Dr. Kris Siemionow is a board certified orthopaedic surgeon. He completed orthopedic surgery residency at the Cleveland Clinic Foundation and spine surgery fellowship at Rush University Medical Center. Dr. Siemionow's PhD focused on the effects of inflammation on nerve cell function.
Dr. Siemionow is the Co-founder & CEO of Holo Surgical, a company developing a proprietary neural network and algorithm to deliver the world's first-in-human digital surgery based on augmented reality and artificial intelligence.
Holo Surgical's clinical tested ARAI surgical navigation system provides real-time patient specific 3D anatomical visualization for surgical planning, intraoperative guidance, and post surgical data analytics.
Published clinical papers are available here
Please welcome welcome to another episode of unmet need hosted by serial founder CEO Jeff Smith, your number one podcast for healthcare innovation. Jeff and his guests tackle the biggest problems in healthcare and share their experience building successful businesses and medical device diagnostics, therapeutics, digital health, and so much more desease unmet need hosted by Jeff Smith. Hello and Welcome to the next episode of unmet need. I'm your host Jeff Smith. Today we have a very special guest and a good friend of mine Dr. Chris shimin of Dr. Shimon Nava is a Board Certified orthopedic surgeon and entrepreneur who has founded multiple healthcare companies that utilize advanced technology to improve clinical outcomes. Chris completed his residency at the Cleveland Clinic foundation in orthopedic surgery and a spine fellowship at Rush University Medical Center. Dr. Sherman has PhD focused on the effects of inflammation on nerve cell function. He is the CO Founder of global spine outreach a nonprofit whose mission is to save children with severe spinal deformities. He's also co founded a number of other companies in the purpose of time, we're going to let him talk about it. So, Chris, are you just got exhausted? Yes. All of the things you've done already and still very young guy. So first of all, welcome, and thanks for being on unmet need. Yeah, thanks for having me, Jeff. And you know, as you probably are aware, physicians love to collect titles so there has to be a long list of accomplishments behind all every physicians name. So that's, that's joking aside, but yeah, thanks. Thanks so much for having me. I'm happy it worked out for the audience. If it's okay, can I use your first name for the week? Long enough? You've always been gracious about that. Respect with with a with a last name like mine first name goes goes in handy very, very often. Yeah. What do you mean by that? Well, you know pronunciation of my last name, which has nine letters. So most of them are vowels is has been challenging ever since I came to the United States. I've heard a number of iterations so to speak. So I appreciate you taking the effort to saying it properly. We'll just set the record straight. We'd like to hear you pronounce it. shimmy on off, shimmy enough. Thank you. I've got you that for six years now. My apologies. but who's counting? Art Fair enough? Well, since we started there, when did you move to the United States? So the first time I was in the US is in 1986. My mom was doing a hand surgery fellowship at the Coots and kleinert Institute in Louisville, Kentucky. So I came on a cold December day from Eastern Europe, to Kentucky, which in 1989, was it was a pretty big culture shock. I'm sorry. 1986 was a pretty big culture shock. And we came back again to Poland, which is where I'm from I was born and raised and then came back to to Kentucky again. In 1989, so a little bit of back and forth and then sort of spread out all over the United States from that point forward essentially moving from state to state till I was I was in medical school. So in 86, you were there in Kentucky for three years. We spent about two years or so uncontacted. My mom did that hand fellowship then we went back to Poland and and then you know, sort of when the world was opening up with the with the Berlin Wall and everything coming down at night, when my parents decided to, to come to the US permanently. And when you move back to Poland, were you excited to see your friends? Are you hoping you would stick around us? Yeah, well, you know, you're a kid. So you sort of, kind of they put you in a plane, you probably don't even really know what's going on and you accept things for what they are. I think children are more plastic. they adopt a lot easier, right? I had friends I was coming to my family. I was coming. I was it was not a big deal. Not that I recall. And then once in 1989 hit you were in the US. Yeah. You know, like the world was moving everywhere, right? Every like you have all the Eastern Europeans, Russians, everybody was coming to the US. And there was a big wave of migration around that time. So we were part of that these things that happened in history that are unexpected, or maybe hoped for like the fall of the Berlin Wall, they become catalysts for change, you know, in your case early on in your life, Berlin Wall falls, how did that influence your parents decision to move to the US? Sure. Well, it's no secret that living under any communist regime is is challenging, right? For the very few at the top, it's probably, you know, we're sticking around. But for most of the society, the biggest benefit is leaving. So my parents in similar fashion found much more opportunity for