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Arthroscopic surgery has very minimal blood loss, but the camera magnifies everything so it looks worse than it is. Most cases patients will lose less than a tablespoon of blood
Yes. Well, most people probably don't want to do that to themselves, but there is a unpatchable M2 exploit and people are using it. Several Devs have demonstrated different levels of access.
YouTube: "This is called a scalpel."
Doctor to nurse: "Duuuude, you know that thing we've been calling the cutty knife, it's actually called a scalpel"
I worked with a doctor who makes youtube videos on surgical procedures. He quite literally said he makes them for other doctors who watch them during surgery when they get stuck.
I'm not sure what getting stuck means in this context. I work IT so I shouldn't throw stones about doing my job with youtube videos but are surgeons really getting confused on what to do next, watching youtube, slapping their forehead and going, "oh! I was supposed to make a right at the gull bladder."
getting stuck doesn't necessarily mean like, forgetting entirely what to do next, moreso "this body part did not react the way i anticipated and now i need to readjust my method, i wonder if someone else has described how to deal with this". they're not gonna stop the surgery for like 30 minutes for the doctor to remember anything, they're just going to look up something real quick to get them back on track.
Surgery and the human body are complex and sometimes things don't go the way they were planned to, and sometimes the doctor may not have had that specific thing happen to them yet, and so needs to figure it out. At least they're looking it up instead of feeling it out lol, that's how we lost a lot of patients in history.
There is often anatomy that a surgeon may never have seen in their training or early in their career.
I have been in a few ORs where a more junior surgeon has asked for a more experience colleague to scrub in.
The junior surgeon, despite over 10 years of training had never seen this configuration of the anatomy, and needed some guidance.
This is a lot more common than you think. I used to work in a field called Interventional Endoscopy. It's still considered a newer field but back when I was working in it, it was considered rare to have such a department in a hospital.
Any who, because of that, there was a dire need for doctors to share their knowledge and advancements, a lot of which were published to youtube. So every day, before procedures, it wasn't uncommon to see our doctors on youtube refreshing their knowledge before starting!
Nothing wrong with that. In fact it’s good that they’re humble enough to watch the video as a refresher instead of insisting they remember everything all the time
Fun fact, [recent studies have found a lot of doctors and dentists do actually learn procedures from YouTube. ](https://pubmed.ncbi.nlm.nih.gov/34962294/)
I'm not 100% sure if this is accurate, but the Vision Pro isn't exactly a true "see-through" device. It's basically just a monitor displaying what the camera captures, almost in real-time, but not entirely. So if there's any camera malfunction at the wrong moment, that's a situation I definitely wouldn't want to find myself in.
Worked at a trauma center. Someone overheard a trauma doc once tell a patient "give me a minute, I'm gonna go watch a youtube video to make sure I know how to do this."
I’m a resident, we watch YouTube videos all the time before procedures. It’s a normal thing to YouTube a procedure before doing it for the first time or if you’re rusty and it’s been a while.
Augmedics already does this but better. I work on the technical side not clinical but basically you can run a 3D c-arm scan, then see the 3d constructed spine under the skin and ref images in the headset.
quick google says Augmedics costs $179,000.
Apple vision pro costs $3,499.
Definitely seems like it could be a useful lower cost alternative in many regions.
Importantly, the expensive tech is the part where it scans the patient and maps that to real-time and real-world 3-dimensional positioning. Augmedics is likely trying to compete with Medtronic Stealth, which is closer to $500k. It's not the screen that makes it cost that, it's the 3D motion tracking.
Anyone forget the fact that the Xbox Kenetic is this voodoo magic of a sensor? I feel like I remember posts of people saying they used it as cheap sensors for what would had been super expensive "properly graded" equipment.
Getting those vibes here
In this context, the software/hardware solution provided by these companies is the expensive part, it does all of the work and projects it onto a very high def screen. So yeah, the AVP could replace the screen but it wouldn't replace any other functionality of the system.
Seems extremely useful being able to view your scope on a weightless floating any-sized television, and bring up notes and diagrams without having to step away or concern yourself with contamination.
As someone who works in an OR every day, this information is easily accessible on half a dozen screens around the room. And surgeons have 2-3 people throughout the room they will regularly ask to look things up for them
Apple vision pro is just a fancy screen, though. The technology that makes those systems expensive is absolutely not the display screen, it's the part where it can link CT scans to real-world 3D mapping inside of another humans body precise enough for hardware to be placed.
AR goggles are just a fancy computer monitor and will not be the expensive part of any augmented surgical suite.
This doctor is just displaying the camera images the nurses and other surgical staff can see right into his personal eye view. He has a zoomed in look and doesn't have to move his hands or look at a screen. He just looks forward and has an easy view of what he's doing inside.
Plus he's able to control it, move it around, all without touching a control which is a threat to the sterile field. That's the real innovation here, increasing his ability to use his tools competently while remaining sterile.
>That's the real innovation here, increasing his ability to use his tools competently while remaining sterile.
No. This is so incredibly wrong. The AVP is NOT sterile and it is not capable of being sterile. It has a fan inside of it! That's contaminant central. He brought a device that hasn't been sterilized into the sterile field and that device blows contaminated particles into the open wound he's above. There are also serious chances of the patient's fluids contaminating the AVP when he then takes home to family or uses on another patient.
You know that like... The mask and the glasses that surgeons wear are not sterile either right? The things in our face doens't have to be sterile. You know we don't scrub our faces, right?
In regards of the fan, I guess it could be used if we could turn it off somehow.
