TEDxBeaconStreet
Steven Schwaitzberg: A universal translator for surgeons
Filmed:
Readability: 4.1
514,886 views
Laparoscopic surgery uses minimally invasive incisions -- which means less pain and shorter recovery times for patients. But Steven Schwaitzberg has run into two problems teaching these techniques to surgeons around the world: language and distance. He shares how a new technology, which combines videoconferencing and a real-time universal translator, could help.
Steven Schwaitzberg - Surgeon and technologist
Dr. Steven Schwaitzberg is on a mission to teach surgeons around the world to perform minimally invasive surgery. But first, he's had to find the right technology to allow communication across the language barrier. Full bio
Dr. Steven Schwaitzberg is on a mission to teach surgeons around the world to perform minimally invasive surgery. But first, he's had to find the right technology to allow communication across the language barrier. Full bio
Double-click the English transcript below to play the video.
00:16
So I want to talk to you about two things tonight.
0
226
3822
00:19
Number one:
1
4048
2284
00:22
Teaching surgery and doing surgery
2
6332
3316
00:25
is really hard.
3
9648
2133
00:27
And second,
4
11781
1584
00:29
that language is one of the most profound things
5
13365
2499
00:31
that separate us all over the world.
6
15864
3318
00:35
And in my little corner of the world,
7
19182
1917
00:36
these two things are actually related,
8
21099
1950
00:38
and I want to tell you how tonight.
9
23049
1932
00:40
Now, nobody wants an operation.
10
24981
4006
00:44
Who here has had surgery?
11
28987
3939
00:48
Did you want it?
12
32926
1323
00:50
Keep your hands up if you wanted an operation.
13
34249
1558
00:51
Nobody wants an operation.
14
35807
2092
00:53
In particular, nobody wants an operation
15
37899
3062
00:56
with tools like these through large incisions
16
40961
5488
01:02
that cause a lot of pain,
17
46449
1975
01:04
that cause a lot of time out of work or out of school,
18
48424
3532
01:07
that leave a big scar.
19
51956
2251
01:10
But if you have to have an operation,
20
54207
2902
01:13
what you really want is a minimally invasive operation.
21
57109
2531
01:15
That's what I want to talk to you about tonight --
22
59640
2032
01:17
how doing and teaching this type of surgery
23
61672
2734
01:20
led us on a search
24
64406
1467
01:21
for a better universal translator.
25
65873
2534
01:24
Now, this type of surgery is hard,
26
68407
2343
01:26
and it starts by putting people to sleep,
27
70750
3524
01:30
putting carbon dioxide in their abdomen,
28
74274
2117
01:32
blowing them up like a balloon,
29
76391
1816
01:34
sticking one of these sharp pointy things into their abdomen --
30
78207
5189
01:39
it's dangerous stuff --
31
83396
3547
01:42
and taking instruments and watching it on a TV screen.
32
86943
4643
01:47
So let's see what it looks like.
33
91586
1967
01:49
So this is gallbladder surgery.
34
93553
1766
01:51
We perform a million of these a year
35
95319
2032
01:53
in the United States alone.
36
97351
2218
01:55
This is the real thing. There's no blood.
37
99569
2050
01:57
And you can see how focused the surgeons are,
38
101619
3134
02:00
how much concentration it takes.
39
104753
2515
02:03
You can see it in their faces.
40
107268
1684
02:04
It's hard to teach, and it's not all that easy to learn.
41
108952
6507
02:11
We do about five million of these in the United States
42
115459
1978
02:13
and maybe 20 million of these worldwide.
43
117437
5287
02:18
All right, you've all heard the term:
44
122724
2833
02:21
"He's a born surgeon."
45
125557
1798
02:23
Let me tell you, surgeons are not born.
46
127355
3400
02:26
Surgeons are not made either.
47
130755
3737
02:30
There are no little tanks where we're making surgeons.
48
134492
3340
02:33
Surgeons are trained one step at a time.
49
137832
4455
02:38
It starts with a foundation, basic skills.
