WEBVTT 00:00:00.226 --> 00:00:04.048 So I want to talk to you about two things tonight. 00:00:04.048 --> 00:00:06.332 Number one: 00:00:06.332 --> 00:00:09.648 Teaching surgery and doing surgery 00:00:09.648 --> 00:00:11.781 is really hard. 00:00:11.781 --> 00:00:13.365 And second, 00:00:13.365 --> 00:00:15.864 that language is one of the most profound things 00:00:15.864 --> 00:00:19.182 that separate us all over the world. 00:00:19.182 --> 00:00:21.099 And in my little corner of the world, 00:00:21.099 --> 00:00:23.049 these two things are actually related, 00:00:23.049 --> 00:00:24.981 and I want to tell you how tonight. NOTE Paragraph 00:00:24.981 --> 00:00:28.987 Now, nobody wants an operation. 00:00:28.987 --> 00:00:32.926 Who here has had surgery? 00:00:32.926 --> 00:00:34.249 Did you want it? 00:00:34.249 --> 00:00:35.807 Keep your hands up if you wanted an operation. 00:00:35.807 --> 00:00:37.899 Nobody wants an operation. 00:00:37.899 --> 00:00:40.961 In particular, nobody wants an operation 00:00:40.961 --> 00:00:46.449 with tools like these through large incisions 00:00:46.449 --> 00:00:48.424 that cause a lot of pain, 00:00:48.424 --> 00:00:51.956 that cause a lot of time out of work or out of school, 00:00:51.956 --> 00:00:54.207 that leave a big scar. 00:00:54.207 --> 00:00:57.109 But if you have to have an operation, 00:00:57.109 --> 00:00:59.640 what you really want is a minimally invasive operation. 00:00:59.640 --> 00:01:01.672 That's what I want to talk to you about tonight -- 00:01:01.672 --> 00:01:04.406 how doing and teaching this type of surgery 00:01:04.406 --> 00:01:05.873 led us on a search 00:01:05.873 --> 00:01:08.407 for a better universal translator. NOTE Paragraph 00:01:08.407 --> 00:01:10.750 Now, this type of surgery is hard, 00:01:10.750 --> 00:01:14.274 and it starts by putting people to sleep, 00:01:14.274 --> 00:01:16.391 putting carbon dioxide in their abdomen, 00:01:16.391 --> 00:01:18.207 blowing them up like a balloon, 00:01:18.207 --> 00:01:23.396 sticking one of these sharp pointy things into their abdomen -- 00:01:23.396 --> 00:01:26.943 it's dangerous stuff -- 00:01:26.943 --> 00:01:31.586 and taking instruments and watching it on a TV screen. 00:01:31.586 --> 00:01:33.553 So let's see what it looks like. 00:01:33.553 --> 00:01:35.319 So this is gallbladder surgery. 00:01:35.319 --> 00:01:37.351 We perform a million of these a year 00:01:37.351 --> 00:01:39.569 in the United States alone. 00:01:39.569 --> 00:01:41.619 This is the real thing. There's no blood. 00:01:41.619 --> 00:01:44.753 And you can see how focused the surgeons are, 00:01:44.753 --> 00:01:47.268 how much concentration it takes. 00:01:47.268 --> 00:01:48.952 You can see it in their faces. 00:01:48.952 --> 00:01:55.459 It's hard to teach, and it's not all that easy to learn. 00:01:55.459 --> 00:01:57.437 We do about five million of these in the United States 00:01:57.437 --> 00:02:02.724 and maybe 20 million of these worldwide. NOTE Paragraph 00:02:02.724 --> 00:02:05.557 All right, you've all heard the term: 00:02:05.557 --> 00:02:07.355 "He's a born surgeon." 00:02:07.355 --> 00:02:10.755 Let me tell you, surgeons are not born. 00:02:10.755 --> 00:02:14.492 Surgeons are not made either. 00:02:14.492 --> 00:02:17.832 There are no little tanks where we're making surgeons. 00:02:17.832 --> 00:02:22.287 Surgeons are trained one step at a time. 00:02:22.287 --> 00:02:26.139 It starts with a foundation, basic skills. 00:02:26.139 --> 00:02:30.904 We build on that and we take people, hopefully, to the operating room 00:02:30.904 --> 00:02:32.672 where they learn to be an assistant. 00:02:32.672 --> 00:02:34.806 Then we teach them to be a surgeon in training. 00:02:34.806 --> 00:02:37.738 And when they do all of that for about five years, 00:02:37.738 --> 00:02:41.104 they get the coveted board certification. 00:02:41.104 --> 00:02:43.738 If you need surgery, you want to be operated on 00:02:43.738 --> 00:02:46.222 by a board-certified surgeon. 