Lifelike simulations that make real-life surgery safer
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0:01 - 0:05What if I told you
there was a new technology -
0:05 - 0:09that, when placed in the hands
of doctors and nurses, -
0:09 - 0:14improved outcomes for children
and adults, patients of all ages; -
0:15 - 0:18reduced pain and suffering,
-
0:18 - 0:21reduced time in the operating rooms,
-
0:21 - 0:24reduced anesthetic times,
-
0:24 - 0:26had the ultimate dose-response curve
-
0:26 - 0:28that the more you did it,
-
0:28 - 0:30the better it benefitted patients?
-
0:31 - 0:34Here's a kicker: it has no side effects,
-
0:34 - 0:37and it's available no matter
where care is delivered. -
0:38 - 0:41I can tell you as an ICU doctor
at Boston Children's Hospital, -
0:41 - 0:43this would be a game changer for me.
-
0:43 - 0:48That technology is lifelike rehearsal.
-
0:49 - 0:53This lifelike rehearsal is being delivered
through medical simulation. -
0:54 - 0:58I thought I would start with a case,
-
0:58 - 1:01just to really describe
the challenge ahead, -
1:01 - 1:04and why this technology is not just
going to improve health care -
1:04 - 1:07but why it's critical to health care.
-
1:08 - 1:10This is a child that's born, young girl.
-
1:10 - 1:12"Day of life zero," we call it,
-
1:12 - 1:15the first day of life,
just born into the world. -
1:15 - 1:16And just as she's being born,
-
1:16 - 1:18we notice very quickly
that she is deteriorating. -
1:19 - 1:22Her heart rate is going up,
her blood pressure is going down, -
1:22 - 1:24she's breathing very, very fast.
-
1:24 - 1:29And the reason for this
is displayed in this chest X-ray. -
1:29 - 1:31That's called a babygram,
-
1:31 - 1:34a full X-ray of a child's body,
a little infant's body. -
1:34 - 1:36As you look on the top side of this,
-
1:36 - 1:38that's where the heart and lungs
are supposed to be. -
1:38 - 1:41As you look at the bottom end,
that's where the abdomen is, -
1:41 - 1:43and that's where the intestines
are supposed to be. -
1:44 - 1:46And you can see how
there's sort of that translucent area -
1:46 - 1:49that made its way up into the right side
of this child's chest. -
1:49 - 1:53And those are the intestines --
in the wrong place. -
1:54 - 1:56As a result, they're pushing on the lungs
-
1:56 - 1:59and making it very difficult
for this poor baby to breathe. -
1:59 - 2:01The fix for this problem
-
2:01 - 2:03is to take this child immediately
to the operating room, -
2:03 - 2:06bring those intestines
back into the abdomen, -
2:06 - 2:07let the lungs expand
-
2:07 - 2:09and allow this child to breathe again.
-
2:09 - 2:12But before she can go
to the operating room, -
2:12 - 2:15she must get whisked away
to the ICU, where I work. -
2:15 - 2:17I work with surgical teams.
-
2:17 - 2:18We gather around her,
-
2:18 - 2:22and we place this child
on heart-lung bypass. -
2:24 - 2:25We put her to sleep,
-
2:25 - 2:28we make a tiny
little incision in the neck, -
2:28 - 2:31we place catheters into the major
vessels of the neck -- -
2:31 - 2:35and I can tell you that these vessels
are about the size of a pen, -
2:35 - 2:37the tip of a pen --
-
2:37 - 2:39and then we have blood
drawn from the body, -
2:39 - 2:41we bring it through a machine,
it gets oxygenated, -
2:41 - 2:43and it goes back into the body.
-
2:43 - 2:45We save her life,
-
2:45 - 2:47and get her safely to the operating room.
-
2:49 - 2:50Here's the problem:
-
2:52 - 2:53these disorders --
-
2:53 - 2:57what is known is congenital
diaphragmatic hernia -- -
2:57 - 3:00this hole in the diaphragm that has
allowed these intestines to sneak up -- -
3:00 - 3:02these disorders are rare.
-
3:03 - 3:07Even in the best hands in the world,
-
3:07 - 3:11there is still a challenge
to get the volume -- -
3:11 - 3:13the natural volume of these patients --
-
3:13 - 3:15in order to get our expertise
curve at 100 percent. -
3:15 - 3:17They just don't present that often.
-
3:19 - 3:22So how do you make the rare common?
