Welcome back to DITM– It has been some incredibly busy times with so many exciting new projects.  I’m hppy to be back and provide a fresh set of visions of the impact of future technology on medicine. 

After a year of prep I just gave a Keynote lecture at the International Congress of Endoscopy where I showedthe first ever surgery recorded in 4k ultrahigh definition.  Stay tuned for posts with all the details and pictures but here’s the press release for now.  The AAGL society also issued a report. 

Steven F. Palter, MD

The FDA has published its 510(k) approval letters for March 2008. In terms of surgery, endoscopy, and imaging a few items caught my eye.

Part 1 looked at a new monitor.  Here is a device from Ethicon that allows accessory instruments to be placed along with endoscopes- primarily for flexible scopes primarily used for the lung or GI tract.

These concepts of placing multiple instruments through new and unique entry devices is a huge area of research and development in surgery including Natural Orifice Surgery and SIngle Port Surgery.

First the announcement from FDA:

DEVICE: ETHICON ENDO SURGERY SHEATH AND ARTICULATING ACCESSORY CHANNEL - ETHICON ENDO-SURGERY, INC. 510(k) NO: K073484(TRADITIONAL)
ATTN: RENEE L ROWE PHONE NO : 513-337-8243 4545 CREEK RD. SE DECISION MADE: 10-MAR-08 CINCINNATI, OH 45242-2839

Text from Ethicon’s application on how it works.

The flexible Sheath is installed over the insertion tube of the endoscope. The Sheath
contains a track (C-Channel) along which the Articulating External Accessory Channel can
be can be introduced and removed without removing and re-introducing the endoscope,
allowing for multiple intubations and/or specimen retrieval independent of the endoscope.
The Articulating External Accessory Channel enables the use of two accessory devices
simultaneously - one in the Articulating External Accessory Channel and the other in the
endoscope working channel. The Articulating External Accessory Channel provides off
axis articulation to off the shelf accessory devices, thereby allowing the user to more
effectively direct devices to the targeted tissue.
Improvements

The external accessory channel of the new device is not fixed to the scope and can be
introduced and removed without a need to remove or re-introduce the endoscope. The
LSI Solutions Endoscopic External Accessory Channel predicate device is fixed to the
endoscope and must be must be removed and re-introduced with the endoscope.
* The new device enables articulation of compatible commercially available endoscopic
accessory devices for improved ability to reach the target tissue.

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Hello again all my friends, supporters, and loyal readers! After far too long of an absence I am back. So much time has passed and so much has happened that I wanted to fill you all in and welcome you back to my regular schedule of postings on all new in medical technology.

So you may ask- what the heck happened to you? We thought you were dead? Here is my free form list of all that has happened to tie me up and take me (temporarily) off-line. Here is a list of just some of things that took my attention in the last few months.

1) First and foremost my wife gave birth to our son the babyinthemachine. Despite being old pros at this a newborn really takes a hit to your free time! Happily she did awesome in pregnancy and labor and all went perfectly. It is always a bit of an event when an Ob Gyn’s wife gives birth we have really seen it all before, but that gets mixed up with the knowledge of every little thing that could go wrong at every step and trying to stay at the correct end of the bed (the head) ! The little guy came home and has been a delight. This led to the quick realization that these kids no way fit in our car we had to buy some new transportation. Thanks to Edmunds - remember never pay over invoice I won’t say what we got but I am sure you can guess…

Here’s the little guy in utero

[youtube]v/up2vpWyFSow[/youtube]

2) All of my research of the use of High Definition video for Surgery got picked up by the medical and lay press and I was doing a fair bit of lecturing and speaking. This was a real pleasure for me having worked on the development of these tools since 1999.

3) National Geographic featured footage from my high def surgery on their special Inside the living body. This led to a series of interviews and lectures including the peculiar thing that is morning drive FM radio shock jocks. No need to go any further. I’ll post some excerpts coming soon.

