sponsored links
TEDMED 2011

Yoav Medan: Ultrasound surgery -- healing without cuts

October 24, 2011

Imagine having a surgery with no knives involved. At TEDMED, Yoav Medan shares a technique that uses MRI to find trouble spots and focused ultrasound to treat such issues as brain lesions, uterine fibroids and several kinds of cancerous growths.

Yoav Medan - Medical inventor
With his team, Yoav Medan is developing a tool for incision-less surgery via focused ultrasound. Full bio

sponsored links
Double-click the English subtitles below to play the video.
Over the last 13 years --
00:15
one, three, 13 years --
00:17
I've been part of an exceptional team at InSightec in Israel
00:19
and partners around the world
00:22
for taking this idea, this concept,
00:24
noninvasive surgery,
00:27
from the research lab to routine clinical use.
00:29
And this is what I'll tell you about.
00:32
13 years --
00:34
for some of you, you can empathize with that number.
00:36
For me, today, on this date,
00:39
it's like a second bar mitzvah experience.
00:41
(Laughter)
00:43
So this dream
00:46
is really enabled
00:49
by the convergence
00:51
of two known technologies.
00:53
One is the focused ultrasound,
00:55
and the other one is the
00:57
vision-enabled magnetic resonance imaging.
01:00
So let's first talk about focused ultrasound.
01:03
And I hold in my hand
01:07
a tissue-mimicking phantom.
01:09
It is made out of silicon.
01:11
It is transparent, made just for you.
01:13
So you see, it's all intact,
01:16
completely transparent.
01:19
I'll take you now to the acoustic lab.
01:21
You see the phantom within the aquarium.
01:24
This is a setup I put in a physics lab.
01:26
On the right-hand side,
01:28
you see an ultrasonic transducer.
01:30
So the ultrasonic transducer
01:32
emits basically an ultrasonic beam
01:35
that focuses inside the phantom.
01:37
Okay, when you hear the click,
01:40
this is when the energy starts to emit
01:44
and you see a little lesion form
01:46
inside the phantom.
01:49
Okay, so everything around it
01:52
is whole and intact.
01:54
It's just a lesion formed inside.
01:56
So think about, this is in your brain.
01:58
We need to reach a target inside the brain.
02:01
We can do it without harming any tissue.
02:03
So this is, I think,
02:06
the first kosher Hippocratic surgical system.
02:08
(Laughter)
02:11
Okay, so let's talk a little bit about ultrasound,
02:13
the force of ultrasound.
02:15
You know all about imaging, right, ultrasound imaging.
02:17
And you know also about lithotripsy --
02:20
breaking kidney stones.
02:23
But ultrasound can be shaped
02:26
to be anything in between,
02:29
because it's a mechanical force.
02:32
Basically, it's a force acting on a tissue
02:35
that it transverses.
02:37
So you can change the intensity, the frequency,
02:39
the duration, the pulse shape of the ultrasound
02:42
to create anything
02:45
from an airbrush to a hammer.
02:47
And I am going to show you
02:50
multiple applications in the medical field
02:52
that can be enabled
02:54
just by focusing,
02:56
physically focusing.
02:58
So this idea
03:01
of harnessing focused ultrasound to treat lesions in the brain
03:03
is not new at all.
03:06
When I was born, this idea was already conceived
03:08
by pioneers such as the Fry brothers
03:11
and Lars Leksell,
03:14
who is know actually
03:16
as the inventor of the gammaknife.
03:18
But you may not know
03:20
that he tried to perform lobotomies in the brain,
03:22
noninvasively,
03:24
with focused ultrasound in the '50s.
03:26
He failed,
03:29
so he then invented the gammaknife.
03:31
And it makes you ponder
03:33
why those pioneers failed.
03:36
And there was something fundamental
03:40
that they were missing.
03:42
They were missing the vision.
03:44
It wasn't until the invention of the MR
03:46
and really the integration of MR
03:49
with focused ultrasound
03:51
that we could get the feedback --
03:53
both the anatomical and the physiological
03:56
