TEDxUCC -- Padraig Cantillon Murphy --When Doctors and Engineers Talk
The engineer advocates for interdisciplinary communication between medicine and engineering to revolutionize surgery, arguing that current limitations in minimally invasive techniques can be overcome using self-deployed magnetic devices to create sealed access points. The central problem—gaining access to internal organs without permanent incisions—is illustrated using the analogy of getting through a balloon, which the technology aims to solve. This potential is demonstrated through animal studies showing the magnetic coupling of internal and external targets for diagnostic and therapeutic access.
## Speakers & Context
- Engineer (speaker); addresses an audience composed primarily of physicians/doctors, implying a goal of changing professional dialogue.
- Acknowledges that his field (engineering) rarely overlaps with the physicians' worlds.
- The context is presenting a solution for surgical access problems using magnetic technology.
- Highlights the need for better communication between engineers and physicians to solve complex medical problems.
## Theses & Positions
- The story of surgery and minimally invasive intervention is enabled not just by medical pioneers but by technology and interdisciplinary collaboration.
- Surgery is not for healthy people but for sick people who have difficulty recovering from large wounds.
- Current minimally invasive methods are limited by the need to create permanent, leak-prone incisions.
- A potential future direction is achieving surgery *without* making any external incisions.
- The core solution lies in engineers developing self-deployed magnets that can create sealed, temporary access points within the body.
- Overcoming complex clinical engineering problems requires more than theoretical knowledge (like Maxwell's equations); it requires communication.
## Concepts & Definitions
- **Minimally Invasive Surgery:** Surgical interventions requiring smaller incisions than traditional open surgery.
- **Asepsis techniques / Antiseptics:** Innovations developed in the 19th century (by people like Pastor Lisst Semil Viice) that allowed surgery to move beyond mere pain management.
- **Single incision laparoscopy:** A breakthrough allowing a camera and multiple instruments to enter through a single, small port.
- **Gastrotomy:** The medical term for the exit port from the stomach wall.
- **Balloon problem:** Analogy used for the challenge of gaining internal access (e.g., to a gallbladder or appendix) from the inside of a cavity (like the stomach) without creating a permanent leak.
- **Magnetic coupling/mating:** The act of snapping two deployed magnetic devices together for temporary structural linkage.
- **Contrast study:** Procedure used to test for leaks by injecting a liquid that visualizes the passage in fluoroscopic imagery.
## Mechanisms & Processes
- **Evolution of Surgery:**
- 19th Century: Anesthesia (painless) $\rightarrow$ Need for asepsis (infection control).
- 20th Century: Technology (heart-lung machine) enabling "big surgery."
- Mid-80s: Laparoscopic surgery began to appear, facilitating smaller, less traumatic procedures.
- **Magnetic Access System:**
1. Place a spontaneously unfolding magnet (red device) in the target organ (e.g., small intestine).
2. Place a second magnet (blue device) inside the stomach.
3. Use an endoscope to guide an instrument to couple the two magnets, creating a "magnetic sandwich."
4. This coupling creates a temporary, self-sealing access point (mini-gastrotomy) between the two organs.
- **Stent Retrieval Modification:** Using a permanent magnet attached to a stent to allow external retrieval, eliminating the need for a second in-hospital endoscopy procedure.
## Timeline & Sequence
- **19th Century:** Development of anesthesia, paving the way for surgery.
- **19th Century:** Pasteur Lisst Semil Viice develops asepsis techniques/antiseptics, advancing surgery.
- **20th Century:** Technology (e.g., heart-lung machine) enables major surgical advances.
- **Mid-80s:** Laparoscopic surgery begins to appear.
- **Present Day:** Single incision laparoscopy is advanced; current work uses magnets for access.
- **Future Goal:** Surgery without external incisions.
- **Recent Implementation:** Performing magnetic coupling in animal studies.
- **Future Opportunity:** Medical students and engineers sit together in a classroom setting at the speaker's institution (CAR).
## Named Entities
- **Briman Women's Hospital** — Location where brilliant physicians approached the speaker with a problem.
- **Pastor Lisst Semil Viice** — Person credited with realizing asepsis techniques and antiseptic development.
- **Mass General** — Institution where the concept of making surgery painless began.
- **CAR (institution)** — Location where the speaker's lab, the bioelectromagnetics group, is situated.
- **Kidney/Gallbladder/Appendix/Small Intestine** — Organs mentioned as targets for non-incisional access.
