Medicine in small doses

Real-time broadcasts of operative surgery to your surgical trainees’ computer screens may be as simple as you putting on a pair of glasses. Much enthusiasm has greeted the introduction of Google Glass, by surgeons in the United States and the United Kingdom, but there are some drawbacks and the inevitable sceptics. Google Glass is a form of wearable technology with an optical head-mounted display (OHMD). It is a device that is worn like conventional glasses, but that combines a computerized central processing unit, touch pad, display screen, high-definition camera, microphone, bone conduction transducer and wireless connectivity (Muensterer et al. Int J. Surg. 2014; 12: 281–9). It was developed by Google X, the facility within Google that focuses on technical advancements such as driverless cars. The prototype was developed in 2011 and weighed 3.6 kg, but the current model is lighter than the average pair of sunglasses. The ‘Explore’ edition was released in April 2013 and was evaluated by Explorer program, a group of beta testers numbering about 8000 across the United States, including members of the American College of Surgeons (ACS). After demonstrations at the 2013 ASC Clinical Congress, the ACS Health Information Technology Committee is developing a postgraduate course in surgical tele-mentoring (ACS Bulletin 2014; 99: 9–16). The advantages of this technology in the operating theatre are boundless. The OHMD facility allows the surgeon to simultaneously view and check diagnostic images uploaded into the device while operating, without changing his line of sight. Similarly, plastic surgeons can view images of the patient’s requested and desired outcome while focusing on the job at hand. The World Health Organization surgical check checklist application can be displayed by simple voice activation, potentially reducing adverse events and avoiding wrong site surgery. Probably the greatest advantage of Google Glass is its video camera, perched just above the right eye of the wearer, allowing real-time transmission of exactly what the surgeon is seeing. Dr Rafael Grossmann from Bangor, Maine, reportedly conducted the first Google Glass-equipped operation, a percutaneous endoscopic gastrostomy, in June 2013, and has become an enthusiast for its realism and application for remote learning. This was demonstrated to great effect by Dr Shaphi Ahmed, a colorectal surgeon, a first for the United Kingdom, in May 2014. He was able to provide a broadcast in real-time streaming over the Internet of an anterior resection and excision of liver metastases watched live by around 13 000 surgical trainees, students and interested lay people, in 115 countries around the world, on computers, tablets or smartphones. Questions were sent to the surgeon into the chat box alongside the live feed. The queries appeared on the bottom left-hand side of the Google Glass, displayed away from the surgeon’s main stream of vision so as not to impede the surgery, and he was able to address the questions. Ninety percent of the trainees surveyed wanted this type of learning to be part of their curriculum (RCS Bulletin 2014; 96: 223). Not all is smooth sailing with this device. Patient confidentiality is an obvious problem, and the need for ‘media’ informed consent. Google Glass needs an open Wi-Fi network or a Bluetooth connection to a tethered cellular phone to connect to the Internet. Patient data can be loaded into ‘the cloud’ without encryption or security messages in place. There are several technical limitations that will need to be overcome including: increasing battery life, sharper resolution, better optics and zoom function, improved Wi-Fi connectivity, and improved voice recognition capability. Some complain that the image are no better than one gets from an iPhone and the battery life may be as short as 1 h, necessitating the need for external battery packs, which add to its complexity and ‘clunkiness’. There are safety and privacy concerns, outside the operating theatre when used by the general public. The police are concerned about road safety risks, and some restaurateurs are banning their clients from wearing the device wishing to protect the privacy issues of their other customers. Australia has not been left behind in the applications of Google Glass with the Australian Breastfeeding Association providing glasses to mothers. Breastfeeding counsellors, through the mother’s perspective, can advise mothers struggling with breastfeeding (http://www.abc.net.au/news/2014-06-0). Clearly, the ACS has taken a lead in the development of this technology and our own college, through the Division of Education, Development and Assessment, could evaluate its utility in skills laboratory simulations, similar to that used by Philips Healthcare (http://www.healthcare.philips.com). Only time will tell whether Google Glass will create a new dimension in surgical education or simply be another gimmick with security and privacy risks. Its potential advantages in the operating theatre, and the likely refinements of the technological glitches, tip the balance in favour of it heralding a new era in surgical education and safety.