# 2022 Pediatric Surgery Update Course - Top disruptive technologies in medicine — GCMD Library

In this session, Drs. Ramy Shaaban and Em Tombash guide us through the most disruptive technologies of the last year. What innovations are going on in the world? They explain each one. An amazing trip on what is coming and how the future may look. 

00:00 Introduction
01:42 Innovations for medical/surgical education
7:00 Innovations in medical practice
13:20 Innovations in technical preparation
18:04 Patient wristband innovation

The 10th Annual Pediatric Surgery Update Course was held on August 30, 2022 in Cleveland, Ohio and was livestreamed to a global audience. The full day symposium is designed to give an update each year on the contemporary management of common problems in pediatric surgery. We highlight what's new in pediatric surgery that you need to know!

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Type: video · 26 min · posted 2026-07-22
Canonical: https://library.globalcastmd.com/watch/2022-pediatric-surgery-update-course-top-disruptive-technologies-in-medicine-13590

## Transcript
All right, we're back and we have a very different session than we've ever done before. Uh, in our lab at Cincinnati Children's Hospital, we are very focused on paying attention to what are the new technologies that are becoming disruptive? What do we pay attention to? How do we know what to pay attention to? To, uh, and so, uh, M. Tombas and Rami Sha Aban, who are part of our team, worked together to try to do an environmental scan of things that we think are coming soon, uh, things that will be disrupting the field of, of healthcare and especially pediatric surgery. So with that, I'm going to introduce, uh, M Tombas. You just skip. Oh, here you go. Fellow of Cincinnati Children's Hospital Medical Center, and I am Rami Chapan, an assistant professor of Instructional Technology and learning Sciences. First and foremost, I'd like to say that we're glad to be here presenting you the latest innovations that we believe are transforming healthcare. We separated them into two categories, innovations for medical, surgical educational purposes, or clinical purposes. So, we have our first poll here. Um, we have pre-recorded 4 different videos and we're going to discuss, um, our poll questions in the upcoming videos, but, ah, I just wanted to ask, what do you think is the best way to teach trainees about medical topics? Um, textbooks or lectures, videos or podcasts, escape rooms, virtual reality, AI or handsome models to practice on which we've been doing for the last decades. Let me, let me even go. Does anyone here use anything other than the top one? Uh, does anyone use videos, podcasts, escape rooms, virtual reality, or hands-on models to teach? Which of those do you use? Yell it out. Now, do you use any of those? What, what do you use? Hands-on models. Box trainers. Anything else? Videos? OK. All right. All right, um. Ellen, Paul Oh, it's, it's still adjusting, but videos, podcasts, and hands-on models are the top. Yeah, I mean, that's something. Obviously we're biased. We believe that media is becoming, uh, critical to learning now, but, uh, let's, let's roll the video. If you are ready, let's get started with innovations for educational purposes. Medical education has changed focus to a more learner-centered model, placing learners at the center of innovation in training and over the past two decades. About today's first topic, I believe everyone knows what an escape room is. An escape room is a time-bound immersive adventure experience. It is basically a room with hidden clues and keys where you're trying to get yourself out of before the time ends, and activities typically include a variety of sequential puzzles or can be adapted into an escape box challenge where participants work to successfully unlock a box. So it should be no surprise when I tell you that escape room needs teamwork. Since communication, teamwork, and resilience all require active practice by healthcare teams, escape rooms or escape box exercises can help healthcare teams to develop and enhance those skills, as well as reinforce medical knowledge. Medical escape rooms have been utilized to teach and reinforce a variety of topics, including discussing cancer diagnosis, cardiovascular physiology, and fluids and electrolytes. Despite appearing to be a super. Efficient form of entertainment, escape room can be grounded in a sound educational theory and when used effectively acts as a low post high impact resource for a variety of learners. There are a lot of institutions adopting medical escape rooms to teach their residents, nursing staff, and other trainees how to recognize and respond to certain medical conditions like preeclampsia, sepsis, and patient safety. Texas Children's Hospital, the Woodlands, the University of Kansas health system. Penn Presbyterian Medical Center, University of Minnesota are a couple of examples that have built a medical escape room to improve education among trainees. Luckily, there are a lot of publications from different institutions