both scientists. And then they felt that, you know, they would come to the US and sort of be able to pursue their academic careers, which did happen and then they did actually very well as a result and I think most people that that came in, that's a Era also probably did not have too many second thoughts professionally at least, obviously, there's a, there's a, there's a price to pay in the sense of leaving family and friends behind, which would you sort of carry with you but you know, the interesting you you say about the COVID. And there being an impact of you count during our lives, how many of these very rare occurrences have happened? It's, it's sort of astonishing to me, right? I mean, we've had 911, we've had 2008 market crash, we had the.com bubble, we had the Berlin Wall, it's like literally every, you know, not even every decade, we have some major event that sort of never happened before. And we we learn to get by and live with it and adjust. And, you know, I think every period after each one of those events that I mentioned, has been sort of more positive and better, right. I'm sort of counting on that happening here. And, and then moving forward. You know, often, Chris, you're kind enough to share a book recommendation with me and I try to send one back and you read probably five for every book that I read. But I think one of the books we talked about that just made me think of is the Black Swan event. Sure. Very familiar. Yes. But the point you just made is interesting, because in my career, I've been working for 20 years.com was the front end of that 911 came right after that, and then the 2008 financial crisis, and if in fact, we're heading into a COVID-19 recession, which some people think we are, that is a lot of black swan events. Now, that doesn't make them very black swans anymore, does it? No, it does. In that case, it's almost like a person as we think about our careers and plan for what we want to do and the projects we tackle. It's almost like not if it's when, sure and how is your plan going to be nimble enough to first indoor the unexpected event and then while everybody else is worried and retrenched, maybe you actually can advance and gain some some headway so the this past week, the the vision Fund, which is part of SoftBank They presented their their quarterly earnings. And they you know, for the audience that doesn't know they raised, the largest venture capital fund in history is 100 billion dollars. And they've now deployed all of that capital. If you take the number of days since they had the funds since they closed, they've averaged 100 million dollars of investment per day. But what I've found really fascinating is they have this great slide deck because all kinds of funny slides unicorns, like falling into cliffs, but there's a slide that compares the degree of innovation and technology that drove a large part of the US economy for many years after the Great Depression. Then after that, what they're calling the COVID recession, there were six blocks, right so this is like visualizing where they see the investment themes and the biggest opportunities and you know, although unmet need is focused on healthcare innovation, that's not what the vision fund focuses on. They focus on Uber we work any any type of technology business, but out of state Six themes coming out of COVID-19 telemedicine telehealth is one of them. And I think that's probably going to be one of the areas with the most growth because regardless of the line of work, we're all in when everybody has to stay home for months to prevent waves of sick people coming into a hospital infrastructure that can't stand the waves. Healthcare is front and center on everyone's mind. Absolutely. it coincides with going back to 2001. When the.com bubble happened in 911, shortly after most of the technologies, the underlying technologies that are enabling a lot of the telemedicine, telehealth most of the important things that drive our economy now, they were just getting started, right, just getting broadband. So interesting that we would start there with that background. You get to the US how many years until you settle in and said this is home and I like it here. Well, you know, it's like I said I had the advantage of coming as a kid, right. So I think it's just so much easier. You know, I I think when you come in your late teens, it becomes harder. I think when you come in my father's age who was in his early 40s, it becomes very difficult. Right? So I, for me, it was literally within a week. So I would want to I was probably not my English wasn't great, but I was I was definitely, you know, feeling that I can do everything I want to do. And it was it was good, right? I mean, your kids like me playing and that's, that's most important when you're, you know, eight or nine years old. And so both of your parents as academics, did you have a natural interest in school and Science and Learning or is that something you developed over time? Absolutely not. Absolutely not. I don't think I was a great student. I was definitely not interested in what was happening academically. In school. I had my own interests, which were definitely nerdy but not in line with the school curriculum. You know, I was into like reptiles and lizards and then you know, I'm kind of machinery associated with tanks and planes and would try to spend a lot of time actually on that. Researching reading, like doing things that you may consider productive, but