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So uh welcome everyone to our next uh webinar in the Oscar and Digital Surgery Collaborative Series. Uh This one focuses on digital solutions from industry and I'm, I'm really grateful to be joined by some, some um really important um industry players in digital surgery. Uh with us tonight, we've got representatives from intuitive medtronic and, and proximity. Um and, and uh I'm really delighted to be able to share their expertise with you. Um So without any further ado, I'd like to introduce James Westbury from intuitive uh who's the senior group manager uh for products marketing uh and digital in Europe. So James over to you. Thanks and let me just um share my screen and I just let me know Andrew when you can um give me a heads up that you um you can see what I'm seeing, you should see integrated intelligence. Yeah, that's perfect. Thank you very much, great stuff um evening everybody. Um Thank you, Andrew for the invite to, to talk this evening for 1015 minutes um on what we're doing at Intuitive um from a digital surgery and um digital solutions perspective. Um So quick background to who I am. Um I head up the Digital Solutions um product team, er, for Europe, but as you can tell by the accent, I'm, I'm UK, I based um based just outside of um Leicester, um South Leicestershire. So thanks for the opportunity to, to share some thoughts today on what we're doing from a digital surgery side of things. So, before we go a little deeper into what digital surgery means, um how we're approaching digital surgery now and what the short to medium term looks like. I want to start really at, at, at the beginning with, with what we see is the intuitive ecosystem. Um So this is the products, learning and services that, that help surgeons, health care teams um and trust treat patients in the best possible way so they can get home um and continue with their, their lives. We do this around three elements and we're now on our fourth generation of, of da Vinci robot um I with eye and a recent introduction over the last 18 months, um with an integrated portfolio of instrumentation and vision and imaging you'll see at the bottom right hand side, we've got training and digital insights. This here is the focus for, for today uh where I'm gonna go a little bit deeper into some of the platforms uh which we have are intuitive to help teach, train support healthcare professionals globally and also some cool future forward looking technology to help analyze surgery. Um going forward. Um But as we're talking about digital surgery by, by nature, um, robotic da Vinci surgery is digital. Um, it's like a, it's like a big computer, a large computer, um, and digital surgery is at the center of everything we've done in the past for the last 2025 years and everything that we do do going forward. So, three small subsections of today for, for 1010 minutes, how we approach digital? Um what are the products or the digital products that help you access um the ecosystem and insights and then a couple of slides on what the future looks like um from a digital product that intuitive. So it, when we start at the very beginning, you know, we wanna make sure that we're aligned to what you do. Uh We want to make sure that we're solving a problem that is a problem. And there are 33 that we identified where digital surgery can help support, support you in. Um now and in the future, the first one is um helping surgical teams er reduce complications. The second one is there is a variability in, in care, team performance. And the third one is that there is vast, um there is vast generation of data being produced and the way we look at it underneath is in column one, when we talk about complications um is that we wanna make sure that we're providing um the latest digital technology to help you um understand your surgery in the way that you can make the right decisions at the right time. Secondly, with regards to variability, um we wanna help you identify um a pathway foot towards improvement and help identify areas whether it's skill or performance. And then thirdly, data is great. Um There's a lot of data being produced, but often don't, people don't know how to or healthcare settings don't know how to easily identify, um can't digest the information. And so it's up to us to be able to help you understand your data in a more detailed way. So you can use it in a more proactive way. And that comes down to three, but it comes down to three elements helping you understand or develop program efficiency, help you be able to make the right insights at the right time to make the right clinical decision. And third, help with a personalized um learning journey, whether that's at the beginning of a of a da Vinci surgery um career or more experienced, it doesn't matter where your your pathway is and what we call this is really inte intelligence as digital goes through the complete ecosystem of products, learning and services and the approach that we work to um it might not seem a novel or unique approach, but actually what is novel and unique or what is, what is difficult to, to really get right is being able to connect the data, insight and actions of what we do digitally or what you do digitally. And so we want to help you healthcare settings and and surgeons connect data insights and actions in this virtual concept of you have data, you have data on the er da Vinci system, high quality um system data, which ob is, is objective. But obviously all of that data, we wanna make sure that we're giving you in an easy to understand um format that you can then take action. So then you can go continue on the virtuous loop back to data insights and actions. So we want to help you have meaningful insights um that you can take the next step to help you achieve your goals. And the way we approach that virtuous loop of data insights and action is actually around three core digital products to help you access what you need at the right time. And we start at the top right hand side where it's centered around intuitive hub so that you can capture and connect your data in the or intuitive hub is the is the touch screen which is integrated into the da Vinci system. And there are two applications um which are part of intuitive hub. The first application is around media manager. So being able to capture edit and share your surgical videos and then the second application is via telepresence. So being able to live stream your surgery um out of the or to help teach, train and share your experience from an educational perspective and that's capturing data. And so that's the first or virtuous loop element of capturing data in the or the second one is how do you access your data? And that's via the platform of my intuitive, which is, you know, on your mobile phone um and also available on web and this is where you can access all of that rich data that