Добавил:
kiopkiopkiop18@yandex.ru t.me/Prokururor I Вовсе не секретарь, но почту проверяю Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз: Предмет: Файл:
Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_869_Библиотеки_им_академика_М_И_Перельмана.pdf
Скачиваний:
0
Добавлен:
31.08.2026
Размер:
36 Мб
Скачать
45 Next-Generation Robots fortaTME
473
assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes: the ACOSOG Z6051 randomized clinical trial. JAMA. 2015;314(13):1346–55. https://doi.org/10.1001/jama.
2015.10529.
9. Jayne D, Pigazzi A, Marshall H, Croft J, Corrigan N, Copeland J, Quirke P, West N, Rautio T, Thomassen N, et al. Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: the ROLARR randomized clinical trial. JAMA. 2017;318:1569–80.
10. Barbash GI, Glied SA. New technology and health care costs--the case of robot-assisted surgery. N Engl J Med. 2010;363:701–4.
11. Marks JH, Myers EA, Zeger EL, Denittis AS, Gummadi M, Marks GJ. Long-term outcomes by a transanal approach to total mesorectal excision for rectal cancer. Surg Endosc. 2017;31:5248–57.
12. Marks J, Frenkel J, D’Andrea A, Greenleaf C.Maximizing rectal cancer results: TEM and TATA techniques to expand sphincter preservation. J Surg Oncol. 2011;20:501–20.
13. Moore JS, Cataldo PA, Osler T, Hyman NH.Transanal endoscopic microsurgery is more effective than tra­ditional transanal excision for resection of rectal masses. Dis Colon Rectum. 2008;51(7):1026–30; dis­cussion 1030–1. Epub 2008 May 15.
14. Atallah S, Albert M, Larach S.Transanal minimally invasive surgery: a giant leap forward. Surg Endosc. 2010;24(9):2200–5. Epub 2010 Feb 21
15. Sylla P, Rattner DW, Delgado S, Lacy AM. NOTES transanal rectal cancer resection using transanal endo­scopic microsurgery and laparoscopic assistance. Surg Endosc. 2010;24(5):1205–10.
16. Atallah S, Parra-Davila E, deBeche-Adams T, Albert M, Larach S. Excision of a rectal neoplasm using robotic transanal surgery (RTS): a description of the technique. Tech Coloproctol. 2012;16:389–92.
17. Atallah S, Nassif G, Polavarapu H, et al. Robotic­assisted transanal surgery for total mesorectal exci­sion (RATS-TME): a description of a novel surgical approach with video demonstration. Tech Coloproctol. 2013;17:441–7.
18. Verheijen PM, Consten ECJ, Broeders IAMJ.Robotic transanal total mesorectal excision for rectal cancer: experience with a rst case. Int J Med Robot Comput Assisted Surg. 2014;10:423–6.
19. Gomez Ruiz M, et al. Robotic-assisted laparoscopic transanal total mesorectal excision for rectal can­cer: a prospective pilot study. Dis Colon Rectum. 2015;58(1):145–53.
20. Atallah S, Marin-Perez B, Parra-Davilla E, deBeche­Adams T, Nassif G, Albert M, Larach S. Robotic transanal surgery for local excision of rectal neopla­sia, transanal total mesorectal excision, and repair of complex stulae: clinical experience with the rst 18 cases at a single institution. Tech Coloproctol. 2015;19:201–410.
21. Huscher CGS, Bretagnol F, Ponzano C. Robotic­assisted transanal total mesorectal excision: the key against the Achilles’ heel of rectal cancer? Ann Surg. 2015;261(5):120–1.
22. Kuo LJ, Ngu JCY, Tong YS, Chen CC. Combined robotic transanal total mesorectal excision (R-taTME) and single-site plus one-port (R-SSPO) technique for ultra-low rectal surgery- initial experience with a new operation approach. Int J Color Dis. 2017;32:249–54.
23. Tan Wen Sheng B, Wong P, Teo Ee Hoon C.Transoral robotic excision of laryngeal papillomas with Flex Robotic system- A novel surgical approach. Am J Otolaryngol. 2018;39(3):355–8.
24. Remacle M, Prasad WNM. Preliminary experience in transoral laryngeal surgery with a exible robotic system for benign lesions of the vocal folds. Eur Arch Otorhinolaryngol. 2018;275(3):761–5.
