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