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How Alder Hey NHS Trust uses HoloLens in the operating theatre

Mixed reality provides a way to present medical data and enable experts and consultants to offer advice during complex procedures

Alder Hey Children’s NHS Foundation Trust has deployed Microsoft HoloLens 2 and Dynamics 365 Remote Assist as part of an initiative to use mixed reality in a clinical setting.

Rafael Guerrero, director of the Heart Centre and of innovation at Alder Hey, said HoloLens 2 and Dynamics 365 Remote Assist allow colleagues, experts and collaborators from other departments and other hospitals to connect with each other easily and remotely.

The Heart Centre at Alder Hey currently uses HoloLens 2 to support clinicians in acute care scenarios while remaining heads-up and hands-free to concentrate on their tasks – allowing users to share information and their exact view in high definition without pausing their work or holding additional devices.

This has helped to reduce the number of clinicians around the bedside during ward visits, support emergency procedures by dialling in additional expertise when required, and enhance surgery by using visualisation of 3D models to aid clinicians when performing heart procedures. 

In one case, HoloLens was used to help a surgeon place a tiny stent inside a blood vessel of a small child. “The tech we use helps by giving the clinician easy access to information or advice,” said Guerrero.

Microsoft partner Insight, a HoloLens reseller, began discussing the use of mixed reality with Alder Hey in April. Working alongside Microsoft Office 365 consultants, Phil Moore, digital innovation lead, public sector at Insight, said the Insight team was able to develop a fast-start deployment that could provide Alder Hey with a solid foundation for mixed reality.

The fast-start programme comprised technology enablement, covering Alder Hey’s network, the Microsoft Teams environment, device connectivity and remote assistance integrated into Teams. “It is amazing what you can do out of the box with Remote Assist and Teams,” said Moore. 

Insight has worked with a number of NHS trusts on clinically-led trials of the technology, which offers virtual ward rounds, which Moore said can help to supplement training. “All medical schools have a challenge in providing students with enough ward hours,” he added.

Insight ran a number of design thinking workshops with Alder Hey to understand the process of clinical service delivery and potential issues that could arise when using augmented reality and collaboration tools such as HoloLens and Teams.

Moore said that such conversations are needed in order to productise the deployment and move beyond proof-of concept-implementations. “Issues around resilience are the same as any other piece of tech in the operating theatre,” said. “The network is backed up to 4G/5G.”

Guerrero said that although new technology is used as a tool or aid for the surgeon to use, there are other ways of accessing the same information. “It just takes longer and is not as accessible,” he said. “Ultimately, the success of any procedure is down to the skills of the surgeon and the team.”

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Guerrero believes there are many ways that hospitals can use augmented reality. “While Covid-19 has acted as a catalyst, mixed reality devices like HoloLens that can support collaboration, mobility and remote learning need to be part of the technology that we use to drive a healthcare revolution,” he said.

“Using HoloLens, we have already demonstrated the potential of mixed-reality healthcare applications to minimise the number of staff required to be in contact with patients; share expertise in the shortest possible time and from any location; and, ultimately, increase the quality of care.

“However, there are many more opportunities to integrate the technology with other systems. For instance, as a centre of expertise for congenital heart treatment responsible for more than 8.5 million people across Wales, Northwest England and the Isle of Man, these applications would allow us to support clinicians and patients in other hospitals and in the community, without the need for travel in either direction – helping the NHS to treat patients and share expertise more efficiently to improve patient care.”

Guerrero said that many types of operation, and reviewing medical imaging before and during a case is essential for surgeons. “Recently, 3D imaging has helped surgeons visualise the target organ in great detail and therefore plan for their case,” he said. “Largely, the planning stage takes place in the office and sometimes quite a while ahead of time.

“Every patient is different. Even two children with the same condition will have subtle variations. Therefore planning closer to the time of the operation and having real-time discussion and visual aid makes a difference to the surgeon’s stress level and preparedness.

“Mixed-reality technology is a platform to deliver such interaction. It takes each surgeon a little time to adjust after years of training, but they quickly recognise the advantage and adopt this readily.”

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