50
142287
3852
02:42
We build on that and we take people, hopefully, to the operating room
51
146139
4765
02:46
where they learn to be an assistant.
52
150904
1768
02:48
Then we teach them to be a surgeon in training.
53
152672
2134
02:50
And when they do all of that for about five years,
54
154806
2932
02:53
they get the coveted board certification.
55
157738
3366
02:57
If you need surgery, you want to be operated on
56
161104
2634
02:59
by a board-certified surgeon.
57
163738
2484
03:02
You get your board certificate,
58
166222
1984
03:04
and you can go out into practice.
59
168206
2343
03:06
And eventually, if you're lucky, you achieve mastery.
60
170549
4267
03:10
Now that foundation is so important
61
174816
4032
03:14
that a number of us
62
178848
1901
03:16
from the largest general surgery society in the United States, SAGES,
63
180749
3567
03:20
started in the late 1990s a training program
64
184316
2866
03:23
that would assure that every surgeon who practices minimally invasive surgery
65
187182
4351
03:27
would have a strong foundation of knowledge and skills
66
191533
4582
03:32
necessary to go on and do procedures.
67
196115
2685
03:34
Now the science behind this is so potent
68
198800
4099
03:38
that it became required by the American Board of Surgery
69
202899
3784
03:42
in order for a young surgeon to become board certified.
70
206683
3550
03:46
It's not a lecture, it's not a course,
71
210233
3785
03:49
it's all of that plus a high-stakes assessment.
72
214018
3398
03:53
It's hard.
73
217416
2234
03:55
Now just this past year,
74
219650
3134
03:58
one of our partners, the American College of Surgeons,
75
222784
3066
04:01
teamed up with us to make an announcement
76
225850
1862
04:03
that all surgeons should be FLS (Fundamentals of Laparoscopic Surgery)-certified
77
227712
3470
04:07
before they do minimally invasive surgery.
78
231182
3084
04:10
And are we talking about just people here in the U.S. and Canada?
79
234266
3444
04:13
No, we just said all surgeons.
80
237710
1973
04:15
So to lift this education and training worldwide
81
239683
4699
04:20
is a very large task,
82
244382
1250
04:21
something I'm very personally excited about as we travel around the world.
83
245632
3942
04:25
SAGES does surgery all over the world, teaching and educating surgeons.
84
249574
4692
04:30
So we have a problem, and one of the problems is distance.
85
254266
4039
04:34
We can't travel everywhere.
86
258305
2233
04:36
We need to make the world a smaller place.
87
260538
2818
04:39
And I think that we can develop some tools to do so.
88
263356
2683
04:41
And one of the tools I like personally is using video.
89
266039
3983
04:45
So I was inspired by a friend.
90
270022
2450
04:48
This is Allan Okrainec from Toronto.
91
272472
2249
04:50
And he proved
92
274721
2605
04:53
that you could actually teach people to do surgery
93
277326
4246
04:57
using video conferencing.
94
281572
2700
05:00
So here's Allan teaching an English-speaking surgeon in Africa
95
284272
4233
05:04
these basic fundamental skills
96
288505
2550
05:06
necessary to do minimally invasive surgery.
97
291055
2717
05:09
Very inspiring.
98
293772
1600
05:11
But for this examination, which is really hard,
99
295372
3766
05:15
we have a problem.
100
299138
2817
05:17
Even people who say they speak English,
101
301955
2600
05:20
only 14 percent pass.
102
304555
2517
05:22
Because for them it's not a surgery test,
103
307072
2016
05:24
it's an English test.
104
309088
3875
05:28
Let me bring it to you locally.
105
312963
1609
05:30
I work at the Cambridge Hospital.
106
314572
1667
05:32
It's the primary Harvard Medical School teaching facility.
107
316239
3283
05:35
We have more than 100 translators covering 63 languages,
108
319522
5316
05:40
and we spend millions of dollars just in our little hospital.
109
324838
5184
05:45
It's a big labor-intensive effort.
