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Welcome to BIOTECH NATION !!! With understandable interviews requiring no background in science, BTN attracts a wide global audience. From everyday people looking for hope in treatments in development, to bioentrepreneurs interested in the experience of their fellow travelers, to venture capitalists looking for possibilities in cutting-edge breakthroughs, to scientists simply interested in the work of others, BioTech Nation is the voice of human endeavor, driving science to new realities for everyone. These interviews are drawn directly from the public radio program, "Tech Nation", which also can be heard in numerous global radio and podcasting venues.
When you sign off on a surgery, you have certainly met your surgeon. But do you know what advanced surgical tools they are using? Technation Health chief correspondent, doctor Daniel Kraft, talks about the many breakthroughs in robotic and digitally enabled surgery. Daniel, welcome back.
Dr. Daniel Kraft:Well, great to see you and to hear you.
Dr. Moira Gunn:Now I have to say, you know, you always think of my surgeon. My surgeon is this this person, this human being who's you know, you put your trust in this person to to operate on you. But more and more, we're seeing technology do that.
Dr. Daniel Kraft:Well, technology is playing more and more in a role in all sorts of interventions, particularly in in surgery. I hate to break it to you, but I'm sure you've got the world's best surgeon. But a little known secret is that 50% of surgeons are below average. So clearly not yours. But, you know, there's opportunity now with technology to make, you know, the average or the below average surgeon, at the sort of top of their field.
Dr. Daniel Kraft:And that's what we all want if someone's operating on you or a friend or family member. And we're sort of at this super convergence now where surgery is becoming much more digitally enabled. It's blending with the field of augmented and virtual reality and extended reality with robotics, with AI, with big data. And so it's an exciting time now to, make procedures more available, particularly because there's huge surgical deserts around the planet. You know, billions of folks don't have access to a surgeon if they need to have something as simple as their appendix taken out or a biopsy for a potential breast cancer, for example.
Dr. Daniel Kraft:So my hope is that we can use some of these technologies we'll talk about in the session to really help democratize not just medicine, but surgical interventions around the planet.
Dr. Moira Gunn:Well, having been a math major, I don't know how to tell you this, but there'll always be 50% of the surgeons below average. We can't we can't actually change that. We can raise the average performance that we could do. And that's, I think, what we're trying to do, raise that average.
Dr. Daniel Kraft:Well, surgery is a very sort of both cognitive and a physical skill. You have to have sort of good surgical hands, not just spur to be smart. And the challenges for any clinician and particularly those in the surgical specialties is they have to train. They have to go through almost apprenticeship. Usually a general surgery specialty is 5 years enough and the subspecialty a couple more to specialize in colorectal or gyne surgery, etcetera.
Dr. Daniel Kraft:And so the opportunity now in this new age is instead of just sort of see 1, do 1, teach 1 as most of us trained in the clinical realm and to practice on patients, now we can use technology to enable surgeons and clinicians of all sorts, from nurses to physical therapists to practice in these simulated environments using virtual reality, for example. So instead of going to the OR and trying it out for the first time, you put on your virtual reality headset, like the Meta Quest or now the Apple Vision Pro, which I just received mine. And you're now virtually in the operating room and you can practice a procedure. It might be a very standard one, like a total knee replacement. Or if you're a neurosurgeon operating on a very specific neurologic lesion or aneurysm, which might be very, very specific, you know, one of a kind, you can really practice that procedure and get it right.
Dr. Daniel Kraft:And just like pilots now have to train the flight simulators. The future of a lot of medical education and training is gonna be in these sort of reality type simulators where you can stress to fail, make mistakes, and learn not just as a solo clinician, but often in even collaborative team environment. So part of the future of medicine and surgery is these virtual environments. One of the leading companies started by a friend of mine, is called OsoVR, which is really quite magical. You go in the handstand, you are literally there and you pick up the instruments, you can learn a new skill.
Dr. Daniel Kraft:And they've been able to show that surgeons learn faster, maintain that knowledge for longer, and the outcomes are better. So we're just the beginning of this new realm, but, exciting new ways to train.
Dr. Moira Gunn:Now it's one thing to have these simulations which really help us not only to learn and to get better, but to also certify you. It's like, hey, you know, you you you if you really have lost your touch or don't have the surgeon's hands, if you will, then okay, maybe you can't, be a surgeon any longer or be on particular surgeries. But there's a big difference between simulation and actually operating on people. How real is that today?
