Augmented reality telementoring tool to assess and guide chief to intern intraoperative education: The Google Glass Experience

Daniel A Hashimoto, MD, MS, Roy Phitayakorn, MD, MHPE, Carlos Fernandez-del Castillo, MD, Ozanan Meireles, MD. Massachusetts General Hospital.

Telementoring utilizes a two-way audio-video feed to allow for intraoperative consultation without the physical presence of a consultant. Prior studies have demonstrated the efficacy of telementoring; however, much of the work in telementoring has been conducted in laparoscopic and robotic surgery given the ease of acquiring high quality intraoperative video. Telementoring in open surgery has been limited by a lack of technology to reliably transmit two-way video, although smartphones have facilitated impromptu telementoring through the use of video conferencing applications.
Google Glass is a wearable device that displays a video screen over one eye and allows for video conferencing as well as smartphone functions such as text messaging and web browsing. Functions are voice and head motion activated. It features a 720p camera that shows the user's point-of-view (POV) and transmits sound directly to the user through temporal bone vibration. We assessed the feasibility of using Glass as a telementoring tool with an attending surgeon remotely viewing a chief resident taking an intern through a procedure. The Chief was wearing a Google Glass while the attending provided guidance from a desktop computer. Selected segments of video were compared to video conferencing feed obtained on an Apple iPhone 5 (1080p, 30 fps, Video stabilization) using FaceTime over the same wifi network.
At a connection speed of 5 Mbps download/1.3 Mbps upload, Glass was able to provide and receive video with acceptable lag. The heads up display on Glass allowed attendings to show anatomy and imaging from their desktop computer, and hand motions to the trainees without requiring trainees to move their heads away from the operative field. All video connections are simple plug and play through the Google Hangouts app.
The main criticisms of Glass involved its suboptimal video quality for surgical live imaging standards.  Video captured by Glass had poor black differentiation and lacked autofocus that made it difficult for attendings to appreciate tissue planes. Furthermore, the camera position on Glass is optimized for recording line-of-sight 90degrees from the coronal plane of the face and cannot be adjusted. This required the residents to operate with their chins tucked to their chest to provide the attending with a good POV video.  Attendings reported superior video quality from the iPhone; however, full resident POV with the iPhone was difficult as a non-scrubbed observer had to hold the phone to obtain video.
Google Glass, though early in development, can be utilized in intraoperative telementoring and surgical education but is not without its limitations. Ergonomic factors preclude the use of Glass for long cases if being used to stream the surgeon's POV, and the lack of autofocus cripples it's ability to relay video of great enough quality to allow a virtual consultant to assist in difficult dissections. Future models of wearable technology intended for surgical application should focus on appropriate ergonomic design and high quality optics while retaining Glass's ability to stream and receive meaningful data in the operating room.

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