552735
research-article2014
SRIXXX10.1177/1553350614552735Surgical InnovationHamann et al
Letter to the Editor
Experiences in Adoption of Teledermatology in Mohs Micrographic Surgery: Using Smartglasses for Intraoperative Consultation and Defect Triage
Surgical Innovation 2014, Vol. 21(6) 653–654 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1553350614552735 sri.sagepub.com
Dathan Hamann, MD1, W. Soren Mortensen, MD2, Carsten R. Hamann2, Andrea Smith, MD2, Benjamin Martino, MD2, Christian Dameff, MD3, Jeffrey Tully, MD3,4, John Kim, MD2, and Abel Torres, MD, JD2 Decades after its development, Mohs micrographic surgery (MMS) remains the first-line treatment for skin malignancies in functionally and aesthetically sensitive areas. By nature, the size, shape, and extent of Mohs defects are not known prior to margins being cleared by histological examination. In many large institutions, multiple patients are treated concurrently, and the decision for optimal method and surgeon for defect closure is a collaborative effort between multiple subspecialists. This may include dermatology, plastic surgery, otorhinolaryngology, and other surgical subspecialties. Although effort is always made to communicate effectively, tools that improve the communication between physicians participating and collaborating in patient care will improve outcomes and make these processes less strenuous and more efficient. This conflagration of complicated scheduling, defect repair triage, and coordination between multiple departments provides an ideal environment for the application of intradepartmental telemedicine. We report with great interest that telemedicine and other telecommunication technologies are increasingly used to coordinate care in surgery and dermatology. For example, Lamel et al1 have explored the use of mobile phones for skin cancer screening and Kanthraj2 has described the successful use of teledermatology for remote consultation in dermatosurgery. Additionally, plastic surgeons have used third-generation smart phones for triaging wounds and other traumas.3 Telehealth technologies have also been used in MMS, especially for the purpose of telepathology.4 For example, distinguishing between basal cell carcinoma from benign histology on difficult frozen sections may be aided by dynamic telepathology intraoperatively. Smartglasses (Google Glass, Google Inc, Mountain View, CA) are a new telecommunication device, computer engineered to fit into a pair of eye-glasses (Figure 1). They are hands-free, voice-activated tools that present
Figure 1. A. A student in the dermatology department uses smartglasses to conduct a teleconsultation and discussion with the head and neck surgery resident scheduled to perform defect repair at a distant location. B. Defect photo taken with the smartglasses and transmitted hands-free to the head and neck surgery department.
information to the user on a small translucent optical display. These features make smartglasses well suited to dermatological surgery where infection control and complex procedures prevent the surgeon from using other devices like computers or cell phones. Our device is also fitted 1
Ohio State University, Columbus, OH, USA Loma Linda University Medical Center, CA, USA 3 Maricopa Medical Center, Phoenix, AZ, USA 4 Phoenix Children’s Hospital, Phoenix, AZ, USA 2
Corresponding Author: Dathan Hamann, Department of Internal Medicine, Division of Dermatology, The Ohio State University, 2012 Kenny Road, Columbus, OH 43221, USA. Email: [email protected]
Downloaded from sri.sagepub.com at COLORADO STATE UNIV LIBRARIES on June 29, 2015
654
Surgical Innovation 21(6)
with a 5 megapixel 720p HD camera capable of highdefinition and hands-free photo and video recording and streaming. Because of the versatility of this technology and related subsequent technologies, smartglasses may be especially useful for surgeons performing MMS defects repairs in the future. We have explored several potential applications at Loma Linda University where the surgeons in the Department of Dermatology and the Department of Otolaryngology and Head and Neck Surgery coordinate care and share the caseload for MMS defect reconstruction. First, smartglasses enable store-and-forward telemedicine by allowing hands-free photo and video capturing capabilities with seamless uploading online. As the size and difficulty of the postexcision defect is variable, anticipating and scheduling defect repairs can be complex. At Loma Linda University, patients undergoing MMS who had prescheduled reconstructions with the Department of Otolaryngology and Head and Neck Surgery were identified. After having completed MMS, still photos and video recordings of the defects were taken and seamlessly transmitted to the Head and Neck surgeons intraoperatively. The smartglasses were also utilized during MMS on patients without prescheduled reconstructions with facial plastics or head and neck surgery but who had complex defects or anticipated complicated closures. Additionally, the videoconference functionality in smartglasses enables live teleconsultation. Again, cases with completed MMS excisions were discussed with surgeons in the HNS department intraoperatively via videoconference regarding possible closure methods. In this way, the HNS surgeons could remotely view the operative field and participate in decision making, which may include closure methods or referral for closure. This may all be accomplished hands-free without breaking the sterile field. Enabling quick consultation with other surgeons is not only useful for difficult cases, but is also an asset for procedural fellows and resident education.