definitely not by school standards. Right? So it was it was sort of a challenge for my parents to get me interested in school. Did they see at least the curiosity that you're exploring all these topics? Or did they want you to be more focused on getting A's? Yeah, it's probably like any other parent right? They sort of judge you like the school judges you for for most of it, but ah, you know, they themselves are probably not super aware of the system here. school system. You know, in Poland, in Europe, the schools mostly focus on memorizing telephone books and are very impractical things and then you have to recite them, you know, which sort of silly in the days of Google Assistant Alexa where you can get all that information right without even needing how to you don't even need to know how to read and write you just talk. But, but that's how school is there. And you know, if you are not able to produce the That kind of content out of you, then you're probably not not impressing many people. But, you know, like I said, I had my own interest, I kind of stuck with them and, and then things ended up okay, but I'm definitely seeing similar interest in, you know, in our kids and I think you just got to support them, right? Because you know, forcing them to do things is not the good way to go here. And knowing that it ended up okay for me or other people that sort of are doing similar things is pretty encouraging. So, you know, not that I'm some, you know, PhD on education, but, but I think it's kind of common sense if you're interested in something and pursuing those. Those pursuits can definitely translate and morph into something more productive and in the future as you grow. curiosity and being encouraged to explore things are interested in for the love of the information and that's something I value as part of my education and I try to record Ignore that when my kids practice it versus have to memorize this phone book so that I can get a 99 or 100%. And then a plus, you know, we're grade something that validated you when you were in school. Only if they were would have been good. Most of the time we're not, you know, I, you know, like, grade school and I would say even early high school I, I kind of did my own thing. And you know, it wasn't Not that I wasn't paying attention. I was, you know, unfocused. It just wasn't, wasn't something was interesting to me. I became very interested. I would say, it's got like a late bloomer scenario, I became very interested in things that would make teachers happy, and then parents happy probably in my very late teens, early 20s. You know, I became very interested like in organic chemistry would you know, when I was like 20 2021, which was a good time for that, you know, what I was trying to do, but before that, It was just not something that that would that would find much time for me. So, you know, every and that's the problem with the educational system, everybody sort of develops at a different pace. And sometimes there's just not enough time or not enough room or runaway as you would say, for for people that are maybe late bloomers or find those interests later in life. Right. I think the nice thing about the America is that there's so many just avenues to get into things right are plenty people that switch careers and plenty of those histories, plenty of people that went back to school, I think, you know, once again, and that's, that's what's great about it, because in Europe if you're, you know, 35 and you want to go to medical school, that's just non starter, your complete albatross, right. versus one of the people that we were renting from originally was, was a artist cool in her late 30s went to medical school and actually became one of the first Da Vinci robotic surgery operators in ob gyn here in Chicago. So, crazy story right. So that is that Not happening in Europe, right? That's just, you know, you sort of your path is said, I mean, you go from high school to college, right? So it's just, it's just a different world. When I describe you to friends, or people that we know mutually, you know, whether in the industry or academics, you're always the example for me of unbelievable passion, energy, and unrelenting work ethic. And I've looked at my own drive and work ethic and sometimes thought maybe I should read it down. And I'm always like, Well, Chris works five times harder, and he's doing 10 times as many things. So he always made me feel better about working a lot. But where did you get that work ethic? And is that something that you saw in your parents? It's funny you say that, obviously, I appreciate the compliment. I vividly remember being lectured to my parents, pretty much as long as I lived with them, you know, I need to like finish tasks that I started that I need to be focused that I need to do this need to do that. So you know, I think it's impossible To do the summer you gave me your it's impossible to do those things and I guess put up that kind of vibe. If you're not doing something you're interested in, right? I mean, you can only force yourself so much. I mean, all it's so much pressure on you, whether it's from peers, friends, you know, parents or whatever, spouses that can only go so far, then you're just going to burn out and crash and burn. So I think if you find a niche for yourself, and that's why I think it's so important to let these you know, kids of mine and everybody else's, I guess to to sort of find something that are interested in and