every day you as patients ask your
surgeons the wrong question it’s a
question whose answer gives you
confidence in your surgeon hope in the
outcomes of what may be a complex
procedure and relief to some of the
concerns that you are certainly having
how many of my surgeries have you done
before may sound like a very simple
question but it is far more complex
because not only do you have the
question wrong but the answer that
you’re expecting is also incorrect and
even if your surgeon reluctantly answers
that question
they will be doing so in a very
inaccurate way the reason is obvious all
of us are different we differ in our
external features height weight and so
many other characteristics the same
concept applies for our internal
structure so no matter how many times
your surgeon has performed a procedure
they will have never experienced your
surgery until it’s done and the
reasoning behind that question is as
surgeons perform procedures over and
over again they gain a wealth of
knowledge and surgeons who are able to
take the knowledge of your case and
apply it to the knowledge of a previous
case they have done to accurately
predict the outcomes of your surgery are
the experts in the field but when faced
with the countless anomalies and
variations of complex surgery especially
cancer surgery even our best experts
predictions become inaccurate and
sometimes even wrong unfortunately
exposing patients to longer operations
excessive blood loss during the surgery
and sometimes even complications which
may be lethal what if there was a way or
a technology where I could take the
knowledge of your surgery and give it to
your surgeon days before you walk into
the operating room
and have your surgeon use that knowledge
to perfect the real thing well for the
last three years our team at the
simulation innovation laboratory
University of Rochester have been
working on perfecting such a technology
using a combination of 3d printing and
polymer casting we are now able to
produce accurate lifelike organ models
but it’s not any model
it’s your model this is a replica of one
of my patients kidneys that looks feels
and acts like the real thing would
during an operation and the reason for
that is we used their cat scan as a
template and the process starts by
taking patients cat scans and importing
them into a 3d segmentation software
which enables us to individually
localize each component of the kidney
and then combine it into a virtual
three-dimensional computer-aided design
which can then be fed into a 3d printer
but if I want to produce the lifelike
characteristics of human tissue
I cannot directly print this in hard
plastic so instead our team develops a
technique by which we print negative
molds which are then injected with a
hydrogel that is adapted to mimic the
characteristics of human tissue it can
be a softest fat and as stiff as muscle
but if I want to predict the outcomes of
surgery I have to reenact every single
step of the procedure
I can’t just take this kidney and cut
through it in my kitchen table I need to
put the surgeon in the environment which
is the operating room and have them use
the same instruments they would in the
live surgery so to achieve this realism
all the organs within a 10 centimeter
radius of his kidney were also processed
and they were placed in their anatomical
location within a body cast and then
taken down into the operating room and
hooked up with bodily like fluids so
that the model can bleed
and that created a realism that was
never encountered before what we like to
call this is a surgical rehearsal
because that’s truly what the surgeon is
doing rehearsing the surgery before the
live event to bring this into context I
want to share with you the story of this
patient because they were the very first
patient that we used this technology on
cm as I would call him is a 69 year old
male who presented in my clinic with a
nine centimeter mass occupying almost
half his left kidney but this patient
also hypertensive diabetic and had a
very strong family history of kidney
disease making him more vulnerable to
dialysis if I want to truly safely
remove this tumor I would need to remove
the entire kidney but that would change
his life forever because he would need
dialysis meaning he would need to be
hooked up to a machine three times a
week for three hour sessions to filter
his blood alternatively I can only cut
the tumor out but that would expose him
to another risk which is uncontrollable
bleeding during surgery because the
blood supply the kidney acts like a tree
trunk and its branches the closer you
get to the center of the kidney the
larger the blood vessels you’re gonna
encounter while you’re cutting through
it and the more difficult it is to
control him during surgery so I was
faced with a dilemma do I take out this
patients kidney and change his life
forever
or do I undergo this risky maneuver and
put him at risk for uncontrollable
bleeding which might also end up with
removing the kidney and as le helpless
surgeon I asked my patient what do you
think I should do and the patient’s
response dr. Ghazi I trust you
you’re gonna do everything you can to
save that kidney but in reality all I
could do was play back the surgery in my
head over and over again at that same
time our lab had a major breakthrough in
developing patient specific models so I
decided to take this for a run
we made a model of this patient and put
it in a body cast and took it to the
operating room and as expected we had an
extensive amount of bleeding in the
surgery or in the rehearsal now had this
happened in the real event I would have
to remove this patients kidney and he
would be on dialysis for the rest of his
life to tell you the truth at that point
I felt deflated we had put in so much
effort and accomplished nothing I was
gonna have to go to this patient and
tell them you’re gonna be on dialysis
for the rest of your life but then as I
was cleaning this model I realized that
I was literally doing an autopsy on this
patients kidney I could find out what
went wrong and correct it during the
surgery I was excited I went back to the
drawing board and after examining the
kidney and examining the
three-dimensional design I realized that
there was this sweet spot where I could
remove the entire tumor with negative
margins and stay away from those major
vessels that were bleeding we’d still
have leaning but not as much as those