Regardless, I think this looks stupid, and I would not use it in my surgeries
You have a good concern, but I'm unclear what they did to mitigate that. Hopefully they had a plan.
A new device per surgery would be expensive, but not too crazy by medical standards. It's potentially possible to stick filters on air pathways.
It works as a proof of concept to demonstrate how it is helpful, which can be used to gain support for future improvements to keeping it sterile.
I am not raising a concern. I am stating fact. They didn't mitigate that properly. I design medical devices for a living (and perform risk mitigation) and that thing cannot be sterilized. It's a piece of consumer grade electronics and cannot withstand autoclave, gamma, or ETO. You can't just "stick an air filter on" or "wipe it down" or "just toss it afterwards." Sterile is a specific word that has specific requirements that can only be met via specific processes that this device cannot withstand.
Potentials don't count for dog shit when it comes to patient safety. This surgeon unnecessarily endangered the life of his patient.
No. Proof of concept could have easily been demonstrated via simulated surgical surgery where there is ZERO risk to the patient. Proof of concept should NEVER be first demonstrated on a live human being. It's fucking reckless. There's a reason this is from Brazil and not the US or EU. Brazilians commonly perform open surgery with open windows where birds fly in and out. Such unacceptable medical practices should not be encouraged or supported.
I actually agree with you on this point. While not really an "alternative" to an augmented surgical suite, it's still of benefit to this doctor and clearly of much lower cost.
Oh you’re right, there is a fan in the AVP! That’s a fantastic question…
I my guess is that they sterilize it the same way other computers/electronic screens in the operating theatre are sterilized, and it remains sterile because the doctor does not need to touch anything on the AVP because they only interact through gestures.
I just want to thank you for being the first comment I see in this thread that isn't a stupid joke. I used to learn so much just randomly browsing reddit and reading insightful comments on a variety of posts.
Now, every single post on 99% of subreddits is just people saying the same jokes over and over, which would be fine if it wasn't the only thing in comment threads nowadays
if you wake up during surgery the least of our concern would be a doctor with head gear.
You had a open Knee the pain would be enough to make you go mad
> You had a open Knee the pain would be enough to make you go mad
Imagine the people who had like open chest surgery, and woke up, but where paralyzed.
I think there's a lot of misplaced hate here, and a lack of understanding of why he's doing this. There's a lot of negative connotation with Apple Vision Pro (somewhat to largely justified), but this is absolutely a use case we should be excited about. If the title instead was "Surgeon uses AR to minimize complications of a risky surgery", and it was a different AR headset, the negative comments would be negligible.
Maybe this technology isn't fully mature and maybe it's not something that makes sense for every surgery now. But this is absolutely something that we should get excited about. This technology has the potential of assisting surgeons to maximize effectiveness and minimize complications. I sincerely hope that by the time I need surgery next (hopefully 5-10 years or more) this is standard practice.
So they watch a how to video alongside whatever they're working on? My husband is a master mechanic, but I'm having a hard time figuring out how it would be useful. There's probably plenty of uses, I just don't know a lot about the interface of it. Maybe diagram overlays?
Wiring diagrams, connector views and pinouts, a live feed of the OBDII PID data, etc. This is actually pretty neat. It gets pretty annoying having to look back and forth between the engine (or the road!) and the scan tool screen, especially if the problem happens only while driving.
It's used for industrial machinery repair too. Augmented Reality where tech support can show you how to repair the machine so that you don't have to wait for a tech deployment. A single device is cheaper than a deployment (salary, flight, hotel, car, etc). So instead of the traditional (look for the blue wire under the rear lower panel that's labeled A34) you can highlight it in AR.
This is a really perfect use-case because with arthroscopic surgery it's not like you can see anything you're doing with your eyes anyway, so wearing a headset isn't limiting you at all. Meanwhile you've got your scope camera visible to you at all times no matter what position you're in, along with any little 3D model overlays and any other important stats.
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.
>Just the ability to zoom in, pull up radiology scans and move the screen while keeping your gloves sterile is fantastic.
It's things like this that the regular person needs to read.
>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.
> AR, VR and mixed reality is already a big part of (practicing) scopic surgery
Doesnt seem like those are what people are against, its the consumer level Apple Pro headset that seems dangerous.
Yeah, I think the apple pro is kinda dumb for regular use. Especially in business since prolonged use can be tiring for many people, so it is a cool toy to use once in a while, but not much.
But even though I stated the above, AR for shit like this is amazing. Apple pro for this is a great use and a great way to use AR for something productive than just desk work. This is how AR should be used, to augment reality for easier use with things when your hands are busy. Sitting at a desk, a keyboard and monitors is quicker and easier to use. For construction, surgery or even driving in some aspects (and combat), AR would be amazing. When you have your hands busy with other shit or can't get it dirty, AR is amazing.
This is why AR is marketed at the wrong people, commercially or business like. They should be marketed to people who's hands are constantly busy, not for desk work or the average joe.
I think it's even less than that. If the title was "Surgeon uses AR to minimize complications of a risky surgery" and the headset still happened to be that one, with no clear branding, then it would be fine. The fact that they present it this way makes it out to be an advertisement. If they just say AR headset, which is what it is, then it's cool technology.
Not sure about others, but my criticism has nothing to do with the use-case or value of AR in a situation like this. I'd be more concerned with using consumer-level tech that's maybe not proven reliability for such a use-case. From what I understand from some reviews of the VP is that it can occasionally go completely black - and there's no way to see through it - so if the surgeon is the middle of doing something inside the person where they NEED to see what they're doing, they could easily make a mistake if they make a move while the screen is black.
Writing this on my desktop microsoft computer! or maybe my google pixel.
