TEDxUCC -- Padraig Cantillon Murphy --When Doctors and Engineers Talk
[Applause] so I make magnets for minimally invasive surgery now I'm not a surgeon I'm not a medical doctor I'm an engineer and I'd like to talk to you a little bit about how that works because generally speaking I know a lot of you folks are probably Physicians or doctors our worlds don't overlap that often but let me take you back to those Hazy Days of medical school when you may have shared an anatomy lecture with future dentists or a pharmacology lecture with the future pharmacists or studied basic science with the chemists the biochemists but I bet you never shared a classroom with an engineer and for me that goes to the root of how engineers and Physicians communicate and what I'd like to do is to take a few minutes to tell you about what happens when we do and the reason I can do this is because a couple of brilliant physicians at briman Women's Hospital in Boston approached me a number of years ago with a problem now in order to appreciate their problem and to see where they were going I need to step back and explain to you where we've come from because 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 and I'd like to begin with the similar moment of 19th century medicine the development of anesthesia Mass General revolutionized the field of surgery surgery became painless now it was painless but you were still pretty likely to die afterwards infection was rampant and it took the genius of people like Pastor lisst semil viice to realize asepsis techniques and the development of antiseptics surgery came of age but it was the 20th century when technology took Center Stage thanks to antiseptics surgeons could not now operated everywhere and they did even inside the human heart thanks to technology like the heart lung machine and big surgery had arrived now big surgery is wonderful but big surgery leaves big wounds and the problem is that surgery isn't for healthy people it's for sick people and sick people have a tough time recovering from Big wounds and very soon people began to think about this Physicians realized this very early on and US Engineers took a while to catch up but eventually around the mid 80s what my mom still calls Keyhole surgery laparoscopic surgery began to appear now for us non-physicians it's difficult to appreciate surgery is difficult laparoscopic surgery is doubly difficult the technical challenges of operating these rigid instruments along closed paths in very tight spaces are enormous surgeons retrained and the benefits to patients were significant less wounds faster recovery time and this is where we are today not just here but single incision laparoscopy is with us right now and when you think about the ability to place a camera and multiple instruments into a single port about this size around your belly button that's a phenomenal technological breakthrough and if you're interested to understand the role that robotics may play in this I would encourage you to take take a look at Katherine Moore's wonderful Ted Talk from a couple of years ago talking about the work on the DCI robot but tonight I'd like you to imagine the future the future of surgery so surgery without wounds and it's not science fiction right now all around the world there are teams of Surgeons inter conventionalists Engineers trying to make this a reality so this is the problem think about trying to access something like the gallbladder or the appendic without making any external incisions on your patients it's a tough problem I I like to think of it as the balloon problem okay bear with me okay the analogy is imperfect but I am an engineer this is the stomach and the problem is that 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 so excuse me leaks are bad natural arice surgery is not just science fiction this is a reality in many um centers of excellence around the world but it faces significant challenges engineering challenges and this is where we come in the engineers and the solution we came up with is magnets not just any magnets uh these are self deployed magnets and you'll see what I mean in just a minute so it isn't as easy as I make it sound we also had to get these magnets through a space about the width of my tum not your esophagus by the way and when we had them in the stomach we had to make them about this size that's large enough for an instrument called endoscope to get through the center so it was a tough problem so let me show you what we did in our work the target was the small intestine it lies on the other side of the stomach wall and we began by placing one of these spontaneously unfolding magnets inside in that Target that's the red device that you see here and then placing a second magnet inside in the stomach that's the blue device that you see and by magnetically maing or snapping these two devices together gain instantaneous access into our Target sounds easy right well we've done this in animal studies and what you see here is a combination of the view from the end of that flexible endoscope and a bird's eye Lapras opic camera positioned on the animal's abdomen and the procedure begins very simply we make a small incision in the stomach uh wall a second incision into our Target and I as I said this is the small intestine in our work next step we fed uh long guide wire that's that blackened yellow striped material that you see here deeply into the Target and this serves as the tram line for our train which you see at the top of the screen that train is a catheter which has delivered our magnets down the esophagus and into the Target and you'll see that in this x-ray footage the magnet is still folded up and deploys only when we want to and only when we're in the correct position you see the square out outlay of the magnet in this footage we can pull that back to the site of original exit from the stomach and then comes the second step we deploy a second magnet in the stomach and using an endoscope spearing that magnet we can couple or mate those two devices together creating if you like a magnetic sandwich a magnet the stomach small intestine and a magnet and this frames the original gastrotomy that's the medical term for that exit Port out of the stomach and that's what you see in this footage now let me get back to the balloon we need to make sure that this is self sealing leaks are really bad and in order to test that we did something called a contrast study we injected this liquid which shows up like black smoke as you see here in fluoroscopic imagery and we're able to fill the loops of um small intestine with this uh substance and check and verify and make sure that there were no leaks which we could do not just that but we were able to gain access deep into small intestine something that you can't do right now with conventional minimally invasive techniques endoscopes don't go here and with some refinement with some more engineering we believe that this kind of approach has potential to access maybe appendicitis maybe a gallbladder removal the possibilities exist now all of this took place because doctors and Engineers talked to each other and you might be forgiven for thinking that I've forgotten my place that I'm an engineer well here in in cor at the bio electromagnetics group we spend a lot of time simulating testing designing these kind of complex systems so that when we go to these studies the devices do what we want them to do and the other thing I wanted to say is that you don't need to understand Maxwell's equations and stress tensors to solve the big clinical engineering problems it's a question of talking and some of these problems are not rocket science and as an example of that I want you to think about one of the most common procedures in endoscopy the placement of a stint short plastic device particularly biller Sten pancreatic Sten usually they're placed after an oscopy helps speed up healing prevents further blockages and they sit there for about two three weeks and then either they fall out or you take them out the endoscopist takes them out but either way the patient has to go back to the hospital to get that stent removed and with a small modification we may be able to eliminate that second trip to the hospital let me show you what I mean so here's our stent being placed in the animal model and at the end of the stent what you'll notice is a small magnetic attachment a permanent magnet which allows us to use a second magnet outside of the animal's body to remove the that stent from the tree when we want to there's no need for a second endoscopy if you can couple those two magnets and my point here is that 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 and you might have gathered this is something that I really believe in that we have tremendous potential to help each other solve big problems and because I believe in this for the first time in 160 years of education here in car our medical students and our Engineers are are afforded the opportunity to sit in the same classroom solving real CL clinical problems posed by clinicians in interdisciplinary teams and it's an experiment but it's one that I think is worth undertaking because 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 that's my big idea thanks for listening [Applause]