Qfour years ago, surgeon Santiago Horgan performed the world’s first robotically assisted gastric bypass surgery, a major medical breakthrough. Now Horgan is working on a new tool that he says could be more transformative in the operating room: Apple Vision Pro.
Over the past month, Horgan and other surgeons at the University of California, San Diego have performed more than 20 minimally invasive operations while wearing Apple mixed reality headsets. Apple released the headset to the public in February, and it was largely a commercial failure. But practitioners in several industries, including architecture and medicine, have tested how they can serve specific needs.
Horgan says that wearing headsets during surgery has increased their effectiveness while lowering the risk of injury—and could have a big impact on hospitals across the country, especially those that can’t afford specialized equipment. “This is the same level of revolution, but it will impact more lives because of access to the revolution,” he said, referring to an earlier breakthrough in 2000.
Horgan directs the Center for Surgery of the Future at UC San Diego, which explores how new technologies can improve the surgical process. In laparoscopic surgery, the doctor sends a tiny camera through a small incision in the patient’s body, and the camera’s view is projected onto a monitor. Doctors must then operate on the patient while looking at the screen, a complex feat of hand-eye coordination, while processing other visual variables in a pressurized environment.
“I usually turn around and stop the operation to look at the CT scan; wanted to see what happened with the endoscope [another small camera that provides a closer look at organs]; looking at the monitor for his heart rate,” Horgan said.
As a result, most surgeons report experiencing discomfort when performing minimal access surgery, a 2022 study found. About a fifth of surgeons surveyed said they would consider early retirement because the pain they experienced was frequent and uncomfortable. Therefore, a good mixed reality headset allows the surgeon to see the patient’s surgical area and, without looking up, a virtual screen showing the laparoscopic camera and the patient’s vitals.
In previous years, Horgan tried other headsets, such as Google Glass and Microsoft HoloLens, and found the resolution wasn’t high enough. But he tested the Apple Vision Pro before its release and was immediately impressed. Horgan applied for approval from the institutional review board at the University of California, which gave the green light for use of the device. In September, he led the first surgery with an Apple headset, for a paraesophageal hernia. “We were all blown away: It was better than we expected,” Horgan said.
In the weeks since, UC San Diego’s minimally invasive department has performed more than 20 surgeries with the Apple Vision Pro, including acid reflux surgery and obesity surgery. Doctors, assistants, and nurses all wear headsets during the procedure. No patients have yet opted out of the experiment, Horgan said.
Christopher Longhurst, chief of clinical and innovation at UC San Diego Health, said that while the Vision Pro’s price of $3,499 may seem intimidating to the average consumer, it is inexpensive compared to most medical devices. “A monitor in an operating room might cost $20,000 to $30,000,” he said. “So $3,500 for a headset is like budget dust in a healthcare environment.” This price tag can make it attractive to small community hospitals that don’t have the budget for expensive equipment. (The FDA has not approved this device for widespread medical use.)
Longhurst also tested the Apple Vision Pro’s ability to create 3D radiology imaging. Over the next few years, he expects the team at UC San Diego to release several papers documenting the headset’s efficacy in various medical applications. “We believe that this will become the standard of care in the years to come, in operating rooms around the world,” Longhurst said.
Apple Vision Pro isn’t the only device vying for surgeons’ attention. There are other surgical visualization systems on the market that promise similar benefits. Startup Augmedics developed an AR navigation system for spine surgeons, which superimposes 3D CT scan images of patients across their bodies, theoretically allowing doctors to operate as if they had X-ray vision. Another company, Vuzix, offers a headset that is much lighter than the Vision Pro, and allows surgeons anywhere in the world to see the point of view of the surgeon performing the operation and give them advice.
Ahmed Ghazi, director of minimally invasive and robotic surgery at Johns Hopkins in Baltimore, has used Vuzix headsets for remote teaching, so trainees can see from a supervisor’s perspective. He recently used Microsoft HoloLens to give a patient a “surgical practice” of his operation: both wore headsets, and he guided her through a virtual 3D recreation of her CT scan, explaining how he would remove the tumor. “We were able to guide him through the process: ‘I’m going to find the blood vessels that feed the tumor, cut them out, dissect them from here, make sure I don’t hurt them,’” he said. “There is potential for us to bring patients into that world, to give them a better understanding.”
Ghazi said as more headsets are brought into operating rooms, it is important for doctors to take precautions, especially regarding patient privacy. “Any device connected to a network or WiFi signal has the potential to be exposed or hacked,” he said. “We have to be very diligent in what we do and how we do it.”
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Miguel Burch, who heads the division of general surgery at Cedars-Sinai Medical Center in Los Angeles, has tested various medical-focused headsets over the years. He said the Apple Vision Pro is especially useful because of its adaptability. “If everything we want to use in augmented reality is attached to a different device, then we have 10 different headsets and 15 different monitors,” Burch said. “But with this one, you can use it with anything that has a video feed.”
Burch said he suffered three different injuries during his career as a result of minimally invasive surgery. He now hopes to bring Apple Vision Pro to Cedars-Sinai, and believes the headset’s current medical functionality is “the tip of the iceberg.” “Not only is this an ergonomic solution to the problem faced by surgeons who have to end their careers early,” he said, “but the ability to create overlapping images will greatly enhance our capabilities.”
