[Applause]
so thanks for that introduction and in
light of that one day a robot will
perform surgery on you just let that
sink in for a minute how does that make
you feel how should it make you feel in
fact there are people in this very room
who have already had a robot perform
surgery on them and don’t even know it
it didn’t look like this though the
robot that performed surgery on you
didn’t look at all like this so let me
give you an example so about a week ago
I went to my annual eye exam this is me
walking into the doctor’s office and I
sat down in the doctor’s office and boom
right in front of me was not one but
three robots that looked like this now
you might be thinking oh these don’t
look like robots to me where’s the laser
eyes or the Terminator looking head but
I assure you these are robots
inside of each of them is a brain that
thinks our sensors that can see the
world around them and our motors that
can move parts of them around just like
you or I move our hands and arms so
these really actually are robots and so
one of them actually you know scanned my
eye and picked out the exact perfect
glasses prescription for me and oh by
the way these glasses when they got made
they got made by yet another robot they
ground them to the exact thickness and
curvature for my eyes so there were a
lot of robots involved here but let’s
take it one step further so by show of
hands how many people here today have
had LASIK eye surgery so yeah I sees
number of hands in the audience so there
are forty million people worldwide who
have had LASIK surgery and those of you
who’ve had it you had a robot operate on
you and it looked like this so again not
what you picture as a robot but in
side there our motors aiming a laser
beam at your eye to cut parts of it out
so that your eye will be reshaped so you
can see better and so why is it that we
want a robot involved in these kind of
procedures well take a look at this this
is a video of my wife’s eye and the
first thing you notice is it moves
around quite a bit and people are wide
awake when they’re getting LASIK surgery
so there’s no guarantee they’re not
gonna look off to the side and do you
really want a doctor holding the laser
beam as that eye moves around I sure
don’t I want a robot that can really
fast and accurately track and compensate
for that eye movement and get the cut in
exactly the right place so this is not
just an eye surgery this is a trend in
all sorts of surgery this is the number
of robots in surgery that are in human
use today and you can see the dramatic
upward rise in just the last couple of
years and if we drill down to just one
of those robots this is the da Vinci
system from Intuitive Surgical and you
can see that the same sort of dramatic
upward tick and now it’s used on
three-quarters of a million people per
year so this is why I say a robot will
one day be used if it hasn’t already
been in your surgical procedure and I
want to take a step back and ask why
that is and so I’m going to show you a
picture that’s a little graphic
it’s what surgery looks like today when
a robot is not used so if you’re
sensitive to that just close your eyes
for a second here’s what surgery looks
like so when I look at this and I’ve
observed many surgical procedures in the
operating room the first thing I see is
they’ve made a really big incision on
the patient and why is it so big because
they have to get something this big
inside the person that’s the only reason
they cut made that big of a cut on the
patient they got to get their hand in
there and then the other thing I noticed
is that they spend the vast majority of
their time in surgery just looking for
what they’re trying to operate on
where’s the organ I want to work on
where’s the tumor inside that organ that
consumes a lot of their time and robots
can actually help with both of these
jobs and make them a lot better so
here’s the most popular robot on the
market today this is the da Vinci system
from intuitive in this system the doctor
is sitting over on the left hand side
your screen at a console remote
controlling the robot that’s on the
right hand side of your screen that’s
over the patient and here’s what it
looks like the doctors hands are on the
bottom and then on the top are the robot
hands and you can see that the robot
hands are directly following whatever
the doctor does so what’s the advantage
of this well the robot hands are the
size of a ballpoint pen instead of the
size of my hand or arm and so you can
get those into the patient through much
smaller incisions so that’s a big win
for the patient what are some of the
drawbacks of the current generation of
surgical robots
well they require a lot of space inside
the patient because they have these
rigid tool shafts that have to pivot at
the body wall so you need a lot of room
to work in so what does that do well it
limits them to areas of the body like
the abdomen that can be inflated to
create that space where can’t they go
today
areas like the brain you can’t really
blow up the person’s head to create more
space places like the lungs if you want
to go down the throat there’s just not
room for the tool to work or parts of
the urologic system where the the
structures are so small that those robot