in order to have a completely noninvasive, closed-loop
03:59
surgical procedure.
04:03
So this is how it looks, you know,
04:06
the operating room of the future today.
04:08
This is an MR suite with a focused ultrasound system.
04:11
And I will give you several examples.
04:14
So the first one is in the brain.
04:16
One of the neurological conditions
04:18
that can be treated with focused ultrasound
04:21
are movement disorders,
04:23
like Parkinson's or essential tremor.
04:25
What is typical to those conditions,
04:28
to essential tremor for example,
04:31
is inability
04:34
to drink or eat cereal or soup
04:37
without spilling everything all over you,
04:41
or write legibly so people can understand it,
04:44
and be really independent in your life
04:47
without the help of others.
04:50
So I'd like you to meet John.
04:52
John is a retired professor of history
04:55
from Virginia.
04:57
So he suffered from essential tremor for many years.
04:59
And medication didn't help him anymore.
05:02
And many of those patients refused to undergo surgery
05:06
to have people cut into their brain.
05:09
And about four or five months ago,
05:11
he underwent an experimental procedure.
05:14
It is approved under an FDAIDE
05:19
at the University of Virginia
05:22
in Charlottesville
05:24
using focused ultrasound
05:26
to ablate a point in his thalamus.
05:28
And this is his handwriting.
05:33
"On June 20th," if you can read it,
05:36
"2011."
05:39
This is his handwriting
05:42
on the morning of the treatment
05:44
before going into the MR
05:46
So now I'll take you through
05:48
[what] a typical procedure like that looks like,
05:50
[what] noninvasive surgery looks like.
05:53
So we put the patient on the MR table.
05:56
We attach a transducer, in this case, to the brain,
05:59
but if it will be a different organ,
06:01
it will be a different transducer attached to the patient.
06:03
And the physician
06:07
will then take a regular MR scan.
06:09
And the objective of that?
06:12
I don't have a pointer here,
06:14
but you see the green, sort of rectangle or trapezoid?
06:16
This is the sort of general area of the treatment.
06:21
It's a safety boundary
06:23
around the target.
06:25
It's a target in the thalamus.
06:27
So once those pictures are acquired
06:29
and the physician has drawn
06:31
all the necessary safety limits and so on,
06:34
he selects basically a point --
06:37
you see the round point in the middle where the cursor is --
06:39
and he presses this blue button called "sonicate."
06:42
We call this instance of injecting the energy,
06:45
we call it sonication.
06:48
The only handwork the physician does here
06:50
is moving a mouse.
06:53
This is the only device he needs in this treatment.
06:55
So he presses "sonicate," and this is what happens.
06:58
You see the transducer, the light blue.
07:01
There's water in between the skull and the transducer.
07:03
And it does this burst of energy.
07:06
It elevates the temperature.
07:08
We first need to verify
07:10
that we are on target.
07:12
So the first sonication
07:14
is at lower energy.
07:16
It doesn't do any damage,
07:18
but it elevates the temperature
07:20
by a few degrees.
07:22
And one of the unique capabilities
07:24
that we leverage with the MR
07:26
is the ability to measure temperature noninvasively.
07:28
This is really a unique capability of the MR.
07:32
It is not being used
07:35
in regular diagnostic imaging.
07:37
But here we can get
07:39
both the anatomical imaging and the temperature maps in real time.
07:41
And you can see the points there on the graph.
07:44
The temperature was raised
07:47
to 43 degrees C temporarily.
07:49
This doesn't cause any damage.
07:51
But the point is we are right on target.
07:53
So once the physician verifies
07:55
that the focus spot is on the target he has chosen,
07:58
then we move to perform
08:01
a full-energy ablation
08:04
like you see here.
08:06
And you see the temperature rises
08:08
to like 55 to 60 degrees C.