110
330022
1775
05:47
If you think about the worldwide burden
111
331797
4066
05:51
of trying to talk to your patients --
112
335863
1859
05:53
not just teaching surgeons, just trying to talk to your patients --
113
337722
2635
05:56
there aren't enough translators in the world.
114
340357
3148
05:59
We need to employ technology to assist us in this quest.
115
343505
5966
06:05
At our hospital we see everybody from Harvard professors
116
349471
3167
06:08
to people who just got here last week.
117
352638
2434
06:10
And you have no idea how hard it is
118
355072
2285
06:13
to talk to somebody or take care of somebody you can't talk to.
119
357357
2932
06:16
And there isn't always a translator available.
120
360289
2900
06:19
So we need tools.
121
363189
4363
06:23
We need a universal translator.
122
367552
3678
06:27
One of the things that I want to leave you with as you think about this talk
123
371230
4409
06:31
is that this talk is not just about us preaching to the world.
124
375639
5517
06:37
It's really about setting up a dialogue.
125
381156
2549
06:39
We have a lot to learn.
126
383705
1851
06:41
Here in the United States we spend more money per person
127
385556
4500
06:45
for outcomes that are not better than many countries in the world.
128
390056
3850
06:49
Maybe we have something to learn as well.
129
393906
3383
06:53
So I'm passionate about teaching these FLS skills all over the world.
130
397289
4483
06:57
This past year I've been in Latin America, I've been in China,
131
401772
3384
07:01
talking about the fundamentals of laparoscopic surgery.
132
405156
3733
07:04
And everywhere I go the barrier is:
133
408889
3532
07:08
"We want this, but we need it in our language."
134
412421
4634
07:12
So here's what we think we want to do:
135
417055
2917
07:15
Imagine giving a lecture
136
419972
2417
07:18
and being able to talk to people in their own native language simultaneously.
137
422389
4996
07:23
I want to talk to the people in Asia, Latin America, Africa, Europe
138
427385
5688
07:28
seamlessly, accurately
139
433073
4720
07:33
and in a cost-effective fashion using technology.
140
437793
4281
07:37
And it has to be bi-directional.
141
442074
1628
07:39
They have to be able to teach us something as well.
142
443702
2787
07:42
It's a big task.
143
446489
1400
07:43
So we looked for a universal translator; I thought there would be one out there.
144
447889
3066
07:46
Your webpage has translation, your cellphone has translation,
145
450955
3951
07:50
but nothing that's good enough to teach surgery.
146
454906
5200
07:56
Because we need a lexicon. What is a lexicon?
147
460106
2466
07:58
A lexicon is a body of words that describes a domain.
148
462572
4099
08:02
I need to have a health care lexicon.
149
466671
2485
08:05
And in that I need a surgery lexicon.
150
469156
3601
08:08
That's a tall order. We have to work at it.
151
472757
4255
08:12
So let me show you what we're doing.
152
477012
1793
08:14
This is research -- can't buy it.
153
478805
2301
08:17
We're working with the folks at IBM Research from the Accessibility Center
154
481106
4483
08:21
to string together technologies to work towards the universal translator.
155
485589
4933
08:26
It starts with a framework system
156
490522
2134
08:28
where when the surgeon delivers the lecture
157
492656
2732
08:31
using a framework of captioning technology,
158
495388
3167
08:34
we then add another technology to do video conferencing.
159
498555
4416
08:38
But we don't have the words yet, so we add a third technology.
160
502971
3485
08:42
And now we've got the words,
161
506456
2650
08:45
and we can apply the special sauce: the translation.
162
509106
4551
08:49
We get the words up in a window and then apply the magic.
163
513657
4380
08:53
We work with a fourth technology.
164
518037
2284
08:56
And we currently have access to eleven language pairs.
165
520321
3984
09:00
More to come as we think about trying to make the world a smaller place.
166
524305
4501
09:04
And I'd like to show you our prototype
167
528806
2649
09:07
of stringing all of these technologies that don't necessarily always talk to each other
168
531455
4833
09:12
to become something useful.
