Thriving In The Digital Age: Dr Roger Smith and Robotic Surgery Technologies

Dr. Roger Smith, an expert in robotic surgery technologies, AI and healthcare, and military simulation and training, discusses the advancements and challenges in robotic surgery. He explains how robots are used to measure the skill levels of surgeons and the importance of training courses and simulations. Dr. Smith also highlights the benefits of robotic surgery, such as reduced damage to the body, improved stability of instruments, and faster recovery times. He discusses the future of telesurgery and the role of AI in robotic surgery technologies. Dr. Smith advises tech professionals to bet their careers on AI, as it is expected to have a significant impact in every industry.
www.rddsmith.com
www.linkedin.com/in/rogersmithcto

Transcript

Joe Crist (00:01.116)
Hello everyone and welcome to another exciting episode of Thriving in the Digital Age. Joining me today is Dr. Roger Smith. He's an expert in robotic surgery technologies, AI and healthcare, and military simulation and training. He has 30 years of experience in creating technology solutions in healthcare, military, defense, and the US government. Roger, thank you so much for joining us today. Could you tell us a little more about yourself?

Roger Smith (00:28.716)
Great to be here. Yeah. So let's go backwards instead of going back to when I was in kindergarten. Um, so I spent the last 10 years, 12 years now working in robotic surgery and I'm not a surgeon. I'm a computer scientist and what we do, we use, um, the robots to measure the skill levels of surgeons. So in the last 10 years, 20 years,

Robotics in surgery has grown gradually and then really rapidly. And these devices are something that a surgeon needs to be trained on before they can start using it. Get a certain number of cases under their belt, get a certain number of simulated experiences under their belt. And so we put them through training courses. And during those training courses, we measure the degree to which they're getting better each day.

And so by the end of the course, it's very much like a college course. By the end of the course, we know whether they have gone from knowing nothing to being an A student or B student, whatever. And then we do analyses of those results and publish them. And we're usually looking at how different features of the robot or different features of simulators of the robot work in conveying skills.

So if you've ever sat in a flight simulator or a driving simulator or anything like that, they try to make it as close to the real thing as possible, but it's never exactly the same. And the degree to which is different can provide something called negative training. And negative training means, let's say 95 % of what you experienced was exactly what you're going to be doing with surgery, but 5 % of

you learn to do something that you should not do in surgery because the simulator is a little different or the exercise that's not surgery is a little different. And so we try to measure all of that so we can improve and get that feature out in later training. So that's been the last 10, 12 years. And my short bio talks about military simulation because

Roger Smith (02:55.466)
The skills that I needed to do that, I actually developed in a prior career developing simulators for the military. And those are your typical flight simulators for the F -16 and jets like that, or simulators for tanks rolling across a battlefield, blowing things up. That's the two major parts of my career.

Joe Crist (03:20.796)
That's a pretty impressive background. you know, just out of curiosity, like what drove you to that, you know, that field is you're doing like very deep things.

Roger Smith (03:32.256)
Yeah, so that does require starting from the front end of the career. So I actually went to college and got degrees in mathematics and statistics first. And then later I got a computer science degree. And I was, you know, bouncing around college going, what do you do with math plus computer science? And I was interviewed by Lockheed Martin to work in the factory where they make the F -16 finder.

And I was like, I'm not a mechanic. I'm not going to be out there riveting the plane together. But they had a very robust simulation division that created these simulations of the F -16 in combat and put it through all these different, what if this, what if that, and tried to analyze how an encounter between an F -16 and a surface to air missile might go, or between an F -16 and a MiG and an air to air dogfight.

There were models for all these different scenarios. And you try to estimate how this would happen in real life because at the time, and still for the most part, we're not at war with a major power. And so we try not to have those encounters in real life, but we want to know how the equipment will perform. So I started doing that and then gradually moved through, you know, from, from the planes.

