Through the Looking Glass and onto the Operating Table

April 24, 2015 0 comments Open printer friendly version of this article Print Article

Over the past two years, surgeons and scientists from Jakarta to Jacksonville have been exploring potential applications of the Google Glass device in the OR. The device has been used to live stream surgeries, teach residents and fellows, consult specialists, and develop safety checklists. Some projects are not even in the beta stage yet, while others are already on their way to commercial development. Join us after the jump for a fascinating look at the cutting edge technology by North Florida dermatologist, Dr. Jonathan Kantor.



Through the Looking Glass… and into the Operating Room: Wearable Technology at a Crossroads

The past three years have seen a sea change in the use of wearable technology, as Google Glass has shifted from a curiosity to a ubiquitous annoyance in some areas, and glassholes have reared their bespectacled heads from New York to San Francisco.

While the advent of hidden-camera-toting technology fiends—and a daytime-soap-opera-worthy tale of infidelity, infighting, and secret technology programs gone awry at Google—may seem to herald the premature death of the barely-born device, Google Glass is showing significant promise in a surprising area: the operating room.

What is Google Glass? It is important to remember that it is not just a wearable video camera. Instead, it is a highly mobile computer incorporating a tiny optical display, camera, microphone, bone-conduction speaker, touchpad, gyroscope, and accelerometer. The ability to not only record photos and video in a hands free fashion, but to interact with this tiny mobile computer with voice commands alone, means that surgeons—who must remain sterile while operating—can wear the device and interact with it seamlessly in the operative setting.

So far, Google Glass has shown promise in several areas in the realm of surgery:

First, hands-free recording, coupled with the ability to stream images over the internet, means that surgical techniques can be recorded or taught to trainees and colleagues around the world. Esoteric techniques and subtle exam findings can now be taught live, and doctors and patients alike can benefit from the improved communication and learning opportunities.

Second, the ability to send images live means that consultations can take place anywhere and anytime, as doctors send each other images and videos over a (still in development!) secure interface.

Third, checklist applications are already in use in some areas, allowing surgeons to visually and verbally confirm preoperative checklists. As with the now ubiquitous (and legally mandated) preoperative time-out, this helps increase the level of patient safety by forcing surgeons to verbally give an ok to a litany of preoperative checks, such as whether the patient’s identity and surgical site have been confirmed, whether the consent form has been signed, and whether the attending surgeon has given the ok to proceed with surgery.

Fourth, these devices are being developed to interact with electronic medical records. Though the Affordable Care Act and the Meaningful Use program have markedly increased the pace of adoption of electronic medical records, for most patients and doctors this has shown little benefit over the staid—yet reliable—paper charts of old. Adding an interface to permit patient data recording and note writing through the Google Glass device may make electronic records more usable and practical, while potentially increasing patient safety and the quality of medical record documentation.
 
So how do the most important people in the room—the patients—feel about all this technology in the operating room? The answer, surprisingly—in the words of the incomparable Larry David—is pretty, pretty, pretty good. In fact, a study I published last month in Dermatologic Surgery—the largest ever published on the use of Google Glass in the surgical setting—found that a full 100% of patients were willing to be treated and operated on with the Google Glass device when performing Mohs micrographic surgery for skin cancer removal.

What does the future hold? Checklist applications are certainly a great start, but they are just that—a start. In a talk I gave at the American Society for Dermatologic Surgery Annual Meeting late last year in San Diego, the audience was polled on how likely they were to use Google Glass in their practices in the next year, 5 years, and 10 years. While a minority of physicians and surgeons thought they would be using the device in the next year, almost all believed that by the end of the decade they would be using this in the context of patient care.

One exciting area for future development is using Google Glass, or a similar device, to live navigate the ins and outs of a tumor during surgery.

Data from a preoperative imaging study, such as an MRI, can be uploaded to a computer, and after the device is calibrated to the patient, the images from the MRI can be overlaid on the live person.

By glancing at the device’s screen, the surgeon can see—on and in the actual live patient—where tumor is present based on the MRI findings.

This represents the next evolutionary step in surgical imaging.

A century and a half ago, no imaging was available. Then, with the advent of x-rays, we could look at a light box in the OR and check on the location of a fracture or other abnormality. Over the past couple of decades, computers have revolutionized intraoperative imaging by allowing surgeons to view multiple image types, zoom in and out, and adjust the view. The holy grail, however, remains overlaying the imaging on the actual live patient. Imagine performing a breast cancer surgery while being able to look at the breast tissue on the live patient and see the areas where tumor was present on MRI highlighted in yellow, orange—or even pink. While even a few years ago this would have sounded like science fiction, a study published last year demonstrated the proof of concept of this approach.

With Google’s recent announcement of the shuttering of the Glass Explorer program, speculation has risen as to whether the company intends to let this technology die on the vine. Recent reports suggest that Google may be pursuing a more commercially-viable Glass device, priced so that mere mortals can consider its purchase and available without a complex application process. While rumors of the Glass’s death have been greatly exaggerated, its next iteration will likely include features and hardware specially geared for the medical community—and this may be a boon to doctors and patients alike.

Jonathan Kantor, MD is a Board-Certified Dermatologist and Medical Director of Florida Center for Dermatology, P.A., with offices in St Augustine and St Vincent’s Dillon Building, and is Adjunct Assistant Professor of Dermatology at the Perelman School of Medicine at the University of Pennsylvania.  He is the first physician in the world to use Google Glass for skin cancer surgery and Mohs micrographic surgery, and his research on Google Glass has been published in JAMA Dermatology and Dermatologic Surgery. He is one of the world’s leading skin cancer specialists, and lectures internationally on surgical techniques, epidemiology, wound healing, and skin cancer. Dr. Kantor and his team can be reached at 904-342-7765.