Dr. Daniel Kraft:Well, you still often need to have good hands, but now our hands are being augmented by technology. Robotic surgery isn't really new anymore. There's huge companies like Intuitive Surgical that really pioneered the space and now a whole new bevy of now FDA cleared robotic surgery technologies that can do everything from a total knee replacement in a much less invasive way, to neurosurgery, to shoulder surgery. Almost every element of surgery is now ending this robotic element where right now the surgeon is sort of hands on guiding almost basically every single element of that surgical case. But emerging in this new age is kind of like, our cars are getting more and more self driving.
Dr. Daniel Kraft:They're becoming a bit more augmented to the point where in the next decade, we'll see the advent of, you know, fully robotic surgery still with sort of the surgeon, like the pilot on the airliner, kind of still standing there and making things are going okay. But a lot of things like, you know, draw that line and have this robotic surgery sew it up or make the anastomosis click connecting 2 parts of the bowel, for example, are becoming, quite possible. And that's gonna become a way to augment and upscale surgeons to get in smaller spaces and to do, procedures that would never have been done, in the past.
Dr. Moira Gunn:If I go in for a surgery, is there a requirement to tell me there's gonna be a robot in there? Like, if they're already in there, they're just doing it. I just don't know.
Dr. Daniel Kraft:Well, a very important part of any medical procedure is consent. And hopefully, that's involved in the consent procedure. And that's another area that's kinda getting interesting, not just having the surgery. The surgery, the procedures, obviously, a core component, but what happens beforehand, prehab, and then post surgery when you're doing, quote, unquote, rehab. There's new digital tools, etcetera, to get you ready for your colonoscopy to make sure you, for example, did your bowel prep in the right way.
Dr. Daniel Kraft:There's now sensors you might go home with after a procedure to see how you're doing. So for example, wearing a simple Fitbit after you've gone home from a total knee replacement and measuring how many steps you're doing. Obviously, the 1st couple of days might be slow, but you want to see that upward trajectory. Small digital biomarkers of how you're doing can be very important to help a surgeon and the patient and their caregivers kind of see how you're doing and is that on track or off track. It kinda goes beyond the, the the robot or the surgeon, but engaging the patient, the care team in all the layers that happened before, during, and after a procedure.
Dr. Moira Gunn:And, you know, after a surgery like that, we'll just take the knee replacement. After a surgery like that, there's a whole bunch of people that just don't wanna move. Just wanna sit there. And you can say, oh, yeah. I'm doing all these exercises.
Dr. Moira Gunn:Yeah. I'm doing it. But they're really not. I guess you can give the the Fitbit or your your iPhone to, you know, your your friend and have them walk around the house. But, I mean, I don't know how you tell them.
Dr. Daniel Kraft:Well, that's a great point. I mean, physical therapy, often folks really aren't very, engaged with that or don't follow it. My father just had a total knee replacement about a month ago. I went there for the pre op and the surgery and a few days at home to make sure he was situated. And he was very on top of doing his presurgery physical therapy to get ready and then post, and he's done quite well.
Dr. Daniel Kraft:But if I'm not there as is, you know, doctor Sun, now you can have, you know, a virtual coach. It might be an avatar that says, How are you doing today? I've looked at your wearable data and, you need to get up a few more times. You might have that physical therapist who can't visit you at home come up on the screen or on a robot. And now with platforms like virtual reality, you can gamify your physical therapy.
Dr. Daniel Kraft:Let's say you had a shoulder surgery or for example, and now you go to the VR headset and you swoop at balloons and you get points and it gives you gaming points. It keeps folks engaged. So we're trying to blend these modalities together because most folks now often leave the surgical suite and go directly home after the same day. And you need those sort of tools to see how folks are doing on path. We're now in this sort of era of crowdsourcing.
Dr. Daniel Kraft:Right? We crowdsource our driving with things like Google Maps and Waze. We're starting to see the era where instead of just being that surgeon in the OR who, you know, was trained 5, 10, 20 years ago, and this is the way they do it, now they can sort of be recorded. You can see if they have good hands or not. You can see where they are in the procedure, kind of now using this era of AI and big data.
Dr. Daniel Kraft:So one example is a company, called Theator, Theator. Io, that is now recording thousands of surgeries like laparoscopic cholecystectomies where they take out your gallbladder. And they're learning what makes a good procedure, where are mistakes happening, can they identify dangerous anatomy, or if there's a bleed or if you've cut the wrong, vessel? And so these are gonna end up sort of blending into this idea of a Google Maps or ways for the surgeon to sort of say, hey, slow down. This is a dangerous part.