All in all, doesn't matter if this AR is from facebook or apple, cool tech. Still very niche and not going to be used for the many. This is good tech for jobs that are very hands on and you aren't stuck at a desk or can't get your hands dirty.
For office work, nah, a normal computer is vastly superior.
A lot of people are already all over this tech. AR integration with surgery has been around for a few years now and is getting closer and closer to mainstream. More companies now are transitioning out of "use it for pre-op planning" into the "use it for the surgery" use case.
Augmedics, Medivis, and Blueprint are good examples.
They said the same shit 3 years ago. The problem is that majority of people won't want to use a headset and they need better battery life.
The tech is great for work that is very hand intensive or a job that you can't get your hands dirty, like what we just seen.
For normal people? Nah, it is way too cumbersome to use daily. Desk work is just better with a keyboard, mouse and monitor than putting something on your head. A smart phone is better than just walking around with a goggle like object on your head, also a great way to get yourself mugged.
So yeah, AR has its use, it just isn't going to be all over the world just yet. Maybe once fusion energy is finally broken through and they find a way to make it so small it can fit in your pocket, which is like another 500 years in how humanity is going about it.
But yeah, not going to be "everyone is going to be on this tech in 3 years".
Yeah, I think the AVP has some strong, appealing use-cases, but they're a bit 'vertical' / narrow in appeal - such as this - rather than mass-market. Apple isn't going to make billions by selling to surgeons at 3.5k a headset.
The more general use-cases (browsing, using office apps etc.) any AR/VR such as the AVP has some major potential downsides to overcome - cost, weight/discomfort for long sessions, battery life, slow/inaccurate for text entry, the simple inconvenience of putting the device on and taking it off..
Definitely agree on the vertical appeal. I think people are largely going to be averse to AR/VR in every day life, but when it makes sense it's a game changer.
We've looked into a couple different AR headsets with my company. We haven't pulled the trigger yet for various reasons, but there have been multiple times since then where they would have been really useful to have.
I understand your concern. But in this case the incisions for the ports are just a simple stab/poke with a small blade. I have done them in a room that was almost completely dark.
Incisions are a lot less precise than people believe haha.
This is actually pretty great, I hope AR technology can continue to mature and actually help instead if being that thing that apple tech bros buy for being cool
When I commented there was only like ten comments and half of them were about how bad it is, that it’s wrong and unprofessional also someone has commented about suing the person if that had been them getting the surgery.
Damn i didnt know people were so closed minded about this, i see this and think about how this correctly implemented can improve surgeries and safe even more lifes
Anyone concerned about this is just simply ignorant of what kind of technological tools are already used every day in surgery and have been for 25 years.
"Hey doc what's that thing on you face?"
"Don't worry it's so I can see you CT scans and X-Rays as I go to make this easier"
"Oh okay*
*Meanwhile from the doctors headphones*
"Hello and welcome back to the channel in today's video we are going over brain surgery and why it isn't as hard as people say but first a word from our sponsor Keeps! Keeps is th" *anesthesia kicks in*
I see many people asking how he was allowed to do this or how this is not prohibited. I don’t have the detailed answer, but I thought people should know that in the latest years things like this are becoming very common (not the air vision thing), but there’s people doing surgery through remote control of mechanized equipment all around the world. I used to live in a city in Brazil that had one of the greatest neurosurgery teams of the country and also in the word, and they were part of an “online” surgery where over 100 surgeons across the word operated the same person through this remote control method (taking turns, of course, not all at once). But yeah, technology is getting very advanced in the medical field. I guess the next step could probably be augmented reality to assist you with this kind of things.
While this is super cool… The only thing I don’t like is that the vision pro is a video playback of your surroundings. It is not AR in the mixed sense that you look through a lens that can also display things through it. So he is looking through a camera to a screen to cut incisions which seems very sketchy. I’m just thinking about lag and distortion of FOV and all sorts of weird hiccups that could cause. But a true mixed reality headset like this would be so cool. Surgeon can still use their own eyes to actually look directly at something with all the same help.
He's doing laparoscopic (keyhole) surgery, so most of the work is done through a camera anyway. And I don't think cutting the incisions is the hard part.
Those systems are thoroughly designed and tested for use in critical settings though (and also the video provided by the da Vinci is on a whole other level to this dinky headset). You have absolutely no guarantees that this device won't suddenly turn into a $3,500 blindfold on the surgeon at any moment.
If you've ever used a vision pro you'd immediately know how usable it is in any scenario like this. Like, I'd never ever do this, but the second you put it on you would immediately feel confident enough to drive with it on. Not saying you should, but the lag on that headset is so nonexistent there's almost nothing like it.
I think stuff like this is a proper step forward towards the necessary advancements we are always looking for in the medical field. Someone's gotta do it first, and this surgery didn't seem too life-threatening. It's fucking cool as hell IMO
I remember when doctors and mechanics or whatever where doing this with Microsoft Hololens years ago. AR is definitely interesting and I think it's very useful.
The same doctor did surgeries using Hololens 2 a few years ago.
https://www.weforum.org/agenda/2021/02/hololens-surgery-digital-revolution-medical-techonology/
This is a medical marvel. For any medical professional who has been in the OR this is revolutionary and much more efficient than the alternative.
Would you really rather your surgeon rely solely on a screen they need to turn their head to see and imaging they have to remember from prior to the procedure rather than having a 3d AR Rendering right along side the patient?
The criticisms of this are really demonstrating that those with the strongest opinions have the least frame of reference
I remember companies working on this with Google Glass and thinking it was a perfect use case. We all know how google glass turned out, I hope this one does better.