4) 20/20 did a piece on my research on visualization in surgery including high def and future vision autofluorescent laparoscopy. What a delight that was to do. Bob Brown and crew were great to work with and they then invited me back onto ABC News for a show about innovators. I’ll be posting video clips from this too.

5) DITM - this blog- hit its one year anniversary and I celebrated all that the experience has brought to me and allowed me to share.

6) My wifeinthemachine Michele Lang sold and published a major future tech-sci fi-romance Netherwood which included dozens of examples of current and future med tech from the pages of this blog in the Shomi Line from Dorchester Publishing. All this is woven into a story of a technological future world where computers become sentient and the local sheriff must destroy the man set out to destroy the network but learns he is her virtual reality lover who holds the secret to the survival of mankind. The book can be ordered at Amazon now and has gotten amazing reviews. She be posting some updates and interviews here to come!

7) I was honored to be chosen to be a High Definition Visionary Site by Sony Medical. As one of the few MD’d chosen for this distinction I have access to their wealth of electronic knowledge and product engineering. For full disclosure I do not receive any financial payments for this relationship. They are helping me with a demo research project for HD surgery education on the internet and on improving visualization and archiving of surgery. I’ll be posting more from this to come.

I was involved in the keynote general session at the 38th Annual International Congress of Gynecologic Endoscopy (The AAGL). A true honor, this was the third time I led a session on new technology in medicine and the second year in a row. This year I focused the session on NOTES - or natural orifice surgery. This amazing new technology still in development is where physicians pass special flexible never before seen endoscopes through natural body openings (mouth, anus, vagina, etc) to reach any part of the body without any incisions at all. Needless the say the audience was in awe of the video of an appendectomy removed without external incisions and pulled out the patient’s mouth! More from this session will be posted with updates and excerpts on this technology.

9) As part of this session I presented new research of mine on the transformation of medical technological research and mathematical modeling that shows we are on the cusp of unparalleled explosive growth in med tech innovation. Of course more to come on this!

10) I was elected vice-president of the ACGE (Council for Gynecologic Endoscopy) - established to elevate standards in operative endoscopic procedures performed by gynecologists. We will be continuing our efforts on surgeon and facility standards and review including the validation of simulator based evaluations. More to come!

11) I was chosen by the AAGL as well on a special ongoing press conference panel on the future of gynecologic endoscopy. I have to say it was a real honor and validation of years of work when The President of the society Dr Charles Miller introduced me as the visionary of the society. Videos and transcripts will be posted.

12) Related to this I began an advisory role for a company developing a gyn NOTES procedure which will likely begin clinical trials for infertility very soon.

13) We had the Annual meeting of the American Society for Reproductive Medicine (ASRM) - the largest infertility meeting where I serve on the program committee and chair the video program. I’ll be posting updates of new research including a dinner I had with the world’s expert on human pheromones.

14) The Society of Reproductive Surgeons (SRS) of the ASRM invited me to chair their postgraduate course on fertility surgery at next year’s meeting. Of course the topic I chose is “New Technology in Fertility and Reproductive Surgery”. I’ll run the course as a lecture and hands on lab and we will include robotic surgery, alternatives to hysterectomy, surgical simulators, Natural Orifice Surgery, Autofluorescence, Office Surgery, High Definition, High Intensity Ultrasound surgey and many others. I’ll post updates as we go along.

15) I continued my usual lecturing, research, publications, and the development of a new innovative DITM podcast series.

16) Had some minor surgery- I am really an expert on edoscopes and the entire GI track as well now.

17) My clinical practice Gold Coast IVF had our busiest and most fertile year ever! Countless pregnancies in my usual mix of complex cases left me grateful and delighted to be a part of this specialty. Using all the tools in my armamentarium (drugs, surgery, IVF, egg and sperm donation, etc) allowed me to help create more families than ever. I treated local patients and those who traveled from around the country and from Nations as distant as Russia, China, and Nigeria.