-
3:24 - 3:25Here's the other problem:
-
3:26 - 3:31in the health care system
that I trained for over 20 years, -
3:31 - 3:32what currently exists,
-
3:32 - 3:35the model of training is called
the apprenticeship model. -
3:35 - 3:37It's been around for centuries.
-
3:37 - 3:41It's based on this idea that you see
a surgery maybe once, -
3:41 - 3:43maybe several times,
-
3:43 - 3:45you then go do that surgery,
-
3:45 - 3:49and then ultimately you teach
that surgery to the next generation. -
3:50 - 3:53And implicit in this model --
-
3:53 - 3:55I don't need to tell you this --
-
3:55 - 4:00is that we practice on the very patients
that we are delivering care to. -
4:02 - 4:04That's a problem.
-
4:07 - 4:09I think there's a better approach.
-
4:09 - 4:14Medicine may very well be the last
high-stakes industry -
4:14 - 4:17that does not practice prior to game time.
-
4:18 - 4:22I want to describe to you a better
approach through medical simulation. -
4:24 - 4:28Well, the first thing we did is we went
to other high-stakes industries -
4:28 - 4:31that had been using this type
of methodology for decades. -
4:31 - 4:32This is nuclear power.
-
4:32 - 4:36Nuclear power runs scenarios
on a regular basis -
4:36 - 4:40in order to practice
what they hope will never occur. -
4:40 - 4:44And as we're all very familiar,
the airline industry -- -
4:44 - 4:47we all get on planes now,
comforted by the idea -
4:47 - 4:53that pilots and crews have trained
on simulators much like these, -
4:53 - 4:56training on scenarios
that we hope will never occur, -
4:56 - 4:58but we know if they did,
-
4:58 - 5:00they would be prepared for the worst.
-
5:01 - 5:05In fact, the airline industry has gone
as far as to create fuselages -
5:05 - 5:07of simulation environments,
-
5:07 - 5:10because of the importance
of the team coming together. -
5:11 - 5:13This is an evacuation drill simulator.
-
5:14 - 5:18So again, if that ever were to happen,
these rare, rare events, -
5:18 - 5:21they're ready to act
on the drop of a dime. -
5:23 - 5:28I guess the most compelling for me
in some ways is the sports industry -- -
5:28 - 5:30arguably high stakes.
-
5:30 - 5:34You think about a baseball team:
baseball players practice. -
5:34 - 5:36I think it's a beautiful example
of progressive training. -
5:36 - 5:39The first thing they do
is go out to spring training. -
5:39 - 5:42They go to a spring training camp,
-
5:42 - 5:44perhaps a simulator in baseball.
-
5:45 - 5:48They're not on the real field,
but they're on a simulated field, -
5:48 - 5:50and they're playing in the pregame season.
-
5:50 - 5:53Then they make their way to the field
during the season games, -
5:53 - 5:56and what's the first thing they do
before they start the game? -
5:56 - 6:01They go into the batting cage
and do batting practice for hours, -
6:01 - 6:04having different types of pitches
being thrown at them, -
6:04 - 6:08hitting ball after ball
as they limber their muscles, -
6:09 - 6:10getting ready for the game itself.
-
6:11 - 6:13And here's the most
phenomenal part of this, -
6:15 - 6:17and for all of you who watch
any sport event, -
6:17 - 6:19you will see this phenomenon happen.
-
6:20 - 6:23The batter gets into the batter's box,
-
6:23 - 6:25the pitcher gets ready to pitch.
-
6:25 - 6:28Right before the pitch is thrown,
-
6:28 - 6:29what does that batter do?
-
6:29 - 6:31The batter steps out of the box
-
6:32 - 6:34and takes a practice swing.
-
6:34 - 6:36He wouldn't do it any other way.
-
6:37 - 6:41I want to talk to you about how
we're building practice swings like this -
6:41 - 6:42in medicine.
-
6:42 - 6:46We are building batting cages
for the patients that we care about -
6:46 - 6:47at Boston Children's.
-
6:47 - 6:50I want to use this case
that we recently built. -
6:50 - 6:55It's the case of a four-year-old
who had a progressively enlarging head, -
6:55 - 6:56and as a result,
-
6:56 - 6:59had loss of developmental milestones,
neurologic milestones, -
6:59 - 7:02and the reason for this problem is here --
-
7:02 - 7:04it's called hydrocephalus.
-
7:05 - 7:07So, a quick study in neurosurgery.
