Feasibility of smart glasses in supporting spinal surgical procedures in low- and middle-income countries: experiences from East Africa

Abstract

OBJECTIVE Telemedicine technology has been developed to allow surgeons in countries with limited resources to access expert technical guidance during surgical procedures. The authors report their initial experience using state-of-the-art wearable smart glasses with wireless capability to transmit intraoperative video content during spine surgery from sub-Saharan Africa to experts in the US. METHODS A novel smart glasses system with integrated camera and microphone was worn by a spine surgeon in Dar es Salaam, Tanzania, during 3 scoliosis correction surgeries. The images were transmitted wirelessly through a compatible software system to a computer viewed by a group of fellowship-trained spine surgeons in New York City. Visual clarity was determined using a modified Snellen chart, and a percentage score was determined on the smallest line that could be read from the 8-line chart on white and black backgrounds. A 1- to 5-point scale (from 1 = unrecognizable to 5 = optimal clarity) was used to score other visual metrics assessed using a color test card including hue, contrast, and brightness. The same scoring system was used by the group to reach a consensus on visual quality of 3 intraoperative points including instruments, radiographs (ability to see pedicle screws relative to bony anatomy), and intraoperative surgical field (ability to identify bony landmarks such as transverse processes, pedicle screw starting point, laminar edge). RESULTS All surgeries accomplished the defined goals safely with no intraoperative complications. The average download and upload connection speeds achieved in Dar es Salaam were 45.21 and 58.89 Mbps, respectively. Visual clarity with the modified white and black Snellen chart was 70.8% and 62.5%, respectively. The average scores for hue, contrast, and brightness were 2.67, 3.33, and 2.67, respectively. Visualization quality of instruments, radiographs, and intraoperative surgical field were 3.67, 1, and 1, respectively. CONCLUSIONS Application of smart glasses for telemedicine offers a promising tool for surgical education and remote training, especially in low- and middle-income countries. However, this study highlights some limitations of this technology, including optical resolution, intraoperative lighting, and internet connection challenges. With continued collaboration between clinicians and industry, future iterations of smart glasses technology will need to address these issues to stimulate robust clinical utilization.

Towards Wearable Augmented Reality in Healthcare: A Comparative Survey and Analysis of Head-Mounted Displays

“…Although the majority of the smart glasses used in the selected studies were Google Glass, eight exceptions were considered. Harris et al [10] chose ODG R-7 AR glasses with installed NuLoupes for their demonstration; Munusamy et al [11], Kim et al [12], and Sommer et al [13] used Vuzix smart glasses in their research studies; Maruyama et al [14] selected the Moverio BT-200 (Seiko Epson Corporation); Park et al [15] and Jang et al [16] selected the Moverio BT-35E smart glasses (Suwa, Japan: Epson Inc.); and the VR X-Ray glasses developed by Skilitics and Virtual Medical Coaching, New Zealand, were selected by Kato et al [17].…”

“…It is important to note that the vast majority of the studies examined the potential use of Google Glass as an intraoperative intervention (9/15, 60%) [10,11,[13][14][15][18][19][20][21], as well as its potential use in preoperative/teaching (4/15, 26.7%) [12,16,17,22] and postoperative (1/15, 6.6%) [8] settings (Figure 2). Another analyzed study [23], which did not cover any of these three applications, was associated with Google Glass applications in the medical industry, as well as its useful contribution to physicians.…”

“…The authors selected international studies related to medical applications of Google Glass Figure 3 shows the countries that conducted the research. The studies selected were conducted in the USA [10,13,18,22], South Korea [12,16,20], Japan [14,17], Germany [21], Italy [8], the UK [15], Spain [19], Turkey [23], Malaysia [11], and Tanzania [13].…”

“…During spine surgeries, a smart glasses system with an integrated camera and microphone was used to transmit in-3 patients of scoliosis correction Vuzix Smart Glasses Spine Surgery Regarding operative settings, Google Glass was used in various surgical specialities, including urological surgery [19,21], spinal surgery [13,20], oncological surgery [24], orthopaedic surgery [15], and neurological surgery [11,14,18] (Table 1). This technology was also applied in preoperative settings, namely dermatology visits [22] and nursing skills training [12].…”

“…Orthopaedic Surgery [13] To evaluate the feasibility and accuracy of using smart glasses with augmented reality technology for neurosurgical navigation.…”