comes through intuitive hub and your or experience. And then from that, in that digestible, easy to understand, digestible format, it helps you take action. And the one that I've highlighted on this slide here at the bottom right hand side is you take action with Sim. Now, sim now being the simulator which is helps you with skill drills, um procedural simulation and videos to help you through um the learning curve and beyond from a Da Vinci surgery perspective. So, in summary, to this slide, it's the three access points of digital surgeries via intuitive hub inside the or my intuitive outside of the or so you can gain your insight and then the learning platform of sin now, um which can help you not just help you progress at the start of your da Vinci career, but post you know, more experience as well as you um build your numbers and to put into context of the data, insights and action of as I've just, you've got the data from the inside the or with the procedural data, you've got your insights and actions um via my intuitive and media manager within medium or so tag your procedures, you can create hashtags and you've also got the book marking. So it's almost like a library of your procedures. And I always go back to the concept that if I go into an index of a book, I go to the index to find what chapter you need to look or review. It's exactly the same within the media, manageable concept is that you've got your library of 100s of procedures. And actually by searching for key words or phrases which you've used in the past, you can bring up that very specific point in time over your 100s of um procedures. So you can identify it and it pulls it up straight for you. So helping you be more efficient finding the content that you need and when and then finally taking action via the three points which I've already mentioned, which is telepresence sin. Now, some learning plans and videos, which we've got on the learning portal. So I hope that gives a concept of how the data, insights and action of what we do today um around digital surgery. Now, when we look to to the future, we've got a, we've got a very comprehensive ecosystem today and we've got digital tools to help you get to where you need to be. But there's a continuation of innovation needs and asked from, from you and surgeons to us to help support um competence and proficiency in surgery. So there has been an ask to us is can you provide more objected data to help you um identify where you need to improve? We've got helping with s surgeon, technical skills. And then there is, have we give you a, a unique um personalized recommendation training plan to help you improve throughout your, your da Vinci career. And that's been the ask back to us um with regards to the technology that we build from what we've got today. And this is the first glimpse into the future. There's no, there's no um to expectation on when you'll, when you'll see it when it's been launched or introduced. But this is the sort of concepts we're that we're looking at for the future and this is case insights um which helps extract objective insights from surgery to help surgeons elevate their skills with the goal to improve patient outcome. And that's on the screen in front of you in real terms, what this means is that we have a surgical video. Um We then overlay that surgical video with objective system data. So things like instrumentation, um short form stapling um vision, whether it's with fire fly ig um when do you use um different energy devices and then you overlay that thirdly with artificial intelligence and machine learning. Um So you can segment your video and see the different steps of the procedure and this is the way that we're, we're looking in the future and a little bit of repetition here. But it's the same concept of all that information comes up in the or you access case insights through my intuitive. And then we're link, making that third link into the future where we're actually supporting surgeons now identify actually which modules or which simulation modules are recommendations based on the overlay of the procedure with say a best in class procedure. And so we're coming up with recommendations and that might mean more, you know, more practice on this simulator with regards to dissecting it might be short form stapling exercises. And that's now how we're connecting that virtuous loop to give you that data insight and then recommendation for action. Just one glimpse here. It's quite a busy slide. Um But this is um objective performance indicators, opis and this is just how we break it down with what I've just explained where we've got video data where it's broken down into procedural phase data. We've got event data, which is system data and then actually, we're bringing together kinematic data. So actually, how's the instrument moving um during the procedure? And this is pretty cool, right? Because this is how you can look at surgery and maybe look at the best in class surgeries is maybe a surgeon that is starting on their um on their Da Vinci da Vinci career. And obviously, the path that an instrument take might be different because of different um patient um anatomy. But ultimately, over there are trends and patterns which can be identified from this sort of analysis of kinematic data. And this is how we're bringing it together to help you give more objective insights into teaching and training. And obviously, on the left hand side, here is the mo is the movement of the instruments on the right hand side is obviously what that path looks like on kinematic data. And so the se the second part um or the the medium, medium term view is how we can incorporate also the use of 3D models into, into digital technology within intuitive. Um Again, this is feedback from um from surgeons that they want to be, you know, that you want to be able to include this into, into your um surgery. Um for really three elements. First one is to support with pre op planning, um being able to visualize, visualize the surgery in more depth. And actually, the ask has been a second one is once you've got these scans of 3D modeling, can you can we start creating bespoke um exercises on simulation modules? So actually, you can almost pre prepare for surgery by actually doing the surgery on simulation. Um And that's the sort of narrative and that's the sort of future or innovation that we're looking towards. It's almost like you can have a dry run, you can practice um some, you know, based on maybe, maybe tumor position, we then create a bespoke simulation. So you can practice prior um preoperative, secondly, patient education. Um We've got some examples where surgeons want to be able to educate patients on positioning of certain anatomy before the procedure. And then thirdly, it's interoperatively. Um so to support during the operation for 3D models. And so this again is more medium term, but this is how we're