Actas Urol Esp.

2018;42(3):207---211

Actas Urológicas Españolas

www.elsevier.es/actasuro

NEW TECHNIQUES AND TECHNOLOGIES

Testing Smart Glasses in urology: Clinical and surgical

potential applications夽
E. García-Cruz a,b,c,∗ , A. Bretonnet d , A. Alcaraz b

a
Departamento de Urología, Hospital Plató, Barcelona, Spain
b
Departamento de Urología, Hospital Clínic de Barcelona, Barcelona, Spain
c
EAU Young Academic Urologists Men’s Health Group, Barcelona, Spain
d
Healthcare Innovation, Soft for You, Barcelona, Spain

Received 27 April 2017; accepted 14 June 2017

Available online 24 February 2018

KEYWORDS Abstract
Smart glasses; Objectives: We aimed to explore the potential benefits of using smart glasses --- wearable com-
Google Glass; puter optical devices with touch-less command features --- in the surgery room and in outpatient
Surgery; care settings in urology.
Urology; Materials and methods: Between April and November 2015, 80 urologists were invited to use
Ambulatory care Google Glass in their daily surgical and clinical practice, and to share them with other urologists.
Participants rated the usefulness of smart glasses on a 10-point scale, and provided insights on
their potential benefits in a telephone interview.
Results: During the testing period, 240 urologists used smart glasses, and the 80 initially invited
rated their usefulness. Mean scores for usefulness in the surgery room and in outpatient clinics
were 7.4 and 5.4, respectively. The interview revealed that the applications of smart glasses
considered most promising in surgery were live video streaming and static image playback,
augmented reality, laparoscopic navigation, and digital checklist for safety verification. In out-
patient settings, participants considered the glasses useful as a viewing platform for sharing
test results, for browsing digital vademecum, and for checking medical records in emergency
situations.
Conclusions: Urologists engaged in our experience identified various uses of smart glasses with
potential benefits for physician’s daily practice, particularly in the urological surgery setting.
Further quantitative studies are needed to exploit the actual possibilities of smart glasses and
address the technical limitations for their safe use in clinical and surgical practice.
© 2017 AEU. Published by Elsevier España, S.L.U. All rights reserved.

夽 Please cite this article as: García-Cruz E, Bretonnet A, Alcaraz A. Evaluación del uso de smart glasses en urología: potenciales aplicaciones

en los ámbitos hospitalario y quirúrgico. Actas Urol Esp. 2018;42:207---211.

∗ Corresponding author.

E-mail address: eduard.garcia.cruz@gmail.com (E. García-Cruz).

2173-5786/© 2017 AEU. Published by Elsevier España, S.L.U. All rights reserved.
208 E. García-Cruz et al.

PALABRAS CLAVE Evaluación del uso de smart glasses en urología: potenciales aplicaciones en los
Smart glasses; ámbitos hospitalario y quirúrgico
Google Glass;
Cirugía; Resumen
Urología; Objetivos: Explorar los potenciales beneficios del uso de smart glasses, dispositivos de visual-
Consulta externa ización manejables en modo manos libres, en el quirófano y en consultas externas en urología.
Materiales y métodos: Entre abril y noviembre de 2015 se invitó a 80 urólogos a usar Google
Glass en su práctica quirúrgica y clínica diarias, así como a compartirlas con otros urólogos. Los
participantes puntuaron la utilidad de estos dispositivos en una escala de 10 puntos y aportaron
su percepción sobre los posibles beneficios del dispositivo mediante una entrevista telefónica.
Resultados: Durante el periodo de experimentación 240 urólogos utilizaron las smart glasses y
los 80 inicialmente invitados puntuaron su utilidad. Las puntuaciones medias de utilidad en el
quirófano y en consultas externas fueron de 7,4 y 5,4, respectivamente. La entrevista reveló que
las aplicaciones de las smart glasses consideradas más prometedoras en cirugía fueron la proyec-
ción de vídeos en tiempo real y reproducción de imágenes estáticas, la realidad aumentada,
la navegación laparoscópica y el checklist digital de comprobación de seguridad. En consultas
externas los participantes las consideraron útiles como sistemas de visualización para compar-
tir resultados de pruebas, para buscar información en un vademecum digital y para consultar
historias clínicas en situaciones de urgencia.
Conclusiones: Los urólogos involucrados en nuestra experiencia identificaron diversas utilidades
de las smart glasses con beneficios potenciales para su práctica diaria, especialmente en el
ámbito de la cirugía urológica. Serán necesarios futuros estudios cuantitativos para explotar
las posibilidades reales de las smart glasses y abordar sus limitaciones técnicas, con el fin de
conseguir un uso seguro de estos dispositivos en la práctica clínica y quirúrgica.
© 2017 AEU. Publicado por Elsevier España, S.L.U. Todos los derechos reservados.

