Combining surgical video and animation for education

Still from ex vivo small bowel transplant video (Cred: The Toronto Video Atlas for Liver, Pancreas and Transplant Surgery)

Still from ex vivo small bowel transplant video (Cred: The Toronto Video Atlas for Liver, Pancreas and Transplant Surgery)

Biomedical Communications alumni at the Toronto Video Atlas for Surgery (TVASurg) recently released their newest video “Ex vivo Whipple with small bowel auto-transplant“. TVASurg combines live operating room footage with 3D animation to instruct surgeons in the care of patients who require complex liver, pancreas or transplant surgery. The new video is one of several training tools developed by Perioperative Interactive Education (PIE) at Toronto General Hospital.

PIE creates interactive teaching modules for medical educators and students around the world and makes them available through their website for free. TVASurg began as a PIE project in 2010. In search of a collaborator to capture surgical video for education, staff surgeon Ian McGilvray contacted PIE Manager, Gordon Tait. Tait proposed to McGilvray the creation of an educational tool that combined surgical video with animation.

Albert Fung, who graduated from the Master of Science in Biomedical Communications program in 2010, worked with Tait to develop a video capture system for the operating room.

In the operating room, Fung coordinates with the surgeon and scrub nurse to drape a camera in a sterile plastic sleeve. They mount the camera onto a flexible arm attached to the operating room table. Fung then mounts a second camera to an overhead boom. The in-field and overhead cameras provide Fung with two points-of-view of the surgery. As the videographer, Fung controls the zoom, focus and exposure of the cameras through a cable from outside the surgical field. The surgeon or nurse adjusts the camera at Fung’s request.

The development of this video capture system allows Fung and Tait to record stable, close-up footage of surgeries. Staff surgeon Paul Grieg joined the TVASurg team and, with McGilvray, identifies “scenes” important to education in the video footage.

To develop the animations, Fung uses patient CT/MRI scans to create accurate 3D models of the organs, arteries and veins. Next, he adds surgical tools and animates key surgical steps. Finally, he combines the surgical video with the 3D animation.

“The accuracy of these models makes the transition between video and animation much more convincing,” says Fung.

In 2012, the TVASurg team invited Paul Kelly, a Class of 2011 Biomedical Communications graduate, to contribute his skills in digital 3D sculpting to the project.

“Paul was not afraid to experiment and test new tools or software for projects which was what we really needed in the infancy of TVASurg,” says Fung.

To increase the pace of production, Joy Qu, a Class of 2013 Biomedical Communications graduate, joined the team. Qu brought 3D computer animation and storytelling skills to the project. She also experimented with different approaches to achieve high production standards.

Since the launch of the Video Atlas, PIE has received about 150-200 visits per day to from all around the world including Thailand, India, North and South America.

TVASurg also offers a patient education section which currently features two videos created by alumna Janice Yau, MScBMC 2011, and graduand Naveen Devasagayam, MScBMC 2015. The animations describe surgical procedures, risks and complications of liver transplant and pancreatic surgeries, and post-operative care and discharge information.

Fung, Kelly and Qu will present a talk entitled, “Update on conventional hepato-pancreatico-biliary anatomy” at the July 2015 annual Association of Medical Illustrators meeting in Cleveland, Ohio.  In their talk, they will compare conventional depictions of anatomy with anatomy they have filmed in live surgeries.

Also this month, TVASurg releases their next video “Segment IVa/VIII liver resection for Hepatocellular Carcinoma (HCC)”. An exclusive sneak peek is available here:

“We’re extra proud of the July release because this is our first—my, Paul and Joy’s—collaborative project, and we’re quite happy with the results,” says Fung.

The TVASurg team produces a new video every month. Currently, they are collaborating with a surgeon at St. Joseph’s Health Centre on the development of a teaching module for a laparoscopic pancreatico-jejunostomy technique. The video is scheduled for release in August 2015.

by Maeve Doyle