatric Orthopaedic Society of North America and Canadian Orthopaedic Association.

Tennakoon says he is grateful for the program, which has unleashed a wave of enthusiasm for foot and ankle surgery among his orthopaedics colleagues in Sri Lanka. Last month, the country inaugurated the Sri Lanka Foot and Ankle Society and elected him as its first president.

This month, Bouchard and colleagues from Steps2Walk conducted a program in Tanzania for the first time, which included a variety of on-site training and educational approaches from its newly launched Global Institute. Her team of four saw 32 patients and operated on 14 of them over three days. Telementoring could also be used with this group as an opportunity for ongoing training after the initial trip.

Dr. Michael Chua, Staff Urologist at SickKids, also worked with Ohana One to acquire the smart glasses to support training fellow surgeons in his homeland, the Philippines. His work involves a combination of in-person and augmented reality.

When he ran the pilot, for safety reasons it was done at a short distance. He was in a room close by so he could access the operating room quickly in an emergency. Late last year, Chua received approval for the first long distance procedure, which took place Feb. 2. It was a diagnostic procedure and assessment on a post-operative patient, and he provided guidance to the trainee in the Philippines from his office in Toronto using the smart glasses.

“There’s definitely an advantage in terms of saving time and travel,” he says. “There’s no need to wait for someone to go there, and even though the time zone is different I haven’t found that to be an issue, I just work with them at night.”

Ultimately, Chua hopes to run a satellite paediatric and reconstructive urology fellowship in the Philippines to help enhance knowledge and skills among local trainees to better serve patients in low-to-middle income countries. A urology surgeon, Dr. Kay Rivera, who is from the Philippines and currently training with the Division of Urology at SickKids in Toronto, will return home and eventually become a local trainer. Perhaps one day the fellowship will be 100 per cent remote enabled by smart glasses tech.

Bouchard says the goal of telementoring, regardless of the type of technology used, is to raise the quality of care by providing a more advanced toolkit to fellow surgeons. With the support of the SickKids Centre for Global Child Health Catalyst Grant, the technology was trialed, challenges were identified and overcome, and the initiative expanded to the broader surgical community.

“I think it’s been extremely rewarding and highlighted for me that, while being a surgeon and taking care of patients is fulfilling, educating others and creating sustainable change in areas that really need it is equally important,” Bouchard says. “I’m amazed at how many surgeons in Sri Lanka are versed in foot and ankle the way I am because of the new training that simply didn’t exist before.”