robotics is changing healthcare in many
ways but one of the most dramatic ways
is you know we now have robots that are
actually performing surgery on people a
few years ago my mother had an operation
done by our robot
she wasn’t serious you know things here
she’s fine now my sister-in-law has been
operated by one I’m sure many of you
know people that have had surgeries done
by robot surgeons are guided by surgeons
uh under the control robots but our
robots under the control of surgeons but
actually I’m not sure about that but
anyway and one of the things as I seen
is from the research beside the business
side and the personal side that I’m
surprised that is how accepting the
public is of this technology of having
machines perform surgery on people and
and so I ran across this advertisement
off the internet some years ago that I
had to download and keep and it’s it’s
fascinating when you look at it it’s a
Photoshop it’s from a hospital in Miami
Florida Photoshop of a surgeon with a
robot arm put on him and it says one
part surgeon one part machine both parts
amazing and I think that captures in a
lot of ways how that the public accepts
this in fact they embrace it in certain
ways they you know the hospital’s saying
we’ve got the top technology you should
come here and I think this has been a
success from a financial standpoint for
these companies that are involved and so
that’s encouraged a lot of folks to get
into this market a lot of different
companies are trying to get a piece of
this and expand the market and look at
different procedures that can be done
with different robots and my lab is no
different we’ve been able to take some
of our ideas in in micro robotics and
turn those into steering catheters for
treating heart surgery we’ve gone all
the way from patenting the idea to
spinning off the company to actually
realizing this in the clinic and
performing surgery on humans and that’s
quite a gratifying realization to see
your technology go that far but we’ve
also been interested over the years in a
lot of retinal surgeries ophthalmic
surgery and so one of the diseases we’ve
considered is age-related macular
degeneration it happens to be the
leading cause of blindness in the
industrialized world if you’re gonna go
blind chances are
it’s gonna be from this particular
disease now fortunately there have been
treatments available for some forms and
it’s really helped halt the progression
in fact my coming back to my mother she
gets these every few months she gets
injections and they’re into her eye to
keep the disease from progressing my
mother’s actually quite healthy
normally but she does have these issues
so we’ve also thought about how we might
use robots to help more precisely safely
and economically deliver these these
drugs into the eye these millions and
millions of these injections are done
around the world so as I said eight
related macular degeneration is a
leading leading cause of blindness in
the developing in the developed world in
the industrialized world but in the
world as a whole the leading cause of
blindness is cataracts
something we simply don’t suffer from
here if you have a cataract as you’re
getting older your lens starts to get
opaque there’s a number of clinics in
the area that can perform this surgery
so what’s what’s going on why is this
and of course the reason is that there’s
issues with with performing these
surgeries they’re there they’re there
they require highly trained surgeons and
they’re simply not access in the
developing world so if you get a
cataract in for instance Botswana I
remember when I was a teacher in the
small African village in Botswana one of
my students had a cataract and and there
was just nothing to do about it he he
was blind in that eye but but
fortunately you know health care is in
is improving in the developing world
there been a lot of successes over the
years particularly in infectious disease
malaria for instance from 2010 to 2015
in five years saw a 20% decrease in
incidence of malaria and a 30% decrease
in mortality from that and these are
because of programs like Milla Bill and
Melinda Gates Foundation and and very
concerted efforts to try to address this
tuberculosis is on is decreasing and
we’re seeing the slope on that curve in
the right direction one coming back to
Botswana one of the most saddest stories
has been the incidence of HIV in that
country I left there in 1989 and I
remember as I was leaving talking to the
doctor in our local village clinic he
said we’re starting to see aids this is
1989 we’re starting to see aids in our
village and he was worried the nurses
were worried they realized what that
meant but the rest of the population
really wasn’t aware of what was going on
when I left their life expectancy rates
were at 6 almost 65 years old in 15
years people had lost 15 years of their
life by 2005 life expectancy had fallen
for the country – less than 50 years old
now imagine here in Switzerland if all
of a sudden on average our life
expectancies went down by 15 years
that’s dramatic but but the government
took action Health Organization’s around