hands even can’t get in there so my team
at Vanderbilt and I are working on
building the next generation of surgical
robots that will be able to reach some
of these challenging spaces and where do
we look for inspiration
I mean how should we change that robot
to make it better well we look at the
world around us and we looked at
something you might never have thought
would be associated with surgery or even
robots it was this so we watched
elephants and how their trunks move and
it’s fascinating right these things can
bend and elongate in ways that your hand
and arm could never do and the current
generation of surgical robots could
never hope to do and so we took that
inspiration and we built something
that’s much smaller that’s the size of a
needle but it has that same ability to
bend and elongate as it moves and just
to give you an idea of how small it is
this is our robot compared to the da
Vinci robot and to really drive home how
small it is this is our robot compared
to a penny has a slightly different tip
on it but you can see they’re really
really small which is great for patients
because they get into the body through
very small openings so where can we use
these in surgery
well this is my friend Fabian Maldonado
he’s a doctor at Vanderbilt and he
spends his days taking care of lung
cancer patients and he just gets so
frustrated because the tools that he’s
using
don’t let him help many of the patients
that he wishes he could help and why is
that well the tool he uses mainly is
called a bronchoscope and that’s what
you see here and that goes down the
throat and it can reach about 1/3 of the
lung the green area here on the slide
and but if the patient has a problem
that’s in the outer edge of the lung
this area the outer two-thirds he just
can’t get there down the throat which is
the least invasive way to get there and
so a lot of patients he just has to send
home and say well wait and we’ll see if
your tumor grows well all the while
their life expectancy is plummeting if
their tumor does in fact grow so he has
this dilemma and so he and I set out to
build a better system to help these
patients and this is what we came up
with it’s a three stage system and it
starts out with the bronchoscope just
the standard one that he already uses
and he puts that down the throat as far
as he can go and then out of it he
deploys this concentric tube robot that
I told you about a minute ago and then
the third stage which gets all the way
to the target is a steerable needle so I
haven’t told you about sterile needles
how does that work well it’s based on
the tip design it’s cut like a wedge so
when you push this needle into tissue it
just naturally wants to bend because of
that wedge like tip and so if you can
control both pushing and then spinning
the back end of the needle you can
rename the tip and get that needle to go
wherever you want it to go inside the
patient so how do we test a system like
this well we actually put it into a CT
scanner and then we put it inside of a
pig lung and that’s what you see on the
slide here and I’m about to show you a
video following that robot all the way
on its path from outside the lung all
the way to the edge of the lung so this
is what it looks like this is a CT image
and you see first of all the Brawn to
scoop coming through here and then
pretty soon you’re gonna see the
concentric tube robot pop out of it
which is right about right there and
then quickly followed by the steerable
needle and the steerable needle gets out
to the edge of the lung
and we’ve been able to hit targets with
an accuracy of about a millimeter and to
give you an idea of how small that is
the little dot that you see indicating
the needle that’s about a millimeter
wide so we’re doing really well here but
then we started thinking what’s the next
step you know what else could we do to
help doctors with this kind of really
cool technology and we thought well
we’re only giving them one hand what if
we could give them two hands and so I
was talking with Duke Carol also a
surgeon at Vanderbilt and we were
talking about your logic surgery and
doing rigid endoscope endoscope
procedures and this is what a rigid
endoscope looks like it has a straight
shaft and then a camera at the tip and
out the end of that endoscope you
actually put a fiber-optic laser which
is that blue thing that you see in the
picture and then you use that to cut so
what does this look like when they use
it in surgery looks something like this
if you look close you can see down
toward the bottom of the image you can
see the laser fiber and it’s firing to
cut the tissue and you can see just how
hard these procedures are incredibly
challenging for the doctors because they
have to do everything with one tool they
have to tilt the thing that they’re
actually using to look at the surgical
field at the same time as they’re aiming
the fiber-optic laser and doing these
two things at once
not to mention trying to pull the tissue
into position for cutting is very very
difficult and sometimes they’ll get lost
and not even know am I in the right spot
do I want to cut that or should I be
over here so we built them this which is
a robot that has two hands so it goes
two of our robots have been pushed
through the port in this existing
