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Surgical Software Revolution

Gapingvoid - software

  • Software is infiltrating everything we do these days. Software is going to be a major enabler in our society.” – Steve Jobs.

The software revolution is coming.  Well, for most parts of our lives, it is already here.  One major omission is medicine.  But for one of the most critical parts of health care – surgery – it is almost completely absent.

Admittedly, medicine needs to conservative in its adoption of new things.  Lives are on the line and patients can’t be the guinea pigs for innovation.  The sector has justifiable speed bumps to ensure comprehensive testing for safety and efficacy before any new treatment or tool is put to use on a patient. Still, a good number of tools on the surgeon’s tray haven’t changed t for millennia. NHS Head of Innovation Tony Young highlighted this constancy in his keynote at the Collorectal HTC symposium with the slide shown at the bottom here.

While many of these tools persist with their ancient heritage, a number of operating theatre innovations have obviously emerged.  Nonetheless, by and large, these innovations have largely been on the hardware and device side, not software.  Yes, electronics have entered the operating theatre, but electronics is not software.  A Cuisinart and microwave oven revolutionises the kitchen, but does not introduce the concept of software to it.

While software has powered revolutions in most industries, its impact in healthcare to date has been relatively limited.  Its primary application has been administrative operations (eg.  patient records) and recently consumer mobile health apps (especially with the surge in wearable devices with health sensors).  Software technology in the operating theatre is largely confined to some embedded code in devices.  No open platform exists for the support and deployment of a range of applications using common shared services.

Forclarity envisions a future of healthcare where surgical treatment is enhanced as much by versatile, intelligent and innovative software as most other sectors of industry.  This vision forms the heart of the technology we are working on.  We anticipate that the largest and earliest introduction will take place in the area of imaging, both diagnostic and (minimally invasive) treatment, since the imaging takes the first step into the digital world by digitizing the subject and the problem itself. 

At the first, the applications will be simple, assistive, procedurally non-intrusive, and optional.  They will be the equivalent of spell-checking for surgeons.  If the software misses a “correction” (or proposes a correction that the expertise of the surgeon deems inappropriate and decides to ignore), the patient is no worse off than if no “spell check” was applied in the first place.  But if the “check” catches even a small portion of ‘errors’, it can then improve the process and outcomes for minimal risk and effort.

  • “Companies in every industry need to assume that a software revolution is coming. – Marc Andreessen

Surgeons tools

Colorectal Therapies National Meeting 2017

Colloractal Therapies HTC meeting 2017

The annual National Meeting of the NIHR Coloractal Therapies in Leeds was a milestone event for the HTC who will now be expanding and re-branding it remit after its recent successful award for MIC funding.

The theme of the day was “Jugaad Innovation” which can best be summarised as “make the most with what you’ve got”. Actually surgeons have been applying this principle in one manner or another for years, but maybe the aging populations and health care challenges will be putting extra pressure on the concept (a bit ironically, the setting of the day was the resplendent Leeds Town Hall, one of the most elaborate conference halls I’ve ever at in, but I suspect as a public building it was quite cost effective). To put resource constraints into perspective, the speakers highlighted a number of innovations from the developing areas of Africa and Asia where resources constraints are fundamental.

The day split into roughly three parts:

  1. Keynotes – The highlight was Professor Tony Young, National Clinical Lead for Innovation NHS England, who set the scene laying out a number of critical trends challenging conventional approaches.
  2. Frugal Innovation – An overview of the Jugaad concept as well as several illustrative case study examples (handy Venn diagram below)
  3. Breakouts – The afternoon extended the interaction and networking started at lunch with a more formal set of themed breakouts (unfortunately, the Imaging group had to be cancelled as the facilitator had a last minute conflict).

Frugal Innovation

Colorectal Therapies National Meeting 2017 - Leeds Town Hall

Minimally Invasive Surgery Congress 2017

Minimally Invasive Surgey Congress

Forclarity CEO Bruce Lynn attended the Minimally Invasive Surgery Congress in London this week. The event featured an extensive and authoritative line up of over 40 speakers covering the specialities of Urology, Colorectal (the track Bruce attended), and Hip & Knee.

They also had an exhibition area showcasing about a dozen companies. The most intriguing, from a Forclarity perspective, was Arthrex who has brought a 4K laparoscopic system to market with some striking image resolution and capabilities (see photo above with Arthrex manager Andrew Bell on right).

Dr. Amjad Parvaiz, Director of European Academy of Robotic Colorectal Surgery, Poole General Hospital NHS Trust delivered the keynote “Concept of Precision Surgery for Rectal Surgery” What Role Robotics Play in Achieving this Goal” outlining its 3 imperatives with the directive ““Decisions are more important than incisions.”:

  • Respect embryology planes
  • Minimal tissue trauma
  • Minimal tumor handling

And Parvaiz described the “two revolutions in surgery

  • Laparoscopy 1990s
  • Robotic Surgery 2010s

Shafi Ahmed, Director and Head of Programme Virtual Medics gave a talk titled “The Virtual Surgeon” which expanded on the “revolution” in surgery theme asserting that the “Fourth Industrial Revolution…blurred lines between industrial, biological and digital technologies.” He cited innovations such as Snapchat (“the biggest AR platform in the world”) that could be used to share surgeries online so students around the world could watch them and learn from them. He noted the importance of such pervasively used consumer technologies shaping the mind sets of the new generation of clinicians.

Nigel Hall, Lead Clinician, Consultant Colorectal Surgeon, Addenbrooke’s Hospital NHS Trust gave a talk titled “Transanal Endoscopic Microsurgery (TEMS) Excision of Large Rectal Polyps” where he examined the dynamic tension of cutting “too much or too little” in polyp excision. One of Forclarity’s applications are tools to provide visual aids to alert to missed areas of abnormal tissue. This application directly targets the “too little” side of the problem, but also would ideally help the “too much” side as well if clinicians feel they can reduce the “too much” (healthy) tissue excised for safety sake.

