0:00:00.226,0:00:04.048
So I want to talk to you about two things tonight.

0:00:04.048,0:00:06.332
Number one:

0:00:06.332,0:00:09.648
Teaching surgery and doing surgery

0:00:09.648,0:00:11.781
is really hard.

0:00:11.781,0:00:13.365
And second,

0:00:13.365,0:00:15.864
that language is one of the most profound things

0:00:15.864,0:00:19.182
that separate us all over the world.

0:00:19.182,0:00:21.099
And in my little corner of the world,

0:00:21.099,0:00:23.049
these two things are actually related,

0:00:23.049,0:00:24.981
and I want to tell you how tonight.

0:00:24.981,0:00:28.987
Now, nobody wants an operation.

0:00:28.987,0:00:32.926
Who here has had surgery?

0:00:32.926,0:00:34.249
Did you want it?

0:00:34.249,0:00:35.807
Keep your hands up if you wanted an operation.

0:00:35.807,0:00:37.899
Nobody wants an operation.

0:00:37.899,0:00:40.961
In particular, nobody wants an operation

0:00:40.961,0:00:46.449
with tools like these through large incisions

0:00:46.449,0:00:48.424
that cause a lot of pain,

0:00:48.424,0:00:51.956
that cause a lot of time out of work or out of school,

0:00:51.956,0:00:54.207
that leave a big scar.

0:00:54.207,0:00:57.109
But if you have to have an operation,

0:00:57.109,0:00:59.640
what you really want is a minimally invasive operation.

0:00:59.640,0:01:01.672
That's what I want to talk to you about tonight --

0:01:01.672,0:01:04.406
how doing and teaching this type of surgery

0:01:04.406,0:01:05.873
led us on a search

0:01:05.873,0:01:08.407
for a better universal translator.

0:01:08.407,0:01:10.750
Now, this type of surgery is hard,

0:01:10.750,0:01:14.274
and it starts by putting people to sleep,

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putting carbon dioxide in their abdomen,

0:01:16.391,0:01:18.207
blowing them up like a balloon,

0:01:18.207,0:01:23.396
sticking one of these sharp pointy things into their abdomen --

0:01:23.396,0:01:26.943
it's dangerous stuff --

0:01:26.943,0:01:31.586
and taking instruments and watching it on a TV screen.

0:01:31.586,0:01:33.553
So let's see what it looks like.

0:01:33.553,0:01:35.319
So this is gallbladder surgery.

0:01:35.319,0:01:37.351
We perform a million of these a year

0:01:37.351,0:01:39.569
in the United States alone.

0:01:39.569,0:01:41.619
This is the real thing. There's no blood.

0:01:41.619,0:01:44.753
And you can see how focused the surgeons are,

0:01:44.753,0:01:47.268
how much concentration it takes.

0:01:47.268,0:01:48.952
You can see it in their faces.

0:01:48.952,0:01:55.459
It's hard to teach, and it's not all that easy to learn.

0:01:55.459,0:01:57.437
We do about five million of these in the United States

0:01:57.437,0:02:02.724
and maybe 20 million of these worldwide.

0:02:02.724,0:02:05.557
All right, you've all heard the term:

0:02:05.557,0:02:07.355
"He's a born surgeon."

0:02:07.355,0:02:10.755
Let me tell you, surgeons are not born.

0:02:10.755,0:02:14.492
Surgeons are not made either.

0:02:14.492,0:02:17.832
There are no little tanks where we're making surgeons.

0:02:17.832,0:02:22.287
Surgeons are trained one step at a time.

0:02:22.287,0:02:26.139
It starts with a foundation, basic skills.

0:02:26.139,0:02:30.904
We build on that and we take people, hopefully, to the operating room

0:02:30.904,0:02:32.672
where they learn to be an assistant.

0:02:32.672,0:02:34.806
Then we teach them to be a surgeon in training.

0:02:34.806,0:02:37.738
And when they do all of that for about five years,

0:02:37.738,0:02:41.104
they get the coveted board certification.

