Lifelike simulations that make real-life surgery safer

What if I told you there
was a new technology

that when placed in the hands
of doctors and nurses,

improved outcomes
for children and adults --

patients of all ages --

reduced pain and suffering,

reduced time in the operating rooms,

reduced anesthetic times,

had the ultimate dose response curve

that the more you did it,

the better it benefitted patients.

Here's a kicker:

it has no side effects

and it's available no matter
where care is delivered.

I can tell you as an ICU doctor
at Boston Children's Hospital

this would be a gamechanger for me.

That technology is life-like rehearsal.

This life-like rehearsal is being
delivered through medical simulation.

I though I would start with a case,

just to really describe
the challenge ahead,

and why this technology is not just
going to improve healthcare,

but why it's critical to healthcare.

This is a child that's born --

young girl --

day of life zero, we call it.

The first day of life,

just born into the world.

And just as she's being born,

we notice very quickly
that she is deteriorating.

Her heart rate is going up,

her blood pressure is going down,

she's breathing very, very fast.

And the reason for this is displayed
in this chest X-ray.

That's called a [baby gram],

and this is full X-ray of a child's body,

a little infant's body.

And as you look on the top side of this,

that's where the hearts and lungs
are supposed to be,

and as you look at the bottom end,

that's where the abdomen is,

and that's where the intestines
are supposed to be,

and you can see how there's sort of
that translucent area

that made its way up and to the right
side of this child's chest.

And that is the intestines,

in the wrong place.

As a result, they're pushing on the lungs

and making it very difficult
for this poor baby to breathe.

The fix for this problem

is to take this child immediately
to the operating room,

bring those intestines back
into the abdomen,

let the lungs expand and allow
this child to breathe again.

But before she can go
to the operating room,

she must get whisked away to the ICU,

where I work,

and I work with surgical teams,

and we gather around her,

and we place this child
on heart-lung bypass.

We put her to sleep,

we make a tiny
little incision in the neck,

we place catheters into the major
vessels of the neck --

and I can tell you that these vessels
are about the size of a pen,

the tip of a pen --

and then we have blood
drawn from the body,

we bring it through a machine,

it gets oxygenated,

and it goes back into the body.

We save her life,

and get her safely to the operating room.

Here's the problem.

These disorders --

what is known is congenital
diaphragmatic hernia --

this hole in the diaphragm that has
allowed these intestines to sneak up --

these disorders are rare.

Even in the best hands in the world,

there is still a challenge
to get the volume --

the natural volume of these patients

in order to get our
expertise curve at 100 percent.

They just don't present that often.

So how do you make the rare common?

Here's the other problem.

In the healthcare system
that I trained for over 20 years,

what currently exists,

the model of training is called
the apprenticeship model.

It's been around for centuries.

It's based on this idea that you see
a surgery maybe once,

maybe several times,

you then go do that surgery,

and then ultimately you teach
that surgery to the next generation.

An implicit in this model --

I don't need to tell you this --

is that we practice on the very patients
that we are delivering care to.

That's a problem.

And I think there's a better approach.

Medicine may very well be the last
high-stakes industry

that does not practice prior to game time.

I want to describe to you a better
approach through medical simulation.

Well, the first thing we did is we went
to other high-stakes industries

that had been using this type
of methodology for decades.

This is nuclear power.

Nuclear power runs scenarios
on regular bases

in order to practice what they
hope will never occur.

And as we're all very familiar,

the airline industry.

We all get on planes now
comforted by the idea

that pilots and crews have trained
on simulators much like these,

training on scenarios
that we hope will never occur,

but we know if they did,

they would be prepared for the worst.

In fact, the airline industry has gone
as far as to create fuselages

of simulation environments

because of the importance
of the team coming together.

This is an evacuation drill simulator.

So that again,

if that ever were to happen,

these rare, rare events,

they're ready to act
on the drop of a dime.

I guess the most compelling
for me in some ways,

is the sports industry.

Arguable high stakes.

You think about how a baseball team,

baseball players practice.

I think it's a beautiful example
of progressive training.

The first thing they do is they
go out to spring trainging.

They go to a spring training camp,

perhaps a simulator in baseball.

They're not a real field,

but they're on a simulated field,

and they're playing
in the pre-game season.

Then they make they're way to the field
during the season games,

and what's the first thing they do
before they start the game?

They go into the batting cage,

and they do batting practice for hours,

having different types of pitches
being thrown at them,

hitting ball after ball
as they limber their muscles,

getting ready for the game itself.

And here's the most
phenomenal part of this ...

and for all of you who watch
and sport event,

you will see this phenomenon happen.

The batter gets into the batters box,

the pitcher gets ready to pitch.

Right before the pitch is thrown,

what does that batter do?

The batter steps out of the box,

and takes a practice swing.

He wouldn't do it any other way.

I want to talk to you

about how we're building
practice swings like this in medicine.

We are building batting cages
for the patients that we care about

at Boston Children's.

I want to use this case
that we recently built.

It's the case of a four-year-old
who had a progressively enlarging head,

and as a result,

had loss of developmental milestones --

neurologic milestones --

and the reason for this problem is here,

it's called hydrocephalus.

So a quick study in neurosurgery.

There's the brain,

and you can see the cranium
surrounding the brain.

And what surrounds the brain actaully
between the brain and cranium

is something called cerebrospinal fluid,

or fluid which acts as a shock absorber.

In your heads right now,

there is cerebrosprinal fluid
just bathing your brains

and making it way around.

It's produced in one area,

it flows through

and then is re-exchanged,

and this beautiful flow pattern
occurs for all of us.

But unfortunately in some children,

there's a blockage of this flow pattern,

much like a traffic jam.

As a result,

the fluid accumulates,

and the brain is pushed aside.

It has difficulty growing.

As a result,

the child loses neurologic milestones.

This is a devastating disease in children.

So the cure for this is surgery.

The traditional surgery is to take
a bit of the cranium off --

a bit of the skull --

drain this fluid out,

stick a drain in place,

and then eventually bring this drain
internal to the body.

Big operation.

But some great news is that advances
in