endoscope one of them aims the laser
fiber the other lets the doctor actually
grab the tissue and pull it into
position so what does this look like
when used in surgery this is a model of
a prostate and the doctors job is to cut
out the bottom lobe and you can see is
doing that here the really cool thing to
notice is the image is not bouncing
around at all so he can maintain a view
of the whole surgical field while he’s
working
the other cool thing you notice is he’s
got two hands and he’s about to do
something he could never hope to do
before which is pick up this chunk of
tissue in both hands at once and then do
a slam dunk back into the bladder right
there so he was pretty proud of that one
and that’s a very successful surgical
procedure for this so I’ve told you now
about two different kinds of surgery
lung and prostate and I want to tell you
just about one more example and this one
is really important to me personally
because it affected my family this is my
father and he had a stroke and the kind
of stroke that he had is where a blood
vessel in the brain breaks open and just
dumps blood into the brain and that
blood can’t go anywhere so it starts
compressing the brain tissue and cells
start dying and so there’s unfortunately
not much doctors can do about this my
dad when he went into the hospital he
had just a splitting headache like the
worst headache by a factor of a hundred
that he’d ever had in his life and they
scanned him they did a CT scan they knew
what he had they knew he had a
hemorrhage and the only thing they could
do for him was put him in a hospital bed
and wait and see if he was going to get
better and it turns out that half of the
patients that have this die from it so
there my dad is laying in a hospital bed
and we don’t know if he’s gonna live or
die and so there’s we thought there’s
got to be a better way there’s got to be
something that we could do and so my
students and I a couple years ago
thought well what if we could go into
the brain through a needle and then
deploy one of our tiny elephant trunk
robots and actually vacuum out all of
that blood so we can release the
pressure and let those brain cells live
and so we built a robot to do that and
this is what it looks like here it’s
suctioning out a model of a brain and
we’ve sort of cut that model in half so
you can see what’s going in saw on
inside and it’s actually red jello that
it’s it’s suctioning out here that’s a
good model for a brain hemorrhage and
you can see it got all of it so you know
we think this has a ton of potential for
the future for being able to help
patients like my dad who have hemorrhage
etic strokes okay so speaking of the
future people often ask me well where is
all of this going you’ve showed us all
these cool robots like what’s going to
happen in the future are these gonna
replace doctors that’s often the first
question that I get well the doctors go
away and the robots take over the
operating room my answer to that is
absolutely not at least not any time
very soon at all
probably anytime in the lifetimes of
everyone in this room I don’t think so
and why is that well think back to my
eye exam there’s still an eye doctor
this is my eye doctor she’s still there
and what did all those robots do when I
went in for my eye exam well they were
just tools to help her do her job better
and better and better and that’s what
robots in the operating room are going
to be as tools to help doctors do their
jobs better they’re not going to replace
the doctors they’re just going to give
the doctors better capabilities the
other thing I wanted to point out is
there’s a lot of people involved in each
one of these projects that I’ve shown
you this is a slide showing all of my
doctor collaborators as well as
engineers I work with and probably most
importantly my students and postdocs who
really do a lot of the work and the
great thing about all these people is
the engineers on this slide actually go
into foreign territory and go into the
operating room and watch what’s going on
there and learn about the environment
and see hands on how surgery gets done
and that’s a real challenge for a lot of
Engineers it’s completely foreign land
equally foreign for the doctors is
coming into my engineering lab where
there’s all kinds of equipment they’ve
never seen before and learning about
what the technology can do and then all
of that sets the stage for these sparks
of inspiration and breakthroughs that
can happen like when we marvel at how an
elephant’s trunk works and so just to
finish the story of my dad he survived
he made a complete recovery he was one
of the lucky ones and my parents
actually today are celebrating their
43rd wedding anniversary and
[Applause]
I’m sure they appreciate that and they
would have missed out on 16 of those if
he had died from his brain hemorrhage
right so how should you feel when a
doctor says to you that they’re gonna
use a robot as part of your surgical
procedure you should be thrilled because
that’s the best tool available to help
you and what it can give you is more
years of quality life like my dad had
and most importantly more moments like
this where he was able to hold his
grandson for the first time thank you
very much
you
so thanks for that introduction and in