not necessarily, you know, steer them against their passions, because it's just going to be counterproductive. They're going to revert back to whatever they want it to do eventually, once they get out of your sphere of influence, right. So I think just you know, having good habits is something you can do for them. But But you know, for me personally, I just really enjoy doing what I do. I think I've been given opportunities to explore many fields and found support For that exploration, so and you know, we're in healthcare. So, you know, the bottom line is we're potentially helping other people feel better be healthier, right? So I, for me, that's a pretty big motivator, if you sort of keep that as the carrot on the stick, right that you're here. And then there's another person that's benefiting from from your work, and even if it's just one person, right? So we don't need to, you know, we don't need to save 100 million people if we help one person and actually you see that person, which is something that's unique to a physician, you actually see somebody you've helped. And you know, you could have had a really bad week, you could have had plenty of meetings that didn't go your way or whatever. And you have a clinic, you see a patient that you've helped even a year ago, two years ago, five years ago, come back and see and be like, Listen, and you're like, oh, here, they come back. And they're like, No, no, I'm not seeing you for my back. I'm seeing you for my neck. My back's doing great, right. I know God to that. Right. Exactly, exactly. So you know, it's, I think We are very, you know, fortunate to have that as a reference point. And I think you don't need to be a physician to be able to be part of that. Right. I mean, the guys in the or from the companies, the nurses, anesthesiologists, you know, anybody else's is part of that process. It's kind of like flying a plane, you know, yeah, there's the pilot, but you know, it's hard to get off the ground. If you don't have the control tower, the guy putting the fuel in the tank and somebody wiping that winch. Right. So it's a it's a big time team effort. And it's really true in healthcare, right. It's just such a intensive effort on everybody's part. Well, it's a good segue because there's a lot of coordination that happens in your line of work as a spine surgeon and orthopedist, at what stage in your spine practice did you start to see some of these needs that became the passion and the drive to found hollow surgical? What's the unmet need you're solving? Sure. So you know, I, I was always interested in technology. You know, I was always fascinated by people and still am very, very fascinated by people that have created something that other people use. Not necessarily obviously in spine, whether you know, it's the Vinci robot or, or something as a consumer, like, like a Tesla car just fascinates me that there's one person who or a group of people who kind of put together and over a long enough period of time, they had a product which was beneficial for for all right, so everybody benefit and that's just amazing. And that happens around us happens, you know, you're sitting in this the heart of it in Silicon Valley. So, you know, it happens there daily and, and some of those products are more more useful than others, but they're made by people. So I was always fascinated in healthcare. By that I also recognize that we're sort of antiquated. as a as a as a sector of the economy. I mean, things you know, we do, we've been doing some of them for 6070 years if you take the most common spinal procedure a laminectomy, where we remove bone to take pressure off nerves. I mean, those instruments were invented in like in Germany 1920s, right? And they kind of look the same, and maybe the metals have been better and the machines a little bit better, but the principle hasn't changed. And, you know, on the one hand, you know, you can say that's pretty comforting that it's, you know, we found something that works for that long. But on the other hand, I mean, there has to be a better way of doing that. So, I've always been interested in cooking up with people that have been very innovative. And being a resident, the Cleveland Clinic, there was a decent amount of opportunity, because that's sort of that was that kind of a place where, you know, in the middle of Ohio, you had a lot of brilliant people that were actually doing quite revolutionary stuff. And the institution supported that. So I was in a lucky place from that perspective, they were doing a lot of trials and you know, I was a resident orthopedics and, you know, a lot of companies would come and speak with the physicians there and then try to work with them. And you know, those physicians were the kind of people that got it younger, younger generations involved, then you know, that that was a good ecosystem. So, you know, I've had multiple interactions, and early on in my professional career that were sort of supported not only by the institution because there was a pathway to you know, get some support for your ideas, but also by I guess, pretty pretty strong mentorship on the on the doctor side on physician side and on the industry side. So there's a nice ecosystem there. You know, as most people that that tried to innovate, you fail multiple times. And I've certainly had and have and continue having and hopefully in the future we'll have failures right because that's if you're failing, you know, you're trying and and