-
7:07 - 7:09There's the brain,
-
7:09 - 7:11and you can see the cranium
surrounding the brain. -
7:12 - 7:15What surrounds the brain,
between the brain and cranium, -
7:15 - 7:18is something called
cerebrospinal fluid or fluid, -
7:18 - 7:20which acts as a shock absorber.
-
7:21 - 7:22In your heads right now,
-
7:22 - 7:25there is cerebrospinal fluid
just bathing your brains -
7:25 - 7:27and making its way around.
-
7:27 - 7:30It's produced in one area
and flows through, -
7:30 - 7:31and then is re-exchanged.
-
7:31 - 7:34And this beautiful flow pattern
occurs for all of us. -
7:34 - 7:36But unfortunately in some children,
-
7:37 - 7:39there's a blockage of this flow pattern,
-
7:39 - 7:41much like a traffic jam.
-
7:41 - 7:44As a result, the fluid accumulates,
-
7:44 - 7:46and the brain is pushed aside.
-
7:47 - 7:49It has difficulty growing.
-
7:50 - 7:53As a result, the child loses
neurologic milestones. -
7:53 - 7:56This is a devastating disease in children.
-
7:57 - 8:00The cure for this is surgery.
-
8:00 - 8:03The traditional surgery is to take
a bit of the cranium off, -
8:03 - 8:04a bit of the skull,
-
8:04 - 8:07drain this fluid out,
stick a drain in place, -
8:07 - 8:10and then eventually bring
this drain internal to the body. -
8:10 - 8:11Big operation.
-
8:12 - 8:16But some great news is that advances
in neurosurgical care -
8:16 - 8:20have allowed us to develop
minimally invasive approaches -
8:20 - 8:21to this surgery.
-
8:21 - 8:26Through a small pinhole,
a camera can be inserted, -
8:27 - 8:30led into the deep brain structure,
-
8:30 - 8:34and cause a little hole in a membrane
that allows all that fluid to drain, -
8:34 - 8:36much like it would in a sink.
-
8:36 - 8:39All of a sudden, the brain
is no longer under pressure, -
8:39 - 8:40can re-expand
-
8:40 - 8:43and we cure the child
through a single-hole incision. -
8:45 - 8:46But here's the problem:
-
8:46 - 8:48hydrocephalus is relatively rare.
-
8:49 - 8:51And there are no good training methods
-
8:51 - 8:55to get really good at getting
this scope to the right place. -
8:55 - 8:59But surgeons have been quite creative
about this, even our own. -
8:59 - 9:01And they've come up with training models.
-
9:01 - 9:03Here's the current training model.
-
9:03 - 9:05(Laughter)
-
9:05 - 9:07I kid you not.
-
9:07 - 9:09This is a red pepper,
not made in Hollywood; -
9:09 - 9:11it's real red pepper.
-
9:11 - 9:14And what surgeons do is they stick
a scope into the pepper, -
9:14 - 9:17and they do what is called a "seedectomy."
-
9:17 - 9:19(Laughter)
-
9:19 - 9:25They use this scope to remove seeds
using a little tweezer. -
9:26 - 9:28And that is a way to get under their belts
-
9:28 - 9:31the rudimentary components
of doing this surgery. -
9:32 - 9:35Then they head right into
the apprenticeship model, -
9:35 - 9:37seeing many of them
as they present themselves, -
9:37 - 9:40then doing it, and then teaching it --
-
9:40 - 9:42waiting for these patients to arrive.
-
9:43 - 9:44We can do a lot better.
-
9:44 - 9:49We are manufacturing
reproductions of children -
9:49 - 9:53in order for surgeons and surgical
teams to rehearse -
9:53 - 9:55in the most relevant possible ways.
-
9:55 - 9:57Let me show you this.
-
9:57 - 9:59Here's my team
-
9:59 - 10:03in what's called the SIM Engineering
Division of the Simulator Program. -
10:03 - 10:06This is an amazing team of individuals.
-
10:06 - 10:08They are mechanical engineers;
-
10:08 - 10:11you're seeing here, illustrators.