light of that one day a robot will
perform surgery on you just let that
sink in for a minute how does that make
you feel how should it make you feel in
fact there are people in this very room
who have already had a robot perform
surgery on them and don’t even know it
it didn’t look like this though the
robot that performed surgery on you
didn’t look at all like this so let me
give you an example so about a week ago
I went to my annual eye exam this is me
walking into the doctor’s office and I
sat down in the doctor’s office and boom
right in front of me was not one but
three robots that looked like this now
you might be thinking oh these don’t
look like robots to me where’s the laser
eyes or the Terminator looking head but
I assure you these are robots
inside of each of them is a brain that
thinks our sensors that can see the
world around them and our motors that
can move parts of them around just like
you or I move our hands and arms so
these really actually are robots and so
one of them actually you know scanned my
eye and picked out the exact perfect
glasses prescription for me and oh by
the way these glasses when they got made
they got made by yet another robot they
ground them to the exact thickness and
curvature for my eyes so there were a
lot of robots involved here but let’s
take it one step further so by show of
hands how many people here today have
had LASIK eye surgery so yeah I sees
number of hands in the audience so there
are forty million people worldwide who
have had LASIK surgery and those of you
who’ve had it you had a robot operate on
you and it looked like this so again not
what you picture as a robot but in
side there our motors aiming a laser
beam at your eye to cut parts of it out
so that your eye will be reshaped so you
can see better and so why is it that we
want a robot involved in these kind of
procedures well take a look at this this
is a video of my wife’s eye and the
first thing you notice is it moves
around quite a bit and people are wide
awake when they’re getting LASIK surgery
so there’s no guarantee they’re not
gonna look off to the side and do you
really want a doctor holding the laser
beam as that eye moves around I sure
don’t I want a robot that can really
fast and accurately track and compensate
for that eye movement and get the cut in
exactly the right place so this is not
just an eye surgery this is a trend in
all sorts of surgery this is the number
of robots in surgery that are in human
use today and you can see the dramatic
upward rise in just the last couple of
years and if we drill down to just one
of those robots this is the da Vinci
system from Intuitive Surgical and you
can see that the same sort of dramatic
upward tick and now it’s used on
three-quarters of a million people per
year so this is why I say a robot will
one day be used if it hasn’t already
been in your surgical procedure and I
want to take a step back and ask why
that is and so I’m going to show you a
picture that’s a little graphic
it’s what surgery looks like today when
a robot is not used so if you’re
sensitive to that just close your eyes
for a second here’s what surgery looks
like so when I look at this and I’ve
observed many surgical procedures in the
operating room the first thing I see is
they’ve made a really big incision on
the patient and why is it so big because
they have to get something this big
inside the person that’s the only reason
they cut made that big of a cut on the
patient they got to get their hand in
there and then the other thing I noticed
is that they spend the vast majority of
their time in surgery just looking for
what they’re trying to operate on
where’s the organ I want to work on
where’s the tumor inside that organ that
consumes a lot of their time and robots
can actually help with both of these
jobs and make them a lot better so
here’s the most popular robot on the
market today this is the da Vinci system
from intuitive in this system the doctor
is sitting over on the left hand side
your screen at a console remote
controlling the robot that’s on the
right hand side of your screen that’s
over the patient and here’s what it
looks like the doctors hands are on the
bottom and then on the top are the robot
hands and you can see that the robot
hands are directly following whatever
the doctor does so what’s the advantage
of this well the robot hands are the
size of a ballpoint pen instead of the
size of my hand or arm and so you can
get those into the patient through much
smaller incisions so that’s a big win
for the patient what are some of the
drawbacks of the current generation of
surgical robots
well they require a lot of space inside
the patient because they have these
rigid tool shafts that have to pivot at
the body wall so you need a lot of room
to work in so what does that do well it
limits them to areas of the body like
the abdomen that can be inflated to
create that space where can’t they go
today
areas like the brain you can’t really
blow up the person’s head to create more
space places like the lungs if you want
to go down the throat there’s just not
room for the tool to work or parts of
the urologic system where the the
structures are so small that those robot
hands even can’t get in there so my team
