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TEDWomen 2017

Nadine Hachach-Haram: How augmented reality could change the future of surgery

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If you're undergoing surgery, you want the best surgical team to collaborate on your case, no matter where they are. Surgeon and entrepreneur Nadine Hachach-Haram is developing a new system that helps surgeons operate together and train one another on new techniques -- from remote locations using low-cost augmented reality tools. Watch the system in action as she joins a surgeon in Minnesota performing a knee surgery, live on her laptop from the TED stage in New Orleans. As Hachach-Haram says: "Through simple, everyday devices that we take for granted, we can really do miraculous things." (This talk contains graphic images of surgery.)

- Surgeon, entrepreneur
The co-founder of Proximie, Nadine Hachach-Haram is a curious surgeon with a passion for technology and innovation -- and a desire to make a difference in the world. Full bio

According to the theories
of human social development,
00:12
we're now living
through the fourth great epoch
00:15
of technological advancement,
00:17
the Information Age.
00:20
Connectivity through digital technology
is a modern miracle.
00:22
We can say it has broken down barriers
of time and space which separate people,
00:25
and it's created a condition for an age
00:31
where information, ideas
can be shared freely.
00:32
But are these great accomplishments
in digital technology
00:37
really the endgame
in terms of what can be achieved?
00:40
I don't think so,
00:43
and today I'd like to share with you
00:45
how I believe digital technology
can take us to even greater heights.
00:46
I'm a surgeon by profession,
00:51
and as I stand here today
talking to all of you,
00:53
five billion people around the world
lack access to safe surgical care.
00:56
Five billion people.
01:00
That's 70 percent
of the world's population,
01:03
who according to the WHO's
Lancet Commission
01:05
can't even access
simple surgical procedures
01:08
as and when they need them.
01:11
Let's zoom in on Sierra Leone,
01:13
a country of six million people,
01:15
where a recent study showed
that there are only 10 qualified surgeons.
01:18
That's one surgeon
for every 600,000 people.
01:22
The numbers are staggering,
01:26
and we don't even need to look that far.
01:28
If we look around us here in the US,
01:31
a recent study reported that we need
an extra 100,000 surgeons by 2030
01:33
to just keep up with the demand
for routine surgical procedures.
01:38
At the rate that we're going,
we won't be meeting those numbers.
01:42
As a surgeon, this is
a global issue that bothers me.
01:47
It bothers me a lot,
01:50
because I've seen firsthand
01:51
how lack of access
to safe and affordable healthcare
01:53
can blight the lives of ordinary people.
01:56
If you're a patient
that needs an operation
01:58
and there isn't a surgeon available,
02:01
you're left with some
really difficult choices:
02:02
to wait, to travel,
02:05
or not to have an operation at all.
02:09
So what's the answer?
02:12
Well, part of you are carrying
some of that solution with you today:
02:15
a smartphone, a tablet, a computer.
02:19
Because for me,
02:23
digital communications technology
has the power to do so much more
02:24
than just to allow us to shop online,
02:28
to connect through social media platforms
and to stay up to date.
02:30
It has the power to help us solve
some of the key issues that we face,
02:34
like lack of access
to vital surgical services.
02:39
And today I'd like to share with you
02:42
an example of how I think
we can make that possible.
02:44
The history of surgery
is filled with breakthroughs
02:47
in how science and technology
was able to help the surgeons of the day
02:49
face their greatest challenges.
02:53
If we go back several hundred years,
02:54
an understanding of microbiology
02:56
led to the development
of antiseptic techniques,
02:58
which played a big role in making sure
03:00
patients were able
to stay alive postsurgery.
03:02
Fast-forward a few hundred years
03:05
and we developed
keyhole or arthroscopic surgery,
03:06
which combines video technology
and precision instruments
03:09
to make surgery less invasive.
03:12
And more recently, a lot of you
will be aware of robotic surgery,
03:15
and what robotics brings to surgery
is much like modern automated machinery,
03:19
ultraprecision,
03:23
the ability to carry out procedures
at the tiniest scales
