Words by Ariel S. Frost MD, Emma De Ravin BS, Leila J. Mady MD PhD MPH, Tiffany N. Chao MD, and Jason G. Newman MD

In March 2020, COVID-19 was declared a global pandemic, putting the brakes on surgery at Penn Medicine, like most others across the country. Following national guidelines to stay at home, surgery was limited to essential procedures and essential personnel. In completely uncharted territory, our team of head and neck surgeons worked in eerily empty operating rooms to reduce exposures and risk of viral transmission. 

At the time of these initial lockdowns, there was a furious flurry of information surrounding the novel virus. Some days, it was hard to keep our heads above water in a sea of information. As essential healthcare workers operating in the highest risk area of viral transmission (the nose and mouth), we tried to understand and process the consequences of confronting the virus in all aspects of our lives. Would we contract the virus at work? Would we transmit it to loved ones at home? Would our patients put off seeing their doctors for necessary medical care? And what about surgical education? Infectious disease and social distancing guidelines prevented participation of medical students and resident surgeon physicians (doctors who have completed medical school and are training in a surgical specialty) in the high-risk operating room environment. While we needed these restrictions to reduce viral exposure, these changes meant trainees were missing out on critical firsthand experiences in patient care with no foreseeable end date. These would be the surgeons of the future, and we could not afford – individually or as a society – to let them be under-trained.

Surgery requires knowledge, technical skill, and spot-on judgement. An important part of training is “seeing” the anatomy and surgical steps you read about. You need to see how the surgical instruments dissect and cut, but you also must visualize the dynamic hands and body that operate them. There are subtleties of body positioning, ergonomics of posture, hand stability, and ways of holding instruments that take years to acquire. Surgery must be viewed, practiced, and coached under the watchful eye of senior surgical mentors.

The COVID-19 pandemic ignited a fire in medical educators around the world, and rapidly accelerated our experience with GoPro cameras. We took a shot experimenting with ways to use GoPro cameras to allow our medical students and resident surgeons to watch live surgery. We tried our best, cobbling together a few different technologies and adapting as we needed along the way.

With hands-on surgical education indefinitely suspended in the COVID-19 pandemic, we wanted to capture live surgeries with as high fidelity as possible. Our specialty, head and neck surgery, is unique. It contains high-risk vital structures that lay within narrow corridors that can be difficult to see, and life-threatening if injured. These challenges limit the video-based technology that is available to see what the surgeon sees. A head-mounted GoPro camera was the perfect solution. With slight modifications to adapt a video camera intended for sports and outdoor activities to the operating room, we could capture the surgeon’s point-of-view in high definition. Students and remote learners could see what the surgeon saw - and coupled with 2-way audiovisual livestreaming, they could talk to them as well. Through this livestreamed GoPro surgical experience, we were able to reconnect our learners to their classrooms. The initiative was a resounding success at our institution, enabling trainees, pulled from the hospital during the pandemic, to re-engage and continue their surgical education.