OK - it has been a busy few months here but I am ready for 2008 to do even more! Welcome back to docinthemachine!

Docinthemachine is off to Hollywood to speak about my research on HDTV  surgery as featured on an upcoming National Geographic show - “Inside the Living Body”.

So much incredibly exciting work has been happening that I wanted to share the details.  I have been a champion of high definition TV in medical visualization and surgery since 2000 when I performed the world’s first HDTV endosocpic surgery.  Earlier this year I completed some exciting futher developments.  We tested the use of the highest definition system ever developed for medicine imaging for the first time in wide screen 16:9 format at 1920X1080 progressive.  The folks over at National Geographic got wind of this project and requested footage for an upcoming show “Inside the Living Body” to be broadcast in  HD on their HD channel. 

I supplied them with footge of all of the internal pelvic and abdominal organs as well as inside the uterus.  Thanks goes to my amazing patients fighting to have the opportunity to be the one filmed for the show!

I received a call from them shortly after doing an interview about the work with Wired Magazine (love that mag) asking me to please come to Hollywood for the TCA (Television Critics Association) Convention.  Details of the Meeting are here with my show and panel featured at the top of the list (above the Olson twins, Soporanos, Saturday Night Live and All the broadcast hits).  I didn’t get listed on the panel since it unclear if my schedule would allow attendance but I won’t hold that against them. 

My Panel (plus me):

National Geographic Channel

Inside the Living Body
Incredible Human Machine

Panel to include:
Dr. Steven Zeitels, MD, FACS, Eugene B. Casey Chair of Laryngeal Surgery at Harvard Medical School (HMS) and the Director of the Center for Laryngeal Surgery and Voice Rehabilitation at the Massachusetts General Hospital (MGH)
Dr. Linda Liau, Neurosurgeon and Professor of Neurosurgery at the UCLA School of Medicine; Director of the Comprehensive Brain Tumor Program and director of Neurosurgical Oncology at the UCLA Medical Center in Los Angeles
Stephen Marsh, Ph.D., Cell and Developmental Biology, Executive Producer, Inside the Living Body, Pioneer Productions
Howard Swartz, Executive Producer, National Geographic Channel, Inside the Living Body & Incredible Human Machine

I’m finishing up the posts on the project and the National Geographic Show.  I am so excited to have my surgical footage be the first ever HDTV surgical procedure broadcast.  As I told them- the viewer in his living room will see views of the human body sharper and clearer than almost any doctor has ever seen in endoscopic surgery.  If you were amazed by watching baseball in HDTV and seeing the hairs on the player’s heads wait until you see the amazing clarity of the human internal organs. 

Much more to come…

There has been a lot in the lay press about microsoft’s new touch tablet display.  As CNET writes (video link here):

Microsoft has just announced its Surface Computing technology, a project that has been kept under wraps for five years. Using a giant table-like display, users are able to draw, interact with media, and use another new technology called domino tagging, in which a real-life object on the computer’s surface is identified and becomes an on-screen object that can be interacted with

What is unique about the screen is that it is a collaborative touch table interface.  That is, multiple users can interact and manipulate objects.  While they claim Microsoft has kept this under wraps for 5 years it is not a new concept at all.  Heck, even Minority Report ( my surgical version here) used this concept in its image manipulation scenes. 

Last year at Nextfest GE showed a similar protoype and I had an opportunity to speak with the engineer about potential medical applications (he would not let me take a photo of the table they had).  It’s best use to date in their mind was for collaborative radiology.  However a VERY limited market!  I can only see that being used for teaching sessions for trainees (very good in that setting) or for multi-speciality team surgery planning for complex cases (ie conjoined twins etc).    Much larger uses will be in military and building and geology.

