0:00:00.879,0:00:02.855
The first time I stood[br]in the operating room

0:00:02.855,0:00:04.727
and watched a real surgery,

0:00:04.727,0:00:07.302
I had no idea what to expect.

0:00:07.302,0:00:09.277
I was a college student in engineering.

0:00:09.277,0:00:11.477
I thought it was going to be like on TV.

0:00:11.477,0:00:13.382
Ominous music playing in the background,

0:00:13.382,0:00:16.381
beads of sweat pouring down the surgeon's face.

0:00:16.381,0:00:18.541
But it wasn't like that at all.

0:00:18.541,0:00:20.140
There was music playing on this day,

0:00:20.140,0:00:22.862
I think it was Madonna's greatest hits. (Laughter)

0:00:22.862,0:00:24.989
And there was plenty of conversation,

0:00:24.989,0:00:26.989
not just about the patient's heart rate,

0:00:26.989,0:00:29.762
but about sports and weekend plans.

0:00:29.762,0:00:31.698
And since then, the more surgeries I watched,

0:00:31.698,0:00:33.525
the more I realized this is how it is.

0:00:33.525,0:00:36.278
In some weird way, it's just[br]another day at the office.

0:00:36.278,0:00:38.183
But every so often

0:00:38.183,0:00:40.281
the music gets turned down,

0:00:40.281,0:00:41.711
everyone stops talking,

0:00:41.711,0:00:44.695
and stares at exactly the same thing.

0:00:44.695,0:00:46.855
And that's when you know[br]that something absolutely critical

0:00:46.855,0:00:49.295
and dangerous is happening.

0:00:49.295,0:00:50.311
The first time I saw that

0:00:50.311,0:00:51.543
I was watching a type of surgery

0:00:51.543,0:00:53.832
called laparoscopic surgery

0:00:53.832,0:00:56.390
And for those of you who are unfamiliar,

0:00:56.390,0:00:58.783
laparoscopic surgery, instead of the large

0:00:58.783,0:01:01.277
open incision you might[br]be used to with surgery,

0:01:01.277,0:01:03.485
a laparoscopic surgery[br]is where the surgeon creates

0:01:03.485,0:01:06.502
these three or more small[br]incisions in the patient.

0:01:06.502,0:01:09.368
And then inserts these long, thin instruments

0:01:09.368,0:01:10.482
and a camera,

0:01:10.482,0:01:14.333
and actually does the procedure inside the patient.

0:01:14.333,0:01:16.925
This is great because there's[br]much less risk of infection,

0:01:16.925,0:01:20.085
much less pain, shorter recovery time.

0:01:20.085,0:01:22.677
But there is a trade-off,

0:01:22.677,0:01:24.461
because these incisions are created

0:01:24.461,0:01:26.959
with a long, pointed device

0:01:26.959,0:01:28.423
called a trocar.

0:01:28.423,0:01:30.617
And the way the surgeon uses this device

0:01:30.617,0:01:32.033
is that he takes it

0:01:32.033,0:01:34.000
and he presses it into the abdomen

0:01:34.000,0:01:37.255
until it punctures through.

0:01:37.255,0:01:40.327
And now the reason why [br]everyone in the operating room

0:01:40.327,0:01:42.974
was staring at that device on that day

0:01:42.974,0:01:46.205
was because he had to be absolutely careful

0:01:46.205,0:01:47.672
not to plunge it through

0:01:47.672,0:01:51.613
and puncture it into the organs [br]and blood vessels below.

0:01:51.613,0:01:53.452
But this problem should seem [br]pretty familiar to all of you

0:01:53.452,0:01:56.373
because I'm pretty sure [br]you've seen it somewhere else.

0:01:56.373,0:01:58.165
(Laughter)

0:01:58.165,0:01:59.821
Remember this?

0:01:59.821,0:02:03.937
(Applause)

0:02:03.937,0:02:05.813
You knew that at any second

0:02:05.813,0:02:07.693
that straw was going to plunge through,

0:02:07.693,0:02:09.278
and you didn't know if it was [br]going to go out the other side

0:02:09.278,0:02:10.581
and straight into your hand,

0:02:10.581,0:02:12.277
or if you were going to[br]get juice everywhere,

0:02:12.277,0:02:15.580
but you were terrified. Right?