0:02:41.104,0:02:43.738
If you need surgery, you want to be operated on

0:02:43.738,0:02:46.222
by a board-certified surgeon.

0:02:46.222,0:02:48.206
You get your board certificate,

0:02:48.206,0:02:50.549
and you can go out into practice.

0:02:50.549,0:02:54.816
And eventually, if you're lucky, you achieve mastery.

0:02:54.816,0:02:58.848
Now that foundation is so important

0:02:58.848,0:03:00.749
that a number of us

0:03:00.749,0:03:04.316
from the largest general surgery society in the United States, SAGES,

0:03:04.316,0:03:07.182
started in the late 1990s a training program

0:03:07.182,0:03:11.533
that would assure that every surgeon who practices minimally invasive surgery

0:03:11.533,0:03:16.115
would have a strong foundation of knowledge and skills

0:03:16.115,0:03:18.800
necessary to go on and do procedures.

0:03:18.800,0:03:22.899
Now the science behind this is so potent

0:03:22.899,0:03:26.683
that it became required by the American Board of Surgery

0:03:26.683,0:03:30.233
in order for a young surgeon to become board certified.

0:03:30.233,0:03:34.018
It's not a lecture, it's not a course,

0:03:34.018,0:03:37.416
it's all of that plus a high-stakes assessment.

0:03:37.416,0:03:39.650
It's hard.

0:03:39.650,0:03:42.784
Now just this past year,

0:03:42.784,0:03:45.850
one of our partners, the American College of Surgeons,

0:03:45.850,0:03:47.712
teamed up with us to make an announcement

0:03:47.712,0:03:51.182
that all surgeons should be FLS (Fundamentals of Laparoscopic Surgery)-certified

0:03:51.182,0:03:54.266
before they do minimally invasive surgery.

0:03:54.266,0:03:57.710
And are we talking about just people here in the U.S. and Canada?

0:03:57.710,0:03:59.683
No, we just said all surgeons.

0:03:59.683,0:04:04.382
So to lift this education and training worldwide

0:04:04.382,0:04:05.632
is a very large task,

0:04:05.632,0:04:09.574
something I'm very personally excited about as we travel around the world.

0:04:09.574,0:04:14.266
SAGES does surgery all over the world, teaching and educating surgeons.

0:04:14.266,0:04:18.305
So we have a problem, and one of the problems is distance.

0:04:18.305,0:04:20.538
We can't travel everywhere.

0:04:20.538,0:04:23.356
We need to make the world a smaller place.

0:04:23.356,0:04:26.039
And I think that we can develop some tools to do so.

0:04:26.039,0:04:30.022
And one of the tools I like personally is using video.

0:04:30.022,0:04:32.472
So I was inspired by a friend.

0:04:32.472,0:04:34.721
This is Allan Okrainec from Toronto.

0:04:34.721,0:04:37.326
And he proved

0:04:37.326,0:04:41.572
that you could actually teach people to do surgery

0:04:41.572,0:04:44.272
using video conferencing.

0:04:44.272,0:04:48.505
So here's Allan teaching an English-speaking surgeon in Africa

0:04:48.505,0:04:51.055
these basic fundamental skills

0:04:51.055,0:04:53.772
necessary to do minimally invasive surgery.

0:04:53.772,0:04:55.372
Very inspiring.

0:04:55.372,0:04:59.138
But for this examination, which is really hard,

0:04:59.138,0:05:01.955
we have a problem.

0:05:01.955,0:05:04.555
Even people who say they speak English,

0:05:04.555,0:05:07.072
only 14 percent pass.

0:05:07.072,0:05:09.088
Because for them it's not a surgery test,

0:05:09.088,0:05:12.963
it's an English test.

0:05:12.963,0:05:14.572
Let me bring it to you locally.

0:05:14.572,0:05:16.239
I work at the Cambridge Hospital.

0:05:16.239,0:05:19.522
It's the primary Harvard Medical School teaching facility.

0:05:19.522,0:05:24.838
We have more than 100 translators covering 63 languages,

0:05:24.838,0:05:30.022
and we spend millions of dollars just in our little hospital.

