A remote and immersive setup for pandemic-safe surgical education

Existing challenges in surgical education (See one, do one, teach one) as well as the Covid-19 pandemic make it necessary to develop new ways for surgical training. This is also crucial for the dissemination of new technological developments. As today's live transmissions of surgeries to remote locations always come with high information loss, e.g. stereoscopic depth perception, and limited communication channels. This work describes the implementation of a scalable remote solution for surgical training, called TeleSTAR (Telepresence for Surgical Assistance and Training using Augmented Reality), using immersive, interactive and augmented reality elements with a bi-lateral audio pipeline to foster direct communication. The system uses a full digital surgical microscope with a modular software-based AR interface, which consists of an interactive annotation mode to mark anatomical landmarks using an integrated touch panel as well as an intraoperative image-based stereo-spectral algorithm unit to measure anatomical details and highlight tissue characteristics.We broadcasted three cochlea implant surgeries in the context of otorhinolaryngology. The intervention scaled to five different remote locations in Germany and the Netherlands with lowlatency. In total, more than 150 persons could be reached and included an evaluation of a participant's questionnaire indicating that annotated AR-based 3D live transmissions add an extra level of surgical transparency and improve the learning outcome.