thinking about again, extending all the the evergrowing ecosystem to bring you more tools, resources to help you do to help you you in your, in your, in your role as a surgeon so that the patient can get better, better care and better treatment. And last slide become a conscious of time as well holistically as well from how we look at um digital surgery within, within the, within the flow of preoperative planning, interoperative guidance and postoperative analytics. Um This is how we see it come together and it, it, it is all ever an ever growing ecosystem of digital products and portfolio. Most of these I've talked through in some form or, or another today. Uh whether it be using integrated telepresence either during the procedure to have a surgeon access or or remotely connect with you in the or or the other way. If you want to remotely dial in and view some surgery, you can do it both ways around. And finally, on the right hand side, you've got the customer portal. This is also an holistic view access via my intuitive, which gives um robotic coordinators and executives at the hospital a holistic view of the Da Vinci program as well. And it all comes together from a, a preoperative interoperative and postoperative perspective. So, um I've tried to, I'm conscious of time. Um I've tried to share sort of our vision of where we are today and in the future. So 15 minute goes very quickly. So I hope I've managed to verbalize and give you a concept to where we're going um in the future. So, um thanks Andrew. Thank you very much James. That's absolutely fantastic. Great to see you all the, the brilliant work going on intuitive. Um And yeah, I think digital surgery is, is the future and, and it's great that we've got industry um on uh ready to support us with all these fantastic tools. Um So our next speaker who will be telling us about what Medtronic have, have got um to offer us as, as digital surgeons is George Mogao. He's the from Medtronic. Uh and he's the vice president and General Manager of Medtronic Digital Technologies. So, over to you, George, come off mute. All righty. Can you see my screen? Yeah, perfect. Nice one. Thanks. Uh And thanks uh James, that, that was great. Um I am uh not based in the mid Midlands. I'm based just outside London. I'm Georgia, the, the uh Digital Technologies Business Unit uh within Medtronic. Uh one of the world's biggest med tech organizations. It's great to be with you tonight. Um or whenever you watch this on replay. Uh So from a medtronic perspective, uh we are, are um strategically really committed to starting to lay in digital into our portfolio. Um Surgery for many thousands of years was based on er, surgeons, physicians using little tools, the advent of electricity of camera based technology, robotics. Uh and now digital, I think provides us with a, a an opportunity to really drive uh technology into procedure rooms that benefit surgeons and ultimately most importantly benefits patients from a technology point of view. We have seen some similarities with what we're trying to do with what James uh described uh in the automobile industry and many other sectors that have started to layer in A I automation, smart intelligence and software. Uh most notably probably in the smart cars. I was in San Francisco two weeks ago. Uh and they have autonomous taxis driving all around the city center so you can get a taxi on your phone. Um uh it pulls up no driver in the car seat. And if you go, it really is quite an amazing experience, but just gives you a, a sense of where some of this technology um is going. I don't think that level of automation is coming to surgery any time soon. Um But there are certain foundational aspects that medtronic is working on to make surgeons, physicians lives easier and better. Uh So I am gonna talk through some of our, our ecosystem uh in the next uh 10 or so minutes. Um But one of the really important things we have taken as a, a design decision in our tech is to solve the challenges that surgeons face physicians face every day. The stat in the middle is one which is really very revealing. So this is from a survey we ran in the US of 1000 surgeons, but we also ran a survey of 500 surgeons here in the UK in the NHS uh who had very similar results. On average surgeons said that they lost four hours every week due to inefficient technologies. If you add that up, that adds to an entire working month every year. I borne witness to this uh Just tonight uh with some other team here uh trying to log in, connect to the internet, et cetera with uh laptops and technology. Our most, some of our most important um members of our, our, our healthcare community are losing huge amounts of time due to inefficient technologies that surround them four hours per week. 48 working weeks is 100 and 92 hours per year. There are around 20,000 surgeons in the NHS, which means that there are close to 4 million hours lost every single year due to inefficient technology. If you extrapolate the results of this survey, which equates to 438 years, every year of wasted time of physicians in the NHS in healthcare systems worldwide are not being provided with good enough technology to give them a working experience, which is supportive, that provides solutions that are at their fingertips. And that is one thing we have set out within our division of medtronic to solve for. So there's a quote from Martin Farrier, er, which is an, er, digital health blog. He wrote uh around four weeks ago, he said my computer takes ages to load up in the morning. It's not running slow. It's just the way the system works. Most of the clinical systems demand clicking of irrelevant buttons to collect unseen data. There is something demoralizing about pointless clicks. It detracts from the sense of purpose. They leave me feeling like I'm dying inside, slowly wasting my life. Martin Farrer is a, a chief clinical officer in the NHS and a consultant pediatrician. We hear this loud and clear and the solutions that we are launching and putting at the fingertips of our physicians are recognizing that you need things to work seamlessly and efficiently. One of the things we have found working in surgery is that today, surgeons are still, for example, saving their surgeries, recordings of their surgeries on D VDA, little bit better, maybe USB. Uh but I was uh in a meeting with a surgeon in Belgium last year who had 12,000 DVD S in his attic with his surgery recorded on them. Blockbuster went bust a long time ago. There was only one Blockbuster store still available. Uh, still still open, which I think is in Oregon in the US. Everyone is living a Netflix experience. Aside, some of our most important healthcare workers, including you. So we decided to overcome some of these challenges. We thought, well, why can't we get the case video? The full length case video back to surgeons within 60 seconds under a minute to your phone