Online Live Streaming System for Robotic Surgery With Bidirectional Discussion Through a Commentator: A...

Live broadcasting of robot-assisted surgeries has gained traction as a valuable educational tool offering real-time insights into surgical procedures. However, in Japan, legal restrictions and safety concerns have hindered the widespread adoption of live surgery. This study introduces a novel, modified online live-streaming system with a commentator to facilitate bidirectional discussions, addressing these limitations and enhancing surgical education.

A multi-institutional observational study was conducted using the Intuitive Telepresence system to broadcast da Vinci robotic surgeries. A commentator familiar with the surgeon's style facilitated real-time discussions with remote participants. A questionnaire using a 5-point Likert scale was used to assess usability, surgical comprehension, and bidirectional discussion. Statistical analyses were performed to compare satisfaction levels across different aspects of the system.

Between November 2022 and September 2024, six live robotic surgery broadcasts were conducted, with 15 participants attending a total of 19 sessions. Most participants (94.7%) reported positive experiences with the bidirectional discussions, citing the commentator's role as crucial in explaining surgical decisions. The system was highly effective in conveying robotic instrument handling (94.7% rated 4 or higher) and anatomical understanding (94.7%). However, assistant operations and overall operating room dynamics received lower ratings, with 57.9% rating them as unsatisfactory. Early sessions experienced video quality issues, which improved with stable internet connections; later sessions achieved a 90% satisfaction rate.

Our modified "commentator-based live streaming system" successfully facilitated bidirectional learning and improved robotic surgical education. We aim to expand the use of this live surgical broadcasting system across Japan.