MONTREAL -- When COVID-19 hit Montreal, the Jewish General hospital, like many other hospitals, quickly became off-limits for many elective surgeries including for those involving the heart.

Bringing teams of specialized surgeons in for installing cardiac valves, for example, became a logistical nightmare, said Dr. Lawrence Rudski, who is the director of the Azrieli Heart Centre at the Jewish.

"For these procedures, we normally bring in people from outside," he said. "We only did the most urgent cases. We have partnerships with other centres."

The solution involved connecting the team doing the surgery with an expert who was up to date on the very latest intravenous valve replacement technologies.

That doctor, Sam Radhakrishnan, monitored the surgery from his Toronto office.

"We worked in collaboration with our colleague, Dr. Sam Radakrishnan, in Toronto who was able to see almost everything we see in the operating room, and he can comment and we can see every step of the procedure," said Dr. Ali Abualsaud, a cardiologist at the JGH who took part in the experiment.

This is how it works: Dr. Radhakrishnan is watching remotely from his office, while the other team, in Montreal, is inserting a replacement valve through the aorta on the patient. A technician from the valve manufacturer is making sure the device is loaded correctly.

Back in Toronto, Radhakrishnan is monitoring vital signs and other things in real-time on his screens, while providing guidance to the surgeons.

Think of it as a Zoom session on steroids.

"We had to reinvent a way to broadcast all the screens, like fluoroscopy, echography, vital signs and add to augmented reality with lenses," said consultant Marcel Lafontaine, president of Auger Groupe Conseil based in Trois-Rivieres, which developed the platform in partnership with Medtronic Canada.

"Our job was very simple," he said. "Let's bring the operating room to the office of the doctor. The guy can do two cases in the morning, two in the afternoon."

The technology was developed for cardiology, but it can be applied elsewhere.

The valve technology was developed by the Canadian division of Medtronic, a medical device manufacturer.

"We can imagine that it could be expanded to other types of surgeries, and therapies as well, but it was more urgent to carry on in the heart sector," said director Richard Pare.

It's a new world in the operating room, one where virtual reality could soon be the next step.