Could this be a prototype of a gesture control interface for surgery?  Noir for real time but more so for planning.  I had an extensive discussion of these systems in a late night conference call With Andy Van Dam (you know Computer Science Professor at Brown, Founder of SIGGRAPH, namesake of Andy in Toy Story, invetor of VR and the military Cave technology).  Andy feels 100% that surgery should be immersive - that we will be in the image and use gestures to move the images around us.  Others disagreee 100%.  Many of the the old CAVE researchers (see imersive VR info here)are abandoning that approach for this table like interface.  Here you look into the 3-D space and move the object in 3D but NOT immersed.  See how much immersion is enough?  When I look at a 3D VR travel down the bowel do I want it to look like I am inside the bowel fantastic Voyage style (Andy’s approach) or do I want to stretch it out, slice it open and manipulate the 3D image in front of me twisting and turning it in space (new method)?

Much more on our discussion and the surgical options to follow. 

Scientists report today on the ability to create sperm from bone marrow cells. Initially performed in men, the technique could potentially be performed in women and lead to a sperm cell made from a woman’s body. You got it right- that cell could then fertilize an egg leading to the first female-female conception in human history.

As a fertility specialist I couldn’t resist this story and wanted to share the reality and the hype. Prof. Karim Nayernia, Professor of Stem Cell Biology at the Instatute of Human Genetics at the Univeristy of Mewcastle on Tyne led the project reported in Biology of Reproduction. A summary of the study was released in the Independent today.

The researchers said they had already produced early sperm cells from bone-marrow tissue taken from men. They believe the findings show that it may be possible to restore fertility to men who cannot naturally produce their own sperm.

But the results also raise the prospect of being able to take bone-marrow tissue from women and coaxing the stem cells within the female tissue to develop into sperm cells, said Professor Karim Nayernia of the University of Newcastle upon Tyne.

The report suggests that “Scientists are seeking ethical permission to produce synthetic sperm cells from a woman’s bone marrow tissue after showing that it possible to produce rudimentary sperm cells from male bone-marrow tissue.”

The Two Mommy- No Daddy Baby Making Research Plan:

“Theoretically is it possible,” Professor Nayernia said. “The problem is whether the sperm cells are functional or not. I don’t think there is an ethical barrier, so long as it’s safe. We are in the process of applying for ethical approval. We are preparing now to apply to use the existing bone marrow stem cell bank here in Newcastle. We need permission from the patient who supplied the bone marrow, the ethics committee and the hospital itself.”

If sperm cells can be developed from female bone-marrow tissue they will be matured in the laboratory and tested for their ability to penetrate the outer “shell” of a hamster’s egg - a standard fertility test for sperm.

“We want to test the functionality of any male and female sperm that is made by this way,” Professor Nayernia said. But he said there was no intention at this stage to produce female sperm that would be used to fertilise a human egg, a move that would require the approval of the Human Fertilisation and Embryology Authority.

This same group reported last year that they created artifical sperm from embryonic sperm cells in mice.

(They) isolated stem cells from blastocysts, which are early-stage embryos only a few days old. From these cells were extracted those that would go on to form sperm, known as spermatogonial stem cells (SSCs). The SSCs were then cultured in the laboratory, and when some developed into sperm, they were injected into female mouse eggs and grown into early-stage embryos. The embryos were transplanted into the wombs of surrogate mothers.

The Genetic Disaster That Could Result: Faulty Imprinting. There is a huge genetic time-bomb here. The genetic phenomenon called imprinting. This describes the situation where a particular gene is marked or imprinted with a tag that says if it came from the mother or father- and more importantly only one of the other is active. For example for a particular gene it’s possible that only the maternal copy gene could be active and the copy that comes from the mother could be switched off. If this process goes wrong (mom and dad copy mistakes) then severe genetic diseases can result.