the world took action and started
educating the public antiretroviral
drugs became available and they started
making sure they got all over the
country my wife and I just visited there
last December to go to a wedding for one
of our one of our friends whose son was
getting married and life expectancy
right now in 2017-2018 is back to where
it was in 1989 so that’s a positive
story and what was really encouraging to
see is the joy the people and the
appreciation that people have in this so
as we attended this wedding the weddings
are kind of a two-part deal the first
day you go to the the bride’s home where
the the groom has to pay the bride price
and this particular bride was worth 8
cows 3 goats in a sheep and so there we
go there but during that visit there
there were traditional dancers that were
singing about Botswana singing about the
village singing about you know positive
joyous things and one of the things they
were singing about were HIV drugs you
know imagine that it’s it’s you know I
go back and not many of my students are
alive from when I was a teacher there
now but it’s changed the people
appreciate how it’s changed their lives
and they sing praise to the festa simal
guy who was the president who
implemented these they they shout out
AZT one of the drugs they they use and
it’s it’s changed it had a dramatic
impact and people appreciate that there
so there are a lot of positives things
have been going on in in global health
worldwide but it’s interesting to put it
in perspective so infectious disease
we’ve done well on but if you look at
HIV malaria and tuberculosis and you
those account for less than 10% of the
total disease burden in the developing
world
and there is an estimate now that that
almost a third of disease in the world
period requires some sort of surgical
treatment unfortunately five million
people in the world simply don’t have
access to that and in low and middle
income countries nine out of ten people
it just simply can’t get treated for
cataracts for esophageal cancer for a
number of diseases that we can go in and
actually have a pretty good success rate
with so I think this next map kind of
shows the story the data is a little old
but I think it shows an interesting
story blue is good in this map these are
cataract treatment rates these are the
countries that are being well treated
and this is from 2004 but I still think
that’s relevant the other the green and
the yellow countries there are places
that simply don’t have access to to this
kind of surgery but I think one of the
things that’s interesting to look at in
this plot is India there’s a lot of
poverty in India but it’s in the blue
they’ve made tremendous progress in
addressing that because in India they’ve
been very innovative in how they’ve
addressed some of these needs for
surgery here is something called the
lifeline Express it’s a it’s a train
with an operating room in it and it goes
across the country stops and villages
treats people perform surgery if
necessary and then moves on and they’ve
had a tremendous success and they’ve
they’ve adopted these kind of practices
as well and similar practices to
treating cataracts and things that are
no longer you know the leading cause of
blindness in there in that country so as
an engineer and as a medical robot
assess we started thinking now is there
something we can do in this area as well
as there technology can it bring to bear
so one of the things we went back to and
we looked at cataract surgery one of the
really challenging operations is
something called a capsular exis where
you have to make a very precise cut in
the land in the capsule that holds the
lens to take out the diseased lens and
replace it and so we took the same
technology that we developed for doing
heart surgery when we miniaturized it
and we turned it into a similar kind of
a catheter driven a scalpel that was
able to achieve accuracies to within a
third of the width of a hair coming
close to what the most trained surgeons
abdominus for instance the ones here at
trimly Hospital are
able to accomplish and so technology can
help get over some of these hurdles we
think that are standing in the way of
delivering surgery but we’re not the
only people that are starting to think
about this there’s some groups around
the world that are also starting to look
at this this is from Petra of Al
destry’s group who’s and he’s now at the
University of Leeds and he’s been
looking at what he calls the $2
endoscopy z’ endoscopy czar typically
done in the upper GI to look at your
esophagus and stomach and also in the
colon and the lower GI and if you can
get in there and find these incidents of
disease early enough your chances of
survival are greatly enhanced the
problem is getting these out and doing
these endoscopy Zhai visited a hospital
in francis town in botswana when i was
there recently talked to the
superintendent and asked him what you
know looking at what procedures they can
do and he says oh we can do endoscopy so
yeah we do that here and then he said
but actually at the moment all of our