25. Matheis, et al. Flex Robotic System in transoral robotic surgery: the rst 40 patients. Head Neck. 2017;39(3):471–5.
26. Lang, etal. A European multicenter study evaluating the ex robotic system in transoral robotic surgery. Laryngoscope. 2017;127(2):391–5.
27. Mandapathil M, et al. Transoral surgery for oropha­ryngeal tumors using the Medrobotics Flex System- a case report. Int J Surg Case Rep. 2015;10:173–5.
28. Funk E, Goldenberg D, Goyal N. Demonstration of transoral robotic supraglottic laryngectomy and total laryngectomy in cadaveric specimens using the Medrobotics Flex System. Head Neck. 2017;39(6):1218–25.
29. Schuler PJ, et al. Demonstration of nasopharyngeal surgery with a single port operator-controlled exible system. Head Neck. 2016;38(3):370–4.
30. Atallah S. Assessment of a exible robotic system for endoluminal applications and transanal total mesorectal excision (taTME): could this be the solu­tion we have been searching for? Tech Coloproctol. 2017;21(10):809–14. https://doi.org/10.1007/s10151-
017-1697-6. Epub 2017 Oct 24
31. Atallah S, Hodges A, Larach SW.Direct target NOTES: prospective applications for next generation robotic platforms. Tech Coloproctol. 2018;22(5):363–71.
32. Titan Medical. 2018. Titanmedicalinc.com.
33. Kaouk J, Bertolo R. Single-site robotic platform in clinical practice: rst cases in the USA. Minerva Urol Nefrol. 2019 Jan 28.
34. Kaok JH, Haber GP, Autorino R, Crouzet S, Ouzzane A, Flamand V, Villers A. A novel robotic system for single-port urologic surgery: rst clinical investiga­tion. Eur Urol. 2014;66(6):1033–43.
35. Kaouk JH, Sagalovich D, Garisto J. Robot-assisted transvesical partial prostatectomy using a purpose­built single-port robotic system. Br J Urol Int. 2018;122(3):520–4.
36. Holsinger FC.A exible, single-arm robotic surgical system for transoral resection of the tonsil and lateral pharyngeal wall: next-generation robotic head and neck surgery. Laryngoscope. 2016;126(4):864–9.
474
J. O. Paull et al.
37. Chan JYK, Wong EWY, Tsang RK, Holsinger FC, Tong MCF, Chiu PWY, Ng SSM. Early results of a safety and feasibility clinical trial of a novel single- port exible robot for transoral robotic surgery. Eur Arch Otorhinolaryngol. 2017;274(11):3993–6.
38. Tateya I, Koy YW, Tsang RK, Hong SS, Uozumi R, Kishimoto Y, Sugimoto T, Holsinger FC. Flexible next-generation robotic surgical system for transoral endoscopic hypopharyngectomy: a comparative pre­clinical study. Head Neck. 2018;40(1):16–23.
39. Chen MM, Oroco RK, Lim GC, Holsinger FC. Improved transoral dissection of the tongue base with a next-generation robotic surgical system. Laryngoscope. 2018;128(1):78–83.
40. Marks J, Ng S, Mak T. Robotic transanal sur­gery (RTAS) with utilization of a next-generation single-port system: a cadaveric feasibility study. Tech Coloproctol. 2017;21(7):541–5. https://doi.
org/10.1007/s10151-017-1655-3. Epub 2017 Jul 14
Video-Based Training Apps andDeferred Live Surgery
JoepKnol
46

Introduction

In the progression of surgical training, whether for a novice surgeon learning, a new procedure, or an established surgeon in practice advancing their technical skills with new techniques, many factors are critical to the process of becoming procient and technically skilled and to be able to perform a safe and effective surgical procedure. The most essential factors are procedural knowl­edge, cognitive and psychomotor skills training, and direct guidance from a mentor during all steps of the procedure-specic training pathway (Fig.46.1) [1].