A description of imprinting follows and a detailed description is here and here

However, it is now known that the expression of a small number of the 30,000 or so genes in the cells depends on whether the gene copy was passed down from the father or the mother. This process, whereby the expression of a gene copy is altered depending upon whether it was passed to the baby through the egg or the sperm, is called imprinting. The term “imprinting” refers to the fact that some chromosomes, segments of chromosomes, or some genes, are stamped with a “memory” of the parent from whom it came: in the cells of a child it is possible to tell which chromosome copy came from the mother (maternal chromosome) and which copy was inherited from the father (paternal chromosome). This expression of the gene is called a “parent of origin effect” .

UPDATE:  this same group of scientists havbe repeated and extended this research moving closer to a human all female baby- read about their follow-up project here

VIRTUAL REALITY SURGERY & MILITARY ROBOTS GO MEDICAL

I’ve been a busy little doc the last two weeks.  My research on the development of the autofluorescent laparoscope was awarded a prize paper at the SLS (Society of Laparoendoscopic Surgeons), the American Society for Reproductive Medicine (ASRM), and 2 prizes at the AAGL (”Advancing Minimally Invasive Gynecology Worldwide”).  I am truly honored by the recognition of my work. 

I will be following with posts on all the new technology I saw at these meetings.  Miniaturized endoscopes, stem cell research, preimplantation genetic testing, embryo metabolomics, 3D systems, etc.

I also saw incredible prototypes of new devices, tools, robotics, and visualization - will post as soon as the confidentiality restrictions are freed up. Not ready to go to jail!  The best stuff was hidden in hotel rooms at the Paris in Vegas and never made it to the light of the exhbit floor… 

I am also honored to have been chosen by the AAGL to have delivered the general session lecture on “Future Vision”.  This session layed out my vision for the future on minimaly invasive surgery after endoscopy is obsolete.  Looking 10+ years into the future I presented a summary of the current developments in minaturized self-contained robots in the body, virtual endoscopy using high power CT scans linked to 3D reconstructing computers, and virtual reality technology to present and manipulate the data.  This was a multimedia view of military, computer, and robotic technologies poised to transform medicine as we know it….

The response to the talk was overwhelming and the society is arranging to stream video of it over the net.  I will provide links when they go live.  Obgyn.net also did a podcast interview with me on this concept of “Future Vision-Technology Transforming Medicine” (links coming). 

All coming soon! 

I previously wrote on the fogscreen display system. Just as interesting as the display system is a demo of the hand gesture control concept. Here hands point in space and the display responds with electric ink. There must be a video tracking system trnslating the movements into mouse controls. I can forsee systems where control systems like this would follow a surgeon’s hands.  Just like Tom Cruise in Minority Report (before he jumped on couches).

Well added a bunch of new links today in the mainpage sidebar.  Much more will be added in upcoming days

September 11, 2006…  The launch of docinthemachine.  What a dark and somber day today was on the 5th anniversary of 9-11.  I am reminded of how fast the flood of information comes at us today and how the pace of change has sped up.  Information is everywhere and is more readily accessible than ever before.  The attacks of 9-11 were surely enabled by access to information electronic networks linking operatives across the globe yet used by those who see change and progress and inherently evil.  Information is enabling and liberating and has the power to enable uprisings against those who seek to enslave with fear and ignorance. 

 I live in the world of medicine and see the effects of information dissemination daily.  It may be patients who walk into the office with a grasp of subtleties of a rare illness that 5 years ago they could never have even found the name of without a doctor.  It may be the launch of a new device or diagnostic test unimagined 5 years ago that will transform my practice. New technology in medicine is enabling and disruptive.  I have always been drawn to what’s new and looked at things asking “why don’t we try it in this new way?” or “why can’t we do that with it?”  Therein lies my passion.  Nothing is more exciting than having a developer come to me with a concept or idea for a new device or technology and working to make it real to transform the care of my patients.  However, the most exciting developments will fundamentally change or make obsolete current practice!
These concepts are the basis for this discussion:
1)    To discuss new developments and breakthroughs in medical technology
2)    To uncover technology from outside medicine that will transform future medicine
3)    To examine those disruptive technologies that will revolutionize medical practice