How augmented reality could change the future of surgery | Nadine Hachach-Haram

According to the theories of human social development,

we're now living through the fourth great epoch

of technological advancement,

the Information Age.

Connectivity through digital technology is a modern miracle.

We can say it has broken down barriers of time and space which separate people,

and it's created a condition for an age

where information, ideas can be shared freely.

But are these great accomplishments in digital technology

really the endgame in terms of what can be achieved?

I don't think so,

and today I'd like to share with you

how I believe digital technology can take us to even greater heights.

I'm a surgeon by profession,

and as I stand here today talking to all of you,

five billion people around the world lack access to safe surgical care.

Five billion people.

That's 70 percent of the world's population,

who according to the WHO's Lancet Commission

can't even access simple surgical procedures

as and when they need them.

Let's zoom in on Sierra Leone,

a country of six million people,

where a recent study showed that there are only 10 qualified surgeons.

That's one surgeon for every 600,000 people.

The numbers are staggering,

and we don't even need to look that far.

If we look around us here in the US,

a recent study reported that we need an extra 100,000 surgeons by 2030

to just keep up with the demand for routine surgical procedures.

At the rate that we're going, we won't be meeting those numbers.

As a surgeon, this is a global issue that bothers me.

It bothers me a lot,

because I've seen firsthand

how lack of access to safe and affordable healthcare

can blight the lives of ordinary people.

If you're a patient that needs an operation

and there isn't a surgeon available,

you're left with some really difficult choices:

to wait, to travel,

or not to have an operation at all.

So what's the answer?

Well, part of you are carrying some of that solution with you today:

a smartphone, a tablet, a computer.

Because for me,

digital communications technology has the power to do so much more

than just to allow us to shop online,

to connect through social media platforms and to stay up to date.

It has the power to help us solve some of the key issues that we face,

like lack of access to vital surgical services.

And today I'd like to share with you

an example of how I think we can make that possible.

The history of surgery is filled with breakthroughs

in how science and technology was able to help the surgeons of the day

face their greatest challenges.

If we go back several hundred years,

an understanding of microbiology

led to the development of antiseptic techniques,

which played a big role in making sure

patients were able to stay alive postsurgery.

Fast-forward a few hundred years

and we developed keyhole or arthroscopic surgery,

which combines video technology and precision instruments

to make surgery less invasive.

And more recently, a lot of you will be aware of robotic surgery,

and what robotics brings to surgery is much like modern automated machinery,

ultraprecision,

the ability to carry out procedures at the tiniest scales

with a degree of accuracy that even surpasses the human hand.

But robotic surgery also introduced something else to surgery:

the idea that a surgeon

doesn't actually have to be standing at the patient's bedside to deliver care,

that he could be looking at a screen

and instructing a robot through a computer.

We call this remote surgery.

It is incumbent on us

to find solutions that solve these answers in a cost-effective and scalable way,

so that everyone, no matter where they are in the world,

can have these problems addressed.

So what if I told you

that you didn't really need a million-dollar robot

to provide remote surgery?

That all you needed was a phone, a tablet, or a computer,

an internet connection,

a confident colleague on the ground

and one magic ingredient:

an augmented reality collaboration software.

Using this augmented reality collaboration software,

an expert surgeon can now virtually transport himself

into any clinical setting

simply by using his phone or tablet or computer,

and he can visually and practically interact in an operation

from start to finish,

guiding and mentoring a local doctor through the procedure step by step.

Well, enough of me telling you about it.

I'd now like to show you.

We're now going to go live to Dr. Marc Tompkins,

an orthopedic surgeon at the University of Minnesota.

He's going to perform an arthroscopic surgery for us,

a keyhole surgery of the knee,

and I'd like to disclose

that this patient has consented to having their operation streamed.

I'd also like to point out that in the interest of time,

we're just going to go through the first steps,

marking up the patient

and just identifying a few key anatomical landmarks.

Hello, Dr. Tompkins, can you hear me?

Dr. Mark Tompkins: Good morning, Nadine.

Nadine Hachach-Haram: Everyone from TED says hello.