The procedure-specic knowledge acquisition phase should ideally be completed and tested to validate prociency before advancing along the training pathway. Next, basic technical skills should be practiced in the dry and wet lab setting, before attempting a procedure on live patients and ascending the procedure-specic learning curve [2]. The introduction of minimal invasive surgery (MIS) made this training model more achievable, for both cognitive skills training and mentorship by an experienced surgeon. In MIS, the conduct of the operation is displayed on a screen in real time, the trainer and trainee have the same view to
J. Knol (*) Department of Abdominal Surgery, Jessa Hospital, Hasselt, Belgium e-mail: joep.knol@jessazh.be
help guide safe dissection and appropriate pro­gression through the case, and procedures can be recorded to audit the case- specic anatomy, to cri­tique the chosen surgical planes, and to assess progression of technical skills for focused learn­ing and improvement. As a result, the MIS revolu­tion forced the surgical community to rethink the ideal surgical training pathway and how to adapt to and incorporate new technologies safely into practice. During the same time, cultural shifts in surgical education emerged, where international duty-hour restrictions limited the time trainees have in the hospital setting to perform live proce­dures and receive mentorship, and economic real­ities limited the ability for surgeons in practice to travel and learn new techniques to incorporate more difcult procedures into their practice arma­mentarium [35].
This paradigm shift has driven the search for innovative training solutions, with a greater emphasis on the role of cognitive skills training to accelerate the trainee’s understanding of a pro­cedure, formalize the steps being practiced, and reduce the overall training time required to become technically competent [6].
Much focus in cognitive skills training is placed on deliberate practice and simulation. Deliberate practice assumes that improvement and expertise depend on deliberate efforts to change particular aspects of performance [7]. In many domains of professional life, expertise in complex tasks has been described as only
© Springer Nature Switzerland AG 2019 S. Atallah (ed.), Transanal Minimally Invasive Surgery (TAMIS) and Transanal Total Mesorectal Excision (taTME), https://doi.org/10.1007/978-3-030-11572-2_46
475
476
Surgical
technique
Cognitive
skills
J. Knol
Psychomotor
Pre-task training +
Evaluation
skills
Pre-course
evaluation
Course
attendance
Cadaveric
course +
Live
surgery
Video teaching
Didactic material
Post-course
evaluation
Fig. 46.1 The new pathway for surgical skills training
achievable after 10,000hours of practice– “the 10,000 hour rule” [8]. Surgery ts this rule. In surgery, it seems reasonable that increase in hours of deliberate practice improves perfor­mance. Since MIS is performed while watching a video display, optimization of video teaching can contribute to improved surgeon performance. The need to acquire and master the unique skills required for laparoscopic surgery drove the rapid evolution of simulated-based training and assess­ment of technical skills. As part of the surgical training pathway, dry and wet lab models are most frequently used. Dry labs are working envi­ronments that provide training models, such as box trainers and virtual reality (VR) simulators, while wet labs are an animal-based platform [9]. However, in this digital age, procedural videos will play an increasing role in these simulation­based training sessions [10]. Tools continue to be developed to meet these unique training needs and have great promise to meet the changing environment of surgical training.
In this chapter we will discuss the theory and development of novel tools for current surgical training. We will focus on the introduction of cognitive-task simulation applications (apps) and optimization of use of surgical pattern recogni-
Informed consent
Transparancy
Patient
selection
Proctored initiation of experience
Monitor
personal
outcomes +
data
registration
Safe
performance
tion and images by multi-camera recording that can be made available in a synchronized fashion, known as Deferred Live surgery (dLive).

Mobile Apps

Mobile apps are applications developed for hand­held devices such as smartphones and tablets. While some mobile apps come preloaded with smartphones, users can download others from the mobile app store. In June 2007, Apple, Inc., released the rst iPhone at the Macworld Expo. The iPhone scaled computing from an activity previously limited to desktops to one synced with the modern mobile lifestyle and demand for cog­nitive capability that enables access to the world’s information via the web. In 2008, Google joined the market with Android (operating system)­based smartphones, initially with the HTC Dream phone. During this time period, apps and their associated capabilities continued to grow and scale to meet consumer demand. Now, more than a decade later, global mobile Internet user pene­tration has exceeded half of the world’s popula­tion, with an average daily time spent accessing online content from a mobile device reaching
46 Video-Based Training Apps andDeferred Live Surgery
185, 110, and 43 minutes, respectively, for Millennials (born 1980–2000), Generation X (born 1960–1980), and Boomers (1940–1960) (source: Statista.com, accessed 2018).
