Inside the global operating room

A doctor wearing two sets of glasses does not exactly inspire confidence. But perceptions change if the second pair happens to be Google’s famous computer-mounted, internet-connected eyeglasses, Google Glass.

That is how Dr Pedro Guillén, of Clínica Cemtro, operated on a 37-year-old man with a knee injury on Tuesday afternoon. Over 265 international participants from universities, hospitals and medical societies went online to experience this latest display of state-of-the-art technology: live coverage of a surgical procedure from the viewpoint of the chief surgeon.

Using a chat system, participants were able to send questions to the operating team regarding the two cutting-edge techniques being employed in this particular surgery: autologous chondrocyte (stem cell) implantation and a wireless arthroscope developed by Dr Guillén himself.

As he says, the point was to create “a global operating room.” “There were people from all over the place, or almost,” he notes proudly. “Central Africa was missing. And China, where there are problems accessing the internet.”

Besides a few technical glitches, the two-hour procedure, which involved cell therapy — the patient was implanted with stem cells previously obtained from his own cartilage to help the wound heal faster — served as an early example of what teaching medicine, not to mention other subjects, will be like in the future.

Teaching is only one of the possibilities opened up by Google Glass

“We have progressed from the fishbowls of the old operating rooms [which had glass walls for medical students to look through] to this,” says Guillén, holding up the glasses.

While not commercially available yet, the glasses, or more specifically, the frames — Google is still working on adding sunshades and prescription lenses to its creation — are already a sensation. Detractors criticize the Borg-like look of people with a miniature processor and battery over one eye, but supporters extol the voice-operated interaction and all the possible uses of such a lightweight, wearable computer.

The system has an added advantage: intercommunicability. Guillén selected three spots in the world from which to take questions: Stanford University in the US (he had tried out the system in June with them) and two other centers in Switzerland and Japan. Guillén could even have asked them for help or suggestions had he wished to, though that was not the case.

But teaching is only one of the possibilities opened up by adding Google Glass to existing medical technology in the operating theater. Another is providing advice to a doctor who is not very familiar with a particular technique. If the latter had a communication system such as Google’s, a specialist could walk him or her through a surgery, step by step. The idea is for knowledge, rather than the patient, to travel.

Tuesday’s operation was the latest display of what technology can bring to the field of medicine. Right now, only a lack of equipment and sufficiently powerful internet connections are preventing remote home visits from becoming an everyday reality. And the same goes for follow-ups. The oft-mentioned field of telemedicine is still in its infancy. While humankind is already able to remotely analyze the water content of rocks on Mars, it is still considered exceptional for someone like Susana Ruiz to get her diabetes remotely checked from the Basque Country while she is busy climbing Everest. But revolutionary devices such as the Da Vinci surgical robot, which is operated by a surgeon sitting at a console, are only the tip of the iceberg in terms of practical applications.

Neural connections allow people to work with mind-controlled prosthetic devices

Modernizing medicine is a process that works at many speeds. Major differences are to be found within the same country, the same region, and sometimes even the same hospital. At Madrid’s Gregorio Marañón Hospital, for instance, there is a digital system for handling appointments, yet you still see the old shopping carts filled with manila envelopes containing patients’ medical records, which get manually delivered to each office.

Besides the fact that medical management lags far behind other sectors such as Social Security or the Treasury, where it would be unthinkable to work without a computer, medicine also offers many more opportunities for developing technical applications: from blogs to doctors’ tweets and the implementation of remotely assisted home checks for blood pressure, sugar levels, temperature or cholesterol.

If new technologies can be criticized for anything, it is for having turned up late to the field of ordinary, everyday medicine. There have been quantum leaps in certain high-profile areas, such as anatomic computer models that avoid the need to dissect frogs or dead bodies. Just like in the children’s board game Operation, where touching the sides of the “patient” got players eliminated, minimally invasive techniques such as laparoscopic surgery allow doctors to operate through tiny incisions. Special mannequins are also being built to train medical students in first aid, cardiopulmonary resuscitation (CPR) and how to perform a check-up on a child. At the most spectacular end of the spectrum, neural connections to computers allow people to work with mind-controlled prosthetic devices: the European program Get Up and Walk involves wearable exoskeletons that help paraplegics walk on their own.

You might say that such efforts are excessive and benefit only a few, when the truly important aspects of medicine are vaccines, hygiene and nutrition. But the same was said about the space race, yet few people recollect that breakthroughs such as velcro, the microwave oven and tin foil were all byproducts of that effort.

In any case, the hands of a doctor will ultimately always have final control over the technology. And no system has been devised yet that can prevent a medical student from having to grab a scalpel in order to get hands-on training.

Óscar Gorría, the spokesman for Physicians in Training at the Spanish Medical Colleges Association, which represents all licensed doctors, asserts that this sort of technique is “of great help, but obviously it will not save you from subsequent work. In surgical specialties such as mine, the more you study the theory and the more videos you watch, the better the practical part of it will turn out. And more so now, with all the budget cuts, which means fewer trips to medical conferences, or in procedures such as this one, with only one doctor.”

That final touch of humanity was provided by Guillén himself, when thousands of viewers looking through his glasses saw him insist on sewing up a stitch personally: “I wouldn’t want to screw up at the end.”