some some of these things will work out as they have for me, right. Some of those things work out years after you've thought of them and actually put them into on paper or submitted at some IP or even did some basic work and did a prototype for whatever reason it may not have worked out then. And you know, in healthcare, there's a lot of reasons like the regulatory environment may not be favorable, the money might have dried up, or maybe the materials were not ready or you know, or whatever is currently working is just too too popular. So, I've experienced that as well. But you know, I've always been interested in, in trying to incorporate software and, and some kind of, you know, automation into healthcare. And, you know, that's a big thing to put on your plate. Coming from the medical background where, you know, there's no coding class in medical school. So that's Problem number one for me, oh, ha, how do I get into software? And I always want it to but I, how do you get into software? I wouldn't even know where to meet engineers, then you know, your budget. Like, it's not like I was carrying, you know, treasure chest stuff of cash that could just hire people and start throwing it. Right, which is another problem a lot of people have. So you have a good idea. You know, you want to be in the space. You see, there's a lot of a lot of things you can do. And I guarantee you there are people that are listening, whether they're physicians or people in health are like well, why why are we doing it this way? And you know, I think most people Healthcare is like that, why are we doing this? Why is my patient bringing me a CD with their images? Right? I mean, this was like, 2020 they're still bringing CDs must be the only industry for which they make CDs. So, you know, there's plenty of things like that. And, and plenty of people saying, like, why are you doing that way? There's probably that's probably a good question. Right? Like, why are we doing it? And, you know, there's there's some explanations in terms of, you know, regulatory environment and, you know, the need to prove some of these technologies, but really, it's probably a lack of lack of concentration and effort, you know, so we're sort of behind other industries, which to me is a great opportunity, right? So I think there's so many opportunities in healthcare, whatever the discipline and whatever level you're looking at it from, you know, a rep in the arts or a nurse in the ER or you know, somebody in clinic. There's plenty of these opportunities. So what know what sort of my transition and how I got to to hollow to answer your question is, you know, literally throwing a lot of ideas out there, most of them not being amazing. But frankly, a lot of them being criticized, mostly correctly criticized, meaning that the criticism was was was was justified. And, you know, but you learn from that, right? I mean, that's kind of what I'd said about failing is if you're throwing your idea out there, and you get a bunch of comments on it, you know, that's good. You want that you want engagement, you want people to try to try to, you know, combat your, your thoughts, and, you know, see how you can defend yourself. How do you handle the criticism? I don't pay any attention to any particular criticism now hardest to deal with? Yeah, I think, you know, it's I think it's very hard to deal with criticism, and there's some of these things you're working on for years, right? And then, you know, you show it to somebody and the guy like, looks at it three minutes. I'm just wasting my time and you're like, kind of spent six years on this and you spend three minutes and you know, I didn't even have a chance to tell you why we're doing something or we didn't even learn to hold And right away, I turned you off. So, you know, that, you know, you have to have obviously have a thick skin, but maybe that person that I just described is actually telling you something that you can use, right? So that's how I look at I'm like, this guy just totally blew me off, I thought we had something amazing. We spent a lot of time on a lot of people spend a lot of time on we actually raise some money around this and we've been at it and within three minutes we sort of didn't capture this individuals attention. So let's maybe we should change our approach because a lot of times that's that right? It's just like maybe your presentation is not great. Maybe you don't know what that other party wants from from the product you have designed and that while that product offers that service, right so i think a lot of these things can be easily adjusted some of the things you may need to modify once again not not not you know, heroic effort but may require some some work. And then sometimes the reality is you know, there is no fit, right sometimes it's great engineering, but But nobody really needs it right? It may be over engineered, or the problem you're trying to solve. When you take the product or service to this is my opinion when you take it to the end user that you imagine. And then let's say a handful of them, and you communicate what you believe is the need. And then you say, this is my solution. I think that particular criticism is pretty harsh target user that you're trying to solve problems for, says I don't think about it like this. And to me, that's the feedback that is so valuable, because you can keep going for a really long time. And if there's not a problem, or the problem isn't appreciated