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Podcast: Catherine Mohr: Surgery's past, present and robotic future

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Podcast length: 18 minutes 56 seconds

Podcast Description

This podcast comes from TED 2009, where Catherine Mohr, a surgeon, engineer, and inventor of the LapCap, spoke at length about the history and future of surgery. She discusses where new technology is taking all of medicine, with special focus to Da Vinci's robotic surgery technology.

Presenter Biographies

Catherine Mohr

Catherine Mohr began her career as an engineer, working for many years with Paul MacCready at AeroVironment to develop alternative-energy vehicles and high-altitude aircraft. Her midcareer break: medical school, where she invented a brilliantly simple device, the LapCap, that makes laproscopic surgeries safer. Mohr now oversees the development of next-generation surgical robots and robotic procedures, as the director of medical research at Intuitive Surgical Inc. She also works at Stanford's School of Medicine, where she studies simulation-based teaching methods to teach clinical skills to budding doctors. And she's a senior scientific advisor to the GlobalSolver Foundation, an innovative funding and study group that looks at ways to match up scientists and money to help the world's oceans.

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Podcast viewing notes

"To talk about surgical robots is also to talk about surgery."

With those words, the talk begins. Surgeons cut, reshape, reform flesh. If it was done anywhere but in the operating room, it would be illegal, and it would be horrific.

Surgical instruments and the evolution of surgical technology go together, hand in hand, and cannot be separated. 10,000 years of surgical history are thus condensed into this talk, starting at 1:32 with holes in skulls.

Judging by the healing on the borders of the holes, these people with holes punched in their heads, lived. They lived for weeks, even months after surgery. As the bronze age hits, tools improve, and as tools improve, surgeons become more daring.

Performance art surgery is discussed in depth, where travelling surgeons would perform surgery in front of an audience - as there was no anaesthetic.

Anaesthetic finally came in the 18th century - the removal of sensation. This is when surgery really exploded, when surgeons could delve deeper than ever before. The upshot was, patients died far more quickly than they ever had before - massive infection of deep tissues.

They learned that you should wash your hands before surgery as well as afterwards. The death rate dropped, and you could start doing surgery all over the body. The problem was as incisions got deeper, they got wider, and sometimes the entire arm or torso was completely opened up, skin peeled away, and 20 inches or more of cut to get at deep tissue to see what they were doing.

Patients had a hard time recovering from that, so along came laparoscopy. This process of doing surgery via minimalist incisions was only really possible with the computer revolution, as it involved holes in the outer tissues no wider than the size necessary to get a camera system and a set of tools into the patient. Very little tissue to cut, means very little to heal. This was the dawn of roboticisizing surgery.

Some of the tools had been around since the 1880s as a diagnostic technique, but it was only first used for actual surgery in the 1980s. At 07:40 we see a short film of a laparoscopic procedure carried out on a human, from the camera's point of view.

Within 10 years of the first of a given type of surgery being done laparoscopicly, the trend was for the majority of such surgeries to be done laparoscopicly. However, laparoscopic techniques are a lot harder to learn than the previous sorts, and mistakes were made more frequently. Surgeons gave up 3D vision, their wrists ,and intuitive motion of the instruments in order to operate this way.

In order to overcome the problem, a wrist needs to be put back on the operating instrument. The only way to do this of course is to turn them into robotic arms. It was from this realisation that robotic surgical systems like the Da Vinci were born.

The robotic wrist, pictured at 9:30 allows precise, deft placement of tools right in the flesh, bringing the effect of the surgeon's own wrist back. Rather than holding long tools, the surgeon's hands fit directly into a tactile interface that controls the robotic hands inside the body. Every tiny motion of the surgeon's hand is replicated precisely, with the tool.

With the addition of a stereoscopic camera, the surgeon has depth of field back, with each lens reporting to a different eye. It has achieved such a fine degree of control that bypass vessels have been sown onto a live, beating human heart.

Its so good of course that it almost seems that all surgery should be done this way. A major problem however, is cost. A Da Vinci robot costs as much as it would be to make a life size model of the surgeon in solid 24 carat gold.

Another limitation is if you need to operate in several different places at once, a da vinci system won't work. It takes too long to calibrate at each location. Ther next challenge then, is to fix that.

One idea is to bring all the instruments together in one place, so no further calibration is required. The cameras and all the instruments into the body together, through a single tube.

We also need to take our eyes into the body in new ways, to see below the surface of the body naturally, not just via a single camera. Biomarkers and VR overlays are starting to be utilised.

Additional Research Links

VR Interfaces: The DaVinci surgical robot

Da Vinci gains Gaze Assist

Staff Comments


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