Dr. Daniel Kraft:Give you sort of step by step guidance. In fact, now blended with augmented reality, there's a company called Augmedix out of Israel where the, spine surgeon or the orthopedic surgeon sort of wears an AR headset, can sort of see through the patient's body, leveraging the integration of their CT or MRI data. And then the procedure's being guided for them step by step. And they sort of see through the patient and can do that procedure in a much less invasive, faster, and more evidence based way. So we're gonna see a lot of, improvements in outcomes, I think, by leveraging the knowledge from 1,000 or even 1,000,000 of surgeries and being able to democratize that.
Dr. Daniel Kraft:If you're a junior surgeon, let's say in a remote village in rural Africa, you might have this operating room, but you haven't done this procedure before. Now there's platforms once called Proxymie, started by a plastic surgeon in England to help give coaching. So, in master surgeon, you can come in and see what you're doing and almost put their virtual hand into the patient or on the scene to guide step by step. So we're releasing this super convergence of big data, sensors, robotics, augmented virtual reality, coaching, and new knowledge systems that will hopefully democratize health care and upscale clinicians of all sorts.
Dr. Moira Gunn:Now, Daniel, what's just on the horizon? Like, what is the FDA approved? We know it's gonna be on the market. What are we looking at there?
Dr. Daniel Kraft:We're on the cusp of well, not replacing surgeons, but making them, smaller in a sense. We're in the era of, hopefully, you know, not quite nanobots, but little robots that you can swallow that will go into, for example, your gut and be able to move around and be guided and do certain interventions, like maybe take out a polyp. There's a little start called endiatrics that has a working prototype where you can swallow it and steer it around your stomach. Some will start to go on the more nano side and be able to go through your blood vessels. And there's this whole field that's been coming for a long time called nanomedicine.
Dr. Daniel Kraft:You can imagine now with sort of molecular engineering and synthetic biology, we're gonna start to sort of build little nanobots that will go through your bloodstream or maybe go to across the blood brain barrier and do things in much less invasive ways that can be proactive and maybe able to do therapies in much less invasive, less expensive, and more globalizable manners without even needing an operating model.
Dr. Moira Gunn:Well, is there any way I can, swallow the little robot that can zip around my stomach and make sure that my children do not have the controls? I just wanted to I wanna be really clear about that.
Dr. Daniel Kraft:We're working on the security controls for that. I mean, that's an interesting thing with all these sort of new Internet of medical thing technologies, including ones that can be inside your body to a hearing aid or to a wearable is can someone hack them? Can someone hack your insulin pump and give you too much insulin if you're diabetic? I think there's some science fiction stories around that. Or can can someone hack your pacemaker?
Dr. Daniel Kraft:For example, I think there's a story that former Vice President Dick Cheney, who had a actually had a heart transplant, did have a pacemaker and they turned off the connectivity because they were worried that some of the bad guys might have gotten in there and been able to hack his cardiac electrical system. So with all these technologies, there's always a dark side, but hopefully a much better positive side. And we have to be mindful about how to leverage the good with the bad and to enable the positive outcomes for all these exciting, often very fast moving technologies.
Dr. Moira Gunn:And be mindful. Some of these things that you hear are science fiction. And before you know it, they're science fact.
Dr. Daniel Kraft:Absolutely. We're still inspired by Star Trek. You know, there's now versions of the medical tricorder and the holodeck. And, science fiction often does inspire, the future. So for example, in Star Wars, when Luke Skywalker lost his arm and got that robotic arm, it was kind of nicknamed the Luke Arm.
Dr. Daniel Kraft:And then my friend Dean came in, the famous engineer for DARPA to make a replacement prosthetic, next generation prosthetic for soldiers who lost their arm. They named it the Luke Arm. So sometimes science fiction does become reality and, can inspire all of us.
Dr. Moira Gunn:Well, great to see you. See you next time.
Dr. Daniel Kraft:Alright. See you.
Dr. Moira Gunn:And just for the record, Daniel, no matter what primitive or wildly advanced technology he's using, my surgeon is the best. Technation Health chief correspondent, doctor Daniel Kraft, is the founder and chair of NextMed Health on the web at nextmedhealthanddigital.health. More information about Daniel at danielcraftmd.net.