WEBVTT 00:00:00.879 --> 00:00:02.855 The first time I stood in the operating room 00:00:02.855 --> 00:00:04.727 and watched a real surgery, 00:00:04.727 --> 00:00:07.302 I had no idea what to expect. 00:00:07.302 --> 00:00:09.277 I was a college student in engineering. 00:00:09.277 --> 00:00:11.477 I thought it was going to be like on TV. 00:00:11.477 --> 00:00:13.382 Ominous music playing in the background, 00:00:13.382 --> 00:00:16.381 beads of sweat pouring down the surgeon's face. 00:00:16.381 --> 00:00:18.541 But it wasn't like that at all. 00:00:18.541 --> 00:00:20.140 There was music playing on this day, 00:00:20.140 --> 00:00:22.862 I think it was Madonna's greatest hits. (Laughter) 00:00:22.862 --> 00:00:24.989 And there was plenty of conversation, 00:00:24.989 --> 00:00:26.989 not just about the patient's heart rate, 00:00:26.989 --> 00:00:29.762 but about sports and weekend plans. 00:00:29.762 --> 00:00:31.698 And since then, the more surgeries I watched, 00:00:31.698 --> 00:00:33.525 the more I realized this is how it is. 00:00:33.525 --> 00:00:36.278 In some weird way, it's just another day at the office. 00:00:36.278 --> 00:00:38.183 But every so often 00:00:38.183 --> 00:00:40.281 the music gets turned down, 00:00:40.281 --> 00:00:41.711 everyone stops talking, 00:00:41.711 --> 00:00:44.695 and stares at exactly the same thing. 00:00:44.695 --> 00:00:46.855 And that's when you know that something absolutely critical 00:00:46.855 --> 00:00:49.295 and dangerous is happening. NOTE Paragraph 00:00:49.295 --> 00:00:50.311 The first time I saw that 00:00:50.311 --> 00:00:51.543 I was watching a type of surgery 00:00:51.543 --> 00:00:53.832 called laparoscopic surgery 00:00:53.832 --> 00:00:56.390 And for those of you who are unfamiliar, 00:00:56.390 --> 00:00:58.783 laparoscopic surgery, instead of the large 00:00:58.783 --> 00:01:01.277 open incision you might be used to with surgery, 00:01:01.277 --> 00:01:03.485 a laparoscopic surgery is where the surgeon creates 00:01:03.485 --> 00:01:06.502 these three or more small incisions in the patient. 00:01:06.502 --> 00:01:09.368 And then inserts these long, thin instruments 00:01:09.368 --> 00:01:10.482 and a camera, 00:01:10.482 --> 00:01:14.333 and actually does the procedure inside the patient. 00:01:14.333 --> 00:01:16.925 This is great because there's much less risk of infection, 00:01:16.925 --> 00:01:20.085 much less pain, shorter recovery time. 00:01:20.085 --> 00:01:22.677 But there is a trade-off, 00:01:22.677 --> 00:01:24.461 because these incisions are created 00:01:24.461 --> 00:01:26.959 with a long, pointed device 00:01:26.959 --> 00:01:28.423 called a trocar. 00:01:28.423 --> 00:01:30.617 And the way the surgeon uses this device 00:01:30.617 --> 00:01:32.033 is that he takes it 00:01:32.033 --> 00:01:34.000 and he presses it into the abdomen 00:01:34.000 --> 00:01:37.255 until it punctures through. 00:01:37.255 --> 00:01:40.327 And now the reason why everyone in the operating room 00:01:40.327 --> 00:01:42.974 was staring at that device on that day 00:01:42.974 --> 00:01:46.205 was because he had to be absolutely careful 00:01:46.205 --> 00:01:47.672 not to plunge it through 00:01:47.672 --> 00:01:51.613 and puncture it into the organs and blood vessels below. 00:01:51.613 --> 00:01:53.452 But this problem should seem pretty familiar to all of you 00:01:53.452 --> 00:01:56.373 because I'm pretty sure you've seen it somewhere else. 00:01:56.373 --> 00:01:58.165 (Laughter) 00:01:58.165 --> 00:01:59.821 Remember this? 00:01:59.821 --> 00:02:03.937 (Applause) 00:02:03.937 --> 00:02:05.813 You knew that at any second 00:02:05.813 --> 00:02:07.693 that straw was going to plunge through, 00:02:07.693 --> 00:02:09.278 and you didn't know if it was going to go out the other side 00:02:09.278 --> 00:02:10.581 and straight into your hand, 00:02:10.581 --> 00:02:12.277 or if you were going to get juice everywhere, 00:02:12.277 --> 00:02:15.580 but you were terrified. Right? 