0:02:15.580,0:02:17.556
Every single time you did this,

0:02:17.556,0:02:20.112
you experienced the same[br]fundamental physics

0:02:20.112,0:02:23.192
that I was watching in the operating room that day.

0:02:23.192,0:02:25.738
And it turns out it really is a problem.

0:02:25.738,0:02:28.530
In 2003, the FDA actually came out and said

0:02:28.530,0:02:31.907
that trocar incisions might [br]be the most dangerous step

0:02:31.907,0:02:33.923
in minimally invasive surgery.

0:02:33.923,0:02:36.363
Again in 2009, we see a paper that says

0:02:36.363,0:02:38.547
that trocars account for over half

0:02:38.547,0:02:42.234
of all major complications in laparoscopic surgery.

0:02:42.234,0:02:43.376
And, oh by the way,

0:02:43.376,0:02:46.970
this hasn't changed for 25 years.

0:02:46.970,0:02:48.500
So when I got to graduate school,

0:02:48.500,0:02:50.368
this is what I wanted to work on.

0:02:50.368,0:02:52.176
I was trying to explain to a friend of mine

0:02:52.176,0:02:54.291
what exactly I was spending my time doing,

0:02:54.291,0:02:56.107
and I said,

0:02:56.107,0:02:58.283
"It's like when you're drilling through a wall

0:02:58.283,0:03:01.483
to hang something in your apartment.

0:03:01.483,0:03:05.395
There's that moment when the drill[br]first punctures through the wall

0:03:05.395,0:03:09.047
and there's this plunge. Right?

0:03:11.389,0:03:13.430
And he looked at me and he said,

0:03:13.430,0:03:16.901
"You mean like when they drill [br]into people's brains?"

0:03:16.901,0:03:19.233
And I said, "Excuse me?" (Laughter)

0:03:19.233,0:03:22.281
And then I looked it up and they[br]do drill into people's brains.

0:03:22.281,0:03:24.345
A lot of neurosurgical procedures

0:03:24.345,0:03:28.127
actually start with a drill[br]incision through the skull.

0:03:28.127,0:03:29.912
And if the surgeon isn't careful,

0:03:29.912,0:03:33.496
he can plunge directly into the brain.

0:03:33.496,0:03:35.662
So this is the moment when I started thinking,

0:03:35.662,0:03:38.970
okay, cranial drilling, laparoscopic surgery,

0:03:38.970,0:03:40.634
why not other areas of medicine?

0:03:40.634,0:03:42.578
Because think about it, when was[br]the last time you went to the doctor

0:03:42.578,0:03:45.325
and you didn't get stuck with something? Right?

0:03:45.325,0:03:46.642
So the truth is

0:03:46.642,0:03:49.194
in medicine puncture is everywhere.

0:03:49.194,0:03:51.986
And here are just a couple[br]of the procedures that I've found

0:03:51.986,0:03:55.195
that involve some tissue puncture step.

0:03:55.195,0:03:57.274
And if we take just three of them —

0:03:57.274,0:04:01.370
laparoscopic surgery, [br]epidurals, and cranial drilling —

0:04:01.370,0:04:05.349
these procedures account [br]for over 30,000 complications

0:04:05.349,0:04:08.200
every year in this country alone.

0:04:08.200,0:04:10.915
I call that a problem worth solving.

0:04:10.915,0:04:13.240
So let's take a look at some of the devices

0:04:13.240,0:04:15.744
that are used in these types of procedures.

0:04:15.744,0:04:18.969
I mentioned epidurals. This is an epidural needle.

0:04:18.969,0:04:21.286
It's used to puncture through [br]the ligaments in the spine

0:04:21.286,0:04:23.725
and deliver anesthesia during childbirth.

0:04:23.725,0:04:26.278
Here's a set of bone marrow biopsy tools.

0:04:26.278,0:04:28.214
These are actually used[br]to burrow into the bone

0:04:28.214,0:04:31.714
and collect bone marrow[br]or sample bone lesions.