Then I moved into army equipment, ground, tanks, some of the missiles that were shooting up at the F -16s back in the previous day. So was doing these simulations. And finally, at the end, I was getting to be older and more senior, I managed the creation of a bunch of healthcare simulations for the military. So the army was just starting to add healthcare and treatment of soldiers.

to its portfolio simulations. And I was doing that with the Army and then we were also helping the Veterans Administration do the same thing. And I got to the end of a contract where I was like, this job right now is over and it's time to move from this contract to something else. Well, that was a critical cusp. I had made friends with a bunch of doctors, one particular doctor who kind of knew everybody in the

Roger Smith (05:57.48)
And he came to me and said, you know, everything you know about government contracting, simulation and training and then how you added healthcare there at the end. I know a hospital system that could really use those skills. Would you be interested in coming out of the defense contracting world and going into the healthcare world? And I said, maybe, why not? Make a jump. So I went and interviewed with them.

And it turns out he understated it. They needed somebody with my skills much worse than they realized or than he had described. And so after interviewing with them, we both saw that this was going to be a great opportunity for me to do something new and for them to solve a lot of problems that they had no clue how to solve. So I jumped over to a hospital and started doing

training in robotic surgery instead of training for fighters and tanks. the shift, those are two very different industries, really.

The technology is different. Yeah, that's different. But more importantly, the culture was so different. The culture of a hospital versus the culture of a defense contractor, really different. The metrics of success, the metrics of what decides whether you did a good job this year or not. So my first year in the hospital was mostly learning their culture and learning to value the same things they valued and work towards those.

That was kind of a long description. But that's how I got there, how I moved from... Yeah.

Joe Crist (07:45.574)
No, I love that story. That's quite a journey you've been

Roger Smith (07:50.116)
It has been, and a lot of it's due to luck, being at the right place at the right time, and just knowing people. The more people you know, the more likely you are to have this doctor who knew everybody in the world tap me on the shoulder and go, he knows of an opportunity. I didn't know of it. I didn't apply for it. I wouldn't even have known, but I knew somebody who knew the opportunity.

Joe Crist (08:16.72)
I love that. Dr. Smith, obviously you've been around doing these things for a while now. You've worked in multiple industries. What are the challenges you're really seeing here? Between when it comes to robotics or surgery and even on the military side, what challenges are you seeing that relates to the work you

Roger Smith (08:37.792)
Yeah, so I guess robotic surgery first. When I started doing robotic surgery, if I had said, if you and I had met on the street or, you know, at a conference or something and you weren't in the field and I said, yeah, I help surgeons learn to do robotic surgery. People would freak out. They didn't know what it meant, but they knew that the word robot with the word surgery sounded scary and science fiction and dangerous. That's all they knew.

Since then, I think the public at large understands what they're getting into when you make that reference. The robot that we're talking about is really a slave to the human surgeon, and it only moves instruments when the surgeon moves his or her hands. So it's like a direct slave, master -slave relationship that gets that done. So you're really just transferring the skills of a human through a machine.

It's grown, it's become much more popular. There are some surgeries where the majority of the operations are done with a robot and there are others where they're still doing them either laparoscopically or as an open procedure and robots are just beginning to knock on those doors. what is, I think there's a couple of challenges to that. One

designing a new robot that can do a surgery, let's say inside your ear, or that can do a surgery on your eye. You can imagine how delicate, how tiny that could be. And I use those examples because those kinds of robots are in development, in research and development right now. And they're trying to take the lessons that have been learned over the last 20 years.

with robots that operate in your abdomen and shrink those down to a device that's 10 times smaller and make it work in your ear or on an eye or microsurgery on a vessel, stitching a small vessel vein in your arm back together. So that's the technology part. The other part is even though these machines are really incredible, they're also really expensive.

Roger Smith (11:04.236)
So the leading robot that most people use today around the world is the DaVinci by Intuitive Surgical. And the price for that is around $2 million.

Joe Crist (11:17.776)
So.