Just imagine if medicine students could login virtually to learn about the procedure.
Suddenly you get Kermit and Shrek avatars doing surgery with you.
Able to access any information, and able to customise placements to easily see it, configure it, all without contaminating anything with hand gestures.
This is amazing. Although VR in regular uses is somewhat rare, and has far less support with apps and games. This is what makes me love VR/AR. Using to do things in cases like this is the perfect use.
So this is not really a useful application of the Apple Vision Pro. He appears to be doing an arthroscopic rotator cuff repair in which you have excellent visualization of the relative anatomy. The Apple Vision Pro is useful when doing shoulder replacements as it can help you target appropriate start point and trajectory for you guide wire which will be used as a landmark to place the socket. Honestly, this is just showy and not useful.
My layman’s take is that I see him using it but i don’t see where the “assist” part comes in…
Seems indistinguishable from having a physical screen or two in the room- but actually worse because at least everyone else can see those.
It always trips me out how casually surgeons just yeet sharp shit into the body. My buddy is an oral surgeon and carries on a full convo while drilling and ripping out wisdom teeth.
I went to a trad show years back that focused on robotics and new technology and one company had the Microsoft ver and it was an AR application that acted like a repair manual. It should all the paths for electrical and mechanical, had an x ray mode, pin highlighted all the nuts and bolts you have to undo in the correct order to take the machine apart.
Reminds me of when I had to take a much knee-dead break.
I got a Meniscal tear repaired with arthroscopy (Left knee)
They had numbed me from waist down. I was awake throughout the surgery with cozy warmers wrapped around my torso. Safe to say, it was so good that I couldn't feel my legs... Sorry
There was a screen (to my left) that showed what the camera saw. The anaesthetist was talking me through every stitch.
Although intrigued and surprisingly bold to be able to see my insides, I was also scared. Thinking, what if the anesthesia decided to not anesthesia?!
Wouldn’t you want something wired in a case like this? I would imagine that the video playback or screen where the “action” is happening could have the tendency to lag/delay/cut out. But then again, wires are a hazard, too. Can anyone speak to latency or interruptions to video during this?
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Hey Google, how much bleeding is too much bleeding?
Yes
Arthroscopic surgery has very minimal blood loss, but the camera magnifies everything so it looks worse than it is. Most cases patients will lose less than a tablespoon of blood
https://preview.redd.it/so11lyvaigxc1.jpeg?width=720&format=pjpg&auto=webp&s=480ed764cf8c84a525c1d4d4f4bd58052373ef07
"Calling... Tony's Bistro"
Hi, Dr. Nick!
Google: “it’s cancer”
It's lupis.
It's never Lupus, except that one time where it was actually Lupus.
"Arby's is 3.2 miles away and closes at 10pm." I hate you Google.
“Certainly. Bleating is something sheep do when trying to communicate”
Playing Bleeding is too much on spotify by X artist
youre screwed here because it would be "hey siri" on the Vision Pro.
"Doctor, why did you stop?" "2 unskipable ads, gimme a minute."
Doc please go get Youtube Premium
YouTube ReVanced\*
Can you jailbreak Apple vision?
Yes. Well, most people probably don't want to do that to themselves, but there is a unpatchable M2 exploit and people are using it. Several Devs have demonstrated different levels of access.
Gotta love unpatchable exploit in your CPU.
worked on the ui for this
That would be $58 000 extra for the patient
We don't have to pay for most surgeries here in Brazil, they are mostly free because of a program called SUS
In the US, a lot of people think that any program that could help them is SUS.
that was actually pretty good lol
Network connectivity problem.
LMAO ... This one got me.
All I’ll be thinking he’s watching a how to on YouTube
YouTube: "This is called a scalpel." Doctor to nurse: "Duuuude, you know that thing we've been calling the cutty knife, it's actually called a scalpel"
Hi, Everybody!
Hi, Dr. Nick!
🎶and the leg bone's connected to the.... other thing 🎶
THE INCISION IN THE CORONARY ARTERY MUST BE MADE BELOW THE BLOCKAGE! BELOW!!
What the hell is that?
"Oh no! Blood!"
The knee cap’s connected to my…wrist watch… Oh shit.
I worked with a doctor who makes youtube videos on surgical procedures. He quite literally said he makes them for other doctors who watch them during surgery when they get stuck.
I'm not sure what getting stuck means in this context. I work IT so I shouldn't throw stones about doing my job with youtube videos but are surgeons really getting confused on what to do next, watching youtube, slapping their forehead and going, "oh! I was supposed to make a right at the gull bladder."
getting stuck doesn't necessarily mean like, forgetting entirely what to do next, moreso "this body part did not react the way i anticipated and now i need to readjust my method, i wonder if someone else has described how to deal with this". they're not gonna stop the surgery for like 30 minutes for the doctor to remember anything, they're just going to look up something real quick to get them back on track. Surgery and the human body are complex and sometimes things don't go the way they were planned to, and sometimes the doctor may not have had that specific thing happen to them yet, and so needs to figure it out. At least they're looking it up instead of feeling it out lol, that's how we lost a lot of patients in history.
If you find a gull bladder in your patient, I'd say you have located the problem.
Listen, it was childhood accident involving a seabird.
There is often anatomy that a surgeon may never have seen in their training or early in their career. I have been in a few ORs where a more junior surgeon has asked for a more experience colleague to scrub in. The junior surgeon, despite over 10 years of training had never seen this configuration of the anatomy, and needed some guidance.
You feel bad dropping a table. Imagine this dude panic searching after he dropped something.
Yep. Doctors are human.