Background to use a particular type of smart glass (Google Glass,

Smart glasses (SGs) are wearable computer devices capa-
ble of performing the same complex computing tasks as any
new generation smartphone, laptop or desktop computer.
Inspired by optical head-mounted devices used in aeronau-
tics during the last century, SGs can be fully ‘hands-free’
commanded, making them a promising tool for healthcare
practice.1 The hands-free features of SGs include the ability
to take pictures or record videos in response to the user’s
eye blink or voice-dictating instructions.2 They also provide
the user with visual input, which makes it possible to exam-
ine electronic health records and results of diagnostic tests
through a monocular refractive lens over the right eye with
wireless Internet connection.
Since SGs were used for the first time for video broadcast-
ing during surgery in 2013,1 little peer-reviewed data has
been published. Reports on pilot experiences assessing the
usefulness of SGs in medicine include their use as a tool for
vital signs monitoring during surgery, electrocardiographic
and X-ray reading and interpretation, telemonitoring, and
augmented-reality-assisted surgery.3---6 Nevertheless, most
reports describe the user’s comfort and satisfaction with
these devices over specific applications, while comparing
them with other currently used health information technol-
ogy systems. With the aim of providing further information
on this rapidly evolving field, we explored the potential ben-
efits of SGs in the day-to-day practice of urologists in both
surgical and outpatient care settings.
Material and methods
Eighty urologists from 80 urology specialized centers (60%
public and 40% private) in 44 cities in Spain were invited
Google Inc.)7 in their daily clinical and surgical practice,
and were encouraged to share the device with other col-
leagues and obtain their impression on the use of this
device. After receiving a short training session and signing
an agreement upon delivery of Google devices, a hands-on
experience testing period of two weeks began. Participants
were encouraged to use the device without restrictions,
in any scenario encountered during their daily practice in
either the surgical setting or the outpatient care setting.
Upon completion of the testing period, participants rated
the usefulness of the SGs on a 10-point scale, where 1
meant ‘useless’ and 10 meant ‘very useful’. Additionally,
all registered participants were asked in what tasks they
would most likely use SGs in their daily practice. The assess-
ments were performed in a telephone interview, using a
semi-structured questionnaire (see Suppl. mat.). The most
frequently reported responses for surgery and outpatient
clinics were recorded. Additionally, a website was created
to centralize the reporting of physicians’ experiences using
SGs across several social media platforms with the aim of
building a community for users to share their opinions about
these devices.
Results
Between April and November 2015, 240 urologists (includ-
ing residents, attending physicians, and senior urologists)
used the SGs in their routine practice, and shared 1581
photos and 1106 videos via Twitter, LinkedIn, and Google
plus, all shot with the Google Glass provided for the study.
In addition to the creation of social media news spreading
platforms, only the 80 urologists initially invited provided
structured feedback presented as results herein. The mean
Smart Glasses in urology: Clinical and surgical potential applications 209

