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So I want to talk to you about two things tonight.

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Number one:

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Teaching surgery and doing surgery

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is really hard.

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And second,

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that language is one of the most profound things

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that separate us all over the world.

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And in my little corner of the world,

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these two things are actually related,

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and I want to tell you how tonight.

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Now, nobody wants an operation.

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Who here has had surgery?

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Did you want it?

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Keep your hands up if you wanted an operation.

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Nobody wants an operation.

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In particular, nobody wants an operation

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with tools like these through large incisions

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that cause a lot of pain,

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that cause a lot of time out of work or out of school,

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that leave a big scar.

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But if you have to have an operation,

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what you really want is a minimally invasive operation.

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That's what I want to talk to you about tonight --

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how doing and teaching this type of surgery

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led us on a search

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for a better universal translator.

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Now, this type of surgery is hard,

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and it starts by putting people to sleep,

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putting carbon dioxide in their abdomen,

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blowing them up like a balloon,

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sticking one of these sharp pointy things into their abdomen --

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it's dangerous stuff --

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and taking instruments and watching it on a TV screen.

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So let's see what it looks like.

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So this is gallbladder surgery.

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We perform a million of these a year

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in the United States alone.

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This is the real thing. There's no blood.

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And you can see how focused the surgeons are,

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how much concentration it takes.

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You can see it in their faces.

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It's hard to teach, and it's not all that easy to learn.

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We do about five million of these in the United States

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and maybe 20 million of these worldwide.

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All right, you've all heard the term:

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"He's a born surgeon."

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Let me tell you, surgeons are not born.

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Surgeons are not made either.

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There are no little tanks where we're making surgeons.

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Surgeons are trained one step at a time.

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It starts with a foundation, basic skills.

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We build on that and we take people, hopefully, to the operating room

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where they learn to be an assistant.

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Then we teach them to be a surgeon in training.

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And when they do all of that for about five years,

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they get the coveted board certification.

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If you need surgery, you want to be operated on

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by a board-certified surgeon.

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You get your board certificate,

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and you can go out into practice.

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And eventually, if you're lucky, you achieve mastery.

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Now that foundation is so important

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that a number of us

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from the largest general surgery society in the United States, SAGES,

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started in the late 1990s a training program

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that would assure that every surgeon who practices minimally invasive surgery

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would have a strong foundation of knowledge and skills

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necessary to go on and do procedures.

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Now the science behind this is so potent

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that it became required by the American Board of Surgery

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in order for a young surgeon to become board certified.

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It's not a lecture, it's not a course,

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it's all of that plus a high-stakes assessment.

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It's hard.

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Now just this past year,

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one of our partners, the American College of Surgeons,

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teamed up with us to make an announcement

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that all surgeons should be FLS (Fundamentals of Laparoscopic Surgery)-certified

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before they do minimally invasive surgery.

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And are we talking about just people here in the U.S. and Canada?

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No, we just said all surgeons.

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So to lift this education and training worldwide

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is a very large task,

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something I'm very personally excited about as we travel around the world.

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SAGES does surgery all over the world, teaching and educating surgeons.

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So we have a problem, and one of the problems is distance.

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We can't travel everywhere.

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We need to make the world a smaller place.

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And I think that we can develop some tools to do so.

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And one of the tools I like personally is using video.

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So I was inspired by a friend.

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This is Allan Okrainec from Toronto.

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And he proved

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that you could actually teach people to do surgery

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using video conferencing.

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So here's Allan teaching an English-speaking surgeon in Africa

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these basic fundamental skills

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necessary to do minimally invasive surgery.

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Very inspiring.

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But for this examination, which is really hard,

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we have a problem.

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Even people who say they speak English,

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only 14 percent pass.

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Because for them it's not a surgery test,

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it's an English test.

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Let me bring it to you locally.

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I work at the Cambridge Hospital.

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It's the primary Harvard Medical School teaching facility.

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We have more than 100 translators covering 63 languages,

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and we spend millions of dollars just in our little hospital.

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It's a big labor-intensive effort.