We here document a successful trial of early adoption of intraoperative and perioperative consultation and MMS defect triage using new smartglasses technology. Our preliminary encounters highlight potential future uses and prompt further evaluation and exploration of new teledermatology technologies in a surgical setting. Author Contributions DH, CRH, JT, CD, and AT participated in the planning and study design. DH, CRH, WSM, AS, BM, JK, and AT participated in the clinical execution and manuscript preparation.
Authors’ Note Prior presentations: The content has not been published previously and is not otherwise submitted for publication.
Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.
References 1. Lamel SA, Haldeman KM, Ely H, Kovarik CL, Pak H, Armstrong AW. Application of mobile teledermatology for skin cancer screening. J Am Acad Dermatol. 2012;67:576-581. 2. Kanthraj GR. Teledermatology: its role in dermatosurgery. J Cutan Aesthet Surg. 2008;1:68-74. 3. Farber N, Haik J, Liran A, Weissman O, Winkler E. Third generation cellular multimedia teleconsultations in plastic surgery. J Telemed Telecare. 2011;17:199-202. 4. Sukal SA, Busam KJ, Nehal KS. Clinical application of dynamic telepathology in Mohs surgery. Dermatol Surg. 2005;31:1700-1703.
Downloaded from sri.sagepub.com at COLORADO STATE UNIV LIBRARIES on June 29, 2015
research-article2014
SRIXXX10.1177/1553350614552735Surgical InnovationHamann et al
Letter to the Editor
Experiences in Adoption of Teledermatology in Mohs Micrographic Surgery: Using Smartglasses for Intraoperative Consultation and Defect Triage
Surgical Innovation 2014, Vol. 21(6) 653–654 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1553350614552735 sri.sagepub.com
Dathan Hamann, MD1, W. Soren Mortensen, MD2, Carsten R. Hamann2, Andrea Smith, MD2, Benjamin Martino, MD2, Christian Dameff, MD3, Jeffrey Tully, MD3,4, John Kim, MD2, and Abel Torres, MD, JD2 Decades after its development, Mohs micrographic surgery (MMS) remains the first-line treatment for skin malignancies in functionally and aesthetically sensitive areas. By nature, the size, shape, and extent of Mohs defects are not known prior to margins being cleared by histological examination. In many large institutions, multiple patients are treated concurrently, and the decision for optimal method and surgeon for defect closure is a collaborative effort between multiple subspecialists. This may include dermatology, plastic surgery, otorhinolaryngology, and other surgical subspecialties. Although effort is always made to communicate effectively, tools that improve the communication between physicians participating and collaborating in patient care will improve outcomes and make these processes less strenuous and more efficient. This conflagration of complicated scheduling, defect repair triage, and coordination between multiple departments provides an ideal environment for the application of intradepartmental telemedicine. We report with great interest that telemedicine and other telecommunication technologies are increasingly used to coordinate care in surgery and dermatology. For example, Lamel et al1 have explored the use of mobile phones for skin cancer screening and Kanthraj2 has described the successful use of teledermatology for remote consultation in dermatosurgery. Additionally, plastic surgeons have used third-generation smart phones for triaging wounds and other traumas.3 Telehealth technologies have also been used in MMS, especially for the purpose of telepathology.4 For example, distinguishing between basal cell carcinoma from benign histology on difficult frozen sections may be aided by dynamic telepathology intraoperatively. Smartglasses (Google Glass, Google Inc, Mountain View, CA) are a new telecommunication device, computer engineered to fit into a pair of eye-glasses (Figure 1). They are hands-free, voice-activated tools that present
Figure 1. A. A student in the dermatology department uses smartglasses to conduct a teleconsultation and discussion with the head and neck surgery resident scheduled to perform defect repair at a distant location. B. Defect photo taken with the smartglasses and transmitted hands-free to the head and neck surgery department.
