Google Glass has a long way to go in the OR

Google Glass has a long way to go in the OR

The Royal London Hospital and the Barts and The London School of Medicine and Dentistry presented the first live-streamed surgical procedure in the UK. The operation was an extended right hemicolectomy with resection of a metastatic liver lesion.

Here is what I thought about the event.

The case started about 30 minutes late, which is similar to what would have happened in any operating room in the United States with a case scheduled for 2 o’clock in the afternoon.

I noticed some curious things. Many of the staff, including the anesthesiologist, weren’t wearing masks in the operating room. There is no Joint Commission in the UK.

When the surgeon changed his glove, he opened the inner portion of the package with his bare hand, and the scrub nurse then touched the same area with her gloved hand.

The surgeon did not know what the patient’s preoperative hemoglobin level was and had to ask the anesthesiologist.

The colon procedure was done in under an hour which was impressive considering the patient was somewhat obese, but I thought the surgeon hurried a bit. He could have been more careful. For example, he applied staplers without seeming to double check their position.

I previously listed many reasons why I felt live broadcast surgery was a bad idea.

Among them was the problem of distractions and there were many during the case.

  • The surgeon talked about how many people in different countries were watching.
  • He said that a number of text messages were coming up on his Google Glass screen.
  • At 21 minutes into the case, he stopped for a 5 minute interview with a TV crew.
  • He chatted with a colleague who came into the room for a few seconds.
  • He said hello to a medical student from Australia who had spent some time with him.
  • He asked questions of the audience and answered them himself.
  • Several times, he asked his technical crew how things were going.

Several other issues detracted from the educational value of the operation.

  • The glare from the operating room lights was constant and markedly impaired visibility.
  • Most of the time the Glass camera was aimed too high and too far to the right so much of the operative field was not in view. The surgeon pointed out anatomic structures that the audience could not see.
  • He moved his head frequently causing the picture to jiggle.
  • A stationary television camera with the ability to zoom in would’ve been much more effective.
  • The sound quality was poor and often unintelligible.
  • The liver portion of the case was not shown because the Glass’s battery had to be recharged after 70 minutes.

What this demonstration showed me is that Google Glass has a long way to go before it is useful for education.

“Skeptical Scalpel” is a surgeon blogs at his self-titled site, Skeptical Scalpel.

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  • MarylandMD

    “A stationary television camera with the ability to zoom in would’ve been much more effective.”

    Thank heavens someone is finally talking some sense about this. Google Glass seems to be more a technology in search of a mission when it comes to healthcare.

    There may be a few niches where it will have utility, but in nearly every case that I have seen breathless predictions of the Great Things That Await Us With Google Glass In Medicine, none have been able to come up with an adequate answer this question: If there was such a great need for this, why didn’t someone get it done with smartphones or small cameras years ago, and why don’t you first pilot it with them now, as they are much cheaper and simpler existing technologies?

    • Margalit Gur-Arie

      I was thinking the same thing, but didn’t want to say anything because I am not a surgeon, and I don’t understand the purpose very well…
      How about a little drone mounted camera, with proximity sensors, or that thing they have at football games on top of the field? Would those work? :-)

      • Skeptical Scalpel

        Thank you both for the comments. Good point about the existence of small cameras for years. Glass may have some uses in medicine, but so far it is not clear what they might be.

        • daviddoherty

          Thanks for sharing this interesting article.

          I think the distraction of wearing a mobile phone on your skull and reading/replying to messages while operating presents multiple Patient safety issues and in this application it could’ve all been achieved better with some GoPro Hero3+’s managed by an assistant with an iPad.

          So far we’ve limited our early experimentation to applications in veterinary surgery where we’ve discovered some very interesting new findings (the environment is closer to that found in field surgery/combat casualty care medicine) that we are confident will have wider application when worn by Emergency Medical Responders etc.

          Interesting that you think it’s not useful for education but you’ve been able to observe a surgeon who is confident of the high standards of his operating practice and still:

          > Evaluate his surgical glove changing practices need relearning.

          > Could determine that the Surgeon is not sufficiently aware of their patient’s preoperative haemoglobin level.

          > Can make recommendations that the surgeon might double check positioning when stapling, might implement protocols to discourage colleagues entering the OR for chats, etc.

          Isn’t that educational?

          PS. I’m still convinced the big opportunity lies in Patients using Google Glass ;)

          • MarylandMD

            Using Google Glass as an educational tool for surgeons makes about as much sense as using Google Glass to generate training films for football players. When you perform a complex task, you see and process much more than what is just ~15° directly in front of your head.

            We have to distinguish the idea of the utility of filming surgeries in general from the specific claim that filming surgeries **using Google Glass** is of such utility it will be revolutionary.

  • Skeptical Scalpel

    “Top European football teams have been using Google Glass” but you must be careful when heading the ball from set pieces.

  • MarylandMD

    You can talk about wide angle lenses and Epson smart glasses, but then you are getting into different technology. The topic here is Google Glass. I see it as a bit of a bait and switch to defend Google Glass with features that aren’t available in Google Glass.

    Personally, I keep an open mind about technology in general and even wearable technology, but the current version of Google Glass still seems to be a technology in search of a mission in the medicine. For example, something with a wider angle of view, with the ability to track where you are *looking* (not where your nose is pointing!), and with image stabilization might be more useful in the type of surgical application discussed in the article, but it might not. And those improvements wouldn’t address the safety issues with distractions that I think are perhaps more important.

    Regarding the use in football, keep in mind the article we are discussing talks about those who claim to be “using” Google Glass in medicine are falling quite short of anything useful or even safe. I have seen more than a few videos of Google Glass in medicine and they all seem laughably silly and only prove that some doctors and other folks with extra cash are goofing around and not accomplishing much. So you would have to be more specific on how they are “using” it and what value it has. And suffice it to say that jockeys aren’t the same as football players. But I don’t want to pull this too far off the thread, which is about *Google Glass* in *medicine*.

  • Brian P. Curry

    As an aside, the fact that non-scrubbed personnel weren’t wearing masks doesn’t disturb me all that much. As it turns out, doesn’t seem to affect SSI rates.

  • Carolyn Thomas

    Oh, please. “At 21 minutes into the case, he stopped for a 5 minute interview with a TV crew.” Your list of distractions is a compelling argument against the introduction of Google Glass into the O.R. (as if there aren’t already enough distractions there). For example: “Distracted Doctoring: Updating Your Facebook Status in the O.R.”

    As the poor schmuck who has to lie there on the O.R. gurney while Google Glass cowboys have their fun overhead, I hold no illusions that Glass will actually mean better care for me or other patients. Nor will it mean better education for those observing. I’ve watched a number of cardiac procedures filmed via Glass, and noted the same important filming flaw you note here: “the camera’s aimed too high and too far to the right so much of the operative field was not in view.” So how useful is this, really, as any type of remote training vehicle?

    But early adopters of Glass will continue to promote its usage both in the O.R. and in the exam room. Despite what the hype-meisters keep telling us, there are still far more questions than answers when it comes to its appropriateness in medicine. Thank you for bringing some of them to our attention here.

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