00:02:15.580 --> 00:02:17.556 Every single time you did this, 00:02:17.556 --> 00:02:20.112 you experienced the same fundamental physics 00:02:20.112 --> 00:02:23.192 that I was watching in the operating room that day. 00:02:23.192 --> 00:02:25.738 And it turns out it really is a problem. 00:02:25.738 --> 00:02:28.530 In 2003, the FDA actually came out and said 00:02:28.530 --> 00:02:31.907 that trocar incisions might be the most dangerous step 00:02:31.907 --> 00:02:33.923 in minimally invasive surgery. 00:02:33.923 --> 00:02:36.363 Again in 2009, we see a paper that says 00:02:36.363 --> 00:02:38.547 that trocars account for over half 00:02:38.547 --> 00:02:42.234 of all major complications in laparoscopic surgery. 00:02:42.234 --> 00:02:43.376 And, oh by the way, 00:02:43.376 --> 00:02:46.970 this hasn't changed for 25 years. NOTE Paragraph 00:02:46.970 --> 00:02:48.500 So when I got to graduate school, 00:02:48.500 --> 00:02:50.368 this is what I wanted to work on. 00:02:50.368 --> 00:02:52.176 I was trying to explain to a friend of mine 00:02:52.176 --> 00:02:54.291 what exactly I was spending my time doing, 00:02:54.291 --> 00:02:56.107 and I said, 00:02:56.107 --> 00:02:58.283 "It's like when you're drilling through a wall 00:02:58.283 --> 00:03:01.483 to hang something in your apartment. 00:03:01.483 --> 00:03:05.395 There's that moment when the drill first punctures through the wall 00:03:05.395 --> 00:03:09.047 and there's this plunge. Right? 00:03:11.389 --> 00:03:13.430 And he looked at me and he said, 00:03:13.430 --> 00:03:16.901 "You mean like when they drill into people's brains?" 00:03:16.901 --> 00:03:19.233 And I said, "Excuse me?" (Laughter) 00:03:19.233 --> 00:03:22.281 And then I looked it up and they do drill into people's brains. 00:03:22.281 --> 00:03:24.345 A lot of neurosurgical procedures 00:03:24.345 --> 00:03:28.127 actually start with a drill incision through the skull. 00:03:28.127 --> 00:03:29.912 And if the surgeon isn't careful, 00:03:29.912 --> 00:03:33.496 he can plunge directly into the brain. 00:03:33.496 --> 00:03:35.662 So this is the moment when I started thinking, 00:03:35.662 --> 00:03:38.970 okay, cranial drilling, laparoscopic surgery, 00:03:38.970 --> 00:03:40.634 why not other areas of medicine? 00:03:40.634 --> 00:03:42.578 Because think about it, when was the last time you went to the doctor 00:03:42.578 --> 00:03:45.325 and you didn't get stuck with something? Right? 00:03:45.325 --> 00:03:46.642 So the truth is 00:03:46.642 --> 00:03:49.194 in medicine puncture is everywhere. 00:03:49.194 --> 00:03:51.986 And here are just a couple of the procedures that I've found 00:03:51.986 --> 00:03:55.195 that involve some tissue puncture step. 00:03:55.195 --> 00:03:57.274 And if we take just three of them — 00:03:57.274 --> 00:04:01.370 laparoscopic surgery, epidurals, and cranial drilling — 00:04:01.370 --> 00:04:05.349 these procedures account for over 30,000 complications 00:04:05.349 --> 00:04:08.200 every year in this country alone. 00:04:08.200 --> 00:04:10.915 I call that a problem worth solving. NOTE Paragraph 00:04:10.915 --> 00:04:13.240 So let's take a look at some of the devices 00:04:13.240 --> 00:04:15.744 that are used in these types of procedures. 00:04:15.744 --> 00:04:18.969 I mentioned epidurals. This is an epidural needle. 00:04:18.969 --> 00:04:21.286 It's used to puncture through the ligaments in the spine 00:04:21.286 --> 00:04:23.725 and deliver anesthesia during childbirth. 00:04:23.725 --> 00:04:26.278 Here's a set of bone marrow biopsy tools. 00:04:26.278 --> 00:04:28.214 These are actually used to burrow into the bone 00:04:28.214 --> 00:04:31.714 and collect bone marrow or sample bone lesions. 