Also, among medical trainees and healthcare professionals, the number of mobile Internet users is very high, with an estimated >90% own­ing a smartphone and having medical smartphone apps installed on their devices [11, 12]. In fact, practicing physicians and medical students are the highest percentage of smartphone users among any single community [13, 14]. An impor­tant benet of mobile resources over traditional methods of accessing relevant medical informa­tion lies within their easy, immediate access and ability to update information; reportedly, online resources are more up-to-date than medical text­books [15, 16].
Because of the global accessibility of smart devices and increased availability of apps, there has been a shift in the retrieval method for the online content from use of mobile websites to mobile apps.
Prior surveys have reported that mobile users spend 86% of their online time on mobile apps, with the rest on mobile websites (Flurry Analytics
2014). As they put it: “It’s an App world. The Web Just Lives in it.” The reason for this clear preference is multifaceted, but for users there are several obvious advantages to mobile apps over mobile websites (Fig.46.2):
1. Download speed
2. Notications
3. Personalization
4. Ofine workability
5. Engaged experience
Mobile apps download content faster than websites and therefore are more convenient to users.
Also, with mobile apps, updates and events can be announced with push notications, or in­app messages instead of repetitive emails, which often are automatically ltered into “Junk Mail” and are thus never seen or read by the user. As mobile apps can track and observe user engage­ment, they can provide the user with custom rec-
477
Fig. 46.2 Benets of mobile apps over mobile websites
ommendations or meaningful geographically personalized information. In addition, websites can’t be accessed when ofine; however, most mobile apps offer a basic functionality to operate with cellular data even if the Internet is not connected.
Currently, the two largest global platforms for app distribution are Apple’s “App Store,” which caters to iOS users, and Google Play, belonging to the eponymous company, which caters to Android OS users. The Apple App Store launched in July 2008, at which time it contained 800 apps. Google originally launched the “Android mar­ket” in October 2008; in December 2009 this was rebranded as the “Google Play Store,” containing 6000 apps at that time (source: Statista.com). Currently (2018), it’s estimated that there are 3.6 million apps in Google Play and 2.2 million apps in Apple’s App Store, but the exact number con­tinues to grow daily with new offerings (Fig.46.3). Apple’s App Store offers a variety of
478
Fig. 46.3 Cumulative number of apps downloadable from Apple and Google store
J. Knol
categories to its users. The most popular apps, as dened by downloads, are games (25.04%), busi­ness (9.88%), educational (8.47%), and music (2.49%). Medical apps comprise 1.84% of the total market share for all app users. In a recent study by the Accreditation Council of Graduate Medical Education (ACGME), the most fre­quently requested medical app types were text­book/reference materials, classication/treatment algorithms, and guides for focused general medi­cal knowledge [17].
While the popularity of medically related apps continues to grow, there is still a lack of high­quality apps available. Payne etal. performed a search on the Apple App Store in 2012, reporting relatively few physician-orientated apps at that time, which did not address or meet the needs of the [British] junior doctors [18]. The authors were convinced that currently high-quality medi­cally orientated apps are scarce both in Apple and Google store.
In a recent survey of medical students, ndings were that, after having tried a prototype of an edu­cational app on general practice, students signaled their interest in further development and they highlighted the potential of the app prototype over medical textbooks for both education and medical practice [19]. Advantages associated with the use of smartphones, as listed by medical students and residents, were portability, efcient use of time, exible communications, powerful applications, access to multimedia resources, and fast access to reliable medical information. In addition, apps
can provide content to allow for a rapid review of critical steps and pearls for surgical procedures shortly before a planned operation [20].
The introduction of minimal invasive surgery (MIS) has furthered the progress of apps for surgi­cal teaching. As MIS is performed utilizing a liq­uid crystal display, with the increasing ability for video teaching, and increased focus on teaching pathways for more advanced surgical techniques, the time has come to implement video textbooks in a dynamic format. Therefore, the development of apps with an adaptive content, consisting of expert opinions, surgical videos, medical illustra­tions, 3D animations, and an up- to- date library­like resource, is a logical next step.
Mobile App Development inSurgery
The use of apps in surgical education and speci­cally to teach complex surgical procedures is a recent development that is rapidly evolving. Cognitive-task simulation apps currently avail­able include iLappSurgery™ and dLive™ in addition to Touch Surgery™ (Digital Surgery, London, UK), which offer real-time, easy access to facilitate effective learning without traditional bounds.