at Vanderbilt and I are working on
building the next generation of surgical
robots that will be able to reach some
of these challenging spaces and where do
we look for inspiration
I mean how should we change that robot
to make it better well we look at the
world around us and we looked at
something you might never have thought
would be associated with surgery or even
robots it was this so we watched
elephants and how their trunks move and
it’s fascinating right these things can
bend and elongate in ways that your hand
and arm could never do and the current
generation of surgical robots could
never hope to do and so we took that
inspiration and we built something
that’s much smaller that’s the size of a
needle but it has that same ability to
bend and elongate as it moves and just
to give you an idea of how small it is
this is our robot compared to the da
Vinci robot and to really drive home how
small it is this is our robot compared
to a penny has a slightly different tip
on it but you can see they’re really
really small which is great for patients
because they get into the body through
very small openings so where can we use
these in surgery
well this is my friend Fabian Maldonado
he’s a doctor at Vanderbilt and he
spends his days taking care of lung
cancer patients and he just gets so
frustrated because the tools that he’s
using
don’t let him help many of the patients
that he wishes he could help and why is
that well the tool he uses mainly is
called a bronchoscope and that’s what
you see here and that goes down the
throat and it can reach about 1/3 of the
lung the green area here on the slide
and but if the patient has a problem
that’s in the outer edge of the lung
this area the outer two-thirds he just
can’t get there down the throat which is
the least invasive way to get there and
so a lot of patients he just has to send
home and say well wait and we’ll see if
your tumor grows well all the while
their life expectancy is plummeting if
their tumor does in fact grow so he has
this dilemma and so he and I set out to
build a better system to help these
patients and this is what we came up
with it’s a three stage system and it
starts out with the bronchoscope just
the standard one that he already uses
and he puts that down the throat as far
as he can go and then out of it he
deploys this concentric tube robot that
I told you about a minute ago and then
the third stage which gets all the way
to the target is a steerable needle so I
haven’t told you about sterile needles
how does that work well it’s based on
the tip design it’s cut like a wedge so
when you push this needle into tissue it
just naturally wants to bend because of
that wedge like tip and so if you can
control both pushing and then spinning
the back end of the needle you can
rename the tip and get that needle to go
wherever you want it to go inside the
patient so how do we test a system like
this well we actually put it into a CT
scanner and then we put it inside of a
pig lung and that’s what you see on the
slide here and I’m about to show you a
video following that robot all the way
on its path from outside the lung all
the way to the edge of the lung so this
is what it looks like this is a CT image
and you see first of all the Brawn to
scoop coming through here and then
pretty soon you’re gonna see the
concentric tube robot pop out of it
which is right about right there and
then quickly followed by the steerable
needle and the steerable needle gets out
to the edge of the lung
and we’ve been able to hit targets with
an accuracy of about a millimeter and to
give you an idea of how small that is
the little dot that you see indicating
the needle that’s about a millimeter
wide so we’re doing really well here but
then we started thinking what’s the next
step you know what else could we do to
help doctors with this kind of really
cool technology and we thought well
we’re only giving them one hand what if
we could give them two hands and so I
was talking with Duke Carol also a
surgeon at Vanderbilt and we were
talking about your logic surgery and
doing rigid endoscope endoscope
procedures and this is what a rigid
endoscope looks like it has a straight
shaft and then a camera at the tip and
out the end of that endoscope you
actually put a fiber-optic laser which
is that blue thing that you see in the
picture and then you use that to cut so
what does this look like when they use
it in surgery looks something like this
if you look close you can see down
toward the bottom of the image you can
see the laser fiber and it’s firing to
cut the tissue and you can see just how
hard these procedures are incredibly
challenging for the doctors because they
have to do everything with one tool they
have to tilt the thing that they’re
actually using to look at the surgical
field at the same time as they’re aiming
the fiber-optic laser and doing these
two things at once
not to mention trying to pull the tissue
into position for cutting is very very
difficult and sometimes they’ll get lost
and not even know am I in the right spot
do I want to cut that or should I be
over here so we built them this which is
a robot that has two hands so it goes
two of our robots have been pushed
through the port in this existing
endoscope one of them aims the laser