to your fingertips. First thing we had to solve for was the fact that a lot of surgical video contains very important um private information. When you pull a camera out of a patient in robotics or um endoscopy procedures, you keep filming uh regardless of where the camera is, we've developed A I which runs over that video redacts pixels in real time ensuring that the video we give back to surgeons is fully redacted of ph iit departments like this type of tech. It's really important for medtronic that we only store the type of footage on our servers that is needed. And for physicians, it means that we can get the video back in under 60 seconds. A very crisp, very clear video to you. We believe it's the fastest return of any surgical case to the fingertips. Er that is on the market today. How we do this, we put a computer in the procedure room, we give you software uh and off you go. We also also provide analysis today of that surgical video automated for surgeons in 26 countries. Currently, the way we do this is run various automated analysis of surgery which has been built, designed tested and found by surgeons around the world. Which means today in our app, if you perform a video, if you perform a surgery, you go into our app. After the case, you get seen, not only the video but also analysis, the phases of the surgery performed anatomy relevant to that procedure and also the instrumentation all provided to you yourself. As your own surgeon in Fitbit style analysis, your own procedures analyzed automatically at your fingertips. Here is a video of a surgeon utilizing Medtronics Hugo system, which is available in Europe. And this is exactly what they see. I think this is a prostatectomy case. You will see the phases of the operation, uh anatomy like bladder, the prostate and the surgeon's own analysis available. Today. We believe not only should surgeons be able to get the video back within under a minute, they should also as standard, be able to get analysis which hitherto has taken a very, very long time to provide streaming. Really important to be able to allow trainees into cases, remotely, enable surgeons to be able to access pro train and remotely. But the systems we've seen on the market have been very cumbersome and we decided to set out to build a solution that works within two taps, stream in two taps. That's exactly what we've done. We've introduced a small cordless um solution into the procedure room. Complete seamless integration with the rest of our technology, which means as a surgeon, as a physician in the room, you can stream within two taps, invite anyone to the procedure within two taps. And as someone external, anywhere in the world you can join, you get a push notification on your phone and you're in within one tap. Here is an example of a surgeon doing exactly that about three weeks ago on our platform streaming to participants in India across America and through Europe, super seamless, super easy. We want our technology and we need our digital technology to be easy, seamless to use for you. The consumer of that software, I can't promise you. This is what the teams uh look like when we deploy our tech. But this is not a stock photo. This is a team in actually Portugal, I think who just had installed our our streaming technology. They all look very, very happy. We can't guarantee all your team will look as happy as this. But it's certainly what we're striving to do to provide a good user experience which overcomes so many of the challenges the it and software solutions you deal with day in day out still uh have feedback from users is a really important one, changing the culture of an institution. If you can put technology in which is so seamless and easy to use. That does not require thousands of clicks for, for it to work, but provides you an experience digitally which is at your fingertips, which is easy that gives you the information you need. I am of the belief that the technology can really help change cultures and this is what our physicians are saying back to us. Important here, patients improvement for patient care, patient care and clinicians, where we're going, we're very heavily invested in working with surgeons worldwide to see what types of solutions we can provide during procedures to support you. As you operate. Medtronic already provides this type of technology in colonoscopies. So in endoscopy, we already have a a product called Gi Genius which during the case automatically detects potentially cancerous polyps. You'll see an example of this here. You'll see the little green box detecting um uh polyps that it's been trained to do deployed. Now. Uh in many, many procedure rooms, there was an amazing publication in the lancet uh around two weeks ago, maybe four weeks ago that showed the impact of this technology uh for physicians and ultimately for patients in terms of detecting potentially cancerous polyps. This automation is going to be additive to the physician experience and really provide support augmentation and intelligence during the case. And we are moving towards an era of being able to provide that same type of intelligence that I've just shown in colonoscopy that is available today within surgery to support surgeons to give potential safety net. Uh to provide certain types of technology that can support decisions you make during the case um with very highly validated clinically relevant algorithms. So medtronic has a focus on improving the lives, transforming the lives of patients. Our technology is used worldwide. But I guess one of my my uh most robust uh things II say to the team that's working on technology is it has to be seamless, it has to be easy to use. We cannot have, have physicians feeling like they are dying inside, waiting for things to load, waiting for things to work. In 2024. There are better ways of doing it. Uh And I believe we've got some great technology to showcase that I will end that. I think I've used my allocated time and I'll hand back to Andrew. Thank you very much George. Excellent. Again to see uh the, the fantastic word work that um medtronic are doing particularly impressive that the, the insights are available so quickly. And um as someone who's currently struggling with NHS Wi Fi right now, um those that data and those quotes that you were were um sharing. Definitely ring true. Um So next, we've got a talk um from uh MS Nadine Ha Haram, who's a consultant, plastic surgeon, uh and uh clinical Innovation lead at guys in Saint Thomas uh NHS Foundation Trust. Uh And she's also the founder and CEO of proxy. Um So, uh my colleague Kyle is going to share this presentation, hopefully, just bear with us for a couple of minutes. And perhaps in the meantime, while we're getting that ready, I'll um just have a quick chat about Oscar, which is uh the reason why we're hosting these webinars. So Oscar stands for uh observational study of camera assisted