Roger Smith (11:18.604)
Yeah, these little ones are shrinking down to ear size and eye size. They're not going to be $2 million. But still, investing in that upfront is really expensive. And so if a hospital is going to do that, they have to do a cost benefit analysis that says, OK, we're going to invest $2 million. How many surgeries are we going to use it for in the next year or two years

So therefore, how long does it take before it pays for itself? So that holds back the application of this technology in smaller,

Joe Crist (12:03.994)
Yeah, I know that's

I mean, obviously cost is always like a big factor in this, but what is the general benefit of once they actually have technology like

Roger Smith (12:14.476)
That's a fair question. even though it's whiz banging like that is so cool. You step back and go, well, why did I do that again? Here's some of the advantages. if I were going to remove, I'm not a surgeon. If a surgeon was going to remove somebody's prostate, most men, once they get above 60, are going to have questions about whether they're going to have to the prostate out, unfortunately.

and the prostate resides down in the hip area, kind of deep and below the abdomen, and it's difficult to get to. So, if you use, it's difficult to get to, it's been done as open surgery, it's been done as laparoscopic, now it's being done 90 % of the time with the robot, for a couple of

One, if I want to do surgery with my hands, I have to make an incision in your body big enough to get my hands and whatever instruments I'm holding in them in there. That's a pretty big hole. But if I am doing surgery laparoscopically or with a robot, I only have to make an incision that's like a quarter of an inch long. And then I slide this long chopstick -like instrument, long.

tubular instrument down in and it goes down to where the prostate is to do the work. And the scissors and the graspers and the energy tools, all of those things that need to do the work, they're no longer the size of my hands or requiring a hold the size of my hand. Those instruments are like the size of your little fingernail. And so there's a lot less damage on the body.

as those instruments go in and do their work, than if I try to get my hands and hand instruments in there to do that same work. So that's one advantage, less damage to the body. So I have to cut fewer blood vessels. I have to cut less muscle tissue. I cut fewer nerve endings. And so when you go to heal, you'll heal much quicker and have normal function much quicker than if I had to cut all those things for open surgery.

Roger Smith (14:30.508)
A second thing that's really fascinating technologically, all of us, when you hold an instrument, especially that's a couple feet long, your hand trembles just a little bit. Not because you have Parkinson's or anything like that, it's just natural that you can't hold it. And you can watch the end of that instrument 12 or 18 inches away, you can see it flutter a little bit. The robot can tell the difference, the computers in the robot can tell the difference between intentional movement of my hands

and that little tremor effect. And so it just erases that tremor out. And so even though your hand is tremoring a little bit, the instrument in the body is rock solid and not trembling at all. And so that makes it more stable. And then a third one is an advantage over laparoscopic surgery, which I didn't explain for the lay listeners. It might be too much. But laparoscopic instruments,

are down at the end where the grasper is inside the body, they don't have a wrist at the end. So that means the tip of the instrument is like fixed straight ahead. It can't rotate around like this. There just aren't enough ways for the hand holding the instrument on the outside to do that movement. But with the robot being computer controlled, you can do that rolling motion. And so you get a lot more dexterity down in the body.

And so all of those advantages, when you started adding them up, they created a machine that was almost like perfectly made to do a prostatectomy that's down deep in the pelvis area. And for women, the same story kind of holds for hysterectomies. As women get older, there's more hysterectomies and you get that those same benefits. So you go in and do the surgery.

A lot of times you'll check into the hospital for your surgery on Tuesday, let's say, and have your surgery Tuesday afternoon. You'll spend the night in the hospital. The next morning you'll wake up and they'll start testing you to see if you can check out the next day. And a majority of patients can check out and go back home the next day because so little damage was done to the body. Prior to that, when they were doing

Roger Smith (16:56.065)
those surgeries in an open manner and even laparoscopically you would stay in the hospital a week while you healed enough for them to say it's safe for you to go home and manage yourself. And so the the healthcare system saves all those nights that you would have stayed in the hotel at no cost to you, no cost to the insurance company. So that made it another benefit.