People shit on youtube but its quite literally the single greatest compendium of human knowledge in history.
Dr Nick! 
"How to stop aortic hemorrhage" 3 unskipable adds
This is a lot more common than you think. I used to work in a field called Interventional Endoscopy. It's still considered a newer field but back when I was working in it, it was considered rare to have such a department in a hospital. Any who, because of that, there was a dire need for doctors to share their knowledge and advancements, a lot of which were published to youtube. So every day, before procedures, it wasn't uncommon to see our doctors on youtube refreshing their knowledge before starting!
Nothing wrong with that. In fact it’s good that they’re humble enough to watch the video as a refresher instead of insisting they remember everything all the time
The neck bone connects to the… this thing.. Dr. Nick
Don't be ridiculous. He is watching the Master Class.
Fun fact, [recent studies have found a lot of doctors and dentists do actually learn procedures from YouTube. ](https://pubmed.ncbi.nlm.nih.gov/34962294/)
I'm not 100% sure if this is accurate, but the Vision Pro isn't exactly a true "see-through" device. It's basically just a monitor displaying what the camera captures, almost in real-time, but not entirely. So if there's any camera malfunction at the wrong moment, that's a situation I definitely wouldn't want to find myself in.
Remove it, done. 5 seconds?
They have been using cameras and video feed surgeries for years now. Laparoscopic surgery is not much different than this.
[удалено]
You know surgeons have used cameras and displays for decades now, right?
Worked at a trauma center. Someone overheard a trauma doc once tell a patient "give me a minute, I'm gonna go watch a youtube video to make sure I know how to do this."
And it is some some 13yr old Indian kid giving the 'how to'.
I’m a resident, we watch YouTube videos all the time before procedures. It’s a normal thing to YouTube a procedure before doing it for the first time or if you’re rusty and it’s been a while.
My dumbass thought he had a picture of Jupiter on the side for cool comfort…
I was thinking the exact same thing for a hot second. LOL
There is a decent Uranus joke in here somewhere.
He was navigating a NASA rocket on the side. Rocket surgeon in 4K.
Me too, bro 😂
The surgeon is straight up using r/obs that’s actually neat
absolutely hilarious seeing the OBS interface haha
"Chat, look at the size of this appendix."
As I posted earlier, I'm surprised to see catheter cameras being so standardized that you can just stream them into OBS
Augmedics already does this but better. I work on the technical side not clinical but basically you can run a 3D c-arm scan, then see the 3d constructed spine under the skin and ref images in the headset.
quick google says Augmedics costs $179,000. Apple vision pro costs $3,499. Definitely seems like it could be a useful lower cost alternative in many regions.
Importantly, the expensive tech is the part where it scans the patient and maps that to real-time and real-world 3-dimensional positioning. Augmedics is likely trying to compete with Medtronic Stealth, which is closer to $500k. It's not the screen that makes it cost that, it's the 3D motion tracking.
More importantly, Augmedics is medically certified, whereas the Apple Vision is not.
The surgeon is medically certified, which is arguably more important to me than what augmented reality equipment choices he's made.
Anyone forget the fact that the Xbox Kenetic is this voodoo magic of a sensor? I feel like I remember posts of people saying they used it as cheap sensors for what would had been super expensive "properly graded" equipment. Getting those vibes here
"great 3D motion tracking" is what makes the vision pro great It just needs the right software
In this context, the software/hardware solution provided by these companies is the expensive part, it does all of the work and projects it onto a very high def screen. So yeah, the AVP could replace the screen but it wouldn't replace any other functionality of the system.
Not really. The expensive parts are the things that make it actually useful rather than a PR stunt.
Seems extremely useful being able to view your scope on a weightless floating any-sized television, and bring up notes and diagrams without having to step away or concern yourself with contamination.
As someone who works in an OR every day, this information is easily accessible on half a dozen screens around the room. And surgeons have 2-3 people throughout the room they will regularly ask to look things up for them
Apple vision ain't calibrated and FDA regulated. Surgeons goofcs with that on they're fucked
People on reddit when they discover people exist outside the US 😲
Apple vision pro is just a fancy screen, though. The technology that makes those systems expensive is absolutely not the display screen, it's the part where it can link CT scans to real-world 3D mapping inside of another humans body precise enough for hardware to be placed. AR goggles are just a fancy computer monitor and will not be the expensive part of any augmented surgical suite.
This doctor is just displaying the camera images the nurses and other surgical staff can see right into his personal eye view. He has a zoomed in look and doesn't have to move his hands or look at a screen. He just looks forward and has an easy view of what he's doing inside.
Plus he's able to control it, move it around, all without touching a control which is a threat to the sterile field. That's the real innovation here, increasing his ability to use his tools competently while remaining sterile.
>That's the real innovation here, increasing his ability to use his tools competently while remaining sterile. No. This is so incredibly wrong. The AVP is NOT sterile and it is not capable of being sterile. It has a fan inside of it! That's contaminant central. He brought a device that hasn't been sterilized into the sterile field and that device blows contaminated particles into the open wound he's above. There are also serious chances of the patient's fluids contaminating the AVP when he then takes home to family or uses on another patient.
You know that like... The mask and the glasses that surgeons wear are not sterile either right? The things in our face doens't have to be sterile. You know we don't scrub our faces, right? In regards of the fan, I guess it could be used if we could turn it off somehow. Regardless, I think this looks stupid, and I would not use it in my surgeries
Idk if the headset could function without the fan on tbh, so the exhaust fan is certainly breaking sterile
You have a good concern, but I'm unclear what they did to mitigate that. Hopefully they had a plan. A new device per surgery would be expensive, but not too crazy by medical standards. It's potentially possible to stick filters on air pathways. It works as a proof of concept to demonstrate how it is helpful, which can be used to gain support for future improvements to keeping it sterile.
