Collaborative research and new frontiers in cancer research

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Published: 10 Oct 2017
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Prof Groesbeck Parham - University of North Carolina, Chapel Hill, USA

Prof Parham speaks with ecancer at the RSM meeting on cancer control to discuss surgical interventions in low and middle income countries.

He describes how, using Oculus Rift headsets for virtual training and streamed surgeries for tele-mentoring, technology can bring direct tutoring and advice to operating rooms around the world.

Prof Parham also describes how pathology processing could be moved online, and sets out a timeline for further VR implementation.

What we’re doing is, since it is so expensive to have robotic surgery, to implement robotic surgery in low resource environments like most of the countries in sub-Saharan Africa, we’re using it with open surgery which is not done very frequently in the US. So we’re trying to take that technology that’s used in robotic surgery and apply it to open laparotomies. We’re using the Occulus Rift and other than that a telemetering device where we can observe; once the surgeons are trained we can observe them from a distance and mentor them and monitor them. We can mentor them through something called telestration where they will have a GoPro device as they’re doing the surgery, a GoPro device on their foreheads as they are doing the surgery. That will reflect on a monitor that is next to them in the operating room. That same picture will also reflect on the monitor of the mentor so I can be a distance away and if I see the surgeon… if I want to make a change in a surgical manoeuvre they are about to make I can draw a picture on my monitor and it will show up on his monitor, his or her monitor. He or she will also have audio contact with me so it’s called visual reality telesurgery and telementoring. It’s trying to use applicable technology or resource applicable technology to advance cancer care in the developing world. What it really does is we’re using technology to make up for the human resource gap.

Have online resources fallen short in any way?

Those things help but it’s nothing like having the actual surgical procedures there. So the education, the didactics, is critical and having it online is critical but then the next step is having demonstrations of the surgical procedures and then being able to monitor and mentor those as the newly trained surgeon is performing those procedures.

Do you see this as a way to bring the engineering and web development together?

It’s bringing all of the big data and the newest technology that is now becoming cheaper and cheaper into environments where it’s really needed to help close and fill in the human resource gap. Because we just don’t have enough surgeons, we don’t have enough pathologists so we can use similar technology, what they call telepathology, to help multiply pathology services without having a lot of pathologists around that are necessary for that to happen. We can train technicians to process the tissue on slides and then take pictures of those and then send them across the web to a pathologist who is sitting in a particular place, much as like what’s happening now with x-rays and mammography. A lot of the hospitals, for instance in the United States, are now downsizing, they’re actually getting rid of radiologists because they’re taking those pictures, digitising them and then sending them to a central place where the radiologist just sits and just reads x-rays and he or she can be in India, they can be in Bangladesh, they can be in Russia, they can be anywhere. So every little hospital doesn’t need to have a radiologist like they used to.

Does this save on external training?

That’s right, it’s important to train on site so that people can learn these procedures and know how they work in their environments, that’s the difference. I wouldn’t want to train a surgeon in the United States where he or she has every possible resource – intensive care units for complications after surgery, unlimited supply of blood products and anaesthetic agents – that surgeon needs to learn those surgical procedures in an environment where she or he has a limited source of oxygen, anaesthetic agents, blood, antibiotics, so he or she can make the proper clinical decisions based on the infrastructure that he or she has available to him.

What is the timeline for this virtual reality tool?

The initial virtual reality platform is being produced by a gaming institute in the US and we’ve been working for probably six months. I would venture to say probably the middle of next year that platform should be complete and then we’ll start with the implementation of it in Zambia. So six months to a year.

Final thoughts?

What I’ve learned most out of this conference, it has confirmed that the direction in which I’m moving is appropriate. As I said during my talk, there has been a lot of talk about how big the problem is, how difficult the problem is to solve of cancer control, cancer care, in low resource environments. My philosophy is you start with what is available and you build on that, you make small steps. You implement, you start at the end and then work back towards the beginning. People always like to start by saying, ‘You have to plan, you have to strategize, you have to make an assessment of what’s available. Then once you do all of that you have to get consensus from the stakeholders. Then you have to sit down and figure out how to implement things’. People have been talking about that for years and every time you come to a meeting like this they’re saying the same thing. My philosophy is, OK, we know all of that, we don’t need to make that cake over again. What we need to do is take something small that we think is easily identifiable, feasible and that can probably be implemented and implement it and then study the impact that we’ve had, come back and figure out how we could have done it better - what worked, what didn’t work, why what worked worked, why what didn’t work didn’t work. We’ll come up with a model, but get started, that we get you past the inertia of planning and strategizing. That’s not saying that’s not important but at some point you have to take the dive and my philosophy is take the dive then come to a meeting like this, just like I just did, and say, ‘This is what we did. It can happen. Let’s get off the bench, let’s get started.’ And then make it better.