Send to

Choose Destination
Simul Healthc. 2018 Oct 31. doi: 10.1097/SIH.0000000000000334. [Epub ahead of print]

Augmented Reality Future Step Visualization for Robust Surgical Telementoring.

Author information

From the Departments of Computer Science (D.S.A., V.S.P.) and Industrial Engineering (M.E.C., E.J.R.M., G.T.G., J.P.W.), Purdue University, West Lafayette; and Indiana University, School of Medicine (B.M., S.M., B.L.Z.), Bloomington, IN.



Surgical telementoring connects expert mentors with trainees performing urgent care in austere environments. However, such environments impose unreliable network quality, with significant latency and low bandwidth. We have developed an augmented reality telementoring system that includes future step visualization of the medical procedure. Pregenerated video instructions of the procedure are dynamically overlaid onto the trainee's view of the operating field when the network connection with a mentor is unreliable.


Our future step visualization uses a tablet suspended above the patient's body, through which the trainee views the operating field. Before trainee use, an expert records a future library of step-by-step video footage of the operation. Videos are displayed to the trainee as semitransparent graphical overlays. We conducted a study where participants completed a cricothyroidotomy under telementored guidance. Participants used one of two telementoring conditions: conventional telestrator or our system with future step visualization. During the operation, the connection between trainee and mentor was bandwidth throttled. Recorded metrics were idle time ratio, recall error, and task performance.


Participants in the future step visualization condition had 48% smaller idle time ratio (14.5% vs. 27.9%, P < 0.001), 26% less recall error (119 vs. 161, P = 0.042), and 10% higher task performance scores (rater 1 = 90.83 vs. 81.88, P = 0.008; rater 2 = 88.54 vs. 79.17, P = 0.042) than participants in the telestrator condition.


Future step visualization in surgical telementoring is an important fallback mechanism when trainee/mentor network connection is poor, and it is a key step towards semiautonomous and then completely mentor-free medical assistance systems.

Supplemental Content

Full text links

Icon for Wolters Kluwer
Loading ...
Support Center