The first end-to-end remotely guided transcatheter aortic valve implantation (TAVI) procedure using the Microsoft HoloLens 2 for extended reality (XR) clinical support has been performed at the Jewish General Hospital (JGH, Montreal, Canada).
The procedure was performed as part of a partnership between JGH, Auger Groupe Conseil (AGC) and Medtronic Canada. Sam Radhakrishnan, the proctor or teaching specialist in Toronto, was able to remotely guide the JGH TAVI team of Ali Abualsaud, Nathan Messas, and Emmanuel Moss through the procedure in real time at the JGH in Montreal, using the intraoperative XR platform.
The platform is comprised of three key elements, the Microsoft HoloLens 2, a headset which enables bidirectional remote viewing in real time; a modular system that allows the remote proctor to view the cardiac event monitors in real-time, without requiring the active clinician wearing the HoloLens 2 to look up at the screens, and; a three-dimensional clinical pathway overlay depicting step-by-step instructions for a specific surgical procedure.
“We think of it as bringing the operating room to the surgical specialist. Rather than coordinating resources to bring a specialist to another hospital for training, now we can greatly simplify the process, which can help improve the timeliness of patient care, especially in an emergency,” said awrence Rudski, director of the Azrieli Heart Center. “There are significant advantages to using a real-time, extended-reality system for both the proctor and the clinician on the receiving end, such as having the same view—which is almost better than being in the same, often crowded, room. In addition, this platform has the flexibility to be expanded to many other types of procedures.”
During the initial peak of the pandemic in spring 2020, the JGH was designated as a lead COVID-19 treatment site. The ensuing staffing challenges, combined with travel restrictions, required effective and remote training solutions. In collaboration with Quebec engineering firm AGC, the JGH piloted the use of the Microsoft HoloLens to help train and redeploy staff.
“We chose to work with Microsoft mainly because of the HoloLens 2’s unmatched performance and in part because of the security offered by their encryption design,” said Marcel Lafontaine, CEO of AGC. “We are very proud of our work in combining the mixed reality experience of voice, video and a 3D overlay with no lag time. This is a unique plug-and-play solution, and we are very excited to see it deployed in such an impactful way for clinicians, and ultimately for patients.”
The initial success of this project led to developing remote support in a complex clinical pathway and connectivity to medical imaging with the help of leading medical device company Medtronic.
“We are thrilled to be able to contribute our expertise to this unique partnership and are looking forward to seeing this collaboration extend to other clinical pathways,” said Richard Paré, regional business director of the CardioVascular Portfolio at Medtronic Canada. “This innovative platform can enable health systems to optimise surgical resources and scheduling, while protecting staff, during the pandemic but also afterwards as they shift their focus to addressing the surgical backlog.”
