Scalpel. Retractor. Sutures. The equipment that surgeons use hasn’t changed significantly for many decades. However, if one trial is anything to go by, clinicians could soon be taking augmented-reality glasses into the operating theatre.
Interventional cardiologist Dr Maksymilian Opolski, of the Warsaw Institute of Cardiology, first tested out virtual reality glasses for a heart procedure known as a PCI back in 2015, where he navigated the inside of the patient’s heart using pictures projected onto the heads-up display.
If a significant artery becomes too narrowed, blood flow to some parts of the heart can become cut off and the heart muscle in that area can die — causing a myocardial infarction, or heart attack. In order to restore blood flow to the entire heart, a surgeon inserts a catheter into a vein in a patient’s arm or leg, finds where the coronary artery is blocked, and uses a balloon or stent to help open the vessel back up.
Seeing inside the heart
PCIs are often done on blood vessels that are partially narrowed, rather than totally blocked off. Operating on patients with totally closed off arteries is a particular challenge, and comes with an increased risk of complications during surgery.
It was on one of these patients that Opolski first used Google Glass to assist with a PCI, where CT images of the patient’s blood vessels seen on the augmented reality glasses were used to guide the catheter as it travelled through the veins to the heart.
Glass was released in 2013, but problems with pricing and privacy meant Google stepped back from the technology two years later, ending sales of its first edition of the headset. This year, however, Google relaunched Google Glass as an enterprise tool, targeting industries such as manufacturing and healthcare.
Nearly three years on from his first Glass-assisted procedure, and Opolski has led a 15-patient pilot of the technology that could pave the way for the use of such wearables more widely in future. Traditionally, images of the patient’s heart were shown on monitors in the catheterisation lab; in the pilot, they were projected onto head-mounted augmented reality glasses worn by the surgeon.
The difference in preparing for augmented reality and traditional surgery is only a matter of a few minutes of training, thanks to the “simple and intuitive” nature of the app, says Opolski. Cardiologists could navigate through the images of the patient’s heart using voice commands — not just making the software easy to use, but also ideal for maintaining the sterile conditions of the operating theatre.
After 15 PCIs with the Google Glass and accompanying app, Opolski and his team’s research have shown the technology is “not only feasible and safe, but also does not interfere with the routine activities performed in the catheterization laboratory by operators”. The chances of having an ‘adverse event’ — such as a heart attack — was found to be the same for with-Glass PCIs and without Glass.
The surgeons who used the Glass during the PCIs reported high levels of satisfaction with the technology, and indicated they would be amenable to using the kit in their regular surgical work.
Keeping surgeons happy with their AR kit as its use increases will represent a challenge for the technology industry. As well as putting a heavy emphasis on making the software as user-friendly as possible, technology vendors and the healthcare industry will need to work together on open standards if augmented reality is to take off in the operating theatre.
“Wearable computers are easily accessible and offer a unique opportunity for limitless display of multiple imaging data (both of which might overcome the economic and capacity limitations of the most advanced angiography systems), I have no doubt that AR will shake up clinical practice in the near future,” Opolski said.
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