South African surgeon Professor Stephen Roche from Groote Schuur Hospital and the University of Cape Town (UCT) is one of 15 surgeons from 13 different countries worldwide who are undertaking 13 mixed reality orthopaedic operations as part of a 24-hour event.

Professor Roche has participated in three of the 13 surgeries, leading the surgery in South Africa and assisting in two surgeries conducted in France and Germany.

The surgeons virtually collaborated using Microsoft HoloLens 2, and were led by Professor Thomas Grégory of the Avicenne AP-HP Hospital, France. Professor Grégory performed the first ever mixed reality surgery in December 2017.

Professor Grégory and his team led all 13 mixed reality surgeries from the Avicenne AP-HP Hospital. From there, the surgery toured a number of countries, including: South Africa, France, India, UAE, Ukraine, Germany, Belgium, Morocco, Brazil, Bolivia, Mexico, the US and the UK.

Equipped with the HoloLens 2, the surgeons in each country are able to:

* Visualise and perform surgery via hologram;

* Share their realtime view of the surgery, benefitting from remote peers’ expertise on different clinical cases; and

* Train their peers remotely.

HoloLens is a wireless, holographic mixed reality headset that connects with apps and solutions to enhance or enable collaboration, innovation and productivity. Hand and eye-tracking technology detects where the surgeon’s gaze is, allowing them to operate with greater precision.

The event’s international component enabled healthcare practitioners from different countries and cultures to share the diversity and richness of their respective practices:

* Professor Stephen Roche (orthopaedic surgeon at Groote Schuur Hospital and University of Cape Town): “Interactions during the meetings and recording the surgery make you feel the other surgeons are in the room with you,” he says. “Using this new technology and discussing surgery of the shoulder with world-recognised surgeons has allowed closer relations with the international shoulder community, especially as our normal interactions in international meetings have been cancelled during the pandemic. We are all trying to solve some of the problems of shoulder replacements from different perspectives, and this allows us to share our knowledge in real time. I think it has been a fantastic opportunity to show shoulder surgery in South Africa to the world.”

* Dr Ashish Babhulkar (head of shoulder and sports injuries department at Deenanath Mangeshkar Hospital Pune, India): “In some countries where expertise is higher, surgeons have better results on some specific clinical cases. This experience has allowed us to learn from others in a new way and improve our surgical skills.”

* Dr Bruno Gobatto (orthopaedic surgeon – shoulder and elbow at Jaragua Hospital Brazil): “The greatness of this project is in its ability to bring together people from different cultures and expertise. This is the best way to democratise the use of mixed reality in the surgical block.”

* Dr Rashed Alshaeel (director of orthopedic and trauma at VPS Burjeel Medical City, UAE): “HoloLens will change the way we operate. We will start using it to train our future surgeons and for remote assistance. It’s a new world for the healthcare industry.”

* Professor Thomas Gregory (shoulder, elbow, wrist and hand surgeon at Avicenne AP-HP Hospital, France): “Mixed reality transforms our surgical practices. HoloLens 2 acts as an assistant and allows us to use technology to secure and standardise surgeries.”

* Sikhumbuzo Ngcobo (public sector director at Microsoft South Africa): “We believe that if there is one area where technology should have a significant impact in serving public interest, it is in healthcare. Effective use of technology contributes to improving care globally. From patient experience and caregiver practice, through to providing more comprehensive and secure information to all stakeholders.”

Prof Roche adds: “Technology is playing a bigger role in surgery, research, and healthcare and certainly during Covid-19, where trainees have not been able to operate, this has highlighted the use and need for technology in training and teaching,” says Professor Roche. “The biggest highlight has been the excitement in using something innovative and high-tech with palpable benefits to the teaching and learning of shoulder and elbow surgery.”

It has given surgeons a tool where they can bring trainee orthopaedic surgeons into the operating room ‘virtually’ and take them through the surgery while interacting with them, he adds. It allows senior surgeons to explain the surgery and the planning with realtime access to X-rays, CT scans, and MRI, amongst others.

“It gives us the ability to manipulate these images real-time so intraoperative findings can be checked with our surgical planning. It allows us to access the internet during surgery and more importantly, we can bring a surgeon into the theatre virtually for advice, which would be a massive benefit for a continent like Africa, with many of our colleagues working in poorly resourced areas. You only need stable Wi-Fi and a device to view the link. Surgical support can also be given real-time – as if the senior surgeon is in theatre,” Prof Roche says.

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