Twenty-four years ago, the surgeon Santiago Horgan performed the first robotically assisted gastric-bypass surgery in the world, a major medical breakthrough. Now Horgan is working with a new tool that he argues could be even more transformative in operating rooms: the Apple Vision Pro.
Over the last month, Horgan and other surgeons at the University of California, San Diego have performed more than 20 minimally invasive operations while wearing Apple’s mixed-reality headsets. Apple released the headsets to the public in February, and they’ve largely been a commercial flop. But practitioners in some industries, including architecture and medicine, have been testing how they might serve particular needs.
Horgan says that wearing headsets during surgeries has improved his effectiveness while lowering his risk of injury—and could have an enormous impact on hospitals across the country, especially those without the means to afford specialty equipment. “This is the same level of revolution, but will impact more lives because of the access to it,” he says, referring to his previous breakthrough in 2000.
Horgan directs the Center for the Future of Surgery at UC San Diego, which explores how emerging technology might improve surgical processes. In laparoscopic surgery, doctors send a tiny camera through a small incision in a patient’s body, and the camera’s view is projected onto a monitor. Doctors must then operate on a patient while looking up at the screen, a tricky feat of hand-eye coordination, while processing other visual variables in a pressurized environment.
“I’m usually turning around and stopping the operation to see a CT scan; looking to see what happened with the endoscopy [another small camera that provides a closer look at organs]; looking at the monitor for the heart rate,” Horgan says.
As a result, most surgeons report experiencing discomfort while performing minimal-access surgery, a 2022 study found. About one-fifth of surgeons polled said they would consider retiring early because their pain was so frequent and uncomfortable. A good mixed-reality headset, then, might allow a surgeon to look at a patient’s surgical area and, without looking up, virtual screens that show them the laparoscopy camera and a patient’s vitals.
In previous years, Horgan tried other headsets, like Google Glass and Microsoft HoloLens, and found they weren’t high-resolution 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 green-lit the use of the devices. In September, he led the first surgery with the Apple headset, for a paraesophageal hernia. “We are all blown away: It was better than we even expected,” Horgan says.
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 don headsets during the procedures. No patients have yet opted out of the experiment, Horgan says.
Christopher Longhurst, chief clinical and innovation officer at UC San Diego Health, says that while the Vision Pro’s price tag of $3,499 might seem daunting to a regular consumer, it’s inexpensive compared to most medical equipment. “The monitors in the operating room are probably $20,000 to $30,000, ” he says. “So $3,500 for a headset is like budget dust in the healthcare setting.” This price tag could make it especially appealing to smaller community hospitals that lack the budget for expensive equipment. (The FDA has yet to approve the device for widespread medical use.)
Longhurst is also testing the ability of the Apple Vision Pro to create 3D radiology imaging. Over the next couple of years, he expects the team at UC San Diego to release several papers documenting the efficacy of headsets in different medical applications. “We believe that it’s going to be standard of care in the next years to come, in operating rooms all over the world,” Longhurst says.
Apple Vision Pro is not the only device competing for the attention of surgeons. There are other surgical visualization systems on the market promising similar benefits. The startup Augmedics developed an AR navigation system for spinal surgeons, which superimposes a 3D image of a patient’s CT scan over their body, theoretically allowing the doctor to operate as if they had X-ray vision. Another company, Vuzix, offers headsets that are significantly lighter than the Vision Pro, and allow a surgeon anywhere in the world to view an operating surgeon’s viewpoint and give them advice.
Ahmed Ghazi, the director of minimally invasive and robotic surgery at Johns Hopkins in Baltimore, has used Vuzix headsets for remote teaching, allowing trainees to see from a proctor’s viewpoint. He recently used the Microsoft HoloLens to give a patient a “surgical rehearsal” of her operation: both donned headsets, and he guided her through a virtual 3D recreation of her CT scan, explaining how he would remove her tumor. “We were able to walk her through the process: ‘I’m going to find the feeding vessel to the tumor, clip it, dissect away from here, make sure I don’t injure this,’” he says. “There is a potential for us to bring patients to that world, to give them better understanding.”
Ghazi says that as these headsets are increasingly brought into operating rooms, it’s crucial for doctors to take precautions, especially around patient privacy. “Any device that is connected to a network or WiFi signal, has the potential to be exposed or hacked,” he says. “We have to be very diligent about what we’re doing and how we’re doing it.”
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Miguel Burch, who leads the general surgery division at Cedars-Sinai Medical Center in Los Angeles, has tested a variety of medical-focused headsets over the years. He says that the Apple Vision Pro is especially useful because of its adaptability. “If everything we wanted to use in augmented reality is proprietarily attached to a different device, then we have 10 headsets and 15 different monitors,” Burch says. “But with this one, you can use it with anything that has a video feed.”
Burch says he’s sustained three different injuries over the course of his career from performing minimally-invasive surgeries. He now hopes to bring the Apple Vision Pro to Cedars-Sinai, and believes that the headset’s current medical functions are the “tip of the iceberg.” “Not only is it ergonomically a solution to the silent problem of surgeons having to end their careers earlier,” he says, “but the ability to have images overlap is going to tremendously improve what we can do.”