00:02:46.222 --> 00:02:48.206 You get your board certificate, 00:02:48.206 --> 00:02:50.549 and you can go out into practice. 00:02:50.549 --> 00:02:54.816 And eventually, if you're lucky, you achieve mastery. NOTE Paragraph 00:02:54.816 --> 00:02:58.848 Now that foundation is so important 00:02:58.848 --> 00:03:00.749 that a number of us 00:03:00.749 --> 00:03:04.316 from the largest general surgery society in the United States, SAGES, 00:03:04.316 --> 00:03:07.182 started in the late 1990s a training program 00:03:07.182 --> 00:03:11.533 that would assure that every surgeon who practices minimally invasive surgery 00:03:11.533 --> 00:03:16.115 would have a strong foundation of knowledge and skills 00:03:16.115 --> 00:03:18.800 necessary to go on and do procedures. 00:03:18.800 --> 00:03:22.899 Now the science behind this is so potent 00:03:22.899 --> 00:03:26.683 that it became required by the American Board of Surgery 00:03:26.683 --> 00:03:30.233 in order for a young surgeon to become board certified. 00:03:30.233 --> 00:03:34.018 It's not a lecture, it's not a course, 00:03:34.018 --> 00:03:37.416 it's all of that plus a high-stakes assessment. 00:03:37.416 --> 00:03:39.650 It's hard. 00:03:39.650 --> 00:03:42.784 Now just this past year, 00:03:42.784 --> 00:03:45.850 one of our partners, the American College of Surgeons, 00:03:45.850 --> 00:03:47.712 teamed up with us to make an announcement 00:03:47.712 --> 00:03:51.182 that all surgeons should be FLS (Fundamentals of Laparoscopic Surgery)-certified 00:03:51.182 --> 00:03:54.266 before they do minimally invasive surgery. NOTE Paragraph 00:03:54.266 --> 00:03:57.710 And are we talking about just people here in the U.S. and Canada? 00:03:57.710 --> 00:03:59.683 No, we just said all surgeons. 00:03:59.683 --> 00:04:04.382 So to lift this education and training worldwide 00:04:04.382 --> 00:04:05.632 is a very large task, 00:04:05.632 --> 00:04:09.574 something I'm very personally excited about as we travel around the world. 00:04:09.574 --> 00:04:14.266 SAGES does surgery all over the world, teaching and educating surgeons. 00:04:14.266 --> 00:04:18.305 So we have a problem, and one of the problems is distance. 00:04:18.305 --> 00:04:20.538 We can't travel everywhere. 00:04:20.538 --> 00:04:23.356 We need to make the world a smaller place. 00:04:23.356 --> 00:04:26.039 And I think that we can develop some tools to do so. 00:04:26.039 --> 00:04:30.022 And one of the tools I like personally is using video. NOTE Paragraph 00:04:30.022 --> 00:04:32.472 So I was inspired by a friend. 00:04:32.472 --> 00:04:34.721 This is Allan Okrainec from Toronto. 00:04:34.721 --> 00:04:37.326 And he proved 00:04:37.326 --> 00:04:41.572 that you could actually teach people to do surgery 00:04:41.572 --> 00:04:44.272 using video conferencing. 00:04:44.272 --> 00:04:48.505 So here's Allan teaching an English-speaking surgeon in Africa 00:04:48.505 --> 00:04:51.055 these basic fundamental skills 00:04:51.055 --> 00:04:53.772 necessary to do minimally invasive surgery. 00:04:53.772 --> 00:04:55.372 Very inspiring. 00:04:55.372 --> 00:04:59.138 But for this examination, which is really hard, 00:04:59.138 --> 00:05:01.955 we have a problem. 00:05:01.955 --> 00:05:04.555 Even people who say they speak English, 00:05:04.555 --> 00:05:07.072 only 14 percent pass. 00:05:07.072 --> 00:05:09.088 Because for them it's not a surgery test, 00:05:09.088 --> 00:05:12.963 it's an English test. NOTE Paragraph 00:05:12.963 --> 00:05:14.572 Let me bring it to you locally. 00:05:14.572 --> 00:05:16.239 I work at the Cambridge Hospital. 00:05:16.239 --> 00:05:19.522 It's the primary Harvard Medical School teaching facility. 00:05:19.522 --> 00:05:24.838 We have more than 100 translators covering 63 languages, 00:05:24.838 --> 00:05:30.022 and we spend millions of dollars just in our little hospital. 00:05:30.022 --> 00:05:31.797 It's a big labor-intensive effort. 