Teleneurosurgery between Greenland and Denmark

Abstract

The Department of Neurosurgery at the University Hospital of Copenhagen, Rigshospitalet, provides tertiary care for patients from Greenland, where geographical remoteness and weather-related challenges often hinder timely access to neurosurgical interventions. This article presents a new initiative exploring the use of online supervision technology to facilitate neurosurgical care in remote settings. In 2024, a teleneurosurgical collaboration was launched between Queen Ingrid's Hospital in Nuuk, Greenland, and Copenhagen University Hospital, Rigshospitalet. The program involved training local surgeons to perform cranial neurosurgical procedures using smart glasses, enabling real-time supervision from neurosurgeons in Copenhagen. In May 2024, the first patient was successfully operated on using this approach. Real-time visualization and interactive communication, including drawing and zooming features, allowed precise guidance and effective support. The integration of smart glass technology has the potential to enhance the safety of local neurosurgical care in Greenland and reduce the need for prolonged patient evacuation. This initiative supports the broader vision of equitable healthcare delivery and may inspire future applications in other surgical fields and training environments., are.

Keywords: Global Health; Health Services Accessibility; Health education and promotion; Injury; Traumatology.

Figure 1. (A) The five regions in Greenland (https://en.wikipedia.org/wiki/Administrative_divisions_of_Greenland). (B) The distance from Nuuk to Copenhagen is more than 3500 km (2175 miles).

Figure 2. (A) Gastrointestinal surgeon from Queen Ingrid's Hospital practices craniotomy on a plastic skull using smart glasses during the visit to Rigshospitalet; (B).Hands-on training in burr hole surgery, craniotomy, and optimal positioning of the acute neurosurgical patient at Queen Ingrid's Hospital, Nuuk.

Figure 3. CT imaging of the cerebrum reveals a right-sided chronic subdural haematoma causing compression of the entire right hemisphere and the lateral ventricles. The haematoma measures 26.7 mm at its broadest point, resulting in a 20 mm leftward displacement of the midline structures.

Figure 4. The teleneurosurgical setup. (A) The smart glasses include a microphone, speaker, camera, screen and touchpad for function control, alongside a voice control, allowing the surgeon to operate the functions while wearing sterile attire. (B and C) The operating surgeon wears the smart glasses during the procedure and transmits a live (point-of-view) feed to the supervising surgeon. A live image, which the supervising surgeon can annotate and point to, is projected directly into the field of view of the operating surgeon for visual guidance. (D) The supervising surgeon can watch and provide suggestions in real time from a workstation, laptop or smartphone. The TeleVu software allows for pointing, drawing and providing vocal and visual instructions, which are projected into the operating surgeon’s field of view via the small screen in the smart glasses. (E) The point-of-view image from the surgical field is transmitted live via the TeleVu software.