## Numbers & Data
- Historical timeline points: **19th century**, **20th century**, **mid-80s**.
- Stent placement timeframe: Stents remain in place for **about two to three weeks**.
- Endoscopic observation timeframe: The second magnet deployment is visualized in footage.
## Examples & Cases
- **Historical Context:** The shift from basic anatomy lectures to the necessity of engineering input in surgery.
- **Laparoscopic Surgery:** The ability to operate using rigid instruments along closed paths in tight spaces.
- **Single Incision Laparoscopy:** Placing a camera and instruments through a single port near the belly button.
- **The Balloon Problem:** The concept of needing to pass through a natural orifice (the "balloon") without permanently leaking.
- **Magnetic Demonstration (Animal Model):**
1. Small incision made in the stomach wall.
2. Second incision made into the target (small intestine).
3. A guide wire is fed into the target.
4. A catheter delivers a folded magnet into the target.
5. A second magnet is placed in the stomach.
6. The two magnets are coupled, forming a sealed connection between the stomach and small intestine.
7. Contrast study confirmation: Injecting liquid (black smoke) into the small intestine loops confirms no leaks.
- **Stent Retrieval Example:** Using an external magnet to remove an internal stent without a second surgery.
## Tools, Tech & Products
- **Magnets:** Specifically, self-deployed magnets.
- **Endoscope:** Instrument used to view and navigate inside the body.
- **Catheter:** Device used to guide the magnets down the esophagus.
- **Flexible endoscope:** Type of instrument used for visualization.
- **Contrast agent:** Liquid injected for leak testing (appears like black smoke in fluoroscopic imagery).
- **Guide wire:** Blackened yellow striped material used as a "tram line."
- **Stent:** Plastic device placed after an endoscopy (e.g., biliary/pancreatic stent).
- **Permanent magnet:** Attached to a stent for external removal.
## References Cited
- **Katherine Moore's Ted Talk:** Mentioned as a reference for the DCI robot work.
## Trade-offs & Alternatives
- **Current LVS limitations:** Must create external incisions, risking leakage.
- **Magnetic access potential:** Bypassing the need for permanent incisions entirely.
- **Stent removal:** Current method requires a second hospital visit vs. proposed magnetic removal.
## Counterarguments & Caveats
- The analogy of the balloon is acknowledged as *"imperfect."*
- The speaker notes the current technology is not "quantum physics," but requires complex engineering realization.
- The initial procedure is not simple; it requires guiding magnets through a narrow passage (the width of a thumb/esophagus).
## Methodology
- **Simulation/Design:** The speaker's group (bioelectromagnetics group) spends time simulating and testing complex systems.
- **Animal Studies:** Proof-of-concept testing was performed on animals to demonstrate magnetic coupling.
- **Diagnostic Verification:** Using contrast studies to confirm the self-sealing nature of the magnetic seal.
## Conclusions & Recommendations
- The potential to access internal organs (gallbladder, appendix) without external incisions exists.
- The best path forward involves doctors and engineers working together in interdisciplinary teams in the same classroom environment.
- The primary need is for clinicians and engineers to learn to speak the same language and understand each other's problems.
## Implications & Consequences
- Solving surgical access problems could eliminate the need for secondary, invasive retrieval procedures (like stent removal).
- Interdisciplinary collaboration in medical education could unlock solutions to large, complex clinical problems currently deemed intractable.
## Open Questions
- Whether this magnetic approach can be reliably applied to complex areas like appendicitis or gallbladder removal in humans.
## Verbatim Moments
- *"I make magnets for minimally invasive surgery now I'm not a surgeon I'm not a medical doctor I'm an engineer"*
- *"The story of surgery and the story of minimally invasive intervention isn't just written by the Giants the pioneers of surgery it's also enabled by technology"*
- *"Big surgery leaves big wounds and the problem is that surgery isn't for healthy people it's for sick people"*
- *"I like to think of it as the balloon problem"*
- *"If you want to gain access from ins inside that stomach to the outside for example you want to access a gallbladder or an appendix or a small intestine from inside the natural artifices of the patient you need a technique that enables you to get through this balloon without permanently creating a leak"*
- *"This is the small intestine in our work"*
- *"creating if you like a magnetic sandwich a magnet the stomach small intestine and a magnet"*
- *"This is not quantum physics this is about being in the right place at the right time seeing the problem and being able to communicate it"*
- *"it's only when doctors and Engineers learn to speak the same language learn to talk to each other understand each other's problems that we can actually start solving them"*