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.
A PCI, short for ‘percutaneous coronary intervention’, is a common procedure performed on people that whose coronary arteries—the large blood vessels that provide blood to the heart—have started to close up. 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.
In traditional PCIs, a dye that shows up on X-ray, known as contrast, is injected into the patient’s blood vessel. As the dye travels through the blood vessel, it paints a 2D picture of the patient’s arteries for the clinician to follow with the catheter. However, it only allows the surgeon to see ahead of the blockage, not behind it—depriving them of useful information.
Another type of medical imaging, called CT angiography, can be used to provide a 3D view of the vessels both in front of and behind the blockage; surgeons are now looking at whether CT angiography pictures can be combined with augmented reality technology to offer a new way to see inside the vessels that keep the heart beating. One day, it could be common for surgeons to put on a pair of Google Glass along with their scrubs.
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 chance of having an ‘adverse event’—such as a heart attack—was found to be the same for with-Glass PCIs and without Glass.
While the study was too small to provide a definitive answer to whether the Glass-assisted procedures were better for patients than those conducted without the tech, there are hints that AR can bring some benefits. PCIs where surgeons wore Glass tended to use less contrast to visualize the course of the vessels, which can be beneficial to patients that react to the dye. It also helped surgeons better choose which types of guidewire to use during the procedure.
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.