The first day included a number of sessions on the subject of medical training itself. I particularly appreciated the statement from Ahmed saying, “We don’t train people on perfect operation after perfect operation. We know that’s not how it works. We train people on what goes wrong.”

The event provided many opportunities to meet many of the participants and the speakers. The audience was dominated by clinicians and practitioners. Many seemed impressed that Forclarity was joining in the sessions to get a first-hand look at the problems and challenges surgeons face on a daily basis. As a member of the discussion panel noted about the surge of innovation, “People are coming with solutions looking for problems for it to solve.” Forclarity has been starting with a big investment in examining and understanding the problems first.

NIHR Colorectal Therapies HTC 2016

NIHR Colorectal Therapies HTC 2016 - Prof David Jayne and Bruce Lynn

Forclarity’s founder Bruce Lynn (above right) attended the Colorectal Therapies Healthcare Technologies Cooperative National Meeting this Tuesday hosted at the Royal Armories Museum in Leeds. Organised by Professor David Jayne (above left) at The Royal Armories in Leeds, UK.

The event covered a range of technologies and innovations from nanotechnology to robotics and personalised medicine. The day also included presentations of example trials by students at Leeds Socio-Technical Centre. And for one of the most intimate illustrations of a patient’s odyssey, the short play “Gutted” was staged for the audience over lunch break with an unflinchingly candid portrayal of both the pain and aggravation as well as the lighter absurdities of living with the inflammatory bowel disease Ulcerative Colitis.

In the afternoon, Lynn facilitated and presented the break-out discussion “Seeing the invisible: new imaging technologies for precision surgery” with Graeme Hall (Brandon Medical) and Aaron Quyn (Leeds University). This table explored new technologies that enhance intraoperative imaging and facilitate precision surgery discussing areas of technical difficulty in the diagnostic and interventional setting where enhanced imaging can facilitate improved clinician performance and safer patient outcomes. The discussion by such a diverse group underscored the breadth of opportunities in the medical imaging field.

NIHR Colorectal breakout notes

Enteric HTC Hackday 2016 Overview

Enteric Hackaday 2016 1

Software is infiltrating everything we do these days. Software is going to be a major enabler in our society.” – Steve Jobs

Last week, Forclarity founder Bruce Lynn spoke at the Enteric HTC Hackaday 2016 “Imaging, Sensing and Digital in GI Medicine” held at the Royal Society of Medicine. He overviewed a range of image processing technologies that offer both the exacting performance levels required by and a broad utility applicable to minimally invasive surgery (MIS). While software technology has revolutionized most aspects of our lives, it remains relatively absent from the operating theatre. Surgeries remain largely a device dominated arena. But the rise of MIS has introduced the world of digitization to this environment. Software to manipulate and enhance those digital images is the next logical step.

Lynn overviewed the industries pioneering this technology like film, television, sport and consumer video. A big driver is the power advances in graphics processing driven by new generations of GPUs (Graphical Processing Units). A range of academic and industry development has produced sophisticated tools for tracking, keying, object identification and filtering. He also introduced a range of applications that have strong utility in the MIS environment like structure identification, work area enhancement, and virtual smoke removal.

The second annual event covered an extensive array of technologies including many technologies which dovetailed with the Forclarity presentation and work. The exploitation of imaging technology continues to grow. The most obvious application is diagnostics which for years has been grounded in images from MRIs, x-rays, CT scans, etc. Software is especially starting to drive more innovation in diagnostics with computational algorithms “interpreting” the image information.

  • Director Aston Brain Centre Paul L. Furlong described enhancements in measuring Oesophageal pain responses, gastrointestinal transit time and colonic motility.
  • CEO of Motilent Alex Menys briefed the group on its algorithmic analysis of gut motility for the diagnosis of Crohn’s Disease and other GI ailments.
  • Research Registrar Kapil Sahnan was combining imagery with advanced CAD software to create 3D models of fistulas to provide not jut a virtual, but a “real” model for both diagnostic, guidance and even patient care (as a tangible and visual aid to explain issues to the patient)
  • Dr. Daniel Sifrim MD on intraluminal diagnostics in the oesophagus.

Other non-imaging technologies covered included:

  • Florence Nightingale Foundation Professor of Nursing Christine Norton on faecal detection devices.
  • CUHK and Prince of Wales Hospital Professor Hans Gregersen on biomechanics and bionic device technologies.
  • Docobo Managing Director Adrian Flowerday on remote monitoring.
  • Professor Paul Swain (inventor of Capsule Endoscopy) on the history of technology in medicine.

For more details on Enteric HTC and the Hackaday event, check out the Enteric website.

Companies in every industry need to assume that a software revolution is coming.” – Marc Andreessen

Enteric Hackaday 2016 2

Enteric HTC Hackday 2016

Forclarity-blog-Piero-graphics.png

Forclarity will be presenting at Enteric Healthcare Technology Co-Operative’s “Hackaday 2016” event “Imaging, Sensing and Digital in GI Medicine” on Friday, 14 October…

“The aim of this meeting is to bring together people with an interest and/or expertise in imaging, sensing and digital health in gastrointestinal medicine. The day’s talks will inform attendees of the innovative technologies and solutions emerging to solve unmet NHS needs

Bruce Lynn will be presenting on “Real Time Imaging and Computing Power” discussing the latest image processing technologies and how they can be applied to surgical imaging in real-time with the high performance graphic processing now available.