03:25
with a degree of accuracy
that even surpasses the human hand.
03:29
But robotic surgery also introduced
something else to surgery:
03:34
the idea that a surgeon
03:38
doesn't actually have to be standing
at the patient's bedside to deliver care,
03:39
that he could be looking at a screen
03:44
and instructing a robot
through a computer.
03:46
We call this remote surgery.
03:49
It is incumbent on us
03:54
to find solutions that solve these answers
in a cost-effective and scalable way,
03:56
so that everyone, no matter
where they are in the world,
04:01
can have these problems addressed.
04:03
So what if I told you
04:06
that you didn't really need
a million-dollar robot
04:08
to provide remote surgery?
04:10
That all you needed
was a phone, a tablet, or a computer,
04:12
an internet connection,
04:17
a confident colleague on the ground
04:19
and one magic ingredient:
04:21
an augmented reality
collaboration software.
04:24
Using this augmented reality
collaboration software,
04:28
an expert surgeon
can now virtually transport himself
04:30
into any clinical setting
04:33
simply by using his phone
or tablet or computer,
04:35
and he can visually and practically
interact in an operation
04:38
from start to finish,
04:41
guiding and mentoring a local doctor
through the procedure step by step.
04:43
Well, enough of me telling you about it.
04:47
I'd now like to show you.
04:50
We're now going to go live
to Dr. Marc Tompkins,
04:54
an orthopedic surgeon
at the University of Minnesota.
04:57
He's going to perform
an arthroscopic surgery for us,
05:01
a keyhole surgery of the knee,
05:04
and I'd like to disclose
05:06
that this patient has consented
to having their operation streamed.
05:08
I'd also like to point out
that in the interest of time,
05:14
we're just going to go
through the first steps,
05:16
marking up the patient
05:18
and just identifying
a few key anatomical landmarks.
05:20
Hello, Dr. Tompkins, can you hear me?
05:24
Dr. Mark Tompkins: Good morning, Nadine.
05:28
Nadine Hachach-Haram:
Everyone from TED says hello.
05:30
Audience: Hi.
05:32
NHH: Alright, Dr. Tompkins,
let's get started.
05:36
So let's start with our incisions
and where we're going to make these,
05:38
on either side of the patellar tendon.
05:41
So if you can make
your incisions there and there,
05:43
that should hopefully
get us into the knee.
05:47
MT: All right, I'm going in.
05:51
NHH: Great.
05:53
So we're just getting
inside the joint now.
05:57
So why don't we go around
and have a quick look at the meniscus.
06:02
MT: Perfect.
06:07
NHH: Great, so we can see there's
a small tear there on the meniscus,
06:11
but otherwise it looks alright.
06:15
And if you turn
and head to this direction,
06:18
follow my finger,
06:21
let's have a quick look
at the ACL and the PCL.
06:22
That's your ACL there,
that looks quite healthy,
06:26
no problems there.
06:29
So we've just identified
that small meniscus tear there,
06:31
but otherwise the fluid
around the joint looks OK as well.
06:34
All right, thank you very much,
Dr. Tompkins. Thank you for your time.
06:38
I'll let you continue.
06:42
Have a good day. Bye.
06:43
(Applause)
06:46
So I hope through
this simple demonstration
06:54
I was able to illustrate to you
just how powerful this technology can be.
06:56
And I'd like to point out
that I wasn't using any special equipment,
07:00
just my laptop and a really simple webcam.
07:04
We're so used to using digital technology
07:06
to communicate through voice
and text and video,
07:08
but augmented reality
can do something so much deeper.
07:11
It allows two people to virtually interact
07:15
in a way that mimics
how they would collaborate in person.
07:17
Being able to show someone
what you want to do,
07:21
to illustrate and demonstrate and gesture,
07:23
is so much more powerful
than just telling them.
07:25
And it can make
for such a great learning tool,
07:28
because we learn better
through direct experience.
07:31
So how is this making
a difference around the world?
07:34
Well, back in my teaching hospital,
07:36
we've been using this to support
local district general hospitals
07:38
and providing skin cancer surgery
and trauma treatment.
07:41
Now, patients can access
care at a local level.
07:44
This reduces their travel time,
improves their access,
07:48
and saves money.
07:51
We've even started seeing its use
in wound care management with nurses
07:53
and in outpatient management.
07:57
Most recently, and quite exciting,
07:58
it was used in supporting a surgeon