Joe Crist (17:19.708)
Yeah, that brings up a lot of very interesting points, right? So what I'm really hearing here is though it may be 200 or $2 million upfront, really what you're saving on the back end is risk, right? Reducing liability, reducing the overall cost of the hospital. So it does seem like a fairly wise investment to

Roger Smith (17:41.824)
Yes, when we talked about the tremor and less damage to the body, we didn't take that down the path of, it's usually a small percentage, but for some people, a surgery turns out badly. And then there's the lawsuit that comes after that. So any of those you can eliminate, that's good for the patient's health and good for the financial position of the hospital and the

Joe Crist (18:08.122)
Absolutely. as robotic surgery technologies really do advance, what solutions do you see that are on the market today or even be in the future?

Roger Smith (18:20.78)
Yeah. So something that everybody has been striving for for 20 years is telesurgery. The ability of a surgeon to sit in a large metropolitan area where typically they have a lot of patients coming through, but for them to sit down at their robotic console and do a procedure on somebody who might be in a rural area where they can't, they don't have a surgery.

That was the intent of the research that invented the robot 25 years ago. That's what they were shooting for. But at the time, A, the internet was not nearly as robust as it is now. And so they couldn't conquer that distance. The connection was just not fast enough and not reliable enough. And so they ended up creating a robot that you used in a metropolitan area, in a big hospital where

Surgeon and the patient are 10 feet apart instead of 10 miles or 100 miles apart. But now with the internet being much more stable and the backups for when things go bad, the switching and rerouting being so fast, there's a lot more in the last two or three years, a lot more interest in can we get back to doing telesurgery? Now you would ask, well, why do you want to do

For most people, if you live in a big city, you don't need telesurgery. You've got a doctor that's 10 miles away, 15 miles away, and you'll just go over there and have the surgery with them. But if you live in, I'm gonna use the state of Nebraska, for example. If you live in the state of Nebraska, most of the population lives in small farming towns that are hours away from either

Omaha or Lincoln, the two big metro areas. And currently when they need surgeries, they commute to the hospital and then commute home afterwards. And it's hard to have a close relationship with your doctor when they're four hours away. And if it's an emergency, you're hauling those people into the back of an ambulance or into a helicopter and flying them to Lincoln or Omaha.

Roger Smith (20:48.608)
to have that surgery done if it's an emergency and then getting them back home again. That's the civilian case where you're like, this would be beneficial if it's safe. It's gotta be safe. That's true. But most of these rural towns, I grew up in a very rural area of Colorado and there are no surgeons in the town or even in the county where I grew up. In fact, there are no

The people that are doctors are nurse practitioners that are running a practice out there. And so it's very practical for those rural populations to go, could you extend telesurgery out to us? But then there's a couple of populations where this is more essential. Injured soldiers on the battlefield.

the soldiers that are being wounded, not, America's not in this war, but they're being wounded in the Ukraine, for example. They're in very vulnerable areas. And so when you, when a medic grabs them and pulls them back, you can put them into a vehicle and bring them out of shooting range to a combat surgical hospital, or what they used to call a mash back in the old Korean war. You can bring them back there and have

some surgeons there, but it's a mishmash. If you need somebody who's really talented at vascular reconstruction, that person's definitely not at a combat surgical hospital. But they might be at Massachusetts General and they could do that procedure from Massachusetts General to the Ukraine. Okay, I overreach there. I would prefer they did it from somewhere in Germany to the Ukraine.

miles in the hundreds, not in the thousand. So that's one use case. And then another use case is underserved countries where doctors and surgeons just don't go. And the money to bring somebody out of those underserved countries for a surgery is just not there. And telesurgery could offer them care that they really can't get in any other way.

Roger Smith (23:09.164)
So that's on the horizon. And there's a lot of surgeons right now experimenting with telesurgery, trying to figure out which procedures lend themselves well to this technology and we'll get good results and it'll be safe. And there's a demand for it. Not just one person needs this surgery, but hundreds of people need this surgery. So that's a really hot topic right now. I was just at the leading

conference on robotic surgery. The Society for Robotic Surgery's annual meeting was held two or three weeks ago and there were two four -hour sessions just about telus surgery because there was that many people investigating

But that's probably the up and coming technology that will be more popular within the next five years.