Audience: Hi.

NHH: Alright, Dr. Tompkins, let's get started.

So let's start with our incisions and where we're going to make these,

on either side of the patellar tendon.

So if you can make your incisions there and there,

that should hopefully get us into the knee.

MT: All right, I'm going in.

NHH: Great.

So we're just getting inside the joint now.

So why don't we go around and have a quick look at the meniscus.

MT: Perfect.

NHH: Great, so we can see there's a small tear there on the meniscus,

but otherwise it looks alright.

And if you turn and head to this direction,

follow my finger,

let's have a quick look at the ACL and the PCL.

That's your ACL there, that looks quite healthy,

no problems there.

So we've just identified that small meniscus tear there,

but otherwise the fluid around the joint looks OK as well.

All right, thank you very much, Dr. Tompkins. Thank you for your time.

I'll let you continue.

Have a good day. Bye.

(Applause)

So I hope through this simple demonstration

I was able to illustrate to you just how powerful this technology can be.

And I'd like to point out that I wasn't using any special equipment,

just my laptop and a really simple webcam.

We're so used to using digital technology

to communicate through voice and text and video,

but augmented reality can do something so much deeper.

It allows two people to virtually interact

in a way that mimics how they would collaborate in person.

Being able to show someone what you want to do,

to illustrate and demonstrate and gesture,

is so much more powerful than just telling them.

And it can make for such a great learning tool,

because we learn better through direct experience.

So how is this making a difference around the world?

Well, back in my teaching hospital,

we've been using this to support local district general hospitals

and providing skin cancer surgery and trauma treatment.

Now, patients can access care at a local level.

This reduces their travel time, improves their access,

and saves money.

We've even started seeing its use in wound care management with nurses

and in outpatient management.

Most recently, and quite exciting,

it was used in supporting a surgeon through a cancer removal of a kidney.

And I'd like to just share with you a very quick video here.

I apologize for some of the gruesome views.

(Video) Doctor 1: OK. Show me again.

Doctor 2: If you see here,

that's the upper part, the most outer part of your tumor.

Doctor 1: Yes.

Doctor 2: So it's three centimeters deep,

so this should be three centimeters.

Doctor 1: Yes, yes.

Doctor 2: OK, so you need to get a 3.5 margin.

Doctor 1: I'm going to show you anyway

and tell me what you think about it.

NHH: We're also seeing the use of this technology at a global scale,

and one of the most heartwarming stories I can recall

is from the town of Trujillo in the north of Lima in Peru,

where this technology was used to support the provision

of cleft lip and palate surgery to children,

children from poor backgrounds who didn't have access to health insurance.

And in this town, there was a hospital with one surgeon

working hard to provide this care,

Dr. Soraya.

Now, Dr. Soraya was struggling under the sheer demand

of her local population,

as well as the fact that she wasn't specifically trained in this procedure.

And so, with the help of a charity,

we were able to connect her with a cleft surgeon in California,

and using this technology, he was able to guide her and her colleagues

through the procedure step by step,

guiding them, training them and teaching them.

Within a few months,

they were able to perform 30 percent more operations

with less and less complications.

And now Dr. Soraya and her team can perform these operations

independently, competently and confidently.

And I remember one quote from a mother who said,

"This technology gave my daughter her smile."

For me, this is the real power of this technology.

The beauty is that it breaks boundaries.

It transcends all technological difficulties.

It connects people. It democratizes access.

Wi-Fi and mobile technology are growing rapidly,

and they should play a role in boosting surgical provision.

We've even seen it used in conflict zones where there's considerable risk

in getting specialist surgeons to certain locations.

In a world where there are more mobile devices

than there are human beings,

it truly has a global reach.

Of course, we've still got a long way

before we can solve the problem of getting surgery to five billion people,

and unfortunately,

some people still don't have access to internet.

But things are rapidly moving in the right direction.

The potential for change is there.

My team and I are growing our global footprint,

and we're starting to see the potential of this technology.

Through digital technology,

through simple, everyday devices that we take for granted,

through devices of the future,

we can really do miraculous things.

Thank you.

(Applause)