-
10:11 - 10:16They take primary data
from CT scans and MRIs, -
10:16 - 10:19translate it into digital information,
-
10:19 - 10:20animate it,
-
10:20 - 10:25put it together into the components
of the child itself, -
10:25 - 10:29surface-scan elements of the child
that have been casted as needed, -
10:29 - 10:31depending on the surgery itself,
-
10:31 - 10:35and then take this digital data
and be able to output it -
10:35 - 10:39on state-of-the-art,
three-dimensional printing devices -
10:39 - 10:41that allow us to print the components
-
10:41 - 10:47exactly to the micron detail of what
the child's anatomy will look like. -
10:47 - 10:48You can see here,
-
10:48 - 10:51the skull of this child being printed
-
10:51 - 10:53in the hours before
we performed this surgery. -
10:55 - 10:57But we could not do this work
-
10:57 - 11:02without our dear friends on the West Coast
in Hollywood, California. -
11:03 - 11:06These are individuals
that are incredibly talented -
11:06 - 11:08at being able to recreate reality.
-
11:08 - 11:13It was not a long leap for us.
-
11:13 - 11:15The more we got into this field,
-
11:15 - 11:18the more it became clear to us
that we are doing cinematography. -
11:19 - 11:21We're doing filmmaking,
-
11:21 - 11:23it's just that the actors are not actors.
-
11:24 - 11:26They're real doctors and nurses.
-
11:27 - 11:31So these are some photos
of our dear friends at Fractured FX -
11:31 - 11:32in Hollywood California,
-
11:32 - 11:36an Emmy-Award-winning
special effects firm. -
11:36 - 11:39This is Justin Raleigh and his group --
-
11:39 - 11:41this is not one of our patients --
-
11:41 - 11:42(Laughter)
-
11:42 - 11:45but kind of the exquisite work
that these individuals do. -
11:45 - 11:49We have now collaborated
and fused our experience, -
11:49 - 11:51bringing their group
to Boston Children's Hospital, -
11:51 - 11:54sending our group
out to Hollywood, California -
11:54 - 11:55and exchanging around this
-
11:55 - 11:58to be able to develop
these type of simulators. -
11:58 - 12:03What I'm about to show you
is a reproduction of this child. -
12:07 - 12:12You'll notice here that every hair
on the child's head is reproduced. -
12:12 - 12:16And in fact, this is also
that reproduced child -- -
12:16 - 12:19and I apologize for any queasy stomachs,
-
12:19 - 12:22but that is a reproduction and simulation
-
12:22 - 12:24of the child they're about to operate on.
-
12:26 - 12:29Here's that membrane we had talked about,
-
12:29 - 12:31the inside of this child's brain.
-
12:32 - 12:37What you're going to be seeing here
is, on one side, the actual patient, -
12:37 - 12:39and on the other side, the simulator.
-
12:39 - 12:43As I mentioned, a scope, a little camera,
needs to make its way down, -
12:43 - 12:45and you're seeing that here.
-
12:45 - 12:47It needs to make a small hole
in this membrane -
12:47 - 12:50and allow this fluid to seep out.
-
12:51 - 12:56I won't do a quiz show to see
who thinks which side is which, -
12:57 - 12:59but on the right is the simulator.
-
13:01 - 13:04So surgeons can now produce
training opportunities, -
13:05 - 13:08do these surgeries
as many times as they want, -
13:08 - 13:10to their heart's content,
until they feel comfortable. -
13:10 - 13:14And then, and only then,
bring the child into the operating room. -
13:14 - 13:15But we don't stop here.
-
13:15 - 13:20We know that a key step to this
is not just the skill itself, -
13:20 - 13:24but combining that skill with a team
who's going to deliver that care. -
13:24 - 13:26Now we turn to Formula One.
-
13:27 - 13:30And here is an example
of a technician putting on a tire -
13:30 - 13:34and doing that time and time
again on this car. -
13:34 - 13:37But that is very quickly
going to be incorporated -
13:37 - 13:38within team-training experiences,
-
13:38 - 13:43now as a full team orchestrating
the exchange of tires -
13:43 - 13:46and getting this car back on the speedway.
-
13:46 - 13:50We've done that step in health care,
-
13:50 - 13:54so now what you're about to see
is a simulated operation. -
13:55 - 13:57We've taken the simulator
I just described to you, -
13:57 - 14:01we've brought it into the operating room
at Boston Children's Hospital, -
14:01 - 14:04and these individuals --
these native teams, operative teams -- -
14:04 - 14:08are doing the surgery before the surgery.
-
14:08 - 14:10Operate twice;
-
14:10 - 14:11cut once.
-
14:11 - 14:13Let me show that to you.