uh surgery recording and it's a collaborative audit that we're really hoping everyone can um get involved in. Um So it comes off the back of um some initial work. Um So as, as you've seen uh digital surgery has a huge component um of operative video. And that's a really important um resource in, in uh surgeons making the best use of all of these digital technologies. And so we want to understand in the UK and Ireland um what is going on at, at individual surgeons or operating theater level in terms of surgical video recording. And so we're interested in all patients undergoing any surgery, whether or not it's recorded and we're auditing um those cases in the same way that we keep a log of them in our log books, many of us for our training. Um And it's the similar source of data that we'll be collecting via redcap, which is a secure data um system. Um And then we're also auditing whether or not the the case is recorded. Uh And th and then 30 days later what the patient outcomes are and whether or not that video was used for anything. Um And we think this will be really helpful and we want everyone to, to get involved. There's very low barriers to entry. If you, uh are in the practice of logging your operations via an electronic logbook. Um, then really you're ready to get started with us, um, in, in Oscar. Um, we've got a system of, of local leads, local collaborators, data validators. We'd love you to, to take on uh any role that, that um takes, takes your pick. Um the local leads being responsible for registering the audits locally and, and trying to build engagement. And then um you're very welcome to then also be a collaborator in which you, you would um contribute data from your operating lists uh or, or data validators, which will be to, to make sure that we've not got any uh incomplete data afterwards. And of course, what whatever the role you take on, we'll, we'll be um acknowledging that within our uh collaborative authorship structures in, in all of the outputs that, that we um generate from Oscar and that includes um a PUBMED cit uh publication. So as, as you can see here from our timeline, we're coming to the end of our webinar series and we're gonna start data collection next week. So it's, if you're, if you've not registered yet, then please do scan the QR code on the right and get involved and, and we've got another data collection week coming up in December and we should have all of that um 30 day outcome and video use data by the end of January hoping to, to then have some results in early next year. So what, what's there to do now? Uh register Oscar locally um in your hospital, let your colleagues know about Oscar and, and get them involved too. Um Really collaboration is the way forward here. We'd love to have as many people on involved and on our publications and, and um whatever other outputs we generate uh and then get organized about the data collection, create an or kit account so we can track you for authorship then um next week and in December log your operations as you would on your electronic logbook, but then also log them with us on Redcap and then 30 days after we can go back and fill in that um postoperative data and then present your, your um audits locally. That's a really important point that that's um valued by a lot of uh national selection processes. And then obviously, as I've discussed, we'll um be giving everyone collaborative authorship on, on all of our outputs. Brilliant. So hopefully, Carl of how are we getting on with the, the video? Hi. Yeah, I'm, I'm just trying to do it and it's not letting me do it. Sorry. Um Just bear with me a bit. Sorry about that or Katie. I don't know if you, if your copy is still still working. Yeah, I have a guy. Um Perfect. Yeah, that looks good. Hello, everyone. It's a pleasure to be with you. Thank you so much for inviting me to join you in the Oscar webinar series. Um I'm excited to share with you today a talk about creating a culture of data within healthcare. Thank you. Induction. My name is Nadine has Haram. I'm practicing reconstructive plastic surgeon in London at Ge in ST Thomas. And I'm the founder and CEO of a global medical device company called Proxy Proxy is one of the first real time virtual or platforms to market. I founded the platform with a mission to improve access to care, to improve connectivity from and to to the or and ultimately to address the healthcare challenges that we face in improving access to care, improving productivity, supporting the workforce and enhancing safety in the or and since 2019, we've expanded our growth both through health systems but also increasingly by partnering with medical device companies and O Ems. Today, we're available in many facilities around the world, partnering with over 40 medical device companies. And this is further supported by numerous articles that we've published demonstrating the value of our system. I love that we're making impact now and we know that the health care landscape is rapidly evolving. And I think for us it's really important to be proactive and bring disruptive and comprehensive solutions to make that change. Mhm When I created this in 2016, I really had a vision of using off the shelf everyday technologies that we're used to mobile devices, video streaming the internet, all of these to enable us to connect operating rooms and bring people together to share best practices to exchange knowledge over distance. And we were really connecting and integrating various systems and individuals within the or to provide that comprehensive view of the operating room. Joining up video data from different sources, centralizing it all in one platform. And we realized that in all the ambient video and audio captured, we had truly something invaluable. It went beyond what we were already offering, which was the telepresence and the educational resources. What we have in every recording is data precious data, which is very hard to bring together captured in a secure and anonymized way that would truly and objectively enable us to think about insights that we could extract that would of course benefit patients but also help codify surgery and unlock efficiency again for hospitals. And as we started to dig into the data, the numbers were staggering. You know, we generate about 50 petabytes of data a year, but 80% of that is unstructured and 90 70% of it is unused. It's a daily reality we face, we know that 25% of surgeries in high-income countries are delayed. 