Virtual Instruments: Beyond Telestration in Surgical Telementoring

In surgical telementoring, mentors impart instruction to mentees during surgery using videoconferencing systems that offer telestration tools, namely, pointing and drawing on the surgical view. Although research has established the limits of these telestration tools for conveying instruction in laparoscopic surgery, few works have studied the benefits of novel tools. In this work, we study the use of virtual instruments, mentor-controlled instruments overlaid on the surgical view, for remote instruction during dissection and exposure. We conducted an experiment with 12 medical residents and two attending surgeons serving as confederates, comparing telestration to virtual instruments. We find that while virtual instruments can introduce visual clutter that may hinder understanding or compromise safety, they support conveying instrument orientation, although they are less effective for conveying precise locations and trajectories. Moreover, we observe that demonstrating gestures with virtual instruments is beneficial for novice mentees but unnecessarily constraining for experienced ones. We discuss how virtual instruments can complement telestration in surgical telementoring systems to support instruction during different tasks and learning stages.