Intuitive Surgical

Catherine Mohr: Medical Research, Technology and Innovation

She calls herself “a tinkerer at heart.” And ever since Catherine Mohr walked into a Boston-area bike shop looking for a high school job repairing drive trains and spokes, the New Zealand-born surgeon and inventor has taken tinkering to a mind-boggling high art here in Silicon Valley.

Dr. Catherine Mohr is the Director of Medical Research at Intuitive Surgical, the global technology leader in robotic-assisted minimally invasive surgery. In this role, she evaluates new technologies for incorporation into the next generation of surgical robots. In addition, she is a Consulting Assistant Professor in the department of Surgery at Stanford School of Medicine where she works in the development of simulation-based curriculum for teaching clinical skills. She is also a Medicine Faculty at Singularity University and an Advisor in the Future of Health Systems Working Group of the World Economic Forum.

Dr. Mohr received her BS and MS in mechanical engineering from MIT, and her MD from Stanford University School of Medicine. During her initial training as a mechanical engineer at MIT’s AI Laboratory, Mohr developed compliant robotic hands designed to work in unstructured and dynamic environments. Later, while pursuing an MD degree at Stanford, she identified needs for new laparoscopic surgical instruments and collaborated to develop the first totally robotic roux-en-Y gastric bypass, and invented and then started a company to commercialize the “LapCap” device for safely establishing pneumoperitoneum.

She has been involved with numerous startup companies in the areas of alternative energy transportation, and worked for many years developing high altitude aircraft and high efficiency fuel cell power systems, computer aided design software, and medical devices.  She spoke twice at TED Conference. At her TED2009 Talk, she tours the history of surgery, then demos some of the newest tools for surgery through tiny incisions, performed using nimble robot hands. At her TED2010 Talk, she walks through all the geeky decisions she made when building a green new house — looking at real energy numbers, not hype.

To learn more about her works, please visit her official website.

The following is an interview with Dr. Catherine Mohr about Medical Technology, Innovation and Creating a Better World. The interview has been edited for brevity.

Niaz: Dear Catherine, I really appreciate you taking time to join us at eTalks. I am thrilled to have you.

Catherine: Thank you for the invitation, it is great to be here.

Niaz: You are the Vice President of Medical Research at Intuitive Surgical, where you develop new surgical procedures and evaluate new technologies for improving surgical outcomes. You have profound experience and a body of great works in the field of Medical and Disruptive technology. In addition to that you’re very passionate about the futures in science, technology, engineering and mathematics. At the beginning of our interview, please tell us a little about your background and how did you get started?

Catherine: I am originally from New Zealand and grew up in Boston. Although, you can’t infer either of those facts from my accent. I always knew that I wanted to be a scientist, but my path to medicine wasn’t typical. As an undergraduate, I majored in Mechanical Engineering and built and raced solar cars as part of MIT’s team. That led me to working in alternative energy with Paul MacCready at AeroVironment working on hybrid electric cars and fuel cells. It was a wonderful time, and I remain very committed to sustainable technologies – encouraging kids at every opportunity to consider careers in science and engineering.

Niaz: Tell us about the road that led you to the world of robotic surgery. It was not a straight path, it seems.

Catherine: It wasn’t until after many years of working as an engineer that I went to medical school. I was in my 30s, and hardly the typical medical student. In many ways, I ended up in medicine because I was very interested in getting back onto the steep part of the learning curve. I loved engineering, but I had become an engineering manager, and I was looking for a new challenge.

In medical school, I was doing a lot of research in surgery and surgical technologies as part of my schooling. I encountered the da Vinci Surgical System and I started doing procedure development with one of my attending surgeons. We both work for Intuitive Surgical now – she as the Chief Medical Officer, and I am the VP of Medical Research.

Niaz: Intuitive Surgical is a high technology surgical robotics company that makes a robotic surgical system. Today, Intuitive Surgical is the global leader in the rapidly emerging field of robotic-assisted minimally invasive surgery. We would like to learn more about Intuitive Surgical. Can you please tell us about Intuitive Surgical, its current projects and also how it has been innovating our future?

Catherine: The flagship product at Intuitive Surgical is the da Vinci Surgical System. It allows a surgeon to operate with full dexterity and capability, but through tiny incisions. The da Vinci System has been a major part of the increase in the rates of minimally invasive surgery in many types of procedures where surgeries were too complex, intricate or just too fatiguing. As of early this year, we estimate that there have been two million procedures done worldwide with the da Vinci System.

