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A brave new surgical world

Louis Kavoussi stands next to his surgical suturing device

Louis Kavoussi, MD, envisions a surgical future without human error, starting with his new invention, the Urethra Anastomotic Device

The future of surgery, according to inventor and surgeon Louis Kavoussi, MD, chair of urology for Northwell Health, can be illustrated by an oft-told joke among physicians:

“Inside the operating room, there will be a robot, a doctor and a dog,” Dr. Kavoussi says. “The doctor’s purpose there is to push the button that starts the robot. The dog is there to guard the doctor and make sure he or she doesn’t do anything else.”

He laughs after telling it and said others do too, despite it not being all that popular among his surgical colleagues. “It’s not popular because there’s a lot of truth in it. We’re working on technology that essentially will eliminate surgeons. With automation, you won’t need them.”

Imagine a not-too-distant future that eliminates 99 percent of human surgical errors. “It’s not the stuff of science fiction and Terminator movies. It could be reality within the next decade,” Dr. Kavoussi explained. He has more than a passing interest in that future because he’s helping to create it — working with a team from Hofstra University’s School of Engineering to ensure it becomes a reality.

“We want the elimination of human error for ourselves, our families and patients,” Dr. Kavoussi said. “And through automation, we’re going to get there in short order. This isn’t something that may happen. It’s a certainty.”

quotation mark One always has to question the status quo and think about how change can make life better for our patients.
Louis Kavoussi, MD

What is and isn’t a robot?

Currently, the term ‘robotic surgery’ is a bit of a misnomer, Dr. Kavoussi said. “Robots in the operating room are not ‘real’ robots. They are essentially computers with arms and you need a surgeon to actively move the arms. What we are working on with Hofstra is a completely autonomous suturing robot. Complete autonomy is where all of this is headed.”

The initial plan for that suturing device, currently in prototype, is to make it portable for military and battlefield applications to treat wounded soldiers. “A medic can pull out the device and put it over the incision. The device scans the incision, decides on the best way to clean it, and then closes it up and gets the patient off the battlefield. It’ll take less than a minute.”

An expert in urological diseases, Dr. Kavoussi is not only a surgeon but also an inventor. He has developed a device that is used after a radical prostatectomy to more easily — and precisely — join the bladder and urethra. He’s currently working with i360medical, an international innovation company that takes new health care ideas and medical technologies to market, and the Feinstein Institutes for Medical Research together, to commercialize the Urethra Anastomotic Device. The plan is to guide the product from Dr. Kavoussi’s concept to design through clinical trials and eventually to surgical use.

“That device takes one part of an operation and actually sort of automates it, even though the surgeon is placing it within the body,” Dr. Kavoussi said. “The stitching is automated in that the surgeon is not putting the stitches in one-by-one. It is not fully robotic yet but you can easily see how it will become automated.”

The reason for the emphasis on automation is because it improves quality and speeds healing by eliminating human error. “The general public may not think about it, but the reality is that certain surgeons are more technically proficient than others. With automation and the development of true robots, the idea is to develop devices that, at the very minimum, are as good as the very best surgeon in the world for whatever procedure it is.”

Consider outer space

The reality that advances in one industry spur advances in another can be seen in what may seem like an odd pairing: America’s renewed appetite for space exploration and its $3 trillion health care system. As Dr. Kavoussi explains, though they may seem to be strange bedfellows at first, deep-space exploration necessitates medical automation.

“You cannot have every possible type of surgeon on a mission to Mars or outer planets. And you cannot remotely run surgeries because of the delay in the time signal to go back and forth between Earth and a spaceship or space station. There is too much of a time lag to control a remote surgical arm effectively,” he said.

“These will be long missions and medical events will undoubtedly occur. Someone could have appendicitis or develop a kidney stone. You are going to need an autonomous robotic device to treat the appendix, or a kidney stone or a host of other surgical problems.”

Dr. Kavoussi sees those types of industry connections everywhere. “You know, I’m rooting for the self-driving car, because it has an impact on health. Some patients and family members as they get older are unable or too scared to drive. They don’t leave the house. That impacts socialization, mental health, the ability of people to go to doctors and live their lives. So while I see the very real and positive implications for automating surgery because it is my field, there are so many ways automation will positively impact our health in ways we haven’t even considered.”

As a surgeon and inventor, Dr. Kavoussi is committed to continually learning, exploring, improving and taking insights from all areas. It’s one of the things that drives him. “All I learn from daily living, new technology, new designs, new ideas, I need to bring to my work and think about how they can improve patient care,” he said. “One always has to question the status quo and think about how change can make life better for our patients.”

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