the way you see it, where I see entrepreneurs and where I've made missteps is the value proposition made sense for the target user, but the investor didn't get it or the acquirer didn't get it. I think there's a risk when entrepreneurs have a solution to the stage where you could get product market fit if you could just get to the market. Maybe a capital is your hurdle or some regulatory clearance, but the process of raising the capital because like you mentioned, not everyone has, you know, buckets of money sitting around there all of a sudden to make it a fundable idea, it morphs into something else and be interested if you are having experience with that. Yeah. So, you know, I think it's very difficult in general to raise meaningful money, hire great people, and have everybody interested right off the bat, right. If you're, you've had a huge exit. Everybody's heard about you, those those problems do go away to some degree, but then you're facing some other challenges. But you know, just to back to, to your point, I do think that one thing that I would do differently now having the experience that I do, because, you know, we've been at this for for quite some time now with Hall of Famers six years or so I would try to get in front of those groups, those stakeholders as early as possible. All right, provided you have the discussion. plan to see it through because you will hear a lot of discouraging things right. So get in front of the surgeon and that's the end user let's let's assume it as an example. And as for us with all surgical but you get in front of those end users as soon as possible you don't have a surgeon which makes it easier to some degree to put yourself as a customer but then again, you become super biased and you're definitely drinking your own Kool Aid. So some of that objectivity disappear. So you know, you definitely have friends, right that are doing what would you would you are doing or you have colleagues that are potential customers for you that will listen and then probably spend some time with you. So those are very valuable resources. I think the quicker you get in front of the better similar with investors, you know, right now we're obviously in this COVID situation and meetings are curtailed but but you know, you go to a orthopedic or spine or industry meeting, and there are plenty of people that that are in the in the finance world VC world that go there for that reason to meet other people. It's pretty low stress. You're not asking For any money, you're just saying, Hey, you know, this is what we're working on, I keep you updated and, and then find out what it is that those people need from you, right? So you'll hear some things you'll hear, hey, you know, we only, you know, write a check if you've had FDA and $10 million in revenue. Well, that's good for you to know. Because what's the point of view trying to get excited about getting in front of that guy until you do that? Right? So I think the finance people are always pretty good at giving feedback of what it is that they need to see, to get them excited. And that, you know, lets you gain that perspective. The reality is the early money you'll probably have to come in from you. But you know, I think if you surround yourself with with with good talent for whatever you're developing then that I think the chance of you know, collectively coming up with a solution that gets that gets people excited is a lot easier, especially if the perspectives are different, right. So I'm coming from surgery. We have guys that are coming from software that never been in the operating room, right so talk about a total They'll divide between our experiences, but they're coming up with solutions that are like, really, I mean that that sounds like you've actually, you know, spend some time in the operating room, but it just becomes natural for them to think of problems in such a way. So, I don't know that answers that answers your question. But I think, you know, the, my summary is, you know, you try to get in front of people as soon as possible, you know, they say, and they're not in the consumer world, right? You want to get a minimum viable product and get it out there and try to get so you know, people to criticize it and you know, we're in healthcare, we can get like a minimal viable product, get in the operating room and start operating with something he doesn't develop three weeks ago, right. So that's a non starter for us. Just because, you know, that's not how it works. You will need FDA you need tests, you need animals, you need this, you need that. But, you know, that doesn't mean that you don't have a concept. You don't have a napkin or you have a sawbones model or something. Some kind of a prototype you can show to people and see how they react. I mean, are you totally insane or insane enough where it may work? Right? Very subtle difference between those two ends of the spectrum. Right. So if you go back to the problem that you were trying to solve originally, what was the unmet need you were trying to solve with hollow? And were you insane? Yeah, well, history will judge you. But you know, I think you do have to just be very interested and passionate about something which to some from the outside may look like a bit of insanity. Right. But you know, you need to be focused and and see that what you're doing is important, at least to you to begin with, and then kind of poison other people around you with that concept and get them