information to the user on a small translucent optical display. These features make smartglasses well suited to dermatological surgery where infection control and complex procedures prevent the surgeon from using other devices like computers or cell phones. Our device is also fitted 1
Ohio State University, Columbus, OH, USA Loma Linda University Medical Center, CA, USA 3 Maricopa Medical Center, Phoenix, AZ, USA 4 Phoenix Children’s Hospital, Phoenix, AZ, USA 2
Corresponding Author: Dathan Hamann, Department of Internal Medicine, Division of Dermatology, The Ohio State University, 2012 Kenny Road, Columbus, OH 43221, USA. Email: [email protected]
Downloaded from sri.sagepub.com at COLORADO STATE UNIV LIBRARIES on June 29, 2015
654
Surgical Innovation 21(6)
with a 5 megapixel 720p HD camera capable of highdefinition and hands-free photo and video recording and streaming. Because of the versatility of this technology and related subsequent technologies, smartglasses may be especially useful for surgeons performing MMS defects repairs in the future. We have explored several potential applications at Loma Linda University where the surgeons in the Department of Dermatology and the Department of Otolaryngology and Head and Neck Surgery coordinate care and share the caseload for MMS defect reconstruction. First, smartglasses enable store-and-forward telemedicine by allowing hands-free photo and video capturing capabilities with seamless uploading online. As the size and difficulty of the postexcision defect is variable, anticipating and scheduling defect repairs can be complex. At Loma Linda University, patients undergoing MMS who had prescheduled reconstructions with the Department of Otolaryngology and Head and Neck Surgery were identified. After having completed MMS, still photos and video recordings of the defects were taken and seamlessly transmitted to the Head and Neck surgeons intraoperatively. The smartglasses were also utilized during MMS on patients without prescheduled reconstructions with facial plastics or head and neck surgery but who had complex defects or anticipated complicated closures. Additionally, the videoconference functionality in smartglasses enables live teleconsultation. Again, cases with completed MMS excisions were discussed with surgeons in the HNS department intraoperatively via videoconference regarding possible closure methods. In this way, the HNS surgeons could remotely view the operative field and participate in decision making, which may include closure methods or referral for closure. This may all be accomplished hands-free without breaking the sterile field. Enabling quick consultation with other surgeons is not only useful for difficult cases, but is also an asset for procedural fellows and resident education.
We here document a successful trial of early adoption of intraoperative and perioperative consultation and MMS defect triage using new smartglasses technology. Our preliminary encounters highlight potential future uses and prompt further evaluation and exploration of new teledermatology technologies in a surgical setting. Author Contributions DH, CRH, JT, CD, and AT participated in the planning and study design. DH, CRH, WSM, AS, BM, JK, and AT participated in the clinical execution and manuscript preparation.
Authors’ Note Prior presentations: The content has not been published previously and is not otherwise submitted for publication.
Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.
References 1. Lamel SA, Haldeman KM, Ely H, Kovarik CL, Pak H, Armstrong AW. Application of mobile teledermatology for skin cancer screening. J Am Acad Dermatol. 2012;67:576-581. 2. Kanthraj GR. Teledermatology: its role in dermatosurgery. J Cutan Aesthet Surg. 2008;1:68-74. 3. Farber N, Haik J, Liran A, Weissman O, Winkler E. Third generation cellular multimedia teleconsultations in plastic surgery. J Telemed Telecare. 2011;17:199-202. 4. Sukal SA, Busam KJ, Nehal KS. Clinical application of dynamic telepathology in Mohs surgery. Dermatol Surg. 2005;31:1700-1703.
Downloaded from sri.sagepub.com at COLORADO STATE UNIV LIBRARIES on June 29, 2015