08:11
If you do it for more than a second,
08:13
it's enough to basically destroy
08:15
the proteins of the cells.
08:18
This is the outcome from a patient perspective --
08:22
same day after the treatment.
08:24
This is an immediate relief.
08:27
(Applause)
08:29
Thank you.
08:34
John is one of [about] a dozen
08:36
very heroic, courageous people
08:39
who volunteered for the study.
08:43
And you have to understand
08:45
what is in people's mind
08:47
when they are willing to take the risk.
08:49
And this is a quote from John after he wrote it.
08:52
He said, "Miraculous."
08:55
And his wife said, "This is the happiest moment of my life."
08:57
And you wonder why.
09:01
I mean, one of the messages I like to carry over
09:03
is, what about defending quality of life?
09:06
I mean, those people lose their independence.
09:09
They are dependent on others.
09:11
And John today is fully independent.
09:13
He returned to a normal life routine.
09:16
And he also plays golf,
09:19
like you do in Virginia
09:21
when you are retired.
09:23
Okay, so you can see here the spot.
09:28
It's like three millimeters in the middle of the brain.
09:32
There's no damage outside.
09:34
He suffers from no neurodeficit.
09:36
There's no recovery needed, no nothing.
09:39
He's back to his normal life.
09:42
Let's move now
09:44
to a more painful subject.
09:46
Pain is something
09:48
that can make your life miserable.
09:50
And people are suffering from all kinds of pain
09:52
like neuropathic pain, lower-back pain
09:54
and cancer pain from bone metastases,
09:58
when the metastases get to your bones,
10:01
sometimes they are very painful.
10:04
All those I've indicated
10:07
have already been shown
10:09
to be successfully treated
10:11
by focused ultrasound
10:13
relieving the pain, again, very fast.
10:16
And I would like to tell you
10:19
about PJ.
10:21
He's a 78 year-old farmer
10:25
who suffered from -- how should I say it? --
10:29
it's called pain in the butt.
10:32
He had metastases in his right buttock,
10:34
and he couldn't sit
10:37
even with medication.
10:39
He had to forgo all the farm activities.
10:41
He was treated with radiation therapy,
10:48
state-of-the-art radiation therapy,
10:50
but it didn't help.
10:52
Many patients like that favor radiation therapy.
10:54
And again, he volunteered
10:57
to a pivotal study
10:59
that we ran worldwide,
11:01
also in the U.S.
11:04
And his wife actually took him.
11:08
They drove like three hours
11:11
from their farm to the hospital.
11:13
He had to sit on a cushion,
11:16
stand still, not move,
11:19
because it was very painful.
11:21
He took the treatment,
11:24
and on the way back,
11:26
he drove the truck by himself.
11:29
So again, this is an immediate relief.
11:33
And you have to understand
11:36
what those people feel
11:38
and what their family experiences
11:40
when it happens.
11:43
He returned again
11:45
to his daily routine on the farm.
11:47
He rides his tractor.
11:49
He rides his horse to their mountain cabin regularly.
11:51
And he has been very happy.
11:55
But now, you ask me,
11:58
but what about war, the war on cancer?
12:01
Show us some primary cancer.
12:03
What can be done there?
12:06
So I have good news and bad news.
12:08
The good news: there's a lot that can be done.
12:10
And it has been shown actually outside of the U.S.
12:13
And doing that in the U.S.
12:16
is very painful.
12:20
I don't see, without this nation
12:22
taking it as some collective will
12:26
or something that is a national goal to make that happen,
12:30
it will not happen.
12:33
And it's not just because of regulation;
12:35
it's because of the amount of money needed
12:37
under the current evidence-based medicine
12:40
and the size of trials and so on
12:44
to make it happen.
12:46
So the first two applications
12:48
are breast cancer and prostate cancer.
12:50
They were the first to be treated by focused ultrasound.
12:53
And we have better-than-surgery results in breasts.