0:04:31.714,0:04:33.624
Here's a bayonette from the Civil War.

0:04:33.624,0:04:36.640
(Laughter)

0:04:36.640,0:04:39.233
If I had told you it was a [br]medical puncture device

0:04:39.233,0:04:41.449
you probably would have believed me.

0:04:41.449,0:04:43.642
Because what's the difference?

0:04:43.642,0:04:45.577
So, the more I did this research

0:04:45.577,0:04:47.161
the more I thought there has to be

0:04:47.161,0:04:49.190
a better way to do this.

0:04:49.190,0:04:51.609
And for me the key to this problem

0:04:51.609,0:04:54.020
is that all these different puncture devices

0:04:54.020,0:04:57.822
share a common set of fundamental physics.

0:04:57.822,0:04:59.374
So what are those physics?

0:04:59.374,0:05:00.966
Let's go back to drilling through a wall.

0:05:00.966,0:05:04.598
So you're applying a force [br]on a drill towards the wall.

0:05:04.598,0:05:07.942
And Newton says the wall[br]is going to apply force back,

0:05:07.942,0:05:09.207
equal and opposite.

0:05:09.207,0:05:11.170
So, as you drill through the wall,

0:05:11.170,0:05:13.100
those forces balance.

0:05:13.100,0:05:14.641
But then there's that moment

0:05:14.641,0:05:16.777
when the drill first punctures[br]through the other side of the wall,

0:05:16.777,0:05:19.633
and right at that moment [br]the wall can't push back anymore.

0:05:19.633,0:05:23.100
But your brain hasn't reacted [br]to that change in force.

0:05:23.100,0:05:24.161
So for that millisecond,

0:05:24.161,0:05:26.793
or however long it takes you [br]to react, you're still pushing,

0:05:26.793,0:05:29.337
and that unbalanced force [br]causes an acceleration,

0:05:29.337,0:05:32.449
and that is the plunge.

0:05:32.449,0:05:36.353
But what if right at the moment of puncture

0:05:36.353,0:05:37.977
you could pull that tip back,

0:05:37.977,0:05:40.990
actually oppose the forward acceleration?

0:05:40.990,0:05:43.127
That's what I set out to do.

0:05:43.127,0:05:44.447
So imagine you have a device

0:05:44.447,0:05:47.647
and it's got some kind of sharp tip [br]to cut through tissue.

0:05:47.647,0:05:50.860
What's the simplest way [br]you could pull that tip back?

0:05:50.860,0:05:52.671
I chose a spring.

0:05:52.671,0:05:55.255
So when you extend that spring, [br]you extend that tip out

0:05:55.255,0:05:57.470
so it's ready to puncture tissue,

0:05:57.470,0:05:58.910
the spring wants to pull the tip back.

0:05:58.910,0:06:00.663
How do you keep the tip in place

0:06:00.663,0:06:03.127
until the moment of puncture?

0:06:03.127,0:06:05.550
I used this mechanism.

0:06:05.550,0:06:08.111
When the tip of the device[br]is pressed against tissue,

0:06:08.111,0:06:11.951
the mechanism expands outwards [br]and wedges in place against the wall.

0:06:11.951,0:06:13.655
And the friction that's generated

0:06:13.655,0:06:16.847
locks it in place and prevents[br]the spring from retracting the tip.

0:06:16.847,0:06:18.734
But right at the moment of puncture,

0:06:18.734,0:06:20.798
the tissue can't push back[br]on the tip anymore.

0:06:20.798,0:06:23.980
So the mechanism unlocks [br]and the spring retracts the tip.

0:06:23.980,0:06:25.630
Let me show you that [br]happening in slow motion.

0:06:25.630,0:06:27.278
This is about 2,000 frames a second,

0:06:27.278,0:06:29.150
and I'd like you to notice the tip

0:06:29.150,0:06:31.778
that's right there on the bottom, [br]about to puncture through tissue.

0:06:31.778,0:06:34.839
And you'll see that [br]right at the moment of puncture,

0:06:36.590,0:06:39.892
right there, the mechanism unlocks [br]and retracts that tip back.

