KEY POINTS:
Fifteen surgeons and registrars watched as leading shoulder expert Anders Eklund replaced a 65-year-old woman's shoulder.
They witnessed the incision, the cutting away of tissue and the drilling into bone. They heard the sound of metal as it cut into the humerus and scapula, and the suction as it cleared away blood.
But they weren't even in the same room.
Instead they were in another building, watching it projected on a screen while the Swedish surgeon provided live commentary for the 90-minute reverse shoulder replacement, a relatively uncommon procedure.
In between, the observers asked Dr Eklund questions, such as the best way of getting the drilling angle just right (27deg).
This was a glimpse into what medical training could be like in the future; instead of having two or three surgeons observing in the operating theatre, many more could watch from another room, building or city.
The live surgeries from Ascot Hospital's digital operating theatres were part of an education seminar for surgeons and registrars from the Society of Shoulder and Elbow Surgeons.
Dr Eklund had been brought into the country especially for the procedure, of which only around 50 are done each year in this country. Dr Eklund, meanwhile, is reputed to have performed 300 of these operations.
Video of the surgery was beamed on microwave signals via a specially set up dish from the hospital's rooftop to a conference room in the Ibis Hotel next door.
A camera in the overhead theatre lights, and also a handycam operated by theatre staff, provided the close-ups of the procedure - and the occasional headshot.
Jim Dillon, director of Media Connect, the company that set up the technology behind the event, said it was about turning "the operating theatre into a television studio".
Surgical broadcasts like this were more commonly done using an ISDN line, said Mr Dillon, but an ISDN video link would not have the same picture quality.
He said technology such as this was useful in training exercises, as a visual record of patient notes, and in consultations between two specialists where both cannot be present in the same place.
This was the first time the company had set up something like this, and the sound quality from Dr Eklund was initially quite poor.
Co-director Kevin Purcell said the surgeon's voice had been muffled by his surgical mask, a problem which can be easily remedied for future events.
Auckland orthopaedic surgeon Adam Dalgleish, who was in the theatre with Dr Eklund, said the technology meant surgeons would not miss out on any important details from not being present in the operating room.
"Nowadays, you don't have to fly all over the world just to see one case," said Mr Dalgleish.
Procedure salvages worn-out joints
A reverse shoulder replacement involves reversing the positions of a shoulder's normal ball and socket joint.
The normal socket (glenoid) is replaced with an artificial ball, while the normal ball (humeral head) is replaced with an implant that has a socket into which the artificial ball rests. The bone is usually shaved down to attach the implants, which are then fixed in place with screws.
Auckland orthopaedic surgeon Adam Dalgleish describes it as a "salvage procedure" for patients whose tendons have worn away, or where previous shoulder replacements have failed. Patients in these situations, who are usually over 60, can barely lift their arm.
In New Zealand, around 50 of these operations are performed each year in public and private hospitals. Patients who have had the procedure go from having severe shoulder dysfunction to 90 to 100 degrees full elevation.
The technique was first developed by a French surgeon in 1986, but only became known to the world a decade later, said Mr Dalgleish.
The procedure and implant costs around $25,000 in New Zealand, similar to a hip or knee replacement.