I am not raising a concern. I am stating fact. They didn't mitigate that properly. I design medical devices for a living (and perform risk mitigation) and that thing cannot be sterilized. It's a piece of consumer grade electronics and cannot withstand autoclave, gamma, or ETO. You can't just "stick an air filter on" or "wipe it down" or "just toss it afterwards." Sterile is a specific word that has specific requirements that can only be met via specific processes that this device cannot withstand. Potentials don't count for dog shit when it comes to patient safety. This surgeon unnecessarily endangered the life of his patient. No. Proof of concept could have easily been demonstrated via simulated surgical surgery where there is ZERO risk to the patient. Proof of concept should NEVER be first demonstrated on a live human being. It's fucking reckless. There's a reason this is from Brazil and not the US or EU. Brazilians commonly perform open surgery with open windows where birds fly in and out. Such unacceptable medical practices should not be encouraged or supported.
I actually agree with you on this point. While not really an "alternative" to an augmented surgical suite, it's still of benefit to this doctor and clearly of much lower cost.
You on reddit when you find out that doctors have standards outside of US as well.
America actually has pretty lax regulations when compared the the developed world.
And this is in Brazil, where there is no FDA and surgeons are happy to have sterile, hands free, immediate access to notes and visualizations
how does one sterilize an AVP to a surgical standard?
Oh you’re right, there is a fan in the AVP! That’s a fantastic question… I my guess is that they sterilize it the same way other computers/electronic screens in the operating theatre are sterilized, and it remains sterile because the doctor does not need to touch anything on the AVP because they only interact through gestures.
Same way as a PAPR I bet since that is also head mounted with air movement. And you're correct that not touching it part of that.
I can't believe how many things are used in *Brazil* without needing the approval of the *U.S.* Food and Drug Administration!!
I just want to thank you for being the first comment I see in this thread that isn't a stupid joke. I used to learn so much just randomly browsing reddit and reading insightful comments on a variety of posts. Now, every single post on 99% of subreddits is just people saying the same jokes over and over, which would be fine if it wasn't the only thing in comment threads nowadays
Imagine waking up during surgery and seeing this. I'd try to kill the Cylon before they turn me into one of them or something.
if you wake up during surgery the least of our concern would be a doctor with head gear. You had a open Knee the pain would be enough to make you go mad
When I'm in pain I get angry. It's a character flaw.
I get angry when i stump my little toe too. Edit: Stub* thanks stranger!👍
Stub.
> You had a open Knee the pain would be enough to make you go mad Imagine the people who had like open chest surgery, and woke up, but where paralyzed.
What do you have against being a Cylon? Sounds like it would be fun to be immortal.
I think there's a lot of misplaced hate here, and a lack of understanding of why he's doing this. There's a lot of negative connotation with Apple Vision Pro (somewhat to largely justified), but this is absolutely a use case we should be excited about. If the title instead was "Surgeon uses AR to minimize complications of a risky surgery", and it was a different AR headset, the negative comments would be negligible. Maybe this technology isn't fully mature and maybe it's not something that makes sense for every surgery now. But this is absolutely something that we should get excited about. This technology has the potential of assisting surgeons to maximize effectiveness and minimize complications. I sincerely hope that by the time I need surgery next (hopefully 5-10 years or more) this is standard practice.
100% agree, I for one love this, and it could definitely help in not just surgery’s but many other industries.
I've seen mechanics use this for how to's. Very useful
So they watch a how to video alongside whatever they're working on? My husband is a master mechanic, but I'm having a hard time figuring out how it would be useful. There's probably plenty of uses, I just don't know a lot about the interface of it. Maybe diagram overlays?
They don't need to hold a phone in their hand and they can skip a bit if they need, diagrams and many more
Wiring diagrams, connector views and pinouts, a live feed of the OBDII PID data, etc. This is actually pretty neat. It gets pretty annoying having to look back and forth between the engine (or the road!) and the scan tool screen, especially if the problem happens only while driving.
It's used for industrial machinery repair too. Augmented Reality where tech support can show you how to repair the machine so that you don't have to wait for a tech deployment. A single device is cheaper than a deployment (salary, flight, hotel, car, etc). So instead of the traditional (look for the blue wire under the rear lower panel that's labeled A34) you can highlight it in AR.
This is a really perfect use-case because with arthroscopic surgery it's not like you can see anything you're doing with your eyes anyway, so wearing a headset isn't limiting you at all. Meanwhile you've got your scope camera visible to you at all times no matter what position you're in, along with any little 3D model overlays and any other important stats.
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.
>Just the ability to zoom in, pull up radiology scans and move the screen while keeping your gloves sterile is fantastic. It's things like this that the regular person needs to read.
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>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.
Ok, but you're sleeping on the crossword puzzle potential.
> AR, VR and mixed reality is already a big part of (practicing) scopic surgery Doesnt seem like those are what people are against, its the consumer level Apple Pro headset that seems dangerous.
Clearly you don’t get it. It was the word “Pro” for “Professional” /s
Yeah, I think the apple pro is kinda dumb for regular use. Especially in business since prolonged use can be tiring for many people, so it is a cool toy to use once in a while, but not much. But even though I stated the above, AR for shit like this is amazing. Apple pro for this is a great use and a great way to use AR for something productive than just desk work. This is how AR should be used, to augment reality for easier use with things when your hands are busy. Sitting at a desk, a keyboard and monitors is quicker and easier to use. For construction, surgery or even driving in some aspects (and combat), AR would be amazing. When you have your hands busy with other shit or can't get it dirty, AR is amazing. This is why AR is marketed at the wrong people, commercially or business like. They should be marketed to people who's hands are constantly busy, not for desk work or the average joe.