0:06:39.892,0:06:42.236
I want to show it to you again, a little closer up.

0:06:42.236,0:06:44.428
You're going to see the sharp bladed tip,

0:06:44.428,0:06:46.420
and right when it punctures [br]that rubber membrane

0:06:46.420,0:06:50.572
it's going to disappear[br]into this white blunt sheath.

0:06:50.572,0:06:52.437
Right there.

0:06:52.437,0:06:57.101
That happens within four 100ths [br]of a second after puncture.

0:06:57.101,0:07:00.901
And because this device is designed[br]to address the physics of puncture

0:07:00.901,0:07:02.733
and not the specifics of cranial drilling

0:07:02.733,0:07:04.940
or laparoscopic surgery, [br]or another procedure,

0:07:04.940,0:07:07.597
it's applicable across these[br]different medical disciplines

0:07:07.597,0:07:10.628
and across different length scales.

0:07:10.628,0:07:12.741
But it didn't always look like this.

0:07:12.741,0:07:14.926
This was my first prototype.

0:07:14.926,0:07:17.568
Yes, those are popsicle sticks,

0:07:17.568,0:07:19.470
and there's a rubber band at the top.

0:07:19.470,0:07:22.870
It took about 30 minutes to do this, but it worked.

0:07:22.870,0:07:24.566
And it proved to me that my idea worked

0:07:24.566,0:07:27.958
and it justified the next couple[br]years of work on this project.

0:07:27.958,0:07:29.766
I worked on this because

0:07:29.766,0:07:31.429
this problem really fascinated me.

0:07:31.429,0:07:33.558
It kept me up at night.

0:07:33.558,0:07:36.540
But I think it should fascinate you too,

0:07:36.540,0:07:38.442
because I said puncture is everywhere.

0:07:38.442,0:07:42.706
That means at some point [br]it's going to be your problem too.

0:07:42.706,0:07:44.266
That first day in the operating room

0:07:44.266,0:07:47.250
I never expected to find myself [br]on the other end of a trocar.

0:07:47.250,0:07:51.140
But last year, I got appendicitis [br]when I was visiting Greece.

0:07:51.140,0:07:52.970
So I was in the hospital in Athens,

0:07:52.970,0:07:54.458
and the surgeon was telling me

0:07:54.458,0:07:56.594
he was going to perform [br]a laparoscopic surgery.

0:07:56.594,0:07:59.346
He was going to remove my appendix [br]through these tiny incisions,

0:07:59.346,0:08:02.040
and he was talking about what[br]I could expect for the recovery,

0:08:02.040,0:08:03.482
and what was going to happen.

0:08:03.482,0:08:05.900
He said, "Do you have any questions?"[br]And I said, "Just one, doc.

0:08:05.900,0:08:09.374
What kind of trocar do you use?"

0:08:09.374,0:08:12.879
So my favorite quote [br]about laparoscopic surgery

0:08:12.879,0:08:15.525
comes from a Doctor H. C. Jacobaeus:

0:08:15.525,0:08:19.189
"It is puncture itself that causes risk."

0:08:19.189,0:08:22.325
That's my favorite quote [br]because H.C. Jacobaeus

0:08:22.325,0:08:26.365
was the first person to ever perform [br]laparoscopic surgery on humans,

0:08:26.365,0:08:29.797
and he wrote that in 1912.

0:08:29.797,0:08:35.581
This is a problem that's been injuring and[br]even killing people for over 100 years.

0:08:35.581,0:08:37.815
So it's easy to think that for[br]every major problem out there

0:08:37.815,0:08:41.751
there's some team of experts [br]working around the clock to solve it.

0:08:41.751,0:08:45.100
The truth is that's not always the case.

0:08:45.100,0:08:47.545
We have to be better at finding those problems

0:08:47.545,0:08:50.313
and finding ways to solve them.

0:08:50.313,0:08:53.569
So if you come across a problem that grabs you,

0:08:53.569,0:08:55.450
let it keep you up at night.

0:08:55.450,0:08:57.593
Allow yourself to be fascinated,

0:08:57.593,0:09:00.505
because there are so many lives to save.

0:09:00.505,0:09:03.904
(Applause)