00:04:31.714 --> 00:04:33.624 Here's a bayonette from the Civil War. 00:04:33.624 --> 00:04:36.640 (Laughter) 00:04:36.640 --> 00:04:39.233 If I had told you it was a medical puncture device 00:04:39.233 --> 00:04:41.449 you probably would have believed me. 00:04:41.449 --> 00:04:43.642 Because what's the difference? 00:04:43.642 --> 00:04:45.577 So, the more I did this research 00:04:45.577 --> 00:04:47.161 the more I thought there has to be 00:04:47.161 --> 00:04:49.190 a better way to do this. 00:04:49.190 --> 00:04:51.609 And for me the key to this problem 00:04:51.609 --> 00:04:54.020 is that all these different puncture devices 00:04:54.020 --> 00:04:57.822 share a common set of fundamental physics. NOTE Paragraph 00:04:57.822 --> 00:04:59.374 So what are those physics? 00:04:59.374 --> 00:05:00.966 Let's go back to drilling through a wall. 00:05:00.966 --> 00:05:04.598 So you're applying a force on a drill towards the wall. 00:05:04.598 --> 00:05:07.942 And Newton says the wall is going to apply force back, 00:05:07.942 --> 00:05:09.207 equal and opposite. 00:05:09.207 --> 00:05:11.170 So, as you drill through the wall, 00:05:11.170 --> 00:05:13.100 those forces balance. 00:05:13.100 --> 00:05:14.641 But then there's that moment 00:05:14.641 --> 00:05:16.777 when the drill first punctures through the other side of the wall, 00:05:16.777 --> 00:05:19.633 and right at that moment the wall can't push back anymore. 00:05:19.633 --> 00:05:23.100 But your brain hasn't reacted to that change in force. 00:05:23.100 --> 00:05:24.161 So for that millisecond, 00:05:24.161 --> 00:05:26.793 or however long it takes you to react, you're still pushing, 00:05:26.793 --> 00:05:29.337 and that unbalanced force causes an acceleration, 00:05:29.337 --> 00:05:32.449 and that is the plunge. 00:05:32.449 --> 00:05:36.353 But what if right at the moment of puncture 00:05:36.353 --> 00:05:37.977 you could pull that tip back, 00:05:37.977 --> 00:05:40.990 actually oppose the forward acceleration? 00:05:40.990 --> 00:05:43.127 That's what I set out to do. NOTE Paragraph 00:05:43.127 --> 00:05:44.447 So imagine you have a device 00:05:44.447 --> 00:05:47.647 and it's got some kind of sharp tip to cut through tissue. 00:05:47.647 --> 00:05:50.860 What's the simplest way you could pull that tip back? 00:05:50.860 --> 00:05:52.671 I chose a spring. 00:05:52.671 --> 00:05:55.255 So when you extend that spring, you extend that tip out 00:05:55.255 --> 00:05:57.470 so it's ready to puncture tissue, 00:05:57.470 --> 00:05:58.910 the spring wants to pull the tip back. 00:05:58.910 --> 00:06:00.663 How do you keep the tip in place 00:06:00.663 --> 00:06:03.127 until the moment of puncture? 00:06:03.127 --> 00:06:05.550 I used this mechanism. 00:06:05.550 --> 00:06:08.111 When the tip of the device is pressed against tissue, 00:06:08.111 --> 00:06:11.951 the mechanism expands outwards and wedges in place against the wall. 00:06:11.951 --> 00:06:13.655 And the friction that's generated 00:06:13.655 --> 00:06:16.847 locks it in place and prevents the spring from retracting the tip. 00:06:16.847 --> 00:06:18.734 But right at the moment of puncture, 00:06:18.734 --> 00:06:20.798 the tissue can't push back on the tip anymore. 00:06:20.798 --> 00:06:23.980 So the mechanism unlocks and the spring retracts the tip. 00:06:23.980 --> 00:06:25.630 Let me show you that happening in slow motion. 00:06:25.630 --> 00:06:27.278 This is about 2,000 frames a second, 00:06:27.278 --> 00:06:29.150 and I'd like you to notice the tip 00:06:29.150 --> 00:06:31.778 that's right there on the bottom, about to puncture through tissue. 00:06:31.778 --> 00:06:34.839 And you'll see that right at the moment of puncture, 00:06:36.590 --> 00:06:39.892 right there, the mechanism unlocks and retracts that tip back. 00:06:39.892 --> 00:06:42.236 I want to show it to you again, a little closer up. 00:06:42.236 --> 00:06:44.428 You're going to see the sharp bladed tip, 00:06:44.428 --> 00:06:46.420 and right when it punctures that rubber membrane 00:06:46.420 --> 00:06:50.572 it's going to disappear into this white blunt sheath. 