0:05:30.022,0:05:31.797
It's a big labor-intensive effort.

0:05:31.797,0:05:35.863
If you think about the worldwide burden

0:05:35.863,0:05:37.722
of trying to talk to your patients --

0:05:37.722,0:05:40.357
not just teaching surgeons, just trying to talk to your patients --

0:05:40.357,0:05:43.505
there aren't enough translators in the world.

0:05:43.505,0:05:49.471
We need to employ technology to assist us in this quest.

0:05:49.471,0:05:52.638
At our hospital we see everybody from Harvard professors

0:05:52.638,0:05:55.072
to people who just got here last week.

0:05:55.072,0:05:57.357
And you have no idea how hard it is

0:05:57.357,0:06:00.289
to talk to somebody or take care of somebody you can't talk to.

0:06:00.289,0:06:03.189
And there isn't always a translator available.

0:06:03.189,0:06:07.552
So we need tools.

0:06:07.552,0:06:11.230
We need a universal translator.

0:06:11.230,0:06:15.639
One of the things that I want to leave you with as you think about this talk

0:06:15.639,0:06:21.156
is that this talk is not just about us preaching to the world.

0:06:21.156,0:06:23.705
It's really about setting up a dialogue.

0:06:23.705,0:06:25.556
We have a lot to learn.

0:06:25.556,0:06:30.056
Here in the United States we spend more money per person

0:06:30.056,0:06:33.906
for outcomes that are not better than many countries in the world.

0:06:33.906,0:06:37.289
Maybe we have something to learn as well.

0:06:37.289,0:06:41.772
So I'm passionate about teaching these FLS skills all over the world.

0:06:41.772,0:06:45.156
This past year I've been in Latin America, I've been in China,

0:06:45.156,0:06:48.889
talking about the fundamentals of laparoscopic surgery.

0:06:48.889,0:06:52.421
And everywhere I go the barrier is:

0:06:52.421,0:06:57.055
"We want this, but we need it in our language."

0:06:57.055,0:06:59.972
So here's what we think we want to do:

0:06:59.972,0:07:02.389
Imagine giving a lecture

0:07:02.389,0:07:07.385
and being able to talk to people in their own native language simultaneously.

0:07:07.385,0:07:13.073
I want to talk to the people in Asia, Latin America, Africa, Europe

0:07:13.073,0:07:17.793
seamlessly, accurately

0:07:17.793,0:07:22.074
and in a cost-effective fashion using technology.

0:07:22.074,0:07:23.702
And it has to be bi-directional.

0:07:23.702,0:07:26.489
They have to be able to teach us something as well.

0:07:26.489,0:07:27.889
It's a big task.

0:07:27.889,0:07:30.955
So we looked for a universal translator; I thought there would be one out there.

0:07:30.955,0:07:34.906
Your webpage has translation, your cellphone has translation,

0:07:34.906,0:07:40.106
but nothing that's good enough to teach surgery.

0:07:40.106,0:07:42.572
Because we need a lexicon. What is a lexicon?

0:07:42.572,0:07:46.671
A lexicon is a body of words that describes a domain.

0:07:46.671,0:07:49.156
I need to have a health care lexicon.

0:07:49.156,0:07:52.757
And in that I need a surgery lexicon.

0:07:52.757,0:07:57.012
That's a tall order. We have to work at it.

0:07:57.012,0:07:58.805
So let me show you what we're doing.

0:07:58.805,0:08:01.106
This is research -- can't buy it.

0:08:01.106,0:08:05.589
We're working with the folks at IBM Research from the Accessibility Center

0:08:05.589,0:08:10.522
to string together technologies to work towards the universal translator.

0:08:10.522,0:08:12.656
It starts with a framework system

0:08:12.656,0:08:15.388
where when the surgeon delivers the lecture

0:08:15.388,0:08:18.555
using a framework of captioning technology,

0:08:18.555,0:08:22.971
we then add another technology to do video conferencing.

