Design and Development of Smart Surgical Assistant Technologies

Are Amazon Alexa and Google Home limited to our bedrooms, or can they be used in hospitals? Do you envision a future where physicians work hand-in-hand with voice AI to revolutionize healthcare delivery? In the near future, clinical smart assistants will be able to automate many manual hospital tasks—and this will be only the beginning of the changes to come.

Voice AI is the future of physician-machine interaction and this Focus book provides invaluable insight on its next frontier. It begins with a brief history and current implementations of voice-activated assistants and illustrates why clinical voice AI is at its inflection point. Next, it describes how the authors built the world’s first smart surgical assistant using an off-the-shelf smart home device, outlining the implementation process in the operating room. From quantitative metrics to surgeons’ feedback, the authors discuss the feasibility of this technology in the surgical setting. The book then provides an in-depth development guideline for engineers and clinicians desiring to develop their own smart surgical assistants. Lastly, the authors delve into their experiences in translating voice AI into the clinical setting and reflect on the challenges and merits of this pursuit.

The world’s first smart surgical assistant has not only reduced surgical time but eliminated major touch points in the operating room, resulting in positive, significant implications for patient outcomes and surgery costs. From clinicians eager for insight on the next digital health revolution to developers interested in building the next clinical voice AI, this book offers a guide for both audiences.

Jeff J.H. Kim is an MD/PhD student at the University of Illinois College of Medicine, leading developments in medical AI, health technology, and organ-on-chip microfluidics. During his master's program at Johns Hopkins University, he spearheaded the development of a voice-activated surgical assistant where he successfully implemented his pioneering work in the operating room, improving both patient safety and surgical efficiency. His work is published in the 2021 SPIE Medical Imaging Conference proceedings. He also led the development of several innovative works in neurosurgery and cardiology, developing a voice-activated smart surgical bed and cardiac patch that detects lethal arrhythmia. He obtained a dual bachelor's degree in Electrical Engineering and Neuroscience at Johns Hopkins University.

Richard Um is a graduate researcher at the Johns Hopkins University School of Medicine. His research focuses on translational neurosurgery with an emphasis on in-vitro bench top models to test certain devices used in surgical procedures. With his extensive design and development skills, he created the first prototype of a working voice-controlled operating bed. He has since further developed a smart hospital assistant that provides surgeons with complete control over equipment in the operating room, prioritizing patient safety and workflow efficiency. Richard Um received a bachelor's degree in Biomedical Engineering with a minor in Robotics from the Johns Hopkins University as well as a master's in Biomedical Sciences from Tufts University.

Rajiv Iyer is a pediatric neurosurgeon who recently completed a neurosurgical residency at The Johns Hopkins Hospital and a pediatric neurosurgery fellowship at Primary Children's Hospital/University of Utah, and is currently completing an Advanced Pediatric Spinal Deformity Fellowship at Columbia University/Morgan Stanley Children's Hospital under the mentorship of Dr. Lawrence Lenke and Dr. Michael Vitale. Dr. Iyer will soon be joining the pediatric neurosurgery group at University of Utah as Assistant Professor of Neurosurgery. There, his clinical focus will be on the treatment of complex pediatric spinal disorders, including spinal deformity, craniocervical junction disorders, and spinal column/spinal cord tumors. Thus far in his career, Dr. Iyer has been passionate about learning from experts in the field, and utilizing the best possible techniques to care for his patients. He is enthusiastic to begin his academic neurosurgical career, where he hopes to deliver outstanding pediatric neurosurgical care, while adopting new technology in and out of the operating room in an effort to improve patient outcomes and advance the field.

Nicholas Theodore is an American neurosurgeon and researcher at Johns Hopkins University School of Medicine. He is known for his work in spinal trauma, minimally invasive surgery, robotics, and personalized medicine. He is Director of the Neurosurgical Spine Program at Johns Hopkins and Co-Director of the Carnegie Center for Surgical Innovation and Co-Director of the HEPIUS Neurosurgical Innovation Lab at Johns Hopkins.

In 2016 he became the second Donlin M. Long Professor of Neurosurgery at Johns Hopkins Hospital. Dr. Theodore also holds professorships in Orthopedics and Biomedical Engineering at Johns Hopkins. He is actively involved in the area of preventative medicine within neurosurgery. He has been associated with the ThinkFirst Foundation for several years, having served as the foundation's Medical Director and President. In 2017, Dr. Theodore was appointed to the National Football League's Head, Neck and Spine Committee, of which he became Chairman in 2018. In 2020, Michael J. Fox revealed in his memoir that Dr. Theodore performed a risky but successful surgery on him to remove an ependymoma in Fox's spinal cord.

In 2020, Dr. Theodore received a grant in the amount of $13.48 million from the Defense Advanced Research Projects Agency's (DARPA) Bridging the Gap+ program to fund research in new approaches to treatment of spinal cord injury. With this grant, Dr. Theodore is co-leading the effort to treat patients with spinal cord injury by integrating injury stabilization, regenerative therapy, and functional restoration using targeted electrical ultrasound modalities. As the principal investigators for the program, Dr. Theodore and Dr. Manbachi will coordinate teams at Johns Hopkins and its Applied Physics Laboratory, Columbia University, and Sonic Concepts.

Dr. Amir Manbachi is an Assistant Professor of Neurosurgery, Biomedical Engineering, Mechanical Engineering, Electrical and Computer Engineering at Johns Hopkins University. He is the Co-Founder and Co-Director of the HEPIUS Neurosurgical Innovation Lab. His research interests include applications of sound and ultrasound to various neurosurgical procedures. These applications include imaging the spine and brain, detection of foreign body objects, remote ablation of brain tumors, monitoring of blood flow and tissue perfusion, as well as other upcoming interesting applications such as neuromodulation and drug delivery. His pedagogical activities have included teaching engineering design, innovation, translation and entrepreneurship as well as close collaboration with clinical experts in Surgery and Radiology at Johns Hopkins.

Dr. Manbachi is an author on over 25 peer-reviewed journal articles, over 30 conference proceedings, over 10 invention disclosures/patent applications, and a book entitled Towards Ultrasound-Guided Spinal Fusion Surgery. He has mentored more than 150 students, has so far raised $15 million in funding, and his interdisciplinary research has been recognized by a number of awards, including the University of Toronto's 2015 Inventor of Year award, the Ontario Brain Institute 2013 fellowship, the Maryland Innovation Initiative, and the Johns Hopkins Institute for Clinical and Translational Research's Career Development Award.

Dr. Manbachi has extensive teaching experience, particularly in the fields of engineering design, medical imaging, and entrepreneurship (both at Hopkins and Toronto), for which he has received numerous awards: the University of Toronto's Teaching Excellence award (2014), the Johns Hopkins University career center's award nomination for students' "Career Champion" (2018), and the Johns Hopkins University Whiting School of Engineering's Robert B. Pond Sr. Excellence in Teaching Excellence Award (2018).