12:56
But I have a message for the men here.
13:01
We heard here yesterday Quyen
13:03
talking about the adverse event trait
13:06
in prostate cancer.
13:09
There is a unique opportunity now
13:11
with focused ultrasound guided by MR,
13:13
because we can actually think about
13:16
prostate lumpectomy --
13:19
treating just the focal lesion
13:21
and not removing the whole gland,
13:23
and by that, avoiding all the issues
13:25
with potency and incontinence.
13:28
Well, there are other cancer tumors in the abdomen --
13:32
quite lethal, very lethal actually --
13:38
pancreas, liver, kidney.
13:40
The challenge there
13:43
with a breathing and awake patient --
13:45
and in all our treatments,
13:48
the patient is awake and conscious
13:50
and speaks with the physician --
13:52
is you have to teach the MR some tricks
13:56
how to do it in real time.
13:59
And this will take time.
14:02
This will take two years.
14:04
But I have now a message to the ladies.
14:06
And this is, in 2004,
14:09
the FDA has approved MR-guided focused ultrasounds
14:12
for the treatment of symptomatic uterine fibroids.
14:15
Women suffer from that disease.
14:20
All those tumors
14:24
have heavy bleeding during periods,
14:26
abdominal pressure, back pain,
14:28
frequent urination.
14:30
And sometimes, they cannot even conceive and become pregnant
14:32
because of the fibroid.
14:36
This is Frances.
14:38
She was diagnosed with a grapefruit-sized fibroid.
14:40
This is a big fibroid.
14:42
She was offered a hysterectomy,
14:44
but this is an inconceivable proposition
14:46
for someone who wants to keep her pregnancy option.
14:48
So she elected to undergo a focused ultrasound procedure
14:51
in 2008.
14:55
And in 2010, she became a first-time mother to a healthy baby.
14:57
So new life was born.
15:01
(Applause)
15:03
So in conclusion,
15:05
I'd like to leave you with actually four messages.
15:08
One is, think about the amount
15:11
of suffering that is saved
15:13
from patients undergoing noninvasive surgery,
15:15
and also the economical and emotional burden
15:19
removed from their families and communities
15:23
and the society at large --
15:26
and I think also from their physicians, by the way.
15:30
And the other thing I would like you to think about
15:36
is the new type of relationship
15:39
between physician and patients
15:42
when you have a patient on the table
15:44
[who] is awake and can even monitor the treatment.
15:47
In all our treatments,
15:50
the patient holds a stop sonication button.
15:52
He can stop the surgery at any moment.
15:54
And with that note,
15:58
I would like to thank you for listening.
16:01
(Applause)
16:04

sponsored links

Yoav Medan - Medical inventor
With his team, Yoav Medan is developing a tool for incision-less surgery via focused ultrasound.

Why you should listen

Yoav Medan is the Chief Systems Architect at InSightec Ltd. in Israel, where he works on MRI-guided guided focused ultrasound technology. Before this, he spent 17 years in research and management at the IBM Research Division and was elected to the IBM Academy of Technology. Medan has taught at the EE department at the Technion, Israel Institute of Technology, in addition to serving as a lecturer for Avionic Systems at the Aeronautical Engineering faculty, and mentors young enterpreneurs as part of the Technion Alumni "Technion for Life" program. He plans a 2012 sabbatical as an associate professor at the BioMedical Engineering department of the Technion and its Autonomous Systems Program.

Medan is also the inventor of the QR-code enabled tombstone. Read Adam Ostrow's Q&A with Yoav Medan at TEDGlobal >>

sponsored links

If you need translations, you can install "Google Translate" extension into your Chrome Browser.
Furthermore, you can change playback rate by installing "Video Speed Controller" extension.

Data provided by TED.

This website is owned and operated by Tokyo English Network.
The developer's blog is here.