out there that publish their experience and help to guide. If you want to build a medical escape room, you can use this paper as a reference, which was published a couple of months ago in April 2022 in the medical teacher journal by Casey Davis and her colleagues. Yes, so I'm gonna tell you my thoughts. So I can't tell if this is hokey or if this is meaningful. I also can't tell the difference if this is another way of just saying running through, uh, simulation triages, uh. I, I don't know. Do you know how escape rooms are different than just running through a, uh, medical simulation? I think it's, uh, based on the same concept, but, uh, we're going to talk about gamification next, which, um, escape rooms kind of make it like a game. So. You're trying to compete with another team, uh, to have a better results and you can compete with your previous scores too. And so Rami Shavan, who is an ENT who got a PhD in instructional technology, got his thesis in eSports, and he believes that adding competition to learning actually drastically improves your retention. So, uh, you'll be seeing more competitive uh initiatives coming soon, Mark, I was just going to say if you check your phone, I just texted you and said let's do this. This looks like so much fun. I mean, and again, I think the gamification of education, it can be pun intended, game, a game-changer. Yeah. And Rommy is gonna love you that you just said that because Romy yells at us every day, gamification is the answer, gamification is the answer, and we don't do it much in healthcare. Um, Dan and I always joke that a lot of the stuff that Em is going to show, we sometimes think is a little on the early side. So it's kind of fun and gamey but not really meaningful. ARVR is one of those things. I think it's not quite there yet, except for I did see something cool last week, but, uh, I, I agree with you. Let's, uh, let's work on this. You're already changing the practice. You're already changing my practice. That's right. So, uh, the second core question is, what is the future of medicine? Uh, telementoring, home monitoring, virtual hospitals, telemedicine, and staff robots that carry, uh, blood samples or maybe sometimes patients, uh, in different hospitals in Southeast Asia or all of the above all of the above telementoring, OK, so. I think what's the most impactful? What do you think of these if we look back 7 years from now, what we circle as the one that made the biggest impact in healthcare telementoring, home monitoring, virtual hospitals, telemedicine, and staff, staff robots. And I will say when I say telemedicine, meaning it's much different in the future than it is today. Oh, that's the next video. The Basic, basically wearing a, uh, basically wearing a VR headset and, um, it's telemedicine, but you're in the virtual world. So before we, before we play this, I'm gonna just tell you this is, I'm sensing some of you think this concept is kind of cool. We need help. We feel like we're on an island trying to environmentally scan what's out there. We're trying to create a cohort of people that work together and say, hey, This was just implemented into our hospital. You need to know about this. This is something because we don't talk. So anyone that's interested, we meet every week. We would love to. All right, send me an email or message. All right. uh, oh, the poll, which It's pretty divided all over the place. All right, can you roll the video? Don't, don't worry, there is no wrong choice here. All of these options are possible, and we believe sooner or later all of these technologies will be implemented into healthcare to make patient care better and more effective. Now moving to our next topic, which is based on virtual reality. As a definition, virtual reality is a simulated 3D environment that allows users to explore and interact with. Virtual surroundings in a way that looks like reality. The other term we need to know is metaverse, which is an integrated network of 3D virtual worlds. These worlds are accessed through a virtual reality headset, and users navigate the metaverse using their eye movements, feedback controllers, and voice commands. Tambey grew from Dubai, UAE is the first to build a virtual hospital on the metaverse to interact with patients and to improve patient experience full fledged. Digit virtual hospital will provide patients with an immersive experience in healthcare from the patient experience center to complete walkthrough of the hospital and service. With teleconsultation, just by using their virtual headsets, authors will be able to visit multiple doctors working in a virtual clinic or get a second opinion from various healthcare professionals. Also, a virtual hospital will offer first aid and preventative health programs using AR, VR, and artificial intelligence software to educate. Patients and suggest treatment plans. Of course, VR applications in healthcare are not just limited to virtual hospitals. VR can be used to ease anxiety before procedures or during imaging or help pain postoperative. Even in some cases, VR can be used to