30% of procedures begin late ors are only often utilized at about 60 to 70% capacity. And so it's not surprising that over time can increase labor costs and add to the pain of the system. And of course, we know that about 75% of data from or actions, objects and conditions are going uncapture. When you look at all of this, you realize there's a huge white space in the or a concept that encompasses all of the opportunities where we can be more effective and efficient. If we just leaned into this data to think about, you know, how do I add an extra case a week? How do I think about reduction, waiting lists? How do I scale and train more individuals? But ultimately, how do I make sure patients aren't waiting for their surgeries any longer than they need to reducing their time in pain, reducing their time. And what we know in our hospitals that the ors are already equipped with some of the, you know, state of the art equipment in many hospitals. But the key differentiator and long term impact of all of this lies in the fact that the data collection is siloed. It is the data driven insights that will truly transform our approach to care. And if it sits in silos, it's very hard to craft a true story with lack of standardization, lack of curation of formatting of storage. This inconsistency makes it really, really hard to get a full story. But if we can actually thread the needle and bring all the pieces of the puzzle together. It paints a pretty interesting picture of how systems and devices and people work together in the or. And so II believe here is really the potential to harness the power of real time data analytics to unlock its value. Also considering that data is crucial for training A I models and others, we can really bring a lot of opportunity by collecting curating and connecting the data sets, building a structural foundation of which we can build upon and helping then our systems, our scientists and our device manufacturers to work in a much more concerted way. As you know, we have a hugely rich source of data. Today, we have over 100 terabytes of video, audio device data broken down into surgical procedure, video and different components that have metadata around it about the type of procedure, the the devices used, et cetera, et cetera. We can do a lot with that data and trying to signal and understand how systems white. And so we are at the forefront of creating the connectivity we need in our ors it is becoming the center of this cohesive connective digital ecosystem, capturing data from the operating room for surgeons for or teams for institutions and systems and of course for device companies that single source of truth in the or and so what we do is we really gather information across the patient journey, not just in one component of it, but the whole end to end experience. And that I think is where the opportunity lies. And so now data from all these devices, Softwares can be captured analyzed and layered in with human action to understand in an automated way how we work. Really. What we're doing is we're bringing a systems change, an infrastructure level change which enables us to become the operating system of the intelligent operating room. And of course, we do this by looking at some key applications on our platform such as real time connectivity, unified data analytics and insights and video library. And each of these unlocks some real value for our end user. Yes. As you know when it comes to connectivity, we offer best in class telepresence designed around clinical collaboration, training and instructional use. And from that, we are now able to deliver for high definition low latency feeds, enabling session participants to access those views in however way they want from the operating view to the surgical instrumentation view to other video feeds from a third party device like robots and other imaging equipment. And we've built in all this live collaboration tool to make this a really meaningful interaction, film hosting in moderation features also make it simple. But what you can now see is that we're democratizing access to surgical expertise, which is central to our mission and we care very much about making this available to everyone in world. Of course, when it comes to the library now that you've connected expertise, we're able to curate and collect that data in a secure way. And we're a to then lean into that to look at other components. How do we, for example, extract in real time insights, how do we help you create an or control center automate workflows and ultimately future proof your or through A I applications. And we're able to do this all through a single system and a single login. The operating room is more, more than a room. What happens is there's more than more than be the people who work. There are more than with the staff live. Tomorrow's health care for women today the or are even more more because is there there is the only system for intelligent our technology, tech, tech and real time kind of connectivity, unified data control, powerful disease and A II enhanced with pra pro information in real time time to create, improve and go how to make things happen in the or no one know. So you can learn more innovative, keep the more than by operating only when they. So hopefully you would have seen from that video that you know, real time data really allows us to peel back the layers and understand how complex systems work where they go right and wrong, how they can be improved and ways we've never had available before. We've been working with a hospital partner. Where we were able to demonstrate the opportunity time that could be used. For more cases. With that data, we were able to show that a third of the or time was wasted, 83% of turnover time was inactive. There was a 21 minute range between fastest and slowest prep prep time and that the E pr orometric were not always accurate. Actually, 59% of the time they weren't. So think of all of those missed opportunities, whether it's optimizing individual step times, streamlining procedures. Looking at the case makes or enhancing staff performance, reliable data is essential. I wanna share with you some of the outputs of the data collection. The data here sheds the light on the average process times within a surgical case, revealing three key areas, room, clean time, time between cases and the breakdown of anesthesia time. By examining these segments, we can identify necks that hinder or throughput variations in process time across different procedures could indicate a lack of standardization and surgical workflow and building and analyzing upon this data allows us to establish benchmarks for efficiency and identify areas of improvement ultimately leading to faster turnaround times and a more efficient surgical environment. This is just one example of how surgical data in A I when brought to the forefront can truly revolutionize care by informing improvement initiatives. And to approximate you can view in real time the status of each of your operating rooms, you know when to scrub in one, the ward can send one to think about the next patient. A theater management has a complete and live overview. We leverage real time machine learning to understand the ongoing situation. The or and send targeted notifications to users. This enhances the control center