00:05:31.797 --> 00:05:35.863 If you think about the worldwide burden 00:05:35.863 --> 00:05:37.722 of trying to talk to your patients -- 00:05:37.722 --> 00:05:40.357 not just teaching surgeons, just trying to talk to your patients -- 00:05:40.357 --> 00:05:43.505 there aren't enough translators in the world. 00:05:43.505 --> 00:05:49.471 We need to employ technology to assist us in this quest. 00:05:49.471 --> 00:05:52.638 At our hospital we see everybody from Harvard professors 00:05:52.638 --> 00:05:55.072 to people who just got here last week. 00:05:55.072 --> 00:05:57.357 And you have no idea how hard it is 00:05:57.357 --> 00:06:00.289 to talk to somebody or take care of somebody you can't talk to. 00:06:00.289 --> 00:06:03.189 And there isn't always a translator available. NOTE Paragraph 00:06:03.189 --> 00:06:07.552 So we need tools. 00:06:07.552 --> 00:06:11.230 We need a universal translator. 00:06:11.230 --> 00:06:15.639 One of the things that I want to leave you with as you think about this talk 00:06:15.639 --> 00:06:21.156 is that this talk is not just about us preaching to the world. 00:06:21.156 --> 00:06:23.705 It's really about setting up a dialogue. 00:06:23.705 --> 00:06:25.556 We have a lot to learn. 00:06:25.556 --> 00:06:30.056 Here in the United States we spend more money per person 00:06:30.056 --> 00:06:33.906 for outcomes that are not better than many countries in the world. 00:06:33.906 --> 00:06:37.289 Maybe we have something to learn as well. NOTE Paragraph 00:06:37.289 --> 00:06:41.772 So I'm passionate about teaching these FLS skills all over the world. 00:06:41.772 --> 00:06:45.156 This past year I've been in Latin America, I've been in China, 00:06:45.156 --> 00:06:48.889 talking about the fundamentals of laparoscopic surgery. 00:06:48.889 --> 00:06:52.421 And everywhere I go the barrier is: 00:06:52.421 --> 00:06:57.055 "We want this, but we need it in our language." 00:06:57.055 --> 00:06:59.972 So here's what we think we want to do: 00:06:59.972 --> 00:07:02.389 Imagine giving a lecture 00:07:02.389 --> 00:07:07.385 and being able to talk to people in their own native language simultaneously. 00:07:07.385 --> 00:07:13.073 I want to talk to the people in Asia, Latin America, Africa, Europe 00:07:13.073 --> 00:07:17.793 seamlessly, accurately 00:07:17.793 --> 00:07:22.074 and in a cost-effective fashion using technology. 00:07:22.074 --> 00:07:23.702 And it has to be bi-directional. 00:07:23.702 --> 00:07:26.489 They have to be able to teach us something as well. NOTE Paragraph 00:07:26.489 --> 00:07:27.889 It's a big task. 00:07:27.889 --> 00:07:30.955 So we looked for a universal translator; I thought there would be one out there. 00:07:30.955 --> 00:07:34.906 Your webpage has translation, your cellphone has translation, 00:07:34.906 --> 00:07:40.106 but nothing that's good enough to teach surgery. 00:07:40.106 --> 00:07:42.572 Because we need a lexicon. What is a lexicon? 00:07:42.572 --> 00:07:46.671 A lexicon is a body of words that describes a domain. 00:07:46.671 --> 00:07:49.156 I need to have a health care lexicon. 00:07:49.156 --> 00:07:52.757 And in that I need a surgery lexicon. 00:07:52.757 --> 00:07:57.012 That's a tall order. We have to work at it. NOTE Paragraph 00:07:57.012 --> 00:07:58.805 So let me show you what we're doing. 00:07:58.805 --> 00:08:01.106 This is research -- can't buy it. 00:08:01.106 --> 00:08:05.589 We're working with the folks at IBM Research from the Accessibility Center 00:08:05.589 --> 00:08:10.522 to string together technologies to work towards the universal translator. 00:08:10.522 --> 00:08:12.656 It starts with a framework system 00:08:12.656 --> 00:08:15.388 where when the surgeon delivers the lecture 00:08:15.388 --> 00:08:18.555 using a framework of captioning technology, 00:08:18.555 --> 00:08:22.971 we then add another technology to do video conferencing. 