involved. But for us, you know, what we were initially trying to solve as a problem of visualization. Right? So the whole surgical digital surgery company, we're taking data and converting it into information, and I'll talk to you about that a little bit later. But what our initial problem we were trying to solve is to show the surgeon the internal anatomy without making a cut on the scan. So not a novel concept. I mean, this has been reported, you know, since the 40s 50s. 60s, you read sci fi books from the 60s and 70s. You know, X ray visions very common concept and you just put some pair of glasses on and you look inside the body and you see what you want to see. Right? So there's nothing as, as I, as you will agree, that's revolutionary about that idea. And there's nothing questionable about the need for that, right? So people want that people want to see inside without making a cut. patients don't want to be cut on just so the doctor can see what's going on. Right? What do we do in surgery, we open things up and look. Alright, so the concept is not novel. The need is kind of there both on the surgeon side and, and the the patient's eye surgeon side because you know, if you see everything that sort of D risks the surgery for you, it makes it easier for you. So I didn't invent the concept by any means. But execution i think is where you can sort of stand apart from from other parties. And here's where things get a little bit interesting. So we realized a couple of things. You need to be able to teach the computer anatomy in order to be able to realize your original goal, which we did not have back then we wanted to sort of display the anatomy, take it, let's say for simplicity sake, out of a CT scan and, you know, use some software to process that imaging and sort of throw it there and match it with the patient's anatomy, which by itself is a big challenge. But in order for that to happen, several other things would have to have happen, which are totally independent of us, which when it comes to innovation, a lot of it is is timing driven, right. And the famous thing is Bill Gates was born like three years later, and you wouldn't be where he is now. He be a very smart guy doing something else. So similarly with us, you know, we needed a lot of processing power in the form of graphics cards, so graphical processing units, GPUs, and convolutional neural networks, which is, you know, one of the things that sort of runs machine learning and outside of academic institutions, you know, prior to, let's say, 2013, and be very difficult to process an image using these novel neural networks, which which sort of learned differently than then what was the standard up until that? And, you know, we sort of were fortunate that other people developed tools that we could use to do what we do now, and no one else was doing. Right. So the competition for for that kind of a solution was non existent, since, like I said, the tools literally became available, you know, a year before before we really started working on it on pretty hard. So essentially, what we were able to do as a result of innovation that was independent of us, was to create models where we teach the computer literally anatomy, right, so you feed a CT scan of your body, and the computer knows the difference between a piece of bone a nerve vessel within that bone, it can label it just like you open up a anatomical Atlas. The computer knows the difference between a spine as process, let's say a numbered vertebral body or an aorta or a lumbar nerve. And that's what We start up because I'm a spine surgeon. So we were doing a lot of spine anatomy, but you know that technology is applicable across essentially everything else. So we've gone as far with it as teaching the computer lobes of the liver. So that, you know, you can say if it's in the car, a lobe or whatever, what where's the tumor? And what do you do with it. So once you teach a computer anatomy, a lot of things become available to you. And this is something we were not thinking of at the time. But it's very interesting about innovation, right? So we taught the computer anatomy, which allowed us to sort of realize our initial goal, to control that anatomy and be able to project it, but all of a sudden, you realize, hey, we taught the computer anatomy, so it's kind of like teaching the human surgeon anatomy. So once you teach a computer anatomy, you can teach the computer how to plan a surgery. You can teach a computer ideal placement of implants, whether they're stents and vessels or screws or implants in the spine, right? You can teach the computer since we taught it an atom you can teach it to not do so. Something Do not hit a nerve ever. So the computer knows anatomy so it knows what a nerve is. So you can teach the computer not to hit a nerve. So, if you have a robotics platform very popular obviously topic today the robot does not know the difference between a piece of bone piece of nerve and a vessel. It just does what you know what the surgeon programs to do. So essentially as surgeons programming the robot which not to get into it, but doesn't really meet the definition of a robot which should be an autonomous but it doesn't know the difference between the spine is process the pedicle the L for the Delphi the s one or you know the lesser or greater tuberosity in the shoulder you know, once again so Lola deliver so that so if it computer knows that it can avoid problems, or at least signal the upcoming