to you about one of the biggest myths in medicine and that is the idea that all we need are more medical breakthroughs and then all of our problems will be solved our society loves to romanticize the idea of the single solo inventor who
i 'm a surgeon
and we surgeons have always had this special relationship with light when i make an incision inside a patient 's body it 's dark we need to shine light to see what we 're doing and this is why traditionally
surgeries have always started so early in the morning to take advantage of daylight hours and if you look at historical pictures of the early operating rooms
they have been on top of buildings for example this is the oldest operating room in the western world in london where the operating room is actually on top of a church with a skylight coming in and then this
with plenty of windows to let light in
so nowadays in the operating room we no longer need to use sunlight and because we no longer need to use sunlight we have very specialized lights that are made for the operating room we have an opportunity to bring in other kinds of lights
so let me back up a little bit when we are in medical school we learn our anatomy from illustrations such as this where everything 's color coded nerves are yellow arteries are red veins are blue
that 's so easy anybody could become a surgeon right
not have one person die every minute
well if cancer can be caught early enough such that someone can have their cancer taken out excised with surgery i don 't care if it has this gene or that gene or if it has this protein or that protein it 's
and the way the cancer looks and the way it feels and its relationship to other structures and all of our experience we say you know what the cancer 's gone we 've made a good job we 've taken it out
that 's what the surgeon is saying in the operating room when the patient 's on the table
and then send those bits to the pathology lab in the meanwhile the patient 's on the operating room table the nurses anesthesiologist the surgeon all the assistants are waiting around
and we wait the pathologist takes that sample freezes it cuts it looks in the microscope one by one and then calls back into the room and that may be twenty minutes later per piece so if you 've sent three specimens it 's an hour later and very often they say
you know what points a and b are okay but point c you still have some residual cancer there please go cut
that piece out so we go back and we do that again and again and this
so now you 're faced with telling your patient first of all that they may need another surgery or that they need additional therapy such as radiation or chemotherapy
so in two thousand and four during my surgical residency i had the great fortune to meet dr roger chen
the molecule they had developed had three parts the main part of it is the blue part polycation and it 's basically very sticky to every tissue in your body so imagine that you make a solution full of this sticky material and inject it into the veins of someone who has cancer
three part molecule along with the dye which is shown in green
and you inject it into the vein of someone who has cancer
normal tissue can
boom the tumor labels itself and it gets fluorescent so here 's an example of a nerve that has tumor surrounding it can you tell where the tumor is
i couldn 't when i was working on this
sentinel lymph node dissection has really changed the way that we manage breast cancer melanoma women used to get really debilitating surgeries to excise all of the axillary lymph nodes but when sentinel lymph node came into our treatment protocol
the surgeon basically looks for the single node that is the first draining lymph node of the cancer and then if that node has cancer
so what that means is if the lymph node did not have cancer the woman would be saved from having unnecessary surgery
you have to cut it out bring it back home
anesthesiologists surgeons are waiting around that takes time so with our technology we can tell right away you see a lot of little roundish bumps there some of these are swollen lymph nodes that look a little larger than others who amongst us hasn 't had swollen lymph nodes with a cold
that doesn 't mean that there 's cancer inside well with our technology
the surgeon is able to tell immediately which nodes have cancer i won 't go into this very much but our technology besides being able to
in surgery it 's important to know what to cut out
and what i 'm talking about are nerves
even in so called nerve sparing surgery which means that the surgeon is aware of the problem and they are trying to avoid the nerves but you know what these little nerves are so small in the context of prostate cancer
and they 're known because somebody has decided to study them
which means that we 're still learning about where they
so i said wouldn 't it be great if we could find a way to see nerves with fluorescence
when we put these two probes together
do you guys know where the margins of this tumor
and color code the surgical field
this was a bit of a breakthrough
i think that it 'll change the way that we do surgery we published our results in the proceedings of the national academy of sciences and in nature biotechnology we received commentary in discover magazine in the economist
and we showed it to a lot of my surgical colleagues
they said wow
what needs to happen now is further development of our technology along with development of the instrumentation that allows us to see this sort of fluorescence in the operating room the eventual goal is that we 'll get this into patients
however
we 've discovered that there 's actually no straightforward mechanism to develop a molecule for one time use
understandably the majority of the medical industry is focused on multiple use drugs such as long term daily medications
we are focused on making this technology better we 're focused on adding drugs adding growth factors killing nerves that are causing problems and not the surrounding tissue
we know that this can be done and we 're committed to doing it
i 'd like to leave you with this final thought
successful innovation is not a single breakthrough it is not
successful innovation
and this takes the long term steady courage of the day in day out struggle to educate to persuade and to win acceptance
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