Fig. 1 A surgeon wears Google Glass while performing a procedure.
Courtesy of Paul Sibley, DO

AAOS Now

Published 12/1/2014
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Paul A. Sibley, DO; David W. Martineau, MD

Through the Looking Glass: Google Glass and the Future of Hand Surgery

Paul A. Sibley, DO, and David W. Martineau, MD

The medical technology boom has exploded in recent years. A prime example is the use of Google Glass (Mountain View, Calif.). Glass is a smart, “wearable technology” currently being used and developed in the field of hand surgery with revolutionary potential.

Worn like traditional glasses, Glass is likened to a smartphone on your head (Fig. 1). It has an optical head-mounted display that is akin to watching a 25-inch screen at 8 feet. Its camera is capable of taking high-resolution photos (5 MP) and video (720 p). The 50-gram device responds to both touchpad and voice control, has Wi-Fi/Bluetooth connectivity, and includes a gyroscope, proximity sensor, and bone conduction audio transducer. Released to Google developers in early 2013 and to the public in beta format in early 2014, Glass is compatible with Android and iOS platforms and costs $1,500.

Recent uses in the education arena employ either real-time or recordable video for teaching. However, in the healthcare arena, the challenge is that Google Glass is not designed as a medical device. As a result, surgeons have had to partner with companies to overcome obstacles such as developing HIPAA-compliant software, focusing the wide-field camera, and even attaching surgical loupes.

The appeal of Google Glass for physicians stems from our ever-increasing dependence (both welcomed and mandated) on electronic data. Our profession requires us to use our hands to help people, whether by examining patients or performing surgery. Patient interactions do not lend themselves to sitting in front of a computer for hours at a time sending and receiving data. Unfortunately, such activities are absorbing more and more of our time, taking us “out of the moment” when it comes to patient care.

The instant appeal of Google Glass is the basic philosophy it was built upon: “Keeping people in the moment.” It allows users to send and receive data (such as pictures, video, text messages, and alerts) completely hands-free and without distraction. The point-of-view camera has the potential to assist with documentation, student/resident education, and telemedical applications. A huge attraction is the idea that surgeons wearing Google Glass could broadcast what they see to students wearing Google Glass, whether those students are across the country or opposite them in the operating room (OR).

Challenge, creativity, collaboration
The fact that Google Glass was not designed for the medical field supports creative collaborations between surgeons and software developers. The future is looking very exciting.

In one short year, a plethora of startups have focused exclusively on software developments for Glass. Seasoned medical device companies (such as Designs for Vision, Inc., Ronkonkoma, N.Y.) have developed solutions for attaching loupes and aiming the camera to a task-oriented position (Fig. 2). This enables surgeons to view images (including radiographs, CT scans, and MRIs) at the point of care while maintaining sterility.

Fig. 1 A surgeon wears Google Glass while performing a procedure.
Courtesy of Paul Sibley, DO
Fig. 2 Two views of the task-oriented-position adapter to Google Glass on custom loupes.
Courtesy of Designs for Vision, Inc., Ronkonkoma, N.Y.

The future of Glass in surgery is limitless and includes applications for teleconsultation, medical education, and hands-free patient information. For this technology to progress in hand surgery, HIPAA-compliant development and programming is necessary. Studies will be needed to evaluate the benefits this technology will have for the medical community and our patients.

A personal report
Initially, I (Dr. Martineau) wanted to be able to use them in the OR, which required attaching them to prescription lens loupes. This necessitated collaboration with industry and has resulted in an elegant solution that is currently in production.

I also wanted to take focused pictures and video from the surgeon’s perspective while wearing loupes. Currently, the camera takes a broad-angle image that is not ideal for capturing the fine detail required in hand surgery. Several companies are currently working to develop solutions (both active and passive) to this problem as well.

Because I am working with software developers, I am using Google Glass quite often, but not in the clinical setting. I will wear it weekly during cases because it enables me to do simple things like making hands-free phone calls, text messaging, and occasionally taking pictures and videos. I have found that wearing and using Google Glass actually saves me time.

The biggest feature of Google Glass is its potential. Maximizing this potential is challenging, but it has been, and continues to be, very exciting and rewarding.

Video:
View a video showing dissection of a vascularized medial femoral condyle osteochondral autograft for a scaphoid nonunion with osteonecrosis as seen through Google Glass.

Disclosure: Dr. Sibley—no conflicts; Dr. Martineau—no conflicts

Paul A. Sibley, DO, is currently a hand surgery fellow at Ohio University– Grandview Medical Center (Dayton, Ohio). He can be reached at sibleyp@gmail.com

David W. Martineau, MD, is a hand surgeon, director of innovation at the Hand Center of Southwestern Ohio (Dayton, Ohio), and a current board member of the International Society for Wearable Technology in Healthcare. He can be reached at dmartine79@gmail.com