The health technology app Touch Surgery was the trailblazer. In 2013, the Touch Surgery app was introduced and represented the rst high­quality teaching app made globally available to
46 Video-Based Training Apps andDeferred Live Surgery
479
surgeons, healthcare practitioners, and patients through their smartphones. The Touch Surgery app digitized procedure-specic surgical routes– 3D CGI renderings of patient anatomy and surgi­cal workows – as a cognitive training tool (further information available at www.touchsur-
gery.com). This company has recently released
their newest product, GoSurgery, a cognitive tool that supports surgical teams in the delivery of coordinated workows that can help disseminate the right procedural and instrumentation infor­mation to the right team member, at the right time – so as to work in a coordinated manner, aiming to produce the most benecial patient outcomes.
iLappSurgery andThetaTME App
The iLappSurgery Foundation (www.ilappsur-
gery.com) was founded in 2015 as a not-for-prot
organization with the goal to develop educational material concerning advanced techniques in lapa­roscopic surgery (Fig.46.4). In June 2016, iLapp- Surgery launched the taTME App as a pilot project to explore the need for teaching of a more advanced technique (Fig. 46.5). The iLappSur­gery™ Foundation’s freely available download­able app “taTME” details the history of TME and
all of the technical steps related to this procedure and recognizes its pitfalls and troubleshooting to successfully overcome obstacles.
For a nominal fee, additional content is avail­able to users for further focused learning. Since the inception of the app, Professor RJ “Bill” Heald was one of the mentors of this project and kindly shared his experience on TME, history of rectal cancer surgery, and importance of embry­ology. His presentations were recorded with a green screen background, and, after keying, his slides were projected in the background to achieve a more dynamic effect. The same kind of recording and keying was done for many other world-known experts who lent their time and expertise for the iLapp initiative. In addition, unique illustrations concerning all the steps and pitfalls of taTME were drawn by a medical illus­trator, and 3D animations were developed on patient installation and OR setup. Color grading effects, as rst described by our group in a video manuscript on splenic exure mobilization, were also used in procedural videos of the taTME pro­cedure and included in the app [21].
After launching the iLapp taTME app, there was a steep increase in the number of subscribers, with metrics showing 100, 500, 1500, and 2500 subscribers after 2 weeks, 6 weeks, 6 months, and 24 months after launch, respectively
Fig. 46.4 iLappSurgery logo Fig. 46.5 iLapp taTME logo
480
Fig. 46.6 Growth of iLappSurgery taTME App after launch
(Fig.46.6). In many courses the app has become part of the taTME training pathway and didactic curriculum, as it provides a functional pre- and per-course cognitive skills tool for surgeon dele­gates (UK and Dutch training model as submitted for publication). The library and chapter content is updated on a regular base, and validation as a training tool is pursued.
From the beginning the taTME App was setup as a dynamic text and video book in which some features were crucial:
J. Knol
Administration interface: Easily add content,
news, and events and activate directly online
Secured and compliant: General Data
Protection Regulation (GDPR) and Health
Insurance Portability and Accountability Act
(HIPAA) compliant
Adaptive learning: Possibility to apply rules
in practical exercises and examinations to
allow the content delivery to be adapted to the
knowledge level of the user
Personalized: Possibility to personalize con-
tent for particular users
Evaluations: Exercises, automated exams,
and supervised exams
Congurable push notications: Notications
to inform the users about new content, events,
and news
Analytics and reports: Insights in registration,
engagement, and completion rates
Copy-Paste structure and concept: Same for-
mat for any future app
As a next project, the iLapp Foundation developed an app for laparoscopic liver surgery. Due to the
Fig. 46.7 iLappLiver logo
technical complexity of these procedures, fear of compromising the oncological results, and the lack of training opportunities, uptake of laparoscopic liver surgery was initially slow [22]. With the help of experts in the eld, a training pathway is pre­sented with focus on cognitive skills training. iLap­pLiver has the same format as the taTME App and was launched in September 2018 (Fig.46.7).
As video teaching plays an important role, both in cognitive skills training in general and in the healthcare-related teaching apps, much focus is on improving the images and creating a situa­tion like being in the OR, either by using a multi­camera recording that can be made available in a synchronized fashion (dLive) or by using virtual reality (VR). These images will be added to the available apps in future updates.
