Ahmed A Rahim, BS1, Helena M Mentis, BS, PhD2, Pierre R Theodore, BA, MD1. 1University Of California – San Francisco, 2University of Maryland Baltimore County
In the past few years, teleconsulting and telementoring have emerged as promising answers to increasing needs of everyday surgical collaboration and education. In this trial, we investigate whether video transmission via Google Glass, a wearable computer with an optical head-mounted display, is a feasible method of expertise exchange between coordinating transplant surgeons. Glass and other technologies like it offer the potential to increase ease and availability of surgical training through remote instruction without sacrificing either the quality of the instructing surgeon's communication or the trainee's vantage point.
METHODS AND PROCEDURES
We implemented a pilot trial of ten cases in which heart-and-lung transplant surgeons of the same team stationed at different hospitals communicated via a Google Glass video-stream. As in most transplant cases, two different surgeons performed the organ harvest surgery and the subsequent implant surgery. During the first eight procurements, the harvest surgeon (HS) shared Google Glass-recorded video clips via a secure, HIPAA-compliant online storage service with the implant surgeon (IS), who is often the more specialized and experienced of the two. During the two final procurements, the HS transmitted a live video feed via the ‘Livestream for Glass’ application. The IS was then able to provide virtual support throughout the organ recovery process by helping the HS assess the viability of the heart and/or lungs in question. For example, by discussing factors such as atelectasis of lungs or occurrence of epicardial hematoma, both surgeons could together evaluate any potential risk of transplanting an organ to the candidate recipient in need. The surgeons and observing researchers took notes after each use to capture benefits and hindrances to the display’s use.
The operational design of Google Glass itself was found to be well-suited to surgery as it can be controlled by voice commands and head gestures alone, thereby freeing one's hands for surgical activity. The device's capacity to broadcast an optimal point-of-view in 720p picture quality was rated highly by the implant surgeons and provided precisely the visual context needed to offer robust guidance and support.
Still, there are hindrances surrounding the design of the commercial device and the supporting network architecture it relies upon to transmit video. For example, since Glass's built-in camera is positioned such that it captures video slightly above the user's line-of-sight, it sometimes requires the user to strain her neck further downwards than she normally would in order to capture the desired view. This may cause discomfort and be particularly unfeasible for surgeons during longer sessions of use. In addition, the head-mounted optical device competed for space with glasses, loupes, or a facemask.
Our findings indicate great potential for demonstrable efficacy in surgical consultation and education through the use of Google Glass. Through the transmission of key clinical knowledge and expertise to and from the operating room, surgeons may coordinate input with colleagues in a time-sensitive manner as well as teach and engage students through a unique and compelling format of surgical education without limitations of distance and time.