Current research and development projects at Intuitive Surgical are aimed at increasing the capabilities and decision making resources of the surgeon while continuing to decrease the invasiveness of surgical therapies. The goal is always working toward better surgeries that are less invasive.

Niaz: The da Vinci Surgical System is a sophisticated robotic platform designed to expand the surgeon’s capabilities and offer a state-of-the-art minimally invasive option for major surgery. It has been using all disruptive technologies like robotics, high- definition 3D camera and so on. Please tell us what is the da Vinci Surgical System and how does it work?Catherine: Although it is often referred to as a “robot”, a more appropriate description would really be “telemanipulator,” as it doesn’t make any autonomous decisions of its own. To operate the da Vinci System, the surgeon sits at a console which has both a 3D display and a pair of input devices, which capture the motions of the surgeon’s hands and the da Vinci System moves the surgical instruments in a precise, scaled replica of the motions that the surgeon is making. This is coupled with a 3D camera so that the surgeon sees the instruments in the display superimposed over where they feel their hands to be.

Sitting down at the console, moving these input devices, and seeing the instruments move exactly the same way is the “intuitive” part of the process.

Niaz: How is robotic surgery, using something like the da Vinci system, better than the old-fashioned way with human hands?

Catherine: The human hand is rather large – at least when you are thinking about making an incision in the body large enough to fit that hand through. The da Vinci instruments are only 8mm in diameter, so they allow you to bring all the capability of that human hand into the body, but through a small incision. This is much better for the patients, as they get the same operation inside, but they heal more quickly with less pain.

Niaz: If we look at the evolution of surgery, we can see really huge changes have happened since last the two decades. With the rapid acceleration in human-machine interaction, the potentiality of robotics in surgery is going to be very vast. How can innovations like robotic-assisted surgery change the world of surgery?

Catherine: The changes haven’t only been happening on the surgical side. The improvements in surgery will come partly from synergies with advances in other parts of medicine. Some of the most exciting things that I have seen have been improvements in diagnostics and screening. As we find cancer earlier and earlier when it is easily cured surgically, we won’t have to do huge reconstructive operations to restore the function that would have been lost by cutting out the larger tumor. This gives us the opportunity to further reduce the invasiveness of our surgical therapies by moving to even smaller incisions, or going in through the mouth and avoiding external incisions entirely.

Niaz: What do you see as the future of robotic surgery? What are our core challenges to reach to that future?

Catherine: As we look at reducing invasiveness, we always want to be able to build things smaller while maintaining strength and precision. Interestingly enough, some of the biggest advances in robotics may come from new material science and machine tools.

Niaz: As an expert in the fields of robotic surgery and sustainable technologies, you’re passionate about realizing the potential benefit that appropriately applied technologies can have in our society, and inspiring the next generation of scientists and entrepreneurs to tackle the world’s important problems. Can you please tell us about some interesting and tough technological problems that you want next generation of entrepreneurs to solve?

Catherine: Apart from the new materials, many of the opportunities to do extremely small interventions will rely upon being able to navigate within the body – like having a GPS for the body. Today, we can map the body with things like CT or MRI imaging, however, the body does not stay static. Organs move constantly, which makes navigating with a preoperative image like trying to follow a GPS map while the roads are constantly changing and moving, but your map never updates. Solving these problems would make it easier to make surgery even less invasive.

Niaz: As you know, it’s really hard to do scientific breakthroughs, to build companies like Apple, Google, Space X, and Tesla, to do something in massive levels with truly disruptive technology. I would like to hear your ideas on doing breakthroughs, coming up with authentic disruptive innovation and on building next big organization?

Catherine: It is solving problems that matter that is the key to these disruptive companies. The problems that matter also tend to be hard, so you need to be patient, and dig deep into the technology to get to solutions. None of the companies you mention are short on ambition, they all started fairly small, and they are deep experts in their technologies.

Niaz: Do you believe Silicon Valley is still the best place to build next big technology company?

Catherine: It is the best place because its historical success has led to the intense concentration of tech talent. However, the shortage of housing and the resultant astronomical housing prices make attracting people to come to Silicon Valley who aren’t already here rather difficult.

Niaz: What does actually make Silicon Valley very special?

Catherine: Critical mass. The concentration of talent, and the expectation that you will fail a bit before you succeed continues to attract the ambitious with big ideas. People cycle through startups gaining experience, and they keep going until they do succeed.