00:06:50.572 --> 00:06:52.437 Right there. 00:06:52.437 --> 00:06:57.101 That happens within four 100ths of a second after puncture. 00:06:57.101 --> 00:07:00.901 And because this device is designed to address the physics of puncture 00:07:00.901 --> 00:07:02.733 and not the specifics of cranial drilling 00:07:02.733 --> 00:07:04.940 or laparoscopic surgery, or another procedure, 00:07:04.940 --> 00:07:07.597 it's applicable across these different medical disciplines 00:07:07.597 --> 00:07:10.628 and across different length scales. NOTE Paragraph 00:07:10.628 --> 00:07:12.741 But it didn't always look like this. 00:07:12.741 --> 00:07:14.926 This was my first prototype. 00:07:14.926 --> 00:07:17.568 Yes, those are popsicle sticks, 00:07:17.568 --> 00:07:19.470 and there's a rubber band at the top. 00:07:19.470 --> 00:07:22.870 It took about 30 minutes to do this, but it worked. 00:07:22.870 --> 00:07:24.566 And it proved to me that my idea worked 00:07:24.566 --> 00:07:27.958 and it justified the next couple years of work on this project. 00:07:27.958 --> 00:07:29.766 I worked on this because 00:07:29.766 --> 00:07:31.429 this problem really fascinated me. 00:07:31.429 --> 00:07:33.558 It kept me up at night. 00:07:33.558 --> 00:07:36.540 But I think it should fascinate you too, 00:07:36.540 --> 00:07:38.442 because I said puncture is everywhere. 00:07:38.442 --> 00:07:42.706 That means at some point it's going to be your problem too. 00:07:42.706 --> 00:07:44.266 That first day in the operating room 00:07:44.266 --> 00:07:47.250 I never expected to find myself on the other end of a trocar. 00:07:47.250 --> 00:07:51.140 But last year, I got appendicitis when I was visiting Greece. 00:07:51.140 --> 00:07:52.970 So I was in the hospital in Athens, 00:07:52.970 --> 00:07:54.458 and the surgeon was telling me 00:07:54.458 --> 00:07:56.594 he was going to perform a laparoscopic surgery. 00:07:56.594 --> 00:07:59.346 He was going to remove my appendix through these tiny incisions, 00:07:59.346 --> 00:08:02.040 and he was talking about what I could expect for the recovery, 00:08:02.040 --> 00:08:03.482 and what was going to happen. 00:08:03.482 --> 00:08:05.900 He said, "Do you have any questions?" And I said, "Just one, doc. 00:08:05.900 --> 00:08:09.374 What kind of trocar do you use?" NOTE Paragraph 00:08:09.374 --> 00:08:12.879 So my favorite quote about laparoscopic surgery 00:08:12.879 --> 00:08:15.525 comes from a Doctor H. C. Jacobaeus: 00:08:15.525 --> 00:08:19.189 "It is puncture itself that causes risk." 00:08:19.189 --> 00:08:22.325 That's my favorite quote because H.C. Jacobaeus 00:08:22.325 --> 00:08:26.365 was the first person to ever perform laparoscopic surgery on humans, 00:08:26.365 --> 00:08:29.797 and he wrote that in 1912. 00:08:29.797 --> 00:08:35.581 This is a problem that's been injuring and even killing people for over 100 years. NOTE Paragraph 00:08:35.581 --> 00:08:37.815 So it's easy to think that for every major problem out there 00:08:37.815 --> 00:08:41.751 there's some team of experts working around the clock to solve it. 00:08:41.751 --> 00:08:45.100 The truth is that's not always the case. 00:08:45.100 --> 00:08:47.545 We have to be better at finding those problems 00:08:47.545 --> 00:08:50.313 and finding ways to solve them. 00:08:50.313 --> 00:08:53.569 So if you come across a problem that grabs you, 00:08:53.569 --> 00:08:55.450 let it keep you up at night. 00:08:55.450 --> 00:08:57.593 Allow yourself to be fascinated, 00:08:57.593 --> 00:09:00.505 because there are so many lives to save. NOTE Paragraph 00:09:00.505 --> 00:09:03.904 (Applause)