major vessels so I could control it
during the surgery I rehearsed the
procedure over and over again up till
the night before his surgery that day in
the morning I told my patient there is
light at the end of the tunnel there’s a
chance I can preserve both kidneys and
you can get the best of both worlds so I
went in and we did the surgery and
that’s what happened and we encountered
almost this bloodless plane where I was
able to successfully remove the tumor
with negative margins while preserving
the rest of the kidney with minimal
blood loss during the surgery and that
was because of the knowledge I got from
these rehearsals this patient is now two
years out tumor free and not on dialysis
what was striking to me was our first
interaction that I remember till this
day when he was emerging from
anaesthesia and you’re not all there
when you’re doing that and he looked at
me and I told him yes you still have
both your kidneys his answer was so
inspiring
it was if he was speaking from his
subconscious
he said yeah doc you told me that a
couple of hours ago and that hit me so
hard and I have successfully done this
in over 20 patients now with amazing
results and improving their quality of
life but with an added reduction in
operative time blood loss fewer
complications and even a shorter
hospital stay and it’s amazing the
impact that this technology can have on
healthcare our patients and their
families but and unfortunately there
always is a button the dream of the
vision of having this technology or
having surgeons worldwide practice their
complex procedures on models like these
remains a dream and the reason is not
that this is expensive or it’s
unavailable but believe it or not it’s
the surgeons that are reluctant to
undergo the rehearsals let’s face it all
our surgeons have egos and huge ones
and I have a right to say that because
I’m a surgeon we spent years of our
lives
going through relentless hours of work
in very stressful situations and we even
put away our personal growth and our
families to practice a specific skill
set until we are finally certified and
recognized by our peers and the
community to become surgeons and at that
point we are reluctant or even arrogant
enough to believe that we do not need to
practice before a surgery even if it’s
on a model of our own patient and I
really truly believe that every one of
our surgeons hides behind their wall of
certificates
leaving that they are invincible and
they do not need a technology like this
to improve patients outcomes so why am i
giving this talk here why am I not
giving this talk to the board of
directors of a hospital or an insurance
company or the American College of
Surgeons well I’ve given all those but I
believe the group that is gonna benefit
the most from this technology are the
patients that we operate on every single
day and they are the ones that should be
the strongest advocate for this
technology because if they request it
from their surgeons their surgeons will
comply so the next time you’re having a
complex surgery ask your surgeon the
correct question are you willing to
rehearse my surgery that is going to be
the future of surgery thank you [Applause]
surgeons the wrong question it’s a
question whose answer gives you
confidence in your surgeon hope in the
outcomes of what may be a complex
procedure and relief to some of the
concerns that you are certainly having
how many of my surgeries have you done
before may sound like a very simple
question but it is far more complex
because not only do you have the
question wrong but the answer that
you’re expecting is also incorrect and
even if your surgeon reluctantly answers
that question
they will be doing so in a very
inaccurate way the reason is obvious all
of us are different we differ in our
external features height weight and so
many other characteristics the same
concept applies for our internal
structure so no matter how many times
your surgeon has performed a procedure
they will have never experienced your
surgery until it’s done and the
reasoning behind that question is as
surgeons perform procedures over and
over again they gain a wealth of
knowledge and surgeons who are able to
take the knowledge of your case and
apply it to the knowledge of a previous
case they have done to accurately
predict the outcomes of your surgery are
the experts in the field but when faced
with the countless anomalies and
variations of complex surgery especially
cancer surgery even our best experts
predictions become inaccurate and
sometimes even wrong unfortunately
exposing patients to longer operations
excessive blood loss during the surgery
and sometimes even complications which
may be lethal what if there was a way or
a technology where I could take the
knowledge of your surgery and give it to
your surgeon days before you walk into
the operating room
and have your surgeon use that knowledge
to perfect the real thing well for the
last three years our team at the
simulation innovation laboratory
University of Rochester have been
working on perfecting such a technology
using a combination of 3d printing and
polymer casting we are now able to
produce accurate lifelike organ models
but it’s not any model
it’s your model this is a replica of one
of my patients kidneys that looks feels
and acts like the real thing would
during an operation and the reason for
that is we used their cat scan as a
template and the process starts by
taking patients cat scans and importing
them into a 3d segmentation software
which enables us to individually
localize each component of the kidney
and then combine it into a virtual
three-dimensional computer-aided design
which can then be fed into a 3d printer
but if I want to produce the lifelike
characteristics of human tissue
I cannot directly print this in hard
plastic so instead our team develops a
technique by which we print negative
molds which are then injected with a
hydrogel that is adapted to mimic the
characteristics of human tissue it can
be a softest fat and as stiff as muscle
but if I want to predict the outcomes of
surgery I have to reenact every single
step of the procedure
I can’t just take this kidney and cut
through it in my kitchen table I need to
put the surgeon in the environment which
is the operating room and have them use
the same instruments they would in the
live surgery so to achieve this realism
all the organs within a 10 centimeter
