- I got an email from a company called Lazarus 3D
offering to show me my own internal organs,
not on a screen or visualization,
but by 3D printing a full-size, realistic, and
heavy copy of my abdomen,
and cutting into it with an actual surgical robot.
Now, this isn't going to be the version
with full realistic blood.
YouTube probably wouldn't like that.
But, if you're scared of surgery,
you might want to watch through your fingers.
And also, this isn't an advert.
I paid for my own MRI scan
to get the data that they've worked with,
but I'm not exactly doing
a randomized controlled trial here either.
The company wants to show off.
The case studies I've seen look solid,
but I am not qualified to check medical claims.
I'm just a guy who's about to watch someone
cut into a 3D printed copy of my own guts.
- So our early studies indicate that by performing rehearsals,
there can be clinical benefits,
but that's something that's going to need to be borne out
as we perform more and more studies.
- Let's open it up. - Let's do it.
- In every other human endeavor, an ability to rehearse and practice,
and do so specifically for that individual event,
has major payoffs.
So if we take the best violin player in the world,
and we give them a highly-complicated piece of music,
they're more likely to make a mistake if they're sight-reading it,
than if they've had an opportunity to rehearse.
- The crux of the problem
is that surgeons, unfortunately,
don't have a way to learn outside of the OR.
- It is as heavy as I am.
There we go.
- Whoa! - Wow.
- We use both MRIs and CTs and they can tell you different things.
So this process is called segmentation. We end up with a 3D image of Tom's organs.
We send the "Digital Twin" to the physician that orders it,
so that they can review and approve that design,
and allow for production to begin on that piece.
- I've never, ever taken my shirt off on camera...
but that's me!
- That is you. - I recognize that.
- So this is the upper part of the abdomen.
This is your liver and you can see your spleen here.
- That's sticky.
I kind of assumed that 'that' would feel like 'that',
and it doesn't. They've got completely different textures.
- I mean it's the closest you're going to get to a real abdomen.
- So they have artificially given me a cyst on my left kidney --
on this thing's left kidney!
- That's correct.
- You're going to go in and try and remove it.
- With your permission, I will.
- The camera gets inserted by the technicians.
So for a patient who is under robotic surgery,
they would have those three ports inserted there
and then stitch it back after?
- Yes, sir. Absolutely. Absolutely.
So this is a depiction of the left side of the abdomen,
and, as you can see here,
we have your kidney,
and you also have the collecting system,
which is depicted by this yellow structure here,
and then you have the blue structure which depicts the vein,
and the red structure which depicts the artery.
- We originally made our models more realistic in color,
so that they looked more like real tissue,
but the feedback we got,
is part of what the surgeons wanted, was to have clear demarcations.
This is very clearly where this structure is,
and this is very clearly another.
- This is a skeletonized version
of what you would see in an actual real setting.
Typically, there's a lot of what we call intermediate stratum,
which actually exists between the actual organs
in the vessels of the body, and it's like connective tissues.
It involves fascia as well as fat.
- So every movement you make there is copied at a tiny scale by the robot.
- That's correct. So we can scale this down to one fifth of the human movement.
So one of the advantages of the robot
is that it allows the surgeons to operate longer
into their six and seventh decades of life, even.
If people have tremors, et cetera.
- You can't see this 'cause you're looking at the machine,
but I just, kind of instinctively, grabbed my own abdomen there.
Just, that's...
...that's in there.
That's me!
- That is you, you know.
- They've switched off a few things, right?
So I don't have stomach or intestines there,
and it's not bleeding everywhere.
- We do make models that bleed.
The most common thing we do
is have a hollow artery or vein system that's filled with blood,
and when you make a cut, you'll initially get a bleed
as it drains out of that system,
but then, because it's not hooked up to pumps,
and all of this added complication,
it doesn't continue to bleed.
- What he did do, was he made it a little interesting,
and he created what we call a renal cyst,
which is a thin-walled, fluid-filled sac.
He made this quite challenging for me
in that he positioned it behind your vasculature,
and that's the lovely part about being able to rehearse this
prior to the surgery.
- This is fascinating!
- You know, so as a person is actually being positioned,
and put to sleep,
I'm actually doing a rehearsal.
So what it does,
is it helps me to fine tune my visuospatial perception,
as well as be able to know how to position my hand on the robot.
All of that stuff helps to improve efficiency and accuracy
when you're actually doing the real dissection of a kidney.
The difference with the robot, unlike with a human hand,
you don't have tactile sensation.
So I don't, when I touch this, I don't know how that really feels,
but I can look at the tissue tension when I press here.
This is okay.
This is way too much.
- I know it's not a voodoo doll,
but you did that and something in my guts went, ooh.
- [laughs]
- Oh!
- It's nice to have tissue that pretty much acts like real tissue.
- With one of our collaborators,
they actually used a robotic arm with a scalpel and a force sensor.
So we took animal tissue, this was a pig kidney,
and this arm would make a cut in that kidney,
and it would measure the forces that are experienced
by that scalpel tip.
We could then do the exact same thing to measure
and then we can iteratively improve these materials
to make them behave like real tissue.
- All the 3D printing nerds are going to be asking me,
how on earth they 3D printed soft tissue like this
and they will not tell me.
- Unfortunately, that's a trade secret and I cannot comment on that!
- This is the cyst itself, and see how this tissue here,
this is like your peeling layers of a grape.
- And that is a fluid-filled sac.
- Yes.
- They wouldn't show me how they've 3D printed a fluid-filled thing,
but they have.
You can see the little striations where it's been laid down.
You can see the 3D printed parts. - You sure can.
So I typically like to remove it as one whole cyst,
but oftentimes this is not infected fluid or cancerous,
you know, this is usually benign.
So it's more style points.
They're separating nicely here but sometimes it's really adhered.
- Wow!
Oh. Oh, there we go. - Oh. That's okay.
There we go.
That's fine. - There we go.
This is, A, why surgeons rehearse,
and, B, that, I assume, would not have been critical.
- No, no, not at all. No.
- For every procedure, there are different things
that you need to be worried about.
Sometimes it's that a structure you're operating on
is right next to a major vessel.
Sometimes it's that it's next to nerves.
Sometimes it's that there's a time constraint,
because you have to clamp an artery
and, at that point, that organ will stop getting oxygen
and you are in fact on a clock.
- Our goal is to help surgeons reduce the risk,
reduce their challenges, and empower them.
By empowering the surgeons,
we are also empowering the patients because they know
that when their surgeon has rehearsed ahead of the time,
they are operating with confidence.
- And that's it, and it's coming out now.
- Yep. That's it, right there.
That's your cyst. - Wow.
Okay. I don't know how I feel about this.
- Wow!
That's pretty nice, there.
This is perfect, you know.
- Thank you for removing my cyst.
- Oh, you're very welcome.
Thank you. Yeah.