169
536288
3667
09:15
Narrator: Fundamentals of Laparoscopic Surgery.
170
539955
3796
09:19
Module five: manual skills practice.
171
543751
3613
09:23
Students may display captions in their native language.
172
547364
7283
09:30
Steven Schwaitzberg: If you're in Latin America,
173
554647
1749
09:32
you click the "I want it in Spanish" button
174
556396
1885
09:34
and out it comes in real time in Spanish.
175
558281
3632
09:37
But if you happen to be sitting in Beijing at the same time,
176
561913
2834
09:40
by using technology in a constructive fashion,
177
564747
3333
09:43
you could get it in Mandarin or you could get it in Russian --
178
568080
3266
09:47
on and on and on, simultaneously without the use of human translators.
179
571346
5466
09:52
But that's the lectures.
180
576812
2200
09:54
If you remember what I told you about FLS at the beginning,
181
579012
2851
09:57
it's knowledge and skills.
182
581863
3017
10:00
The difference in an operation
183
584880
2283
10:03
between doing something successfully and not
184
587163
4600
10:07
may be moving your hand this much.
185
591763
3467
10:11
So we're going to take it one step further;
186
595230
2300
10:13
we've brought my friend Allan back.
187
597530
2133
10:15
Allan Okrainec: Today we're going to practice suturing.
188
599663
5101
10:20
This is how you hold the needle.
189
604764
1998
10:22
Grab the needle at the tip.
190
606762
5497
10:28
It's important to be accurate.
191
612259
2458
10:30
Aim for the black dots.
192
614717
3833
10:34
Orient your loop this way.
193
618550
3449
10:37
Now go ahead and cut.
194
621999
4585
10:42
Very good Oscar. I'll see you next week.
195
626584
3888
10:46
SS: So that's what we're working on
196
630472
2866
10:49
in our quest for the universal translator.
197
633338
2983
10:52
We want it to be bi-directional.
198
636321
2084
10:54
We have a need to learn as well as to teach.
199
638405
4201
10:58
I can think of a million uses for a tool like this.
200
642606
4016
11:02
As we think about intersecting technologies --
201
646622
2750
11:05
everybody has a cell phone with a camera --
202
649372
2400
11:07
we could use this everywhere,
203
651772
2216
11:09
whether it be health care, patient care,
204
653988
2083
11:11
engineering, law, conferencing, translating videos.
205
656071
4485
11:16
This is a ubiquitous tool.
206
660556
2400
11:18
In order to break down our barriers,
207
662956
2199
11:21
we have to learn to talk to people,
208
665155
1767
11:22
to demand that people work on translation.
209
666922
4000
11:26
We need it for our everyday life,
210
670922
2350
11:29
in order to make the world a smaller place.
211
673272
2834
11:32
Thank you very much.
212
676106
1700
11:33
(Applause)
213
677806
2382
ABOUT THE SPEAKER
Steven Schwaitzberg - Surgeon and technologistDr. Steven Schwaitzberg is on a mission to teach surgeons around the world to perform minimally invasive surgery. But first, he's had to find the right technology to allow communication across the language barrier.
Why you should listen
Steven Schwaitzberg, MD, is a pioneer in the field of minimally invasive surgery. Over the course of his career, he has worked on developing the techniques and certification standards for this type of surgery, which is far less painful for patients and allows them to return to their normal lives sooner than with traditional surgery.
Schwaitzberg is the Chief of Surgery at the Cambridge Health Alliance at the Harvard Medical School Teaching Hospital. He recently served as the president of SAGES (Society of American Gastrointestinal and Endoscopic Surgeons), a national organization that seeks to advance surgery and improve patient care. Now, he has his eye on teaching minimally invasive surgery techniques to surgeons who live and work across the globe -- a task which has led him on a hunt for the right technology to allow for video conferencing and real-time translation in a surgeon’s native language.
Steven Schwaitzberg | Speaker | TED.com