endoscopes are broken and so people
weren’t getting this analysis so what
pietro has done is come up with some
very innovative ways of designing
completely new ideas and endoscopes
they’re portable they don’t require
electricity they it’s all
battery-powered and going from village
to village he actually took this in
Honduras to look at this there’s a new
professor professor Salome at the
University of Basel and she’s been
working with the group there’s also a
group at Columbia looking at this on how
we can rethink magnetic resonance
imaging technology magnetism m mr– is
of course very important for looking
inside our body and determining do we
need surgery in the first place but
these machines cost millions of dollars
they’re looking at reducing the
requirements on imaging on the quality
of the image and turning us into a
device that’s going to cost less than
$50,000 and so that’s going to open up
diagnostic capabilities that simply
don’t exist in the developing world
right now so finally I want to talk
about sustainable development goals in
2015 the United Nations came out with 17
sustainable development goals the idea
here is to help countries and healthcare
and foundations provide roadmaps on how
can we you know create a sustainable
world what are some of the things and
they go all the way from eliminating
poverty to energy clean water to a
number of different aspects but of
course healthcare is a variant
we need to achieve these health care you
know improvements in health care in
order to get to realize these type of of
SDGs as they’re called and there was a
quote I’m taking here from some medical
researchers at Harvard who pointed out
right after this report came out
sustainable development goals cannot be
achieved without explicit explicitly
addressing one of the most crucial needs
facing the world and that is a lack of
access to surgery we don’t realize that
here a lot of the world just simply
doesn’t have access to surgical
procedures it’s been called a neglected
stepchild of global health and people
are starting to come I think become
aware of this I think it’s a we’re gonna
require a multi-pronged approach to this
we’re gonna need innovations like we see
in India to treat cataracts and the
treat surgeries there but I also think
technology is gonna have to play an
important role in this and so instead of
having our startup and thinking about
our exit strategies maybe we can start
thinking more about who how how can we
treat the most people at the lowest cost
so thank you very much [Applause]
ways but one of the most dramatic ways
is you know we now have robots that are
actually performing surgery on people a
few years ago my mother had an operation
done by our robot
she wasn’t serious you know things here
she’s fine now my sister-in-law has been
operated by one I’m sure many of you
know people that have had surgeries done
by robot surgeons are guided by surgeons
uh under the control robots but our
robots under the control of surgeons but
actually I’m not sure about that but
anyway and one of the things as I seen
is from the research beside the business
side and the personal side that I’m
surprised that is how accepting the
public is of this technology of having
machines perform surgery on people and
and so I ran across this advertisement
off the internet some years ago that I
had to download and keep and it’s it’s
fascinating when you look at it it’s a
Photoshop it’s from a hospital in Miami
Florida Photoshop of a surgeon with a
robot arm put on him and it says one
part surgeon one part machine both parts
amazing and I think that captures in a
lot of ways how that the public accepts
this in fact they embrace it in certain
ways they you know the hospital’s saying
we’ve got the top technology you should
come here and I think this has been a
success from a financial standpoint for
these companies that are involved and so
that’s encouraged a lot of folks to get
into this market a lot of different
companies are trying to get a piece of
this and expand the market and look at
different procedures that can be done
with different robots and my lab is no
different we’ve been able to take some
of our ideas in in micro robotics and
turn those into steering catheters for
treating heart surgery we’ve gone all
the way from patenting the idea to
spinning off the company to actually
realizing this in the clinic and
performing surgery on humans and that’s
quite a gratifying realization to see
your technology go that far but we’ve
also been interested over the years in a
lot of retinal surgeries ophthalmic
surgery and so one of the diseases we’ve
considered is age-related macular
degeneration it happens to be the
leading cause of blindness in the
industrialized world if you’re gonna go
blind chances are
it’s gonna be from this particular
disease now fortunately there have been
treatments available for some forms and
it’s really helped halt the progression
in fact my coming back to my mother she
gets these every few months she gets
injections and they’re into her eye to
keep the disease from progressing my