Joe Crist (24:09.333)
So just out of curiosity, I imagine this requires a lot of investment capital to achieve the values of technologies. Is there a big need for that right now? Obviously, from you, understand, this does make a lot of sense. But do you see anything from the investment community?

Roger Smith (24:25.772)
Huge amounts of money, yes. So if you look at the robots that have been deployed into hospitals, they're FDA approved, they're in hospitals now. There's about a dozen of them that have proven their usefulness, proven their safety, proven that they're an improvement over the alternatives, and they're in hospitals now. There are about 100 robotic surgery companies

in the R &D phase right now. 100.

Joe Crist (25:00.412)
That's a

Roger Smith (25:01.376)
That's huge. And most of those are venture capital funded.

So how they're funded is not really publicly available. But I would say the billionaires and the multimillionaires that got rich in Silicon Valley and being part of Google and Facebook and Amazon and all of that, those people probably are the source of a lot of these funds.

So there's a hundred companies trying to bring out a robot that has some competitive advantage. And one of the things that I do that I'm known for is I have a chart that tracks those recurrently 116 companies that are trying to do robotic surgery and show where they are trying to apply a robot to the body. And I would like to say that chart is current up to date, but the

field is so dynamic that there's a new company created every month and every couple of months there's a company that runs out of funds and collapses. So it's very volatile. There's definitely companies that I haven't found yet that have been started in the last few

Yeah, so it's huge. Now, I would say there's a dozen companies out there that have a device, they're making money. A hundred more companies can't be successful. The number of successes of those hundred is questionable. mean, is it going to be 10? Is it going to be one? I don't think anybody knows for sure. I'm sure it's more than one. I'm also sure it's less than 25.

Roger Smith (26:55.264)
That's as much as you can narrow it down.

Joe Crist (27:00.454)
Yeah, that's such an interesting thing to think about too. Obviously, as the world is becoming more more dynamic, there's global conflict, there's economies that are not doing great, technology is advancing at such a rapid rate that...

You know, we see things change, right? And I'm sure a lot of these new technologies are developing are also impacting a lot of these firms, all these startups that are actually working on these technologies as well, you know, for better or for worse.

Roger Smith (27:31.69)
Mm -hmm. Yeah.

Joe Crist (27:35.91)
So with that in mind, as these do develop with AI becoming more more predominant and advancing so quickly, how do you see AI playing a role in robotic surgery technologies?

Roger Smith (27:53.344)
Yeah. So at the recent conference that I mentioned, I would say AI was either the second most discussed topic or the most. Telesurgery was probably the largest and then AI was probably second or first. So AI is useful in three different phases of a surgery. Before you ever put somebody on the operating table, you have done tests on them, you have done imagery, you've taken blood samples.

You've done a lot of information collection. And it used to be that a human surgeon and maybe a technician would sit down with all that data and try to come to a conclusion of what specifically does this patient need? How are we going, how's this surgery going to proceed? What's the best place to enter the body? How deep are we going to go? All of that. And they would plan that all out. Having an AI help with that plan is something

that's very reasonable. It doesn't require extensive FDA approval because the AI is not going to do anything to the patient. It's going to give an answer to a problem back to the humans and the humans are gonna either approve it or disapprove it. But it's going to help them in their planning for the surgery. So that's preoperative. And then,

Let's skip over the operative part because that's the part you put in a movie, but it's also the most regulated part. Skip to after the surgery. When the surgery is over, you collect all of this data about how many instruments were used during the procedure. How long did it take? How much blood did the patient lose? Were there any untoward events that happened? How many sutures did you, all kinds of data you collect during the surgery.