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If you think about the worldwide burden

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of trying to talk to your patients --

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not just teaching surgeons, just trying to talk to your patients --

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there aren't enough translators in the world.

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We need to employ technology to assist us in this quest.

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At our hospital we see everybody from Harvard professors

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to people who just got here last week.

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And you have no idea how hard it is

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to talk to somebody or take care of somebody you can't talk to.

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And there isn't always a translator available.

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So we need tools.

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We need a universal translator.

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One of the things that I want to leave you with as you think about this talk

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is that this talk is not just about us preaching to the world.

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It's really about setting up a dialogue.

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We have a lot to learn.

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Here in the United States we spend more money per person

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for outcomes that are not better than many countries in the world.

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Maybe we have something to learn as well.

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So I'm passionate about teaching these FLS skills all over the world.

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This past year I've been in Latin America, I've been in China,

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talking about the fundamentals of laparoscopic surgery.

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And everywhere I go the barrier is:

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"We want this, but we need it in our language."

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So here's what we think we want to do:

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Imagine giving a lecture

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and being able to talk to people in their own native language simultaneously.

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I want to talk to the people in Asia, Latin America, Africa, Europe

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seamlessly, accurately

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and in a cost-effective fashion using technology.

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And it has to be bi-directional.

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They have to be able to teach us something as well.

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It's a big task.

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So we looked for a universal translator; I thought there would be one out there.

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Your webpage has translation, your cellphone has translation,

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but nothing that's good enough to teach surgery.

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Because we need a lexicon. What is a lexicon?

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A lexicon is a body of words that describes a domain.

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I need to have a health care lexicon.

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And in that I need a surgery lexicon.

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That's a tall order. We have to work at it.

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So let me show you what we're doing.

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This is research -- can't buy it.

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We're working with the folks at IBM Research from the Accessibility Center

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to string together technologies to work towards the universal translator.

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It starts with a framework system

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where when the surgeon delivers the lecture

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using a framework of captioning technology,

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we then add another technology to do video conferencing.

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But we don't have the words yet, so we add a third technology.

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And now we've got the words,

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and we can apply the special sauce: the translation.

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We get the words up in a window and then apply the magic.

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We work with a fourth technology.

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And we currently have access to eleven language pairs.

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More to come as we think about trying to make the world a smaller place.

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And I'd like to show you our prototype

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of stringing all of these technologies that don't necessarily always talk to each other

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to become something useful.

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Narrator: Fundamentals of Laparoscopic Surgery.

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Module five: manual skills practice.

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Students may display captions in their native language.

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Steven Schwaitzberg: If you're in Latin America,

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you click the "I want it in Spanish" button

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and out it comes in real time in Spanish.

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But if you happen to be sitting in Beijing at the same time,

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by using technology in a constructive fashion,

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you could get it in Mandarin or you could get it in Russian --

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on and on and on, simultaneously without the use of human translators.

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But that's the lectures.

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If you remember what I told you about FLS at the beginning,

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it's knowledge and skills.

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The difference in an operation

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between doing something successfully and not

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may be moving your hand this much.

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So we're going to take it one step further;

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we've brought my friend Allan back.

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Allan Okrainec: Today we're going to practice suturing.

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This is how you hold the needle.

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Grab the needle at the tip.

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It's important to be accurate.

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Aim for the black dots.

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Orient your loop this way.

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Now go ahead and cut.

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Very good Oscar. I'll see you next week.

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SS: So that's what we're working on

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in our quest for the universal translator.

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We want it to be bi-directional.

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We have a need to learn as well as to teach.

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I can think of a million uses for a tool like this.

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As we think about intersecting technologies --

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everybody has a cell phone with a camera --

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we could use this everywhere,

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whether it be health care, patient care,

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engineering, law, conferencing, translating videos.

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This is a ubiquitous tool.

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In order to break down our barriers,

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we have to learn to talk to people,

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to demand that people work on translation.

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We need it for our everyday life,

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in order to make the world a smaller place.

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Thank you very much.

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(Applause)