46 Video-Based Training Apps andDeferred Live Surgery
481

Video-in-Picture

For the iLappSurgery Foundation, there is a spe­cic program developed that can serve as an extension in video teaching and further the inter­active learning experience of apps. It is called Video-in-Picture (VIP). The VIP app (VIPicture) has recently been described in a manuscript on Deferred Live surgery and is freely available in Apple and Google store [23].
One can download the app by searching the App Store for VIPicture or by using a QR code (Fig.46.8). Images that are qualied for use with the application are identied by the presence of the “VIP” logo. After opening the VIPicture appli­cation on your smart device, allow your phone to access your camera. This will activate the camera within the application so as to recognize the image within the manuscript, thereby linking you to the appropriate video demonstration.
In the Deferred Live Surgery section below, the VIPicture App can also be used for this purpose.

Deferred Live Surgery

The technical nature of surgery necessitates an education for trainees that are based on careful observation of procedures, often in a repetitive
Fig. 46.8 iLapp VIPicture QR code
fashion. The traditional teaching of new tech­niques has involved observation of live surgical procedures conducted by experts in the eld with specic transferable skillsets.
Unfortunately, live surgery has inherent limi­tations– primarily centered around the idea that there is signicant variability that cannot be pre­dicted, including preoperative indications, physi­cian tness, intraoperative complexity, and the patient’s overall physiologic tness. Indications for surgery can often be “loosened” by Live Surgery Course organizers for the purpose of recruitment or may vary between the host institu­tion and that of the surgeon’s home practice envi­ronment [24]. Furthermore, patients may be required to wait longer than usual so as to accom­modate the conference’s preset timetable [25]; this can be of signicant concern in oncologic cases.
In addition, language barriers can affect dis­cussions of informed consent between the treat­ing and hosting surgical teams. A number of factors can also affect the intraoperative perfor­mance of surgeons, including operating in an unfamiliar environment with an often unfamiliar team, jetlag (in many cases), operating room traf­c, potentially distractive intraoperative ques­tioning from the audience, and the availability of familiar instrumentation and resources, among others. Many reviews on the subject of live sur­gery have concluded that it is often a number of additive factors, and not one single factor, that result in the potential for adverse events [26, 27].
The presence of these concerns and others led to the development of an alternative method of surgical presentation known as Deferred Live surgery (dLive). In a review of the procedure, our group and colleagues discussed the nature of this technique for surgical education wherein multi­ple 4K synchronized cameras are used to record the multifaceted aspect of surgical procedures [23]. The synchronized nature of the recording and the dLive mainframe allows the presenter to go through an otherwise unedited full-length sur­gical procedure, with the ability to toggle between various intraoperative camera views (Fig. 46.9). This provides the audience with the experience of being exposed to all the advantages of the live
482
J. Knol
Fig. 46.9 Video-in-Picture (VIP) image of dLive mainframe and aspects of the program
procedure, while mitigating most of the ethical and moral challenges of conventional live presen­tation techniques. The original procedure can be performed with all the aforementioned recording equipment, without concerns of affecting patient­centered outcomes of surgery. Furthermore, the procedure can be performed at the usual pace of the surgeon without any need for time constraints. Intraoperative adverse events can also be man­aged, recorded, and subsequently used as an edu­cational tool for members of the audience. Additionally, the high-quality recording and the multiple intraoperative vantage points allow the surgeon to pause, zoom in, and focus on specic parts of the procedure of particular interest to the audience, while being able to switch between the various views in the operating room (Fig.46.10). This technique also allows the surgeon to narrate various specics to the audience, without the concern of loss of intraoperative focus or atten­tion during otherwise critical steps of the proce­dure (the time when questions tend to most commonly be asked during non-deferred live sur-
gical demonstrations). Additionally, users from virtually any point on Earth can have access, with the unique ability to switch between various case presentations to demonstrate specic points in different cases.
The use of dLive technology has been and will continue to be even more advantageous in increasingly complex, multi-team procedures, such taTME.In such procedures, the entire oper­ating room is of critical importance to demon­strate to the audience. Currently, taTME procedures are recorded with seven synchronized cameras, all in 4K quality, including a 360° cam­era that provides an overview of the entire operat­ing room. The positions of the various nursing and surgeon teams, the anesthesiologist vantage point, and location of the different intraoperative towers and equipment all contribute to the safe execution of these complex procedures. Furthermore, the coordination between the peri­neal and transabdominal teams can be presented, providing views of their individual hand motions used to achieve specic intraoperative maneu-