the last thirteen years one three thirteen years i 've been part of an exceptional team at insightec in israel and partners around the world for taking this idea this concept
noninvasive surgery from the research lab
to routine clinical use and this is what i 'll tell you about thirteen years
for some of you you can empathize with that number for me today on this date it 's like a second bar mitzvah experience
this dream is really enabled by the convergence of two known technologies one is the focused ultrasound and the other one is the vision enabled magnetic resonance imaging
it is transparent made just for you so you see it 's all intact
completely transparent i 'll take you now to the acoustic lab you see the phantom within the aquarium this is a setup i put in a physics lab on the right hand side you see an ultrasonic transducer so the ultrasonic transducer emits basically an ultrasonic beam that focuses
inside the phantom okay when you hear the click
this is when the energy starts to emit and you see a little lesion form inside the phantom okay so everything around it is whole and intact it 's just a lesion formed inside so think about
this is in your brain we need to reach a target inside the brain we can do it without harming any tissue so this is i think the first kosher hippocratic
surgical systemlaughter okay so let 's talk a little bit about
you know all about imaging right ultrasound imaging and you know also about lithotripsy breaking kidney stones but ultrasound can be shaped to be anything in between because it 's a mechanical
force basically it 's a force acting on a tissue that it transverses
so you can change the intensity the frequency the duration the pulse shape of the ultrasound to create anything from an airbrush to a hammer and i am going to show you multiple applications in the medical field that can be enabled
so this idea of harnessing focused ultrasound to treat lesions in the brain is not new at all when i was born this idea was already conceived
by pioneers such as the fry brothers and lars leksell who is know actually as the inventor of the gammaknife but you may not know that he tried to perform lobotomies in the brain noninvasively
and it makes you ponder why those pioneers failed
and there was something fundamental that they were missing they were missing the vision it wasn 't until the invention of the mr and really the integration of mr with focused ultrasound that we could get the feedback both the anatomical and the physiological
in order to have a completely noninvasive closed loop surgical procedure so this is how it looks you know the operating room of the future today this is an mr suite with a focused ultrasound system
and i will give you several examples so the first one is in the brain one of the neurological conditions that can be treated with focused ultrasound
and be really independent in your life
without the help of others
so i 'd like you to meet john
john is a retired professor of history from virginia so he suffered from essential tremor for many years
and medication didn 't help him anymore and many of those patients refused to undergosurgery to have people cut into their brain and about four or five months ago he
so now i 'll take you through what a typicalprocedure like that looks like what noninvasive surgery looks like
so we put the patient on the mr table we attach a transducer in this case to the brain but if it will be a different organ it will be a different transducer attached to the patient
this is the sort of general area of the treatment it 's a safety boundary around the target it 's a target in the thalamus so once those pictures are acquired and the physician has drawn all the necessary safety limits and so on
injecting the energy we call it sonication the only handwork the physician does here is moving a mouse this is the only device he needs in this treatment so he presses sonicate and this is what happens you see the transducer the light blue there 's water in between the skull and the transducer
and it does this burst of energy it elevates the temperature
of the mr it is not being used in regular diagnostic imaging
but here we can get both the anatomical imaging and the temperature maps in real time and you can see the points there on the graph
the temperature was raised to forty three degrees c temporarily this doesn 't cause any damage but the point is we are right on target so once the physician verifies that the focus spot is on the target he has chosen then we move
to perform a full energy ablation like you see here and you see the temperature rises to like fifty five to sixty degrees
and this is a quote from john after he wrote it he said miraculous and his wife said this is the happiest moment of my life
and you wonder why i mean one of the messages i like to carry over is what about defending quality of life i mean those people lose their independence they are dependent on others
so you can see here
there 's no recovery needed no nothing he 's back to his normal life let 's move now to a more painful subject pain is something that can make your life miserable
and people are suffering from all kinds of pain like
very painful all those i 've indicated have already been shown to be successfully treated by focused ultrasound relieving the pain again very fast and
i would like to tell you about
he 's a seventy eight year old farmer who suffered from how should i say it it 's called pain in the butt he had metastases in his right buttock and he couldn 't sit even with medication he had to forgo all the farm activities
he was treated with radiation therapy state of the art radiation therapy but it didn 't help many patients like that favor radiation therapy and again he volunteered to a pivotal study that
and
his wife actually took him they drove like three hours from their farm to the hospital
he took the treatment
so again this is an immediate relief and you have to understand what those people feel and what their family
he returned again to his daily routine on the farm he rides his tractor he rides his horse to their mountain cabin
regularly and he has been very happy
but now you ask me but what about war the war on cancer show us some primarycancer what can be done there so i have good news and bad news the good news there 's a lot that can be done and it has been shown actually outside of the u s
and doing that in the u s is very painful i don 't see without this nation
the adverse event trait in prostate cancer there is a unique opportunity now with focused ultrasound guided by
because we can actually think about
well
the challenge there with a breathing and awake patient and in all our treatments the patient is awake and conscious and speaks with the physician
is you have to teach the mr some tricks how to do it in real time and
this will take time this will take two years but i have now a message to the ladies and this is in two thousand and four the fda has approved mr guided focused ultrasounds for the treatment of symptomatic
she was diagnosed with a grapefruit sized fibroid this is a big fibroid she was offered a hysterectomy but this is an inconceivable proposition for someone who wants to keep her pregnancy option so she elected to undergo a focused ultrasound procedure in two thousand and eight
and in two thousand and ten she became a first time mother to a healthy baby so new life was
i 'd like to leave you with actually four messages one is think about the amount of suffering that is saved from patients undergoing noninvasive surgery
and also the economical and emotional burden removed from their families and communities and the society at large
and
i think also from their physicians by the way
the patient holds a stop sonication button he can stop the surgery at any moment and
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