And then once the patient's out, what were their vital signs? How long did it take before you discharged them from the hospital? Did they come back with any complications or any complaints? Did you, at the extreme, did you have to go back to the operating room a few days or weeks later because something wasn't quite right? You can analyze all of that data with AI and then try to figure

Roger Smith (30:14.944)
which approaches or methods in a surgery are giving the best results. And in some cases, if all of the good best results are happening with surgeon A and surgeon B is having more unfavorable results, what's the difference between the two? And how do you prescribe the practices of surgeon A to surgeon B so that surgeon B gets the same positive results?

So you can do that with data after the surgery. Those are the two areas that are going to happen right away, that are happening right now actually. The manufacturers of the robots are looking at all the data they can get their hands on and building models that can help them with that decision making. So that's the kind of thing happening right now. Having an AI in surgery, that, let's

keep that in the science fiction realm for now. I actually write science fiction books about robotic surgery. yes, and putting an AI in the surgery with a human surgeon and then working as partners is part of the plot. And seeing how, suggesting how good AI could be in surgery and also suggesting what that does to the human surgeon's ego when a piece of software is doing half of his or her job.

as part of the plot line in those, yeah. But it also remains furthest down the line.

Joe Crist (31:44.572)
I like that.

Roger Smith (31:54.661)
Yeah, there are other things that are easier to do during surgery, but they're not as interesting in a science fiction

Joe Crist (32:00.892)
still very interesting

Roger Smith (32:02.282)
Yeah, yeah, fascinating.

Joe Crist (32:05.024)
Dr. Smith, I can already see the houses just changing the world, right? And obviously you're lowering costs for hospitals, which is great, but really helping patients and decreasing recovery times as well and decreasing the total costs to the actual patient, really helping them with their quality of life and getting back to normal, right? Like those are all really amazing things. But with that, I actually had one last question for you. Obviously you've had quite a

You've experienced many things and have really helped shape a lot of what goes on in world now, right? When it comes to robotic surgery and also simulations. If you can give any piece of advice to the audience, it would be anything at all. What would that be?

Roger Smith (32:50.934)
So if the audience member.

Joe Crist (32:51.344)
Tough question.

Roger Smith (32:56.156)
is a tech person, computer programmer, engineer. I think they might already know this, but they need to jump on AI like crazy. They need to their career, bet the house, bet everything they have. Okay, that's big. But bet everything they have on AI is going to be successful in every field. I think AI now

is the same as the internet was in 1995 to 2000. We've done so many things with the internet that we never envisioned, like this telecom, for example. And it just keeps getting bigger and bigger and bigger for decades. And AI right now, there's a lot of speculation on what it can do and lot of criticism of, it'll never be that big.

I would say AI is the worst it's ever gonna be right now. It's only gonna become a bigger part of every industry. And so you can't go wrong by betting your career on that. Now, if you look at any tech company, I'm trying to think of some, I'm trying to get off of the big seven and whatever. But if you look at any tech company, Oracle, for example, you have your computer scientists, you have your engineers.

But that company is chock full of people that are business people, administrators, HR reps, that kind of thing. AI companies need those same HR reps, the same as a company that mows lawns for a living. So you probably have a better career if you're an HR rep for an AI company than if you're an HR rep for a lawn maintenance

That's where think that's where the big, the boom is going to be. By now, I think a lot of people have already figured that out. A year ago, 18 months ago, you would get a lot more pushback on that than you would today.

Joe Crist (35:05.872)
Yeah, that's very true. they were since really AI came around. I've seen a lot of changes across multiple industries and you only see more and more investment money going into AI to help develop it. even GPT alone, you see in the advancements it's made and it's been going to lightning

Roger Smith (35:27.156)
It was crazy fast.

Joe Crist (35:29.84)
Thank you for that. So everyone, that was Dr. Roger Smith. Dr., thank you so much for joining us on today's episode. I am so glad you have to join. I learned a lot myself. I'm sure the audience did as well. And for those out there listening, join us next week for another exciting episode of Thriving in the Digital Age. See you