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Technology's role in teaching the world
A chief of surgery travels to India to share pediatric surgical innovations and broadcasts lessons from a Denver medical center.

By Dr. Steven Rothenberg

As the chief of surgery for Rocky Mountain Hospital for Children at Presbyterian/St. Luke’s Medical Center in Denver, Colo., I have focused on customizing surgical planning and evaluation, enhanced visualization during surgery and minimal and noninvasive surgical methods in infants and children. Recently, I had the privilege of sharing this knowledge with physicians in India during a three-day workshop.

Dr. Steven Rothenberg in the new operating room at Rocky Mountain Hospital for Children at Presbyterian/St. Luke’s Medical Center in Denver. The facility includes equipment to perform surgical telementoring.

In September 2010, I traveled to Bangalore to teach a thoracoscopic workshop to more then 250 pediatric surgeons who flew in from all over India to observe this surgery. More than 20 cases of congenital and acquired thoracic were assembled for the surgical demonstration. The most advanced minimally invasive techniques were demonstrated in a variety of pulmonary, tumor and diaphragmatic problems.

These workshops demonstrate an important step forward in surgical innovation and are critical in spreading the knowledge of these advanced techniques. This is especially true in thoracoscopic surgery, as these procedures have long been recognized as some of the more technically challenging surgeries faced by pediatric surgeons. These include the treatment of congenital abnormalities, such a repair of esophageal atresia to complex lung resections.

A classic thoracotomy can cause major stress for a child, particularly a newborn infant who – in the case of this specific condition – is often born small and premature. The operating room procedure is lengthy and adds undue stress to an already vulnerable patient. There are also significant long-term musclo-skeletal sequelae related to having a thoracotomy as an infant or child. All of these issues can be avoided by the use of thoracoscopy.

Recent technological advances have introduced endoscopic techniques to the arsenal of the pediatric surgeon to minimize the stress in children who require major invasive procedures. These techniques can reduce stress on the child, reduce his or her overall pain level and significantly speed patient recovery time.

Throughout the workshop, I moved between two surgery rooms, overseeing and instructing the latest techniques while each surgery was televised through the instrument’s high-definition cameras. In the 14 surgeries I performed, the other doctors had a full view of the instruments and the body cavity, allowing them to see exactly what I saw as I was performing the surgery. During the workshop, we performed the first thoracoscopic tracheo-esophageal repair in India and a number of complicated thoracoscopic lobectomies.

This workshop provided unparalleled opportunities and resources to lead a paradigm shift in surgery toward greater precision and better outcomes. Although some of these techniques have never been taught before in India, many of the surgeons that I taught on my trip were already very familiar with them through surgery broadcasts, which we had previously done online.

Teaching these surgeries abroad is very important, but I cannot be everywhere at once. With the technology that now exists within our new operating rooms at the Rocky Mountain Hospital for Children at Presbyterian/St. Luke’s, surgeons all over the world are able to learn new techniques to help patients in their own countries without needing to expend the huge cost in resources, money and time to travel and learn abroad.

Information systems
One of the tools offered through this advanced minimally invasive surgery equipment in Denver is the convenient access to patient information. The information systems built into the equipment allow doctors to access the medical records of the patient while in surgery, as well as any current patient vitals, directly on the screen. This system is the latest technology in hospital information systems and allows for quicker consult of patient information when timing is an issue. The system also allows for surgeons outside the operating room to log in to the system and check the real-time vitals, X-rays and other critical information of their patients on their smartphone, iPad or computer from anywhere in the world.

Surgical telementoring
A robot mounted in the new operating room was developed to allow for remote consults and teaching of the surgery techniques. This robot is operated by a remote laptop and can be controlled from anywhere in the world to enable:

  • Remote consults: A program called VisitOR1 (InTouch Health) allows for a remote expert consult or second opinion while in surgery via a television screen. This gives the consulting physician full access to the vital signs of the patient, the medical history of the patient, full view of the surgery taking place and a laser pointer to use as a directing tool.
  • Teaching: VisitOR1 allows for interactive remote teaching by allowing the student to move the monitor and ask the surgeon questions during surgery.

HD screens
High-definition monitors (at 1080p) have the highest-quality resolution available and include views that emulate 3D vision. With almost 3D vision on the screens, surgeons can perform rare single-site MIS surgeries on children because there is no need for one or two more incisions for better view.

Such technology is allowing us to make strides in helping patients all over the world. These types of pediatric minimally invasive surgery techniques are not only technically feasible, but provide a safe alternative to classic open thoracotomy that is just as successful and far less stressful on the patients.

We can only serve patients within our reach, teach within our capabilities and travel within the time we have. The technology going into these operating rooms is breaking those boundaries. We are treating patients, consulting, teaching and helping developing countries during surgeries through common tools like our smartphones and laptops.

You can learn more about the VisitOR1 product from InTouch Health at www.intouchhealth.com/products_VisitOR1.html.

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