mother’s actually quite healthy
normally but she does have these issues
so we’ve also thought about how we might
use robots to help more precisely safely
and economically deliver these these
drugs into the eye these millions and
millions of these injections are done
around the world so as I said eight
related macular degeneration is a
leading leading cause of blindness in
the developing in the developed world in
the industrialized world but in the
world as a whole the leading cause of
blindness is cataracts
something we simply don’t suffer from
here if you have a cataract as you’re
getting older your lens starts to get
opaque there’s a number of clinics in
the area that can perform this surgery
so what’s what’s going on why is this
and of course the reason is that there’s
issues with with performing these
surgeries they’re there they’re there
they require highly trained surgeons and
they’re simply not access in the
developing world so if you get a
cataract in for instance Botswana I
remember when I was a teacher in the
small African village in Botswana one of
my students had a cataract and and there
was just nothing to do about it he he
was blind in that eye but but
fortunately you know health care is in
is improving in the developing world
there been a lot of successes over the
years particularly in infectious disease
malaria for instance from 2010 to 2015
in five years saw a 20% decrease in
incidence of malaria and a 30% decrease
in mortality from that and these are
because of programs like Milla Bill and
Melinda Gates Foundation and and very
concerted efforts to try to address this
tuberculosis is on is decreasing and
we’re seeing the slope on that curve in
the right direction one coming back to
Botswana one of the most saddest stories
has been the incidence of HIV in that
country I left there in 1989 and I
remember as I was leaving talking to the
doctor in our local village clinic he
said we’re starting to see aids this is
1989 we’re starting to see aids in our
village and he was worried the nurses
were worried they realized what that
meant but the rest of the population
really wasn’t aware of what was going on
when I left their life expectancy rates
were at 6 almost 65 years old in 15
years people had lost 15 years of their
life by 2005 life expectancy had fallen
for the country – less than 50 years old
now imagine here in Switzerland if all
of a sudden on average our life
expectancies went down by 15 years
that’s dramatic but but the government
took action Health Organization’s around
the world took action and started
educating the public antiretroviral
drugs became available and they started
making sure they got all over the
country my wife and I just visited there
last December to go to a wedding for one
of our one of our friends whose son was
getting married and life expectancy
right now in 2017-2018 is back to where
it was in 1989 so that’s a positive
story and what was really encouraging to
see is the joy the people and the
appreciation that people have in this so
as we attended this wedding the weddings
are kind of a two-part deal the first
day you go to the the bride’s home where
the the groom has to pay the bride price
and this particular bride was worth 8
cows 3 goats in a sheep and so there we
go there but during that visit there
there were traditional dancers that were
singing about Botswana singing about the
village singing about you know positive
joyous things and one of the things they
were singing about were HIV drugs you
know imagine that it’s it’s you know I
go back and not many of my students are
alive from when I was a teacher there
now but it’s changed the people
appreciate how it’s changed their lives
and they sing praise to the festa simal
guy who was the president who
implemented these they they shout out
AZT one of the drugs they they use and
it’s it’s changed it had a dramatic
impact and people appreciate that there
so there are a lot of positives things
have been going on in in global health
worldwide but it’s interesting to put it
in perspective so infectious disease
we’ve done well on but if you look at
HIV malaria and tuberculosis and you
those account for less than 10% of the
total disease burden in the developing
world
and there is an estimate now that that
almost a third of disease in the world
period requires some sort of surgical
treatment unfortunately five million
people in the world simply don’t have
access to that and in low and middle
income countries nine out of ten people
it just simply can’t get treated for
cataracts for esophageal cancer for a
number of diseases that we can go in and
actually have a pretty good success rate
with so I think this next map kind of
shows the story the data is a little old
but I think it shows an interesting
story blue is good in this map these are
cataract treatment rates these are the
countries that are being well treated
and this is from 2004 but I still think
that’s relevant the other the green and
the yellow countries there are places
that simply don’t have access to to this
kind of surgery but I think one of the
things that’s interesting to look at in
