Danny Goel Presents PrecisionOS at LSI USA '23

Transcription

Danny Goel  0:05  

Thank everybody. Just a shout out to Scott Pantel for this opportunity, my first time at LSI. So I get to spend the next nine minutes really changing your perspective on I think where there's a really big opportunity for value. And what I'm about to show you is a software that's been developed by industry leading team of creatives and surgeons. So like most cases, in medicine, we always start with a case. So here's an example of a 12 year old boy who had surgery with a mouth position implant, so many of you in the audience may be parents I am. So there's two things that are wrong with this. Number one is it's the wrong implant. Number two, there's three things, the wrong implant the wrong position, and, of course, the wrong location, or the wrong geometry. So when you look at the outcome of this potential outcome for this young boy, he may go on to have chronic pain, which is a cost driver, he may develop a malignancy, he may have disability, so he's not a tax forming citizen, he may go on and develop opioid use and abuse and may need revision surgery and think about the imaging that was taken during that case and the safety that impacts not just the surgeon, the patient, but the team surrounding that. And I'm going to come back to this case shortly. So when we look at this problem, we know that complications are a major driver for cost around the world. So complications, there's about 50 million surgical complication that happen every year, which costs the system a trillion dollars. And the number one reason with fewer complications to occur is lack of experience from clinicians. And when we look at what's happening in the ecosystem, trainees from residency, are getting less and less practice as they go through residency, we're a recent published paper from general surgery, suggested that only 1% of all cases are being done independently by trainees. That means that they're graduating without experience. So we figure this to be a really, really important problem to solve, and how do we solve it. So my background, I come from an entrepreneurial background, I'm also an orthopedic surgeon, and the CEO and one of the founders, and I've got together with two industry experts in software development, Colin, who's a rendering engineer, and I'll show you some of the work that he's done. And Rob, who's our creative officer. And we have leadership on the enterprise business side from Laura, and John, who comes from Kodak. And they come from a really good diverse background from some of the biggest companies in the world, as you can see from the team. And surrounding that we've built a team of creatives who have come from the organizations as listed now around that we've created a massive advisory board. And why is this important, because we have the ears, eyes and the hearts of the clinicians who see this as a massive problem in the industry. We've got the world's expert in simulation, we've got the world's expert in instructional design to make sure that what we're building doesn't overload the user, which is important for retention and skill when they go to the operating room. Now, the thing that we all have in common as we understand how people learn, and this is going to become apparent in the next video, I show you the science of learning is very clear surgery is not one step, two step, how do you get to outcomes that are improved is error is what drives experience, we need people to make mistakes. So when physicians make mistake, whether the surgical or the non surgical space, we learn from that, and that tribes judgment, judgment is what enhances the decision making. And when you're in the operating room or on the ward or in a procedural room, that decision making is what improves outcomes. So what we've created here, and this is example of the software that we developed, is this is an example of a procedure we've built for a medical device company, because think of the stakeholders in this space. So this is a procedure known as hip arthroscopy. And what I'm doing here is I'm using fluro, as liberally as I want to because there's no radiation, I'm putting the patient's limb under tension, because this is something that I have to do during surgery, which is also a common cause of complications. But I'm also driving a deeper understanding of the problem. So when I go to the OR the actual OR, I actually have a better sense of what I'm doing when I actually get there. So you can see I'm moving the limb into position. Now I'm not a hip surgeon, but I'm going to pretend to be in this virtual space, I'm going to try to identify that lesion with this needle. So I'm making the mistakes as I need. And you can see me targeting that green lesion, I'm intentionally making mistakes. And what I can do is I can pull the bone out of the body and learn from that immediately. And you can see where I've made error and each of those errors could be a risk to the patient and I can do them in this safe environment. Now this procedure to give you some perspective is done in young people. So hockey players, goalies. Ballerinas figure skaters. The most common cause of revision surgery in this case is incomplete resection of that little bump you can see on The upper left. So what I'm going to do is I'm going to take my virtual Burr, and I'm going to remove that lesion. And I'm going to do that liberally. But then what I'm going to do is I'm going to take the bone out of the body and drive a deeper level of understanding from 2d images to 3d images, which I can do in virtual reality, and drive a deeper level of understanding. And I'll get back to it when I show that case. And of course, collaboration is important, because we can do this with anybody around the world. And you can see I've actually failed quite miserably. I've resected very a high number of or high amount of healthy bone, and I did an incomplete resection of that actual lesion. Science speaks volumes in healthcare, we know that if you're going to create something, then you expect it to be adopted, you need evidence to prove that it works. And given the interest of time, I won't go into much of this, but I'll show that all the modalities we use to transfer skill in the OR such as reading videos, simulators, and cadavers, each one of those has been studied independently by leading institutions around the world. And it differs to on the left textbooks in Vienna, you can imagine VR would be much more impactful. There's a study combining of HSS, Lenox Hill and Cedars Sinai showing that simulators there might be some questions there. These are standalone simulators, how do they fare up to doing something in VR. And then of course, the study that's just came out of Columbia showing when they took surgeons and had half of them go into VR, and the other half practice on cadavers, and then examine them on cadavers, they found that the outcomes are equal. So there's something here to be said, More research is to follow. And of course, all of these have been award winning studies, comparing our software to these modalities and education. And again, we've published extensively on this. So again, something that's important healthcare is you have to create value, and then prove that it works with hardcore evidence. Now, the opportunity is very clear that if you're going to create high value experiential learning, the experience in VR has to be authentic, but impactful, it has to be interactive, but meaningful. And of course, that's going to drive collaboration without borders. So if I want to be an expert in Boston, or New York, I should be able to teach somebody in a different part of the world without having to fly there. Now, as mentioned, the stakeholders here are very clear. Medical Device institutions spend the most amount of money training people on the safe use of their products. So how do we help them? And why now, so we're safely past COVID, we're in this new normal. Since then, we have customers with 60 institutions. We're working with multiple and partnered with exclusive partnerships with multiple global professional societies. And of course, we're working with leading medical device companies. Why because they spend so much money on flying physicians to teach them how to use their medical devices safely. As an orthopedic surgeon, we naturally started in orthopedics, we've since expanded into general surgery, diagnostic imaging, cardiac and trauma given the need and the problem that is in front of us. And just to give you some perspective, in the last two years, our software has been used in 57 countries and 800 cities around the world. How do you get that type of scale when certain places don't have access to simulators or cadavers. And the other exciting pieces, we just completed our first project with the Canadian Space Agency. So not only are we trying to leverage this in remote areas of the Earth, we're hoping to do this in space moving forward. So back to that young boy. So what happened to him. So he was transferred to another hospital. And at that hospital was a keen surgical trainee, who actually practiced in our system, this exact case, because we happen to have a model of this exact case. And here is his data. And this has been published in the Journal of American Academy, he started taking 45 Xrays for his first case, and then by the end of it, he was only taking 5 XRays to complete the case, he sped up so you became more efficient in putting the implant in the right location, and a precision score, which we validated, he watched his score go from 70 to 93%. And this is a combination of many different variables that we measure in VR. And he did the case by himself the next day. And during the case, he actually took eight, almost eight times less radiation than the experienced physician in the first case. And so with that, thank you, I will wrap up. When we look at the novel and impactful aspect of what we're doing here in VR. We don't want to replace any of these models of learning because they are very important. We think it serves as a very powerful adjunct. And with that, we do believe that if you practice with purpose that you will operate with precision. Thank you very much.