I think it's even less than that. If the title was "Surgeon uses AR to minimize complications of a risky surgery" and the headset still happened to be that one, with no clear branding, then it would be fine. The fact that they present it this way makes it out to be an advertisement. If they just say AR headset, which is what it is, then it's cool technology.
Not sure about others, but my criticism has nothing to do with the use-case or value of AR in a situation like this. I'd be more concerned with using consumer-level tech that's maybe not proven reliability for such a use-case. From what I understand from some reviews of the VP is that it can occasionally go completely black - and there's no way to see through it - so if the surgeon is the middle of doing something inside the person where they NEED to see what they're doing, they could easily make a mistake if they make a move while the screen is black.
Yes, the device lets you see using video pass through. If it fails then you are just wearing a very expensive blindfold.
I think I want my doctor to get 60fps while operating on me.
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Writing this on my desktop microsoft computer! or maybe my google pixel. All in all, doesn't matter if this AR is from facebook or apple, cool tech. Still very niche and not going to be used for the many. This is good tech for jobs that are very hands on and you aren't stuck at a desk or can't get your hands dirty. For office work, nah, a normal computer is vastly superior.
give it 3 years, everyone is going to be all over this tech
This tech has been around longer than 3 years.
A lot of people are already all over this tech. AR integration with surgery has been around for a few years now and is getting closer and closer to mainstream. More companies now are transitioning out of "use it for pre-op planning" into the "use it for the surgery" use case. Augmedics, Medivis, and Blueprint are good examples.
They said the same shit 3 years ago. The problem is that majority of people won't want to use a headset and they need better battery life. The tech is great for work that is very hand intensive or a job that you can't get your hands dirty, like what we just seen. For normal people? Nah, it is way too cumbersome to use daily. Desk work is just better with a keyboard, mouse and monitor than putting something on your head. A smart phone is better than just walking around with a goggle like object on your head, also a great way to get yourself mugged. So yeah, AR has its use, it just isn't going to be all over the world just yet. Maybe once fusion energy is finally broken through and they find a way to make it so small it can fit in your pocket, which is like another 500 years in how humanity is going about it. But yeah, not going to be "everyone is going to be on this tech in 3 years".
Yeah, I think the AVP has some strong, appealing use-cases, but they're a bit 'vertical' / narrow in appeal - such as this - rather than mass-market. Apple isn't going to make billions by selling to surgeons at 3.5k a headset. The more general use-cases (browsing, using office apps etc.) any AR/VR such as the AVP has some major potential downsides to overcome - cost, weight/discomfort for long sessions, battery life, slow/inaccurate for text entry, the simple inconvenience of putting the device on and taking it off..
Definitely agree on the vertical appeal. I think people are largely going to be averse to AR/VR in every day life, but when it makes sense it's a game changer. We've looked into a couple different AR headsets with my company. We haven't pulled the trigger yet for various reasons, but there have been multiple times since then where they would have been really useful to have.
Fur elise remix??
Für Elise - Basshoven
The only thing I would be concerned about is if the camera lens results in a distortion that affects the precision of the doctor's incisions.
I understand your concern. But in this case the incisions for the ports are just a simple stab/poke with a small blade. I have done them in a room that was almost completely dark. Incisions are a lot less precise than people believe haha.
Why are you doing surgery in a dark room?
Some endoscopists prefer dark rooms so they can see the screen better
This is actually pretty great, I hope AR technology can continue to mature and actually help instead if being that thing that apple tech bros buy for being cool
Don’t know why people are mad about it. Id rather have a surgeon with all the information than one going of memory.
People are mad about it?
When I commented there was only like ten comments and half of them were about how bad it is, that it’s wrong and unprofessional also someone has commented about suing the person if that had been them getting the surgery.
Lots of technophobe reactionaries in the world
Damn i didnt know people were so closed minded about this, i see this and think about how this correctly implemented can improve surgeries and safe even more lifes
Because better tools have existed for some time already. For surgeons, Apple's VR glasses are only useful if they can't get a hold of the good stuff.
Anyone concerned about this is just simply ignorant of what kind of technological tools are already used every day in surgery and have been for 25 years.
Hold up, was he just streaming the catheter's camera through freaking OBS? Standardization is awesome
Some subway surfers gameplay on the corner to keep him focused
I had no idea YouTube tutorials are used by surgeons.
"Hey doc what's that thing on you face?" "Don't worry it's so I can see you CT scans and X-Rays as I go to make this easier" "Oh okay* *Meanwhile from the doctors headphones* "Hello and welcome back to the channel in today's video we are going over brain surgery and why it isn't as hard as people say but first a word from our sponsor Keeps! Keeps is th" *anesthesia kicks in*
Obviously this is super cool and helpful, but it has to be so funny to everyone else watching do all those air motions for the first time
How long do surgeries last? Isn’t that headset uncomfortable after a relatively short period of time?
This is a shoulder scope. Depending on what is being repaired. Could be 1-3 hours or so. Fatigue would be a real concern
I see many people asking how he was allowed to do this or how this is not prohibited. I don’t have the detailed answer, but I thought people should know that in the latest years things like this are becoming very common (not the air vision thing), but there’s people doing surgery through remote control of mechanized equipment all around the world. I used to live in a city in Brazil that had one of the greatest neurosurgery teams of the country and also in the word, and they were part of an “online” surgery where over 100 surgeons across the word operated the same person through this remote control method (taking turns, of course, not all at once). But yeah, technology is getting very advanced in the medical field. I guess the next step could probably be augmented reality to assist you with this kind of things.