problem, Doctor, this is a nerve because I recognize it as a nerve. Would you like me to continue on this path? Yes or No, it's always a surgeon's decision searches in the driver's chair. They have to sign off on the plan. But I do think that this creates a an opportunity unmet need, if you will to prevent problems in the operating room, right. So prevent us humans from having a bad day and hitting a nerve hitting a blood vessel when we were not supposed to. or having that much better of an outcome by being able to pick the right type of an implant for that patient, whether it's personalizing this and the size and shape, but also whether it's personalized, because it meets the density needs of that person, right, because once again, the computer knows anatomy. So it can tell you what the bone density is, and a particular part of the spine, let's say in this example, and then it can create a FDA model finite element analysis model to see what kind of stresses and strains theoretically occur in that part of the spine. All those things happen only because you taught the computer anatomy and obviously, I'm oversimplifying some of the things that need to happen for it to work efficiently but That's a general concept. So our initial goal was to show you inside your body. But in order for us to do that, we had to do a number of other things that we were not thinking about initially, right? I created so many opportunities, which, quite frankly, are much more valuable in my perspective than our original idea, right? The ability to see into the into the anatomy and have the precision of something like a CT scan that's highly valuable and very interesting. And to avoid having to look up at a monitor and to keep your view in the on the surgical site. I always thought that made a ton of sense, particularly as more computer guided surgeries, enter the or more screen show up and it's just another distraction. Sometimes I sympathize with surgeon, how many people are talking to him or her how many things are beeping and how many screens to look at. But if I understand correctly, you couldn't really do that important thing. Unless you had enough coming computational power process all these graphics that the GPU constraint without very started. But then I didn't realize the neural network component of this what happened in technology that enabled the neural network that you're building now with hollow surgical, right. So you know, it's a confluence of things, just once again, I think you're sitting at the epicenter of it, where they're very smart academics like, you know, at Stanford, but also a lot of finance companies that like Intel that saw the value of putting more and more and more money at making these processing units and the software that runs them, that money, that's not much more robust, right. And it's this whole concept from the 1950s of trying to recreate how the human mind perceives, you know, an image, let's say, to and translate into a computer language. So, you know, a lot of people don't really know how these things work. And literally, you know, you train this model, sort of like you would train, train yourself. So we have a whole team at the castle. Anywho it's like the data marking department. So I think it'd be interesting, you know, for people to understand how, how training the computer works. So essentially, you take the images, and you hand mark them, which is very tedious task, very painful. If you can imagine that every slice on a CT scan, and, you know, some CT scans have 400, let's say slices, every one of those slices to be labeled by human being initially, right? Because that's how the training process works. So it's something that's super mundane, but at the same time, you need somebody that's super experienced doing, right? And just have, you know, somebody down the street, much high school kids marking it up, right? I mean, you can do that for some of the other algorithms. So this is a stop sign, yes or no. But now when it comes to say, Well, does the nerve stop here? And then what's the disk starts there? Right? So So that was one of the challenges you need to solve for. But once you get enough of this data, and that's the question How much is enough? And that's not an easy answer. Then you feed it into this network, which is essentially a computer program that that Just does a bunch of calculations on these on these GPUs, right? And then you kind of verify your results. And you know, the results may look great to the computer, you may have great scores, you know, that reflect high accuracy, but then you give it to you and you're like, Oh, my God, this is nothing, what do we expect, right? So then you go back, and you start tweaking the way these calculations are made, where you put more weight and emphasis on which parts of the training, what's more, you know, much more important, and you know, you have to prepare your data accordingly. So it's not an overnight process. And, you know, the concept of network is there. There are a lot of networks available to people that want to get, you know, put a company together and let's say you get, you know, one or two software engineers and, and start playing with these things. There's plenty of open source networks that you can try to reconvert but I think in order to be you know, super efficient and practical, you will need to spend a lot of your own resources and time to design something. That's pretty custom right? Transcribed by https://otter.ai