00:08:22.971 --> 00:08:26.456 But we don't have the words yet, so we add a third technology. 00:08:26.456 --> 00:08:29.106 And now we've got the words, 00:08:29.106 --> 00:08:33.657 and we can apply the special sauce: the translation. 00:08:33.657 --> 00:08:38.037 We get the words up in a window and then apply the magic. 00:08:38.037 --> 00:08:40.321 We work with a fourth technology. 00:08:40.321 --> 00:08:44.305 And we currently have access to eleven language pairs. 00:08:44.305 --> 00:08:48.806 More to come as we think about trying to make the world a smaller place. 00:08:48.806 --> 00:08:51.455 And I'd like to show you our prototype 00:08:51.455 --> 00:08:56.288 of stringing all of these technologies that don't necessarily always talk to each other 00:08:56.288 --> 00:08:59.955 to become something useful. NOTE Paragraph 00:08:59.955 --> 00:09:03.751 Narrator: Fundamentals of Laparoscopic Surgery. 00:09:03.751 --> 00:09:07.364 Module five: manual skills practice. 00:09:07.364 --> 00:09:14.647 Students may display captions in their native language. NOTE Paragraph 00:09:14.647 --> 00:09:16.396 Steven Schwaitzberg: If you're in Latin America, 00:09:16.396 --> 00:09:18.281 you click the "I want it in Spanish" button 00:09:18.281 --> 00:09:21.913 and out it comes in real time in Spanish. 00:09:21.913 --> 00:09:24.747 But if you happen to be sitting in Beijing at the same time, 00:09:24.747 --> 00:09:28.080 by using technology in a constructive fashion, 00:09:28.080 --> 00:09:31.346 you could get it in Mandarin or you could get it in Russian -- 00:09:31.346 --> 00:09:36.812 on and on and on, simultaneously without the use of human translators. 00:09:36.812 --> 00:09:39.012 But that's the lectures. NOTE Paragraph 00:09:39.012 --> 00:09:41.863 If you remember what I told you about FLS at the beginning, 00:09:41.863 --> 00:09:44.880 it's knowledge and skills. 00:09:44.880 --> 00:09:47.163 The difference in an operation 00:09:47.163 --> 00:09:51.763 between doing something successfully and not 00:09:51.763 --> 00:09:55.230 may be moving your hand this much. 00:09:55.230 --> 00:09:57.530 So we're going to take it one step further; 00:09:57.530 --> 00:09:59.663 we've brought my friend Allan back. NOTE Paragraph 00:09:59.663 --> 00:10:04.764 Allan Okrainec: Today we're going to practice suturing. 00:10:04.764 --> 00:10:06.762 This is how you hold the needle. 00:10:06.762 --> 00:10:12.259 Grab the needle at the tip. 00:10:12.259 --> 00:10:14.717 It's important to be accurate. 00:10:14.717 --> 00:10:18.550 Aim for the black dots. 00:10:18.550 --> 00:10:21.999 Orient your loop this way. 00:10:21.999 --> 00:10:26.584 Now go ahead and cut. 00:10:26.584 --> 00:10:30.472 Very good Oscar. I'll see you next week. NOTE Paragraph 00:10:30.472 --> 00:10:33.338 SS: So that's what we're working on 00:10:33.338 --> 00:10:36.321 in our quest for the universal translator. 00:10:36.321 --> 00:10:38.405 We want it to be bi-directional. 00:10:38.405 --> 00:10:42.606 We have a need to learn as well as to teach. 00:10:42.606 --> 00:10:46.622 I can think of a million uses for a tool like this. 00:10:46.622 --> 00:10:49.372 As we think about intersecting technologies -- 00:10:49.372 --> 00:10:51.772 everybody has a cell phone with a camera -- 00:10:51.772 --> 00:10:53.988 we could use this everywhere, 00:10:53.988 --> 00:10:56.071 whether it be health care, patient care, 00:10:56.071 --> 00:11:00.556 engineering, law, conferencing, translating videos. 00:11:00.556 --> 00:11:02.956 This is a ubiquitous tool. NOTE Paragraph 00:11:02.956 --> 00:11:05.155 In order to break down our barriers, 00:11:05.155 --> 00:11:06.922 we have to learn to talk to people, 00:11:06.922 --> 00:11:10.922 to demand that people work on translation. 00:11:10.922 --> 00:11:13.272 We need it for our everyday life, 00:11:13.272 --> 00:11:16.106 in order to make the world a smaller place. 00:11:16.106 --> 00:11:17.806 Thank you very much. NOTE Paragraph 00:11:17.806 --> 00:11:20.188 (Applause)