A heads-up display for diabetic limb salvage surgery: a view through the google looking glass

Abstract

Although the use of augmented reality has been well described over the past several years, available devices suffer from high cost, an uncomfortable form factor, suboptimal battery life, and lack an app-based developer ecosystem. This article describes the potential use of a novel, consumer-based, wearable device to assist surgeons in real time during limb preservation surgery and clinical consultation. Using routine intraoperative, clinical, and educational case examples, we describe the use of a wearable augmented reality device (Google Glass; Google, Mountain View, CA). The device facilitated hands-free, rapid communication, documentation, and consultation. An eyeglass-mounted screen form factor has the potential to improve communication, safety, and efficiency of intraoperative and clinical care. We believe this represents a natural progression toward union of medical devices with consumer technology.

Keywords: augmented reality; diabetes; heads-up display; limb salvage; telemedicine.

Figure 1.

(a) Google Glass. One eye consists of a see-through monocle and integrated camera with bone-conducting or direct in-ear microphone. It connects to the Internet via Bluetooth and mobile phone or directly via Wi-Fi. (b) Connectivity is achieved via wireless local area network or Bluetooth connection using Glass linked to phone via Bluetooth. Remote parties are able to communicate from a mobile device or desktop computer using the Hangouts application (Google; Mountain View, CA).

Figure 2.

Visible defect on main screen with consultant clinician in lower right (a), real-time photograph of admixture of antibiotic-demineralized bone matrix (b), and measured delivery into defect (c, d).

Figure 3.

(a, b) During a delayed primary closure of a high-risk plantar wound, real-time descriptions with instant “screen share” were fed through Glass to a junior resident during the surgical procedure to assist instruction by the senior attending surgeon.

Figure 4.

View during intraoperative consultation for plantar deep space infection to assist in incision planning, exploration, and decompression using senior author’s article’s figures as a case example.