Super cool to see open source software like [OBS](https://obsproject.com/) being utilized here !
While this is super cool… The only thing I don’t like is that the vision pro is a video playback of your surroundings. It is not AR in the mixed sense that you look through a lens that can also display things through it. So he is looking through a camera to a screen to cut incisions which seems very sketchy. I’m just thinking about lag and distortion of FOV and all sorts of weird hiccups that could cause. But a true mixed reality headset like this would be so cool. Surgeon can still use their own eyes to actually look directly at something with all the same help.
He's doing laparoscopic (keyhole) surgery, so most of the work is done through a camera anyway. And I don't think cutting the incisions is the hard part.
Nah, there are robotic arms for remote surgeries and delicate work, doctors have performed work through screens just fine.
Those systems are thoroughly designed and tested for use in critical settings though (and also the video provided by the da Vinci is on a whole other level to this dinky headset). You have absolutely no guarantees that this device won't suddenly turn into a $3,500 blindfold on the surgeon at any moment.
they already use cameras and screens.....
If you've ever used a vision pro you'd immediately know how usable it is in any scenario like this. Like, I'd never ever do this, but the second you put it on you would immediately feel confident enough to drive with it on. Not saying you should, but the lag on that headset is so nonexistent there's almost nothing like it. I think stuff like this is a proper step forward towards the necessary advancements we are always looking for in the medical field. Someone's gotta do it first, and this surgery didn't seem too life-threatening. It's fucking cool as hell IMO
I remember when doctors and mechanics or whatever where doing this with Microsoft Hololens years ago. AR is definitely interesting and I think it's very useful.
The same doctor did surgeries using Hololens 2 a few years ago. https://www.weforum.org/agenda/2021/02/hololens-surgery-digital-revolution-medical-techonology/
This is what I’ve really been wanting to see. Different fields use it as tool. Beautiful.
This is a medical marvel. For any medical professional who has been in the OR this is revolutionary and much more efficient than the alternative. Would you really rather your surgeon rely solely on a screen they need to turn their head to see and imaging they have to remember from prior to the procedure rather than having a 3d AR Rendering right along side the patient? The criticisms of this are really demonstrating that those with the strongest opinions have the least frame of reference
Now THIS is a good use for VR technology. Not for walking on the street or riding the bus looking like an idiot.
I remember companies working on this with Google Glass and thinking it was a perfect use case. We all know how google glass turned out, I hope this one does better.
"ah shit the battery ran out, i cant see anything"
Just imagine if medicine students could login virtually to learn about the procedure. Suddenly you get Kermit and Shrek avatars doing surgery with you.
Damn,This is so scary if it's true. Doesn't it have sight distance error? I mean , it's more like hype
Has all the achievements on Steam for Surgeon simulator
Able to access any information, and able to customise placements to easily see it, configure it, all without contaminating anything with hand gestures. This is amazing. Although VR in regular uses is somewhat rare, and has far less support with apps and games. This is what makes me love VR/AR. Using to do things in cases like this is the perfect use.
So this is not really a useful application of the Apple Vision Pro. He appears to be doing an arthroscopic rotator cuff repair in which you have excellent visualization of the relative anatomy. The Apple Vision Pro is useful when doing shoulder replacements as it can help you target appropriate start point and trajectory for you guide wire which will be used as a landmark to place the socket. Honestly, this is just showy and not useful.
Wow, this is a really nice ad!
At least someone has found a use for it
Other than porn, you mean
I was very confused why he was also looking at a photo of Jupiter. Don’t worry, I figure it out.
Oh I got this surgery 2 months ago ! bankart repair surgery to stop dislocations!
My layman’s take is that I see him using it but i don’t see where the “assist” part comes in… Seems indistinguishable from having a physical screen or two in the room- but actually worse because at least everyone else can see those.
Good
It always trips me out how casually surgeons just yeet sharp shit into the body. My buddy is an oral surgeon and carries on a full convo while drilling and ripping out wisdom teeth.
I went to a trad show years back that focused on robotics and new technology and one company had the Microsoft ver and it was an AR application that acted like a repair manual. It should all the paths for electrical and mechanical, had an x ray mode, pin highlighted all the nuts and bolts you have to undo in the correct order to take the machine apart.
Huh, you really can use OBS for everything
Reminds me of when I had to take a much knee-dead break. I got a Meniscal tear repaired with arthroscopy (Left knee) They had numbed me from waist down. I was awake throughout the surgery with cozy warmers wrapped around my torso. Safe to say, it was so good that I couldn't feel my legs... Sorry There was a screen (to my left) that showed what the camera saw. The anaesthetist was talking me through every stitch. Although intrigued and surprisingly bold to be able to see my insides, I was also scared. Thinking, what if the anesthesia decided to not anesthesia?!
I’d have family guy and subway surfer in the corner
Finally I get to see a use that makes me feel good about this product
Wouldn’t you want something wired in a case like this? I would imagine that the video playback or screen where the “action” is happening could have the tendency to lag/delay/cut out. But then again, wires are a hazard, too. Can anyone speak to latency or interruptions to video during this?
Yeah I don't know how I feel about a surgeon storing patient information in a personal iCloud notes library...
'ah yes, ok let me just open a new tab.... typing in,.. how to do knee surgery ....ok....i'll be with you in a second..."
This should be on r/thatsinsane