reduce the need for sedation or general anesthesia during the minor surgical procedures. In 2018, Lucile Packard Children's Hospital, Stanford, as one of the first. Institutions to pilot VR capabilities in pediatric clinical settings has expanded its VR program to help young patients in more places beyond the hospital. With over 150 use cases per month, Stanford Medicine Children's Health is home to one of the nation's largest VR programs. Their childhood anxiety Reduction Through Innovation and Technology Program, or CHAIRIOD in short, aims to take existing technologies and create new ones. to address the unique needs of individual patients. A team of physicians, engineers, researchers, and child life professionals is currently piloting virtual reality experiences, new tablet-based apps, and interactive bedside projector-based games. And for the next part, I want to introduce a concept called gamification. Gamification is the application of typical elements of game playing to other areas of activities, especially with tasks that are not enjoyable. Such as in-depth safety training or compliance training to encourage engagement with a product or service. Lately we see more and more gamification applications in healthcare. In this perspective, randomized and controlled trial study from Seoul National University College of Medicine showed that VR experience of the preoperative process could reduce preoperative anxiety and improve compliance during anesthetic induction in children undergoing elective surgery and general anesthesia. Over the last decade, using different innovative technologies in healthcare has started directly affecting clinical practices too, and that brings us to our third bold question. OK, before we do this, just some comments, questions. I know, again, I can refer to Dan. We believe, Dan and I always say that virtual reality is still gay and not helpful yet. It's like everyone uses it for training and, and I want to use it for clinical care. I will say two things. Uh, there was a company called Tellaview that I just saw. Mark Levitt told me about it. You wear glasses that look just like these, and the person watching can see what you're seeing and actually In telestrate onto your thing. You can turn it on or off, telestrate while you're operating. The second thing that I think will be coming very soon is overlaying your CAT scans while you're operating. So if there's a tumor, you can see the anatomy if you turn it on or off. These are the applications that I think will become impactful. The final thing is you see these big goggles. I equate that to the big cell phones that came out that were this big, right? Uh, Justin, you probably still have one of those, but the rest of us have moved on. Uh, so I, I think, you know, uh, uh, Apple's going to be coming out with glasses that are literally just glasses, and I think this concept of overlaying augmented reality will become more applicable for surgeons. We can sit poll question, poll question. So this is a poll question and we're asking what is the best way to prepare for complex procedures. Uh, no offense, some of them are old kind of techniques, but, uh, would you, would you rather watching technique videos, using hands-on training models, uh, checking textbooks, asking an attending, which is no offense, uh, rehearsing on patient's digital twin or using VR to recreate the case, or all of the above. Does everyone know what a digital twin is? Are we gonna, are you gonna tell them or should we tell them now? A digital twin is an actual digital replica of, of whatever it is you want. You could, uh, right now you, I think through, there's some app where you can scan your entire room and you can move furniture around and it's, that's a digital twin of your room. You can make a digital twin of a patient and then you can, uh, manipulate the model. But a digital twin is, is you actually use a LiDAR scanner. And you can right now scan this bottle with the iPhone and you will have an exact replica that you can play with and manipulate and see what things might look like and as you adjust. So, all right, and people are using digital twinning hugely over the last 24 months in medicine. OK. Probably all over the place. Is it all over the place? Mostly watching technique videos or rehearsing on the digital twin. OK, where do people get technique videos? Is it mostly YouTube? YouTube web search. You should check app. Thank you. All right, let's, uh, play the video. We live in a world that is changing very quickly every day. There's nothing wrong with watching technique videos or getting lost in the textbook chapters, but in the digital age, I think the best thing we can do as healthcare professionals is probably using technology for the advantage of the patient. Today we have VR. Digital twin artificial intelligence technologies waiting for us to innovate. How we take care of our patients. There are different companies like Induu which gives healthcare experts and educators a way to share their knowledge. And Dubo allows healthcare professionals to create a unique copy of