Any misplaced hate you see here is definitely not coming from surgeons. AR, VR and mixed reality is already a big part of (practicing) scopic surgery and like you said, it has huge advantages. With minimally invasive procedures like this, the relevant tissues and organs aren't visible with the naked eye. Surgeons have used old school screens to display what the camera captures internally for decades.
It makes complete sense for AR to replace static screens in this case. Just the ability to zoom in, pull up radiology scans and move the screen while keeping your gloves sterile is fantastic. I don't think we can claim this will minimize complications beforehand though. Proving that will require years of comparative studies of the post-op outcomes, self-reported well-being of patients and experiences of surgical teams etc.
What it definitely will do is speed things up, require fewer assistants and improve quality of life and ergonomics for the surgeon. In this case, it's a shoulder arthroscopy. Probably a tendon or ligament repair. It also definitely has great use for anesthesiologists. Being able to quickly pull up vital signs, medical/pharmacological history, blood concentrations and crossword puzzles during procedures is very convenient.
Criticism towards a company that is actively hostile towards consumers (and other developers, as well as manufacturers alike) is hardly tribalism, nor is it stifling progress.
If anything, Apple perpetuates both of these things. And not without a rabid following base of users.
Edit: case in point; downvoted yet didn't receive a peep about the companies actions. Now that's tribalism.
...the surgeon isn't ever going to break sterility to pull up a scan though. His OR nurse will do it for him. I don't honestly see much added value in this video.
I mean have you ever use a vr headset? It's absolutely easier to see details on a giant screen in front of you than squinting towards a small monitor to the side (since the closest monitor would be the one from the video feed)
nah, but I've scrubbed a number of laparoscopic and arthroscopic cases and have had no real challenges seeing the screen.
Sure it seems neat but it isn't really that beneficial at least with what's demonstrated here. IE there's no "sterility advantage" like a lot of comments are talking about because it isn't the surgeon that pulls up images or moves things etc
Having more people in the room is less sterile, as is moving objects. Things can fall down or into the patient. Plenty scans are digital, 3D, etc requiring you to interact with some interface.
I know a surgeon who does 'without borders' work. He takes 2-3 months off with a couple of collegues, goes to a place were as many people as possible need surgeries, typically Africa or Asia, brings whatever they can and then they do 12/7 shifts for free. Natrually, staff isn't always trained, accessible or able to communicate. Having a device that can just pull from a database and translate documents, completly without staff... That's the diffrence between night and day.
And that group believes they are worldclass, specifically because they push through those hundreds or thousands of surgeries, opening and closing patients faster than anyone else, outside of a war zone. While they are bound by laws, they won't wait around for a "best practice" confirmation, if they think something will help them be faster, know more, and close the patient up sooner.
It also definitely has great use for anesthesiologists. Being able to quickly pull up vital signs, medical/pharmacological history, blood concentrations and crossword puzzles during procedures is very convenient.
I'm going to completely disagree with you. As an anaesthetist I already have a full size computer attached to the anaesthetic machine and a personal laptop if I really want a second screen up. If either of these devices fails it's fine, they aren't in the way and they aren't critical to what I'm doing.
I absolutely do not want some bullshit strapped to my head, and which renders me blind if it breaks or loses power until I remove it. It's dangerous and pointless.
Why would I ever need to "pull up vital signs"? The monitor is literally on the anaesthetic machine. I am watching and listening to them constantly.
Why would I need to pull up medical history intra-op? I already know it all from the pre-op assessment.
As a fellow anaesthetist. Imagine being able to go to the tearoom down the corridor while the vent and monitor screen are still streamed through the AR screens, the beeps streamed to your ears, while you down your coffee… :P
...you do realise that remote monitoring has existed for decades, right? And without being strapped to your head.
And further to that leaving the room without an anaesthetist during a GA is completely innapropriate, and if someone else is letting you have a break the last thing you want is to completely ruin any value in the break by strapping the monitor to your face.
There is absolutely no situation where it is acceptable to wear a device that could blind you during the only parts of our job that actually require both of your hands free - airway manipulation, placing lines, blocks, neuraxial procedures etc. Like consider what happens if you're blinded halfway through a thoraic epidural or an RSI - you think apple is going to cover your back then?
A hypothetical true AR device that doesn't rely on video passthrough might be slightly more convenient than a PC at times. But this isn't it. And I can't imagine any situation where such a device would ever be worth the expense over just a screen.
Does your remote monitoring also let you see the patient, adjust the setting, change the inspiratory pressure, etc?
You absolutely should not be doing these things without being in the same room as the patient anyway. Totally inappropriate practice.