fiber the other lets the doctor actually
grab the tissue and pull it into
position so what does this look like
when used in surgery this is a model of
a prostate and the doctors job is to cut
out the bottom lobe and you can see is
doing that here the really cool thing to
notice is the image is not bouncing
around at all so he can maintain a view
of the whole surgical field while he’s
working
the other cool thing you notice is he’s
got two hands and he’s about to do
something he could never hope to do
before which is pick up this chunk of
tissue in both hands at once and then do
a slam dunk back into the bladder right
there so he was pretty proud of that one
and that’s a very successful surgical
procedure for this so I’ve told you now
about two different kinds of surgery
lung and prostate and I want to tell you
just about one more example and this one
is really important to me personally
because it affected my family this is my
father and he had a stroke and the kind
of stroke that he had is where a blood
vessel in the brain breaks open and just
dumps blood into the brain and that
blood can’t go anywhere so it starts
compressing the brain tissue and cells
start dying and so there’s unfortunately
not much doctors can do about this my
dad when he went into the hospital he
had just a splitting headache like the
worst headache by a factor of a hundred
that he’d ever had in his life and they
scanned him they did a CT scan they knew
what he had they knew he had a
hemorrhage and the only thing they could
do for him was put him in a hospital bed
and wait and see if he was going to get
better and it turns out that half of the
patients that have this die from it so
there my dad is laying in a hospital bed
and we don’t know if he’s gonna live or
die and so there’s we thought there’s
got to be a better way there’s got to be
something that we could do and so my
students and I a couple years ago
thought well what if we could go into
the brain through a needle and then
deploy one of our tiny elephant trunk
robots and actually vacuum out all of
that blood so we can release the
pressure and let those brain cells live
and so we built a robot to do that and
this is what it looks like here it’s
suctioning out a model of a brain and
we’ve sort of cut that model in half so
you can see what’s going in saw on
inside and it’s actually red jello that
it’s it’s suctioning out here that’s a
good model for a brain hemorrhage and
you can see it got all of it so you know
we think this has a ton of potential for
the future for being able to help
patients like my dad who have hemorrhage
etic strokes okay so speaking of the
future people often ask me well where is
all of this going you’ve showed us all
these cool robots like what’s going to
happen in the future are these gonna
replace doctors that’s often the first
question that I get well the doctors go
away and the robots take over the
operating room my answer to that is
absolutely not at least not any time
very soon at all
probably anytime in the lifetimes of
everyone in this room I don’t think so
and why is that well think back to my
eye exam there’s still an eye doctor
this is my eye doctor she’s still there
and what did all those robots do when I
went in for my eye exam well they were
just tools to help her do her job better
and better and better and that’s what
robots in the operating room are going
to be as tools to help doctors do their
jobs better they’re not going to replace
the doctors they’re just going to give
the doctors better capabilities the
other thing I wanted to point out is
there’s a lot of people involved in each
one of these projects that I’ve shown
you this is a slide showing all of my
doctor collaborators as well as
engineers I work with and probably most
importantly my students and postdocs who
really do a lot of the work and the
great thing about all these people is
the engineers on this slide actually go
into foreign territory and go into the
operating room and watch what’s going on
there and learn about the environment
and see hands on how surgery gets done
and that’s a real challenge for a lot of
Engineers it’s completely foreign land
equally foreign for the doctors is
coming into my engineering lab where
there’s all kinds of equipment they’ve
never seen before and learning about
what the technology can do and then all
of that sets the stage for these sparks
of inspiration and breakthroughs that
can happen like when we marvel at how an
elephant’s trunk works and so just to
finish the story of my dad he survived
he made a complete recovery he was one
of the lucky ones and my parents
actually today are celebrating their
43rd wedding anniversary and
[Applause]
I’m sure they appreciate that and they
would have missed out on 16 of those if
he had died from his brain hemorrhage
right so how should you feel when a
doctor says to you that they’re gonna
use a robot as part of your surgical
procedure you should be thrilled because
that’s the best tool available to help
you and what it can give you is more
years of quality life like my dad had
and most importantly more moments like
this where he was able to hold his
grandson for the first time thank you
very much
you
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