their patient by using CT or MRI scans. Once the patient's digital twin is created, the surgeon can review it with a virtual headset before going into the case. The National Institute of Health, OSF Healthcare, and Children's Hospital of Illinois use NDogle for training surgical teams, evaluating patient cases, research collaborations, and much more. On the other hand, PrecisionOS creates surgical simulations to accelerate skill acquisition or surgical readiness. It has established VR learning partnerships with about 29 medical institutions in North America, including the University of Connecticut, University of Toronto, and the University of British Columbia. Unfortunately, a significant percentage of surgical residents report they do not feel ready to. Independently perform procedures upon completion of their training. So VR training represents an accessible, cost-effective, and deliberate practice methodology to help surgeons reach a competency threshold or achieve surgical mastery. Good news for the institutions who are interested in exploring what Precision OS can offer because the FDA approved Precision OS envision as a VR preoperative planning tool. The patented software to be available in early 2022 lets surgeons use an Oculus Quest 2 device to do preoperative planning, but that doesn't mean it hasn't been used yet. You may have seen on the news a couple of weeks ago surgeons used VR to separate twins with conjoined heads in a 27 hour long surgery. These surgeons. Spend hours of training using VR projection with precision OS vision and planned the operation while wearing an Oculus VR headset. The surgery's direction depended on Great Armond Street Hospital in London, while actual surgery was happening in Rio de Janeiro. This case is also a good example for telementoring, and one of the leaders in this field is proxy. Proximy allows multiple people in remote locations to virtually interact in a way which mimics what they would experience if they were collaborating in the same operating room. Using artificial intelligence, machine learning, and augmented reality, clinicians can remotely interact in a live procedure or assessment from start to finish in a visually and intuitive way. It means they can physically. Show each other where to make an incision in real time or use physical gestures to illustrate a technique. I think we are ready for our last one. What are we innovating this time? Do we want to go through a scenario? Great idea. So Rami, you're a surgeon in a pretty innovative hospital, and their goal is to make patient care better every day. You saw your patient a couple of weeks ago, did the imaging, and used VR simulations for the pre-op planning, and your patient is admitted the day of the surgery. You know that your hospital is trying to improve patient wristbands, which include patient health information, or in short, PHI, because especially for young patients like children and baby, wristbands can create problems. Wristbands are difficult to fasten, may irritate. and must be rotated in order to be scanned. Also, they can be tighter than it's supposed to be, which can hurt the patient or too loose that you can lost. We have a poll question here for you. Considering our problem, please choose if these wrist bands can be innovated and if so, how. You can see the question. Uh Any of the faculty here have any problems with patient response or? Did you ever experience this? So it turns out it's a very easy solution and it's very cost effective. But uh. Should we do finger fingerprint scan? Should we use sticker patient ID, or, uh, should we tell our staff to fasten it better? Sticker, finger fingerprint, or just, just do it better. Be more careful. Forget about wristbands. Why do we have so many stickers on patients? Why don't we have wireless EKGs and wireless pulse ox monitoring on babies in the NICU. You end up walking out like a big sticky pad when you leave the hospital. OK, I'll do research and let you know. We'll get back to you. Fingerprints are winning. Yeah, fingerprints is winning. Fingerprints is winning. I think that should be. OK. All right, let's roll the video. Again, there is no wrong choice here. All of these options are pretty doable, but every option comes with an advantage and disadvantage. And today we will talk about innovating patient wristband by replacing them with a sticker patient IDs by. A company called ID and the product that we're talking about today is their sticker patient ID called IdentityShield. It's a smart ID sticker to replace the hospital wristband, and it is RFID enabled with an optical scanning option. RFID stands for radio frequency identification, and it uses electromagnetic fields to automatically identify and track tags attached to the object. The sticker is made out of a very thin plastic material that's adhesive and non-reactive and hypoallergenic. It includes PHI, like the first and last name, date of birth, date, blood type, or possible allergies, and lasts for 7 days on patients. The common use is NICU, newborns, and children. Due to the high loss rate of the