score for usefulness in the surgery room was 7.4 on a 10- Table 1 Potential applications of smart glasses in urology.
point scale, with 62% of participants scoring 7 to 8 (Fig. 1).
In the case of outpatient clinics, the mean score was 5.4 Percentage of
and the most frequently reported scores were 5 and 6 (25% respondents
and 19%, respectively) (Fig. 2). Table 1 summarizes the (N = 80)
contexts in which SGs were considered useful for urology Operating room
clinical practice. The most promising applications of SGs Live video streaming 90%
in the surgery setting were live video streaming and static Augmented reality 75%
image playback, both for either educational or consulting Live surgical image playback 80%
purposes. Other potentially useful applications identified Checklist 50%
by participants were the creation of a composite view of Laparoscopic navigation 65%
the surgical field through augmented reality, laparoscopic
navigation, and running a checklist for safety verification Outpatient clinics
after completing surgery. Accordingly, in tasks related to Synchronization of diagnostic tests 65%
outpatient care, participants referred to the use of SGs Vademecum 65%
as a viewing platform for sharing diagnostic test results, Hospital settings (i.e. emergency room) 65%
browsing the vademecum for drug prescription informa-
tion, and rapidly checking the medical record in emergency
situations. These applications were considered particularly
useful in the emergency service setting, where urologists
could monitor critically ill patients while performing routine Discussion
activities.
This study aimed to explore the edges of the utilization
of SG during urologists’ daily practice and to appraise the
score 4 score 5
score 10 4% 5% perceived usefulness of these devices when used under
5%
score 6
unrestricted conditions. To prevent any constraint regarding
6% the SG use, no selection criteria were applied to the recruit-
ment of participants, who were provided with the minimum
score 9
13% information to avoid any preconception. This study design,
along with the lack of previous validation of the question-
naire, limits the strength of the quantitative results (i.e.
the assessment of the different rating of each use). Nev-
ertheless, the study provides an overview of the potential
score 7
30% repertoire of uses of SG in urology and the urologists’ pre-
score 8
32% ferences on the various uses.
In our experience, urologists considered SGs more useful
in the operating room than in outpatient clinics and other
hospital settings. This observation is in line with the trend
reported by previous pilot studies assessing user preferences
Figure 1 Usefulness of smart glasses in the surgery room,
and satisfaction among urologists.8,9 Similar to our survey,
rated on a 10-point scale. Results are presented as percentage
in these previous experiences, applications related to live
of participants rating each score.
video streaming of surgery were the highest rated tasks,
score 2 particularly when used for educational purposes. Indeed,
3%
score 9 broadcasting surgical interventions in real time makes it
5%
score 10 possible to visualize the surgical field from the surgeon’s
5%
score 3 perspective, from anywhere in the world; therefore, it could
10%
represent a breakthrough technique for promoting global
continuous medical education.
score 8
13% Augmented reality using SGs was a highly-rated appli-
cation in our study. It involves projecting a computer-
score 5
generated image onto the surgical field to create a
29% composite view which includes significant anatomical infor-
score 7
15%
mation such as tumor shape and size. The feasibility and
safety of this technology were investigated recently in a
study including 30 urologists.6 On a 10-point scale, par-
ticipants rated with a mean of 7.6 the ease of navigation
score 6
and 7.4 the likelihood of using augmented reality in their
22% daily practice. No grade 3---5 surgical complications were
recorded, and the device was considered overall safe. Based
Figure 2 Usefulness of smart glasses in the outpatient setting, on these results, augmented reality has been regarded as
rated on a 10-point scale. Results are presented as percentage one of the most ready-to-use technologies in urological
of participants rating each score. surgery.
210
Laparoscopic navigation and running checklists during
surgery received little support in our experience. Like mon-
itoring vital signs during surgery, these tasks are currently
performed using separate devices which require taking the
visual focus away from the procedural field. Conversely, the
use of SGs for these purposes provides surgeons with rel-
evant information while keeping their eyes on the surgical
procedure. The use of SGs as an alternative monitor dur-
ing surgery has raised doubts regarding attentiveness and
accuracy. However, most studies addressing these issues
concluded that using the screen integrated into SGs to
check vital signs allows for a quicker response to abnormal
signs and increases awareness and attentiveness on these
parameters.5,10 Interestingly, some authors highlighted that
this rapid response might only occur when the SG lens
is placed on the non-dominant eye.11 Similarly, studies
addressing the accuracy of images displayed by SGs dur-
ing surgery (e.g. electrocardiogram records) concluded that
physicians could identify abnormalities with the same accu-
racy as with conventional readings.4,12
In addition to the usefulness of SGs in the surgery room,
a wearable, hands-free device with the ability to record
and show images and video at any time has a high potential
for benefiting physicians in outpatient and hospital settings,
including the display of warnings and test results at the
emergency service. Nevertheless, urologists enrolled in our
experience scored the usefulness of SGs remarkably lower
in these settings. Like the surgery environment, accuracy
is one of the potential drawbacks of SG technology for its
widespread use in these settings. In this regard, a study
specifically investigating the accuracy of SG X-ray images
concluded that SG technology leads to less accurate inter-
pretations than conventional Images.3
To overcome the current limitations of SG technol-
ogy, some companies and research organizations have
designed new custom-made applications, which may not
only enhance SG performance but also expand their scope of
utilization.2,13---15 The opportunity of developing tailor-made
applications might lead to an almost unlimited range of pos-
sibilities, including face recognition and other functions with
the potential to dramatically change the way doctors inter-
act with their patients during medical appointments. The
fast-paced technological progress associated with SG tech-
nology should also encourage us to face the ethical concerns
related to the widespread use of these devices in health-
care practice. These include not only concerns regarding
patients’ privacy, but also social interaction, power, and
ideology.16 Finally, the user’s safety should not be dismissed,
and the potential risk for harmful ophthalmic syndromes and
health issues associated with overexposure to electromag-
netic radiation should be addressed.
In summary, SGs are unique tools capable of significantly
improving daily clinical and surgical practice. Nevertheless,
the speed of progress in this field is a double-edged sword,
with the potential for both enhancing the performance of
healthcare professionals and distracting them from essential
activities. Although the quantitative results must be taken
cautiously due to the limitations of the study design, our
study provides insights regarding the potential repertoire of
uses of SG in the setting of surgical and outpatient care in
the urology field. Further quantitative studies are needed
to exploit the actual possibilities of SGs and address the
E. García-Cruz et al.
technical limitations for their safe use in clinical and surgical
practice.
Financial support
The SmartGlass program has been sponsored by Almirall lab-
oratories.
Conflict of interest
The authors declare that they have no conflict of interest.
Acknowledgements
The authors would like to thank the whole team at i2e3
Research Institute for providing medical writing assistance
during the preparation of this manuscript.
Appendix A. Supplementary data
Supplementary data associated with this article can be
found, in the online version, at doi:10.1016/j.acuroe.
2018.02.004.
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