this plot is India there’s a lot of
poverty in India but it’s in the blue
they’ve made tremendous progress in
addressing that because in India they’ve
been very innovative in how they’ve
addressed some of these needs for
surgery here is something called the
lifeline Express it’s a it’s a train
with an operating room in it and it goes
across the country stops and villages
treats people perform surgery if
necessary and then moves on and they’ve
had a tremendous success and they’ve
they’ve adopted these kind of practices
as well and similar practices to
treating cataracts and things that are
no longer you know the leading cause of
blindness in there in that country so as
an engineer and as a medical robot
assess we started thinking now is there
something we can do in this area as well
as there technology can it bring to bear
so one of the things we went back to and
we looked at cataract surgery one of the
really challenging operations is
something called a capsular exis where
you have to make a very precise cut in
the land in the capsule that holds the
lens to take out the diseased lens and
replace it and so we took the same
technology that we developed for doing
heart surgery when we miniaturized it
and we turned it into a similar kind of
a catheter driven a scalpel that was
able to achieve accuracies to within a
third of the width of a hair coming
close to what the most trained surgeons
abdominus for instance the ones here at
trimly Hospital are
able to accomplish and so technology can
help get over some of these hurdles we
think that are standing in the way of
delivering surgery but we’re not the
only people that are starting to think
about this there’s some groups around
the world that are also starting to look
at this this is from Petra of Al
destry’s group who’s and he’s now at the
University of Leeds and he’s been
looking at what he calls the $2
endoscopy z’ endoscopy czar typically
done in the upper GI to look at your
esophagus and stomach and also in the
colon and the lower GI and if you can
get in there and find these incidents of
disease early enough your chances of
survival are greatly enhanced the
problem is getting these out and doing
these endoscopy Zhai visited a hospital
in francis town in botswana when i was
there recently talked to the
superintendent and asked him what you
know looking at what procedures they can
do and he says oh we can do endoscopy so
yeah we do that here and then he said
but actually at the moment all of our
endoscopes are broken and so people
weren’t getting this analysis so what
pietro has done is come up with some
very innovative ways of designing
completely new ideas and endoscopes
they’re portable they don’t require
electricity they it’s all
battery-powered and going from village
to village he actually took this in
Honduras to look at this there’s a new
professor professor Salome at the
University of Basel and she’s been
working with the group there’s also a
group at Columbia looking at this on how
we can rethink magnetic resonance
imaging technology magnetism m mr– is
of course very important for looking
inside our body and determining do we
need surgery in the first place but
these machines cost millions of dollars
they’re looking at reducing the
requirements on imaging on the quality
of the image and turning us into a
device that’s going to cost less than
$50,000 and so that’s going to open up
diagnostic capabilities that simply
don’t exist in the developing world
right now so finally I want to talk
about sustainable development goals in
2015 the United Nations came out with 17
sustainable development goals the idea
here is to help countries and healthcare
and foundations provide roadmaps on how
can we you know create a sustainable
world what are some of the things and
they go all the way from eliminating
poverty to energy clean water to a
number of different aspects but of
course healthcare is a variant
we need to achieve these health care you
know improvements in health care in
order to get to realize these type of of
SDGs as they’re called and there was a
quote I’m taking here from some medical
researchers at Harvard who pointed out
right after this report came out
sustainable development goals cannot be
achieved without explicit explicitly
addressing one of the most crucial needs
facing the world and that is a lack of
access to surgery we don’t realize that
here a lot of the world just simply
doesn’t have access to surgical
procedures it’s been called a neglected
stepchild of global health and people
are starting to come I think become
aware of this I think it’s a we’re gonna
require a multi-pronged approach to this
we’re gonna need innovations like we see
in India to treat cataracts and the
treat surgeries there but I also think
technology is gonna have to play an
important role in this and so instead of
having our startup and thinking about
our exit strategies maybe we can start
thinking more about who how how can we
treat the most people at the lowest cost
so thank you very much [Applause]
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