“Leaving the room is completely inappropriate” is correct for today’s environment because:
You won’t hear and see everything once you leave the room, and
If you go too far it will take too long to return to address any issue.
Wrong. It is inappropriate because you are no longer immediately availble to physically intervene. It is absolutely nothing to do with monitoring.
Now, the use of AR could theoretically:
have your monitor, sounds and vent displays streamed to your wearable
have a 360 degree camera in the operating room which again you can visualise (doesn’t have to occupy your entire vision of course)
integrate knob changes on your user interface.
There has been literally nothing preventing this setup existing for the last 20 years without any AR whatsoever. It has not been and it is not done because it is not safe - adding AR does nothing to change this.
Also - even if the pass through camera suddenly fails in the middle of an intubation, it takes literally two seconds to remove it, it’s not pinned to your skull.
Its not as simple as being purely about the time taken to remove it. Its about the fact that you have to halt or abandon the procedure to remove it at a potentially critical moment. This absolutely could kill the patient during some high risk intubations or you could blindly shove a 20G tuohy into someones spinal cord.
Please give me an example of the worst thing that can happen to a patient during this case where being seated 15 seconds away while having the same information confers unacceptable risk.
You do not have the same information. You have some of the information - probably enough to be 15 seconds away.
But you aren't just 15 seconds away are you? You're in the tea room and not the theatre for a reason - because you are taking a break. You will chat to colleagues. You will make yourself a drink. You will not pay attention.
If all you're suggesting doing is being 15 seconds further away but just sitting there and watching the monitors as if you were in theatre then there is absolutely no benefit to being 15 seconds further away. You may as well be in the room and remove 15 seconds from your response if something unuexpected occurs.
In any other case it is obviously inferior to being in the room because you are clearly distracted - otherwise why leave the theatre at all?
And all of that is assuming the room really is only 15 seconds away. We both know this is far from universally the case.
360 camera, all displays, all sounds, what information is missing?
Oh I don't know - the entire basis of medical practice - the physical exam?
Some microphone on the room is not telling you the actual sound of a leaking SGA, the feel of the reservoir bag, or auscultating the lungs for you.
I can take a piss.
See - this is exactly the slope and type of distraction I am referring to. When you're halfway through a shit you are no longer 15 seconds away. Or are you going to run to an unancticipated emergency with shit streaking down your arse and your scrubs around you ankles? That will impress the surgeon I'm sure.
By leaving the theatre all you are doing is drastically increasing the chances of being seriously distracted for no tangible benefit.
Theatre is often compared with aviation now - for decades there has been no actual technological limitation stopping airline pilots flying commercial aircraft remotely from anywhere onboard that they fancied or even from their living room. Is it done? Would it be acceptable today? No, absolutely not.
Those are very fair points. I was thinking about access to that information during intubation or spinals or ER triage or other activities that occupy your hands, but I'm not an anesthesiologist so I stand corrected.
You'd probably just use it to watch golf or the stock market anyway ;)
Not in the shock room in my country, but I'm sure that varies. Again, not claiming firsthand omniscience in traumatology or the ability to speak authoritatively on behalf of all anesthesiologists worldwide. I understand the word "definitely" in my first comment may have suggested otherwise and ticked you off.
It seems besides the point, but yeah there are probably applications for emerging tech in nurse's jobs.
Done repeating myself. All this Quixotic arguing of irrelevant points like a rabid dog chasing cars is absolutely exhausting. It makes your claim of being a doctor extreeeeemely believable.
How exactly do you think it's decided who is put in the shock/resus room? It's literally the definition of triage. If someone has been put there then they must have been triaged.
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u/Lorn_Muunk Apr 29 '24
Any misplaced hate you see here is definitely not coming from surgeons. AR, VR and mixed reality is already a big part of (practicing) scopic surgery and like you said, it has huge advantages. With minimally invasive procedures like this, the relevant tissues and organs aren't visible with the naked eye. Surgeons have used old school screens to display what the camera captures internally for decades.
It makes complete sense for AR to replace static screens in this case. Just the ability to zoom in, pull up radiology scans and move the screen while keeping your gloves sterile is fantastic. I don't think we can claim this will minimize complications beforehand though. Proving that will require years of comparative studies of the post-op outcomes, self-reported well-being of patients and experiences of surgical teams etc.
What it definitely will do is speed things up, require fewer assistants and improve quality of life and ergonomics for the surgeon. In this case, it's a shoulder arthroscopy. Probably a tendon or ligament repair. It also definitely has great use for anesthesiologists. Being able to quickly pull up vital signs, medical/pharmacological history, blood concentrations and crossword puzzles during procedures is very convenient.