Wireless live streaming video of laparoscopic surgery: a bandwidth analysis for handheld computers.

Over the last six years, streaming media has emerged as a powerful tool for delivering multimedia content over networks. Concurrently, wireless technology has evolved, freeing users from desktop boundaries and wired infrastructures. At the University of Kentucky Medical Center, we have integrated these technologies to develop a system that can wirelessly transmit live surgery from the operating room to a handheld computer. This study establishes the feasibility of using our system to view surgeries and describes the effect of bandwidth on image quality. A live laparoscopic ventral hernia repair was transmitted to a single handheld computer using five encoding speeds at a constant frame rate, and the quality of the resulting streaming images was evaluated. No video images were rendered when video data were encoded at 28.8 kilobytes per second (Kbps), the slowest encoding bitrate studied. The highest quality images were rendered at encoding speeds greater than or equal to 150 Kbps. Of note, a 15 second transmission delay was experienced using all four encoding schemes that rendered video images. We believe that the wireless transmission of streaming video to handheld computers has tremendous potential to enhance surgical education. For medical students and residents, the ability to view live surgeries, lectures, courses and seminars on handheld computers means a larger number of learning opportunities. In addition, we envision that wireless enabled devices may be used to telemonitor surgical procedures. However, bandwidth availability and streaming delay are major issues that must be addressed before wireless telementoring becomes a reality.

Advancements in immersive VR as a tool for preoperative planning for laparoscopic surgery.

The utility of three-dimensional (3D) models for planning laparoscopic surgery and surgical training has been demonstrated. (1) Computed tomography (CT) scans with oral and intravenous contrast medium are frequently used for preoperative evaluation of patients undergoing complex laparoscopic surgery. Immersive 3D VR overcomes many of the conceptual limitations encountered when conveying or teaching 3D relationships via 2D images traditionally produced by these scans. Over the past year we have made advancements in several areas. First, we have improved the quality of our datasets by utilizing higher resolution multi-detector scans and altering the protocols used. Second, we now register multiple isosurface views with standard axial views and volume textured views to provide additional information and perspective. Third, we now routinely use auto-segmentation techniques to visualize individual structures.

Inclusion of 3-D computed tomography rendering and immersive VR in a third year medical student surgery curriculum.

Computed tomography (CT) scans are frequently used for preoperative evaluation of patients undergoing complex surgery and are therefore commonly encountered by medical students on their surgical rotations. Interpretation of these CT scan images is therefore an integral component of all medical students' surgical rotations. Additionally, advanced rendering available from modem scanners and registration of multimodal or serial scans require the student to understand how volumetric anatomy relates to cross-sectional anatomy. The utility of three-dimensional (3-D) models for conveying surgical anatomy has been demonstrated. Immersive 3-D VR overcomes many of the conceptual limitations encountered when conveying or teaching 3-D relationships via 2-D images traditionally produced by these scans. We are currently using augmented reality as a teaching tool and have incorporated 3-D immersive environments in the third year medical student Surgery rotation. Initial results suggest that this is an effective tool for teaching third year medical students. 3-D CT rendering and immersive VR provide an effective process for utilizing CT datasets to teach surgical anatomy to medical students.