Niaz: You’re a medical technology pioneer, a mechanical engineer, and an expert in robotic surgery. Prior to going to medical school, you worked in the field of alternative energy transportation and sustainable technologies, working for many years with Dr. Paul MacCready at AeroVironment developing alternate energy vehicles, high-altitude aircraft, and high-efficiency fuel cell power systems aimed at reducing our world’s energy consumption and emissions. Can you tell us about how do you connect all of your skills, expertise, ideas and knowledge to break through the threshold in any specific field to get the best out of it or build the big things?

Catherine: Much of what I do involves understanding how the problems we are trying to solve are part of large interconnected systems, and thinking about optimization across the entire system. Optimizing only one part of the solution at the expense of the other important parts is counter-productive. For example, maximizing energy storage without considering weight for an airplane, or improving surgical capability without making it easy enough to operate safely. The big interconnected problems I like to tackle involve many of the same skill sets, even if they are in far flung areas like sustainable energy and surgery.

Niaz: How beneficial is it to have a multi-dimensional background and expertise?

Catherine: Attempting to solve all of these big programs are always team efforts. The myth of the lone inventor is just that – a myth. You need huge diversity of skills on a team, but that very strength means that teams often have difficulty communicating, if the background and experiences of the team members are too different. The people who have experience, background and training in several fields act as the linkers and translators within teams. I like to joke that I am “trilingual” – I speak Geek Speak, Medical Jargon and English – three mutually unintelligible languages. Being able to explain the clinical to the technical and the technical to the clinical is a valuable role.

Niaz: As far as I know you hold several patents. Please tell us about your patents?

Catherine: Most of these are in the area of manipulation or vision on the da Vinci System. You’ll notice that few, if any, of those patents list me as the sole inventor. Invention tends to come when you are solving a new problem with a team, and have the opportunity to try novel solutions. The best ideas are also often hybrids of many people building upon and improving each other’s ideas as you solve a problem together. Patents certainly serve a purpose in that they give you a period of time in which to use an idea before a competitor can legally copy it, but it is the teamwork and problem solving aspect of it that I enjoy the most.

Niaz: What is your favorite part about working at Intuitive Surgical?

Catherine: Getting to remain on the steep part of the learning curve – medicine and technology are changing so rapidly, that keeping up with what is going on is a constant process – one that I enjoy very much.

Niaz: As Vice President of Medical Research, what do you do on a daily basis? What is a normal day like for you?

Catherine: I’m not sure if I really have a normal day. Some days are lab days when we are in the research operating room developing new procedures or testing out prototypes of new instruments. Other days involve traveling around and both speaking about our technology and learning about new technologies from their inventors. And, some days involve trying to look out into the future to see what changes are happening in medicine so that our next products fit the new needs that are arising.

Niaz: What other kinds of projects or initiatives have you been involved in?

Catherine: I started playing the cello recently, and through building our house and blogging about it, I have been active in the conversation about green building and native plant gardening. Recently, I have also started working with GAVI, the vaccine alliance, on technologies for tracking vaccines in developing countries.

Niaz: You wanted to save the world, or at least a piece of it. But you just weren’t sure how to go about it. And now in 2014, we can see your profound body of works that have helped to change the world of robotic surgery and sustainable technologies. I know there are still a lot more to come. What would be your advice for the ones who want to follow your footsteps and change the world to make it a better place to live in?

Catherine: Focus on the problems that matter to you, if it matters to you, it probably matters to other people too. People make the mistake of focusing on what they think other people want, and then their hearts are never really in it. Without passion you won’t have the drive to do all the really hard work that comes with trying to make a difference. People are very impatient for success now, but it will never come unless they take the time to become deeply educated and skilled in the areas needed to be able to make a contribution.

Niaz: Any last comment?

Catherine: The technologies that will probably shape our future careers are in labs somewhere. I expect I will reinvent myself several more times as those technologies come out of the lab and start changing our world.

Niaz: Thanks a lot for joining and sharing us your great ideas, insights and knowledge. We are wishing you very good luck for all of your upcoming great endeavors.

Catherine: Thank you for putting this program together

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Further Reading:

1. Andrew Hessel on Biotechnology, Genetic Engineering and Future of Life Science

2. Aubrey de Grey on Aging and Overcoming Death

3. Irving Wladawsky-Berger on Evolution of Technology and Innovation

4. Gerd Leonhard on Big Data and the Future of Media, Marketing and Technology

5. Viktor Mayer-Schönberger on Big Data Revolution

6. James Kobielus on Big Data, Cognitive Computing and Future of Product

7. danah boyd on Future of Technology and Social Media

8. James Allworth on Disruptive Innovation

9. Brian Keegan on Big Data

10. Ely Kahn on Big Data, Startup and Entrepreneurship