0:08:22.971,0:08:26.456
But we don't have the words yet, so we add a third technology.

0:08:26.456,0:08:29.106
And now we've got the words,

0:08:29.106,0:08:33.657
and we can apply the special sauce: the translation.

0:08:33.657,0:08:38.037
We get the words up in a window and then apply the magic.

0:08:38.037,0:08:40.321
We work with a fourth technology.

0:08:40.321,0:08:44.305
And we currently have access to eleven language pairs.

0:08:44.305,0:08:48.806
More to come as we think about trying to make the world a smaller place.

0:08:48.806,0:08:51.455
And I'd like to show you our prototype

0:08:51.455,0:08:56.288
of stringing all of these technologies that don't necessarily always talk to each other

0:08:56.288,0:08:59.955
to become something useful.

0:08:59.955,0:09:03.751
Narrator: Fundamentals of Laparoscopic Surgery.

0:09:03.751,0:09:07.364
Module five: manual skills practice.

0:09:07.364,0:09:14.647
Students may display captions in their native language.

0:09:14.647,0:09:16.396
Steven Schwaitzberg: If you're in Latin America,

0:09:16.396,0:09:18.281
you click the "I want it in Spanish" button

0:09:18.281,0:09:21.913
and out it comes in real time in Spanish.

0:09:21.913,0:09:24.747
But if you happen to be sitting in Beijing at the same time,

0:09:24.747,0:09:28.080
by using technology in a constructive fashion,

0:09:28.080,0:09:31.346
you could get it in Mandarin or you could get it in Russian --

0:09:31.346,0:09:36.812
on and on and on, simultaneously without the use of human translators.

0:09:36.812,0:09:39.012
But that's the lectures.

0:09:39.012,0:09:41.863
If you remember what I told you about FLS at the beginning,

0:09:41.863,0:09:44.880
it's knowledge and skills.

0:09:44.880,0:09:47.163
The difference in an operation

0:09:47.163,0:09:51.763
between doing something successfully and not

0:09:51.763,0:09:55.230
may be moving your hand this much.

0:09:55.230,0:09:57.530
So we're going to take it one step further;

0:09:57.530,0:09:59.663
we've brought my friend Allan back.

0:09:59.663,0:10:04.764
Allan Okrainec: Today we're going to practice suturing.

0:10:04.764,0:10:06.762
This is how you hold the needle.

0:10:06.762,0:10:12.259
Grab the needle at the tip.

0:10:12.259,0:10:14.717
It's important to be accurate.

0:10:14.717,0:10:18.550
Aim for the black dots.

0:10:18.550,0:10:21.999
Orient your loop this way.

0:10:21.999,0:10:26.584
Now go ahead and cut.

0:10:26.584,0:10:30.472
Very good Oscar. I'll see you next week.

0:10:30.472,0:10:33.338
SS: So that's what we're working on

0:10:33.338,0:10:36.321
in our quest for the universal translator.

0:10:36.321,0:10:38.405
We want it to be bi-directional.

0:10:38.405,0:10:42.606
We have a need to learn as well as to teach.

0:10:42.606,0:10:46.622
I can think of a million uses for a tool like this.

0:10:46.622,0:10:49.372
As we think about intersecting technologies --

0:10:49.372,0:10:51.772
everybody has a cell phone with a camera --

0:10:51.772,0:10:53.988
we could use this everywhere,

0:10:53.988,0:10:56.071
whether it be health care, patient care,

0:10:56.071,0:11:00.556
engineering, law, conferencing, translating videos.

0:11:00.556,0:11:02.956
This is a ubiquitous tool.

0:11:02.956,0:11:05.155
In order to break down our barriers,

0:11:05.155,0:11:06.922
we have to learn to talk to people,

0:11:06.922,0:11:10.922
to demand that people work on translation.

0:11:10.922,0:11:13.272
We need it for our everyday life,

0:11:13.272,0:11:16.106
in order to make the world a smaller place.

0:11:16.106,0:11:17.806
Thank you very much.

0:11:17.806,0:11:20.188
(Applause)