-
14:13 - 14:17(Video) Surgical team member 1:
You want the head down or head up? -
14:17 - 14:18STM 2: Can you lower it down to 10?
-
14:18 - 14:21STM 3: And then lower
the whole table down a little bit? -
14:21 - 14:22STM 4: Table coming down.
-
14:25 - 14:28STM 3: All right, this
is behaving like a vessel. -
14:28 - 14:30Could we have the scissors back, please?
-
14:30 - 14:33STM 5: I'm taking my gloves,
8 to 8 1/2, all right? I'll be right in. -
14:33 - 14:35STM 6: Great! Thank you.
-
14:36 - 14:38Peter Weinstock: It's really amazing.
-
14:38 - 14:40The second step to this,
which is critical, -
14:40 - 14:43is we take these teams out
immediately and debrief them. -
14:43 - 14:45We use the same technologies
-
14:45 - 14:50that are used in Lean
and Six Sigma in the military, -
14:50 - 14:53and we bring them out
and talk about what went right, -
14:53 - 14:54but more importantly,
-
14:54 - 14:57we talk about what didn't go well,
-
14:57 - 14:59and how we're going to fix it.
-
14:59 - 15:02Then we bring them right back in
and do it again. -
15:02 - 15:07Deliberative batting practice
in the moments when it matters most. -
15:08 - 15:10Let's go back to this case now.
-
15:11 - 15:12Same child,
-
15:12 - 15:15but now let me describe
how we care for this child -
15:15 - 15:16at Boston Children's Hospital.
-
15:16 - 15:19This child was born
at three o'clock in the morning. -
15:19 - 15:21At two o'clock in the morning,
-
15:21 - 15:23we assembled the team,
-
15:23 - 15:25and took the reproduced anatomy
-
15:25 - 15:29that we would gain
out of scans and images, -
15:29 - 15:31and brought that team
to the virtual bedside, -
15:31 - 15:33to a simulated bedside --
-
15:33 - 15:37the same team that's going to operate
on this child in the hours ahead -- -
15:37 - 15:39and we have them do the procedure.
-
15:40 - 15:41Let me show you a moment of this.
-
15:42 - 15:44This is not a real incision.
-
15:45 - 15:48And the baby has not yet been born.
-
15:49 - 15:50Imagine this.
-
15:52 - 15:56So now the conversations
that I have with families -
15:56 - 15:59in the intensive care unit
at Boston Children's Hospital -
15:59 - 16:00are totally different.
-
16:01 - 16:02Imagine this conversation:
-
16:04 - 16:08"Not only do we take care of this disorder
frequently in our ICU, -
16:09 - 16:11and not only have we done surgeries
-
16:11 - 16:13like the surgery we're going
to do on your child, -
16:13 - 16:17but we have done your child's surgery.
-
16:18 - 16:20And we did it two hours ago.
-
16:21 - 16:23And we did it 10 times.
-
16:23 - 16:27And now we're prepared to take them
back to the operating room." -
16:29 - 16:31So a new technology in health care:
-
16:32 - 16:35lifelike rehearsal.
-
16:35 - 16:39Practicing prior to game time.
-
16:40 - 16:41Thank you.
-
16:41 - 16:46(Applause)
- Title:
- Lifelike simulations that make real-life surgery safer
- Speaker:
- Peter Weinstock
- Description:
-
Critical care doctor Peter Weinstock shows how surgical teams are using a blend of Hollywood special effects and 3D printing to create amazingly lifelike reproductions of real patients -- so they can practice risky surgeries ahead of time. Think: "Operate twice, cut once." Glimpse the future of surgery in this forward-thinking talk.
- Video Language:
- English
- Team:
- closed TED
- Project:
- TEDTalks
- Duration:
- 16:58
Brian Greene edited English subtitles for Lifelike simulations that make real-life surgery safer | ||
Brian Greene edited English subtitles for Lifelike simulations that make real-life surgery safer | ||
Camille Martínez accepted English subtitles for Lifelike simulations that make real-life surgery safer | ||
Camille Martínez edited English subtitles for Lifelike simulations that make real-life surgery safer | ||
Camille Martínez edited English subtitles for Lifelike simulations that make real-life surgery safer | ||
Leslie Gauthier edited English subtitles for Lifelike simulations that make real-life surgery safer | ||
Leslie Gauthier edited English subtitles for Lifelike simulations that make real-life surgery safer | ||
Leslie Gauthier edited English subtitles for Lifelike simulations that make real-life surgery safer |