radius of his kidney were also processed
and they were placed in their anatomical
location within a body cast and then
taken down into the operating room and
hooked up with bodily like fluids so
that the model can bleed
and that created a realism that was
never encountered before what we like to
call this is a surgical rehearsal
because that’s truly what the surgeon is
doing rehearsing the surgery before the
live event to bring this into context I
want to share with you the story of this
patient because they were the very first
patient that we used this technology on
cm as I would call him is a 69 year old
male who presented in my clinic with a
nine centimeter mass occupying almost
half his left kidney but this patient
also hypertensive diabetic and had a
very strong family history of kidney
disease making him more vulnerable to
dialysis if I want to truly safely
remove this tumor I would need to remove
the entire kidney but that would change
his life forever because he would need
dialysis meaning he would need to be
hooked up to a machine three times a
week for three hour sessions to filter
his blood alternatively I can only cut
the tumor out but that would expose him
to another risk which is uncontrollable
bleeding during surgery because the
blood supply the kidney acts like a tree
trunk and its branches the closer you
get to the center of the kidney the
larger the blood vessels you’re gonna
encounter while you’re cutting through
it and the more difficult it is to
control him during surgery so I was
faced with a dilemma do I take out this
patients kidney and change his life
forever
or do I undergo this risky maneuver and
put him at risk for uncontrollable
bleeding which might also end up with
removing the kidney and as le helpless
surgeon I asked my patient what do you
think I should do and the patient’s
response dr. Ghazi I trust you
you’re gonna do everything you can to
save that kidney but in reality all I
could do was play back the surgery in my
head over and over again at that same
time our lab had a major breakthrough in
developing patient specific models so I
decided to take this for a run
we made a model of this patient and put
it in a body cast and took it to the
operating room and as expected we had an
extensive amount of bleeding in the
surgery or in the rehearsal now had this
happened in the real event I would have
to remove this patients kidney and he
would be on dialysis for the rest of his
life to tell you the truth at that point
I felt deflated we had put in so much
effort and accomplished nothing I was
gonna have to go to this patient and
tell them you’re gonna be on dialysis
for the rest of your life but then as I
was cleaning this model I realized that
I was literally doing an autopsy on this
patients kidney I could find out what
went wrong and correct it during the
surgery I was excited I went back to the
drawing board and after examining the
kidney and examining the
three-dimensional design I realized that
there was this sweet spot where I could
remove the entire tumor with negative
margins and stay away from those major
vessels that were bleeding we’d still
have leaning but not as much as those
major vessels so I could control it
during the surgery I rehearsed the
procedure over and over again up till
the night before his surgery that day in
the morning I told my patient there is
light at the end of the tunnel there’s a
chance I can preserve both kidneys and
you can get the best of both worlds so I
went in and we did the surgery and
that’s what happened and we encountered
almost this bloodless plane where I was
able to successfully remove the tumor
with negative margins while preserving
the rest of the kidney with minimal
blood loss during the surgery and that
was because of the knowledge I got from
these rehearsals this patient is now two
years out tumor free and not on dialysis
what was striking to me was our first
interaction that I remember till this
day when he was emerging from
anaesthesia and you’re not all there
when you’re doing that and he looked at
me and I told him yes you still have
both your kidneys his answer was so
inspiring
it was if he was speaking from his
subconscious
he said yeah doc you told me that a
couple of hours ago and that hit me so
hard and I have successfully done this
in over 20 patients now with amazing
results and improving their quality of
life but with an added reduction in
operative time blood loss fewer
complications and even a shorter
hospital stay and it’s amazing the
impact that this technology can have on
healthcare our patients and their
families but and unfortunately there
always is a button the dream of the
vision of having this technology or
having surgeons worldwide practice their
complex procedures on models like these
remains a dream and the reason is not
that this is expensive or it’s
unavailable but believe it or not it’s
the surgeons that are reluctant to
undergo the rehearsals let’s face it all
our surgeons have egos and huge ones
and I have a right to say that because
I’m a surgeon we spent years of our
lives
going through relentless hours of work
in very stressful situations and we even
put away our personal growth and our
families to practice a specific skill
set until we are finally certified and
recognized by our peers and the
community to become surgeons and at that
point we are reluctant or even arrogant
enough to believe that we do not need to
practice before a surgery even if it’s
on a model of our own patient and I
really truly believe that every one of
our surgeons hides behind their wall of
certificates
leaving that they are invincible and
they do not need a technology like this
to improve patients outcomes so why am i
giving this talk here why am I not
giving this talk to the board of
directors of a hospital or an insurance
company or the American College of
Surgeons well I’ve given all those but I
believe the group that is gonna benefit
the most from this technology are the
patients that we operate on every single
day and they are the ones that should be
the strongest advocate for this
technology because if they request it
from their surgeons their surgeons will
comply so the next time you’re having a
complex surgery ask your surgeon the
correct question are you willing to
rehearse my surgery that is going to be
the future of surgery thank you [Applause]
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