wristbands, which is 12% in this population, the North Wales system, which is New York State's largest healthcare system, has used the badge on over 30,000 patients between October 2019 and November 2020, mostly at the Lenox Hill Hospital in New York City during the pandemic, according. The pilot study, patient, nurse, and clinical staff feedback was overwhelmingly positive, and 80% of the clinicians prefer the IBM shield over traditional wristbands. And with our 5D layer, hospital staff can use NFC to read the badge without ever having to lift the patient's sleeve. Let's not confuse it with the popular term NFTs. NFC stands for near. Field communications and it's a set of communication protocols that enables communication between two electronic devices. Unlike Wi Fi or Bluetooth, NFC interaction is limited to an extremely short range, a distance of 4 centimeters or 1.5 or less. NFC has been a staple feature on smartphones for several years. The first Android device included NFC in 2010 and then Apple followed in 2014, which means NFC has been present since iPhone 6. So it's pretty easy to find devices to use NFC. In result, it's not surprising to see institutions like Children's Health in Dallas, Texas are now using identity shields after Northville Health. We hope you liked our presentation where we try to include innovations affecting different areas of healthcare from training to surgical planning to making patient care better. Thank you for joining us today. Now we can have a couple of questions before our session ends. Yeah, Quick question, um, I was intrigued by the digital twin. So how long does it take to create a digital twin for, you know, prior to an operation? How much time do you need? So, uh, we talked with Dr. Bramlet. Um, he has a lab in um University of Illinois and they've been doing it for regular cases for uh pediatric cardiology cases. Uh, he said it's going to take a couple of hours if it's um emergency, but, um, and the surgical oncology cases they started doing, it's going to take a couple of days, but not more than that. And also they have um a free submission form that you can, uh, we can email whoever interested in. And they can create the digital twin for your patient just to use for the case and they email you for free. Uh, so if you have any VR headset that you can use in practice. Yeah, and, and I'll say that these centers that are popping up over the country are changing and becoming more involved in this type of thing. I was at Nebraska. Uh, about a, a couple of months ago, and they were making digital twins with everything, and I asked them, can we work together to make a digital twin for an inguinal hernia model, a digital twin for what was the other one we were going to do, a hernia. And then there was maybe colorectal model or some malrotation to be able to understand and teach and look at it. They said it should take us no time at all. It's that fast. They just, I, and it absolutely blew my mind. I have to tell you this is up and coming. Todd, what has been the hurdle of this becoming a reality? More quickly, just 15 years ago, Rick Satava stood up at sages. And talked about the patient walking in the hospital getting a scan like a CT scan as they checked in or a regular CT scan and then you took that three dimensional image as the surgeon the day before surgery and you practiced the operation on your brand new robot. And then when you finally got it right, you hit save. Then the next day the patient goes to sleep, you dock the robot and you hit go and you sit there and just watch the operation. So, but that's 15 years old. And so what's been the hurdle? Well, first of all, uh, progression is exponential. So 15 years ago, it would take 15 years to go from science fiction idea to reality. Now we're seeing it in months. And so, uh, now that we're on this upslope curve. The fact that it's happening now that many hospitals already have LiDAR scanning, it's, I think that we'll find in probably 2 years, most of the hospitals here will have some version of this at their fingertips. Um, I just want to take 2 seconds to, to point out M. I met Em on an app called Clubhouse, which I don't know if you know what that is. It's like a, uh, you have these meeting forums to talk about. We did a medical clubhouse. I met Em. She blew my mind. I asked her if she would come and be our fellow. Our Dan has Entrusted in me to allow to have a completely virtual lab. Our lab's been virtual forever. So we had M starting off in Turkey. We've got Rami in Egypt, and we've got, uh, uh, Brittany in Kentucky and Ellen in Akron, and I'm, we're all over the place. And so, uh, I think that we can make real progress. I just want to say that I thought this was a phenomenal presentation, uh, and I want to congratulate you as a just recent medical student grad that this was phenomenal. Thank you. Nice job. Right. Quick, quick break, turnaround so we can put the new faculty up and we're going to come back and talk about who you can send home from the emergency department.

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