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Google Glass for Remote Surgical Tele-proctoring in Low- and Middle-income Countries

A Feasibility Study from Mozambique

McCullough, Meghan C., MD, MS*; Kulber, Louie; Sammons, Patrick, BS*; Santos, Pedro, MD; Kulber, David A., MD*,§

Plastic and Reconstructive Surgery – Global Open: December 5, 2018 - Volume Latest Articles - Issue - p
doi: 10.1097/GOX.0000000000001999
Latest Articles: PDF Only

Background: Untreated surgical conditions account for one-third of the total global burden of disease, and a lack of trained providers is a significant contributor to the paucity of surgical care in low- and middle-income countries (LMICs). Wearable technology with real-time tele-proctoring has been demonstrated in high-resource settings to be an innovative method of advancing surgical education and connecting providers, but application to LMICs has not been well-described.

Methods: Google Glass with live-stream capability was utilized to facilitate tele-proctoring between a surgeon in Mozambique and a reconstructive surgeon in the United States over a 6-month period. At the completion of the pilot period, a survey was administered regarding the acceptability of the image quality as well as the overall educational benefit of the technology in different surgical contexts.

Results: Twelve surgical procedures were remotely proctored using the technology. No complications were experienced in any patients. Both participants reported moderate visual impairment due to image distortion and light over-exposure. Video-stream latency and connection disruption were also cited as limitations. Overall, both participants reported that the technology was highly useful as training tool in both the intraoperative and perioperative setting.

Conclusions: Our experience in Mozambique demonstrates the feasibility of wearable technology to enhance the reach and availability of specialty surgical training in LMICs. Despite shortcomings in the technology and logistical challenges inherent to international collaborations, this educational model holds promise for connecting surgeons across the globe and introducing expanded access to education and mentorship in areas with limited opportunities for surgical trainees.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

From the *Division of Plastic Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, Calif.

Ohana One, Los Angeles, Calif.

Department of Surgery, Matola Hospital, Matola, Mozambique

§Department of Plastic and Reconstructive Surgery, Cedars Sinai Hospital, Los Angeles, Calif.

Published online 5 December 2018.

Received for publication June 19, 2018; accepted September 14, 2018.

Supported through a philanthropic donation from the Jay and Sue Roach Foundation.

Disclosure: The authors have no financial interest to declare in relation to the content of this article or products mentioned within it. The study and Article Processing Charge were funded through a philanthropic donation from the Jay and Sue Roach Foundation.

Supplemental digital content is available for this article. Clickable URL citations appear in the text.

Meghan McCullough, MD, MS, Division of Plastic Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, 1510 San Pablo Street, Suite 415 Los Angeles, CA 90033, E-mail:

Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.