function by prompting teams along the pathway and nudging them through specific actions at the right time. And today, we are really the only platform in the world that is combining real time connectivity, unified data analytics and insights and a powerful learning aid of a video video library. So this gives you an unobstructed view of the or it's flexible and open to work with any device or or set up including cath labs, endoscopy suites. You name it, it's cloud based and accessible at any time from anywhere and it seamlessly integrates into the operating room. It's built around or flows. It's always on. It's an always on solution that enhances rather than interrupts the workflow. Thank you for listening. I've given you a little about data and how we're using data. Please visit our website for more information or scan the QR code to get in touch with our team and join and watch a live day of surgery anytime you want in addition to some of our presentations at the proximity simulation theater. Thank you so much. Excellent. So er brilliant. Thank you very much to Miss hat around um for for a great talk on on proxy. Um So our, our final uh speaker for her this evening is uh Katie Sinister, um who's a medical student at Imperial College, London. Uh And I'm particularly excited to hear from her because she's led some research in digital surgery um by collaborating with Johnson and Johnson. So, um Katy, I can see you're just getting your presentation up now. Fantastic, great. I'll hand over to you. I OK. Great. Sorry. Laptop issues. Yeah. So um as you mentioned, um I'm Katie, I'm a medical student at Imperial. Um And Andrew's just asked me to talk today about a project I did working with Johnson and Johnson and the C SAS device. Um Just a quick overview of what I'll talk about. So talk briefly about experience and some examples I encountered and then speaking a bit about why it's important that we work with industry and what challenges we might face and how we can move forward. So, as I mentioned, I worked with Johnson and Johnson following a pilot of CAS um at Imperial College Healthcare Trust. Um So in case you're not aware, cat is a surgical analytics platform um which records procedures and then subsequently allows for human analysis by expert reviewers and also analysis by A I tools. Um So I became involved after the pilot was completed and I was given that data um and able to sort of analyze the data regarding the engagement with the platform and also speak to the marketing lead. So a bit more about the device. So the actual sort of instrument attaches directly to the laparoscopic stack and recorded the procedure, it was manually started. So you needed to sort of enter the details of who was operating um and what the operation was and then start that and stop that yourself. And then it was then uploaded to the platform given technical skills, grading by A I and written feedback from the experts. The platform also had various other um features so they could access the video library of cases and also rewatch their own videos. So this is sort of some of the data that we we got from C SAS showing the engagement with the platform. And as you can see over the the course of the pilot, I never really reached a consistent level um of uploads. He can get five uploads in one week which given that the device was installed in 10 operating theaters across three hospitals. Um You can imagine there were probably a lot more operations happening than the five that were recorded. So we spoke to the people involved in the trial um about this and what we heard from both surgeons and the industry was slightly different, sort of followed the same idea. So surgeons are saying that a lot of the time they forgot the device was there or that even if they remembered about the device, it might have been after they'd already begun the procedure. And then at that point, it was difficult to use as maybe the Feds team weren't aware of how to use the device or they just simply felt it wasn't worth switching it on at that point. And industry said a similar thing. So they felt that sort of a lack of events and a lack of involvement with the pilot and with the, the users meant that they just weren't thinking about the product and not thinking about using it. And this is just a bit of sort of my interpretation of this. So having had access to this data, also speaking to some of the participants outside of the pilot, we found that very few participants actually engaged with questionnaires that were done before and after the pilot, a post plot debrief held by the C SA team wasn't attended by anyone who had used the device at all. Um And actually, when I did the interviews, there was lots of feedback about CS A S that we received. But ultimately, none of this went back to Johnson and Johnson and the creators of the device, which means that no changes could be made to the product based on what people have found, had worked and maybe had worked less within the operating theater. So this is why I think engagement is very important. Um And we've had lots there about what industry are doing to sort of improve things for us or I'm not a surgeon yet, but to improve things for surgeons and doctors. Um and as this was similar to my experience and the industry reps were very willing to discuss the pros and cons of their technology and had very helpful insights into what may work and what may not work due to the use of their products in multiple hospitals and in multiple pilots, and they were specifically invested in their product. So they are selling it and they are willing to sort of talk and hear about it. Whereas what my understanding was that most surgeons or the users of the platform just found that they might be too busy to be involved in the pilot. They might not have the time to give feedback. For example, the meeting, the post plot debrief was held at lunch time and the doctors might have just finished a ward round and might have been busy and not able to attend, not able to leave their clinical work. We also have to think that the the surgeons might be experiencing multiple products in the operating theater at this time, not just the one as in the industry, are just focusing on their own product. So perhaps there may be fatigue, especially nowadays with loads and loads of products coming out all the time. Um and increasing in complexity as we see more digital surgery becoming incorporated into the operating theater. Also, we have to consider that for the surgeons, they might not see an incentive. And this is again, sort of important with engagement in that we are able to collaborate as industry and users to determine sort of what the priorities are of each of us. So we are able to create products that work for everyone. And if it's not clear to the users at the beginning or how they might benefit from this, then again, it's sort of unlikely that they might