through a cancer removal of a kidney.
08:00
And I'd like to just share with you
a very quick video here.
08:06
I apologize for some
of the gruesome views.
08:09
(Video) Doctor 1: OK. Show me again.
08:14
Doctor 2: If you see here,
08:17
that's the upper part,
the most outer part of your tumor.
08:19
Doctor 1: Yes.
08:23
Doctor 2: So it's
three centimeters deep,
08:25
so this should be three centimeters.
08:28
Doctor 1: Yes, yes.
08:30
Doctor 2: OK,
so you need to get a 3.5 margin.
08:32
Doctor 1: I'm going to show you anyway
08:37
and tell me what you think about it.
08:39
NHH: We're also seeing the use
of this technology at a global scale,
08:42
and one of the most
heartwarming stories I can recall
08:46
is from the town of Trujillo
in the north of Lima in Peru,
08:48
where this technology
was used to support the provision
08:52
of cleft lip and palate
surgery to children,
08:55
children from poor backgrounds who
didn't have access to health insurance.
08:58
And in this town, there was
a hospital with one surgeon
09:02
working hard to provide this care,
09:05
Dr. Soraya.
09:06
Now, Dr. Soraya was struggling
under the sheer demand
09:08
of her local population,
09:11
as well as the fact that she wasn't
specifically trained in this procedure.
09:12
And so, with the help of a charity,
09:16
we were able to connect her
with a cleft surgeon in California,
09:18
and using this technology, he was able
to guide her and her colleagues
09:21
through the procedure step by step,
09:25
guiding them, training them
and teaching them.
09:26
Within a few months,
09:28
they were able to perform
30 percent more operations
09:30
with less and less complications.
09:32
And now Dr. Soraya and her team
can perform these operations
09:34
independently, competently
and confidently.
09:38
And I remember one quote
from a mother who said,
09:42
"This technology
gave my daughter her smile."
09:44
For me, this is the real power
of this technology.
09:48
The beauty is that it breaks boundaries.
09:51
It transcends all
technological difficulties.
09:54
It connects people.
It democratizes access.
09:58
Wi-Fi and mobile technology
are growing rapidly,
10:02
and they should play a role
in boosting surgical provision.
10:04
We've even seen it used in conflict zones
where there's considerable risk
10:07
in getting specialist surgeons
to certain locations.
10:10
In a world where
there are more mobile devices
10:13
than there are human beings,
10:16
it truly has a global reach.
10:18
Of course, we've still got a long way
10:20
before we can solve the problem
of getting surgery to five billion people,
10:22
and unfortunately,
10:26
some people still
don't have access to internet.
10:27
But things are rapidly moving
in the right direction.
10:30
The potential for change is there.
10:34
My team and I are growing
our global footprint,
10:36
and we're starting to see
the potential of this technology.
10:39
Through digital technology,
10:44
through simple, everyday devices
that we take for granted,
10:46
through devices of the future,
10:49
we can really do miraculous things.
10:51
Thank you.
10:54
(Applause)
10:55

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About the speaker:

Nadine Hachach-Haram - Surgeon, entrepreneur
The co-founder of Proximie, Nadine Hachach-Haram is a curious surgeon with a passion for technology and innovation -- and a desire to make a difference in the world.

Why you should listen

Dr. Nadine Hachach-Haram is a surgeon, lecturer and clinical entrepreneur. She drew on her passion for innovation, education and global surgery to co-found Proximie, an augmented reality platform that allows doctors to virtually transport themselves into any operating room, anywhere in the world, to visually and practically interact in an operation from start to finish. From marking up a patient to providing real-time virtual presence in assisting and instructing on an operation, Proximie aims to provide safe, accessible and cost-effective surgery to every patient around the world. Dubbed the "future of surgery" by CNN, Proximie has gone from strength to strength and won multiple awards as well as being the main focus of the Foreign Press Association Science Story of the Year. It aims to revolutionize the delivery and education of healthcare by reducing the cost of that delivery while providing improved quality to the end patient, ensuring that every patient gets the best care, the first time, every time.

More profile about the speaker
Nadine Hachach-Haram | Speaker | TED.com