engage with the pilot or use the device. So as I said, this matters a lot that we engage and because we are using the products, we can't, industry won't be able to change or doubt their products if users aren't giving feedback and this works both ways, they won't be able to sort of improve parts that perhaps people find less useful or less easy to use. And they also won't be able to sort of understand what's working well and that affects the future implementation of their products in other hospitals, other trusts and other countries. It's also important that even before the products being tested, that there is collaboration as like we are creating these devices for surgeons who are ultimately using them. And everyone's opinion is important in creating a device that will work for everyone. And I said it's unavoidable digital surgery is coming and it's going to be in theaters all around the country. It already is in theaters all around the country, meaning we likely will need more industry input and more input from the users of the devices. So when I was thinking about this, I was thinking about do the priorities differ that much and actually, it's quite similar. So both the surgeon and industry ultimately care about the patient. Is the device helping the patient, does it work and is it safe and then does it meet contractual requirements, which is a bit boring? But it is very important then for the surgeons, perhaps they matter to them as easy to use and it doesn't disrupt their workflow or doesn't add an extra step to their workflow and also helps their practice in some way. Whereas for industry, perhaps they're also considering whether the technology is making profit or it's not failing, it's working in the um institutions and they're using it. And also that is a productive device for them to have within their market. It's now thinking about some challenges that we're likely to face going forward. So as I've mentioned, an increasing complexity of the new products, um we're seeing robotics everywhere now and they're becoming increasingly advanced as well as smart instruments used laparoscopically. Um and digital surgery which we're all particularly interested in terms of the videos, um which involves a lot of engagement from industry who are creating these devices that we're going to use. There's also the issue of the NHS under pressure. Um A lot of the technology in the NHS currently, as was mentioned, doesn't work very well and in order to have a lot of these sort of high functioning high tech um technologies that you do need this to be sorted out and that's likely to take a little while, especially with financial constraints that are currently in place and also long waiting lists, everyone's very busy, not enough staff. So lots of problems that are likely to sort of hinder the adoption of the digital surgery. There's also the idea that these A I powered tools and robotics require a lot more sharing of personal or private data. Um So videos of people's surgeries is not only just important for patients to remain confidential, patient needs to remain confidential, but also for the surgeons. Are they comfortable with sharing this? Are they comfortable with people knowing about their operations being recorded and used? And I think it's important that it's very clear, clearly cut out about what guidelines are in place to ensure that this is going to be safely done and done within legal limits and also to address any concerns and any resistance that might be encountered. Yeah, how we can overcome these challenges and what we can do as doctors, surgeons trainees is to become more engaged. So when we're using the products, think about how you find them. Are they good? Are they bad? What do you like about them? What don't you like and then actively engaging in the feedback events because ultimately the industry are trying to help us and we want to use their devices and nothing's going to change if you don't say anything about it. Also sort of again, thinking about the concerns, expectations. It's helpful before things have been made. And it's a really useful opportunity I found working with the industry really insightful because it can make me consider things I've not even thought about. Um So it can actually be really helpful for everyone. Um And finally, as I said, creating the regulatory processes to ensure that users are feeling that the sharing of their data is done safely and correctly. And the NHS have combined with a VP to release some sort of guidance of working with the industry and NHS, which is actually a very interesting read and I'd recommend that you have a look if you're interested in this. Thank you. Excellent. That was a, a fantastic talk. Thank you very much, Katie and II think, yeah, I certainly learnt a lot from, from um seeing how you worked with industry so so well. Uh uh over the course of, of that C SAS project. And, and I think you've given us a, a really good insight into what it's like to, to be involved in that sort of project. Um So thank you everyone um for joining us for tonight's webinar. It's, it's been a real pleasure having you. Um Thanks to all our speakers and I thought all, all of the talks tonight have been absolutely fantastic. Um it's great to see what's on offer. It's, you know, it's a really exciting time to be a surgeon, um, to be involved in digital surgery and, and to get to make use of all these tools that, that industry are providing with us with. Um, and I'm, I'm certainly very excited for, for my hospital to, to get the next Hugo or Da Vinci or whatever. Um, just a, a very quick final plug, please, if you haven't signed up for Oscar already, um please do um scan the QR code and join us. We'd love to have you involved. Um And, and hopefully as, as far as audits go, this is a fairly straightforward one to, to get involved with, it's very accessible to, to people of all different levels. So, so please do get involved. So, yeah, brilliant George James. I can see you've, you've um both um got your camera, any, any final words from you guys at all? I really appreciate the invite and um yeah, II agree with Katie this, you know, technology and I think advancements are, are on the way. And I think that the absolutely key thing is the collaboration between um surgeons, physicians, trainees, nursing staff and industry. So it's fantastic to be part of this um uh collaborative. I appreciate the invite. Thank you. Pleasure and James. Yeah, same um Echo um George's thoughts. Um I appreciate the invite. I think the more collaboration we get and the opportunity to share what we're doing as well with your audience, I think is also greatly valuable. So I appreciate the invite. Thanks, Andrew. Brilliant. Thanks a lot and, and thanks to all our speakers tonight. Um And yeah, I look forward to seeing uh many of our um audience members taking part in Oscar next week and we'll see you later. Mm OK.