Steven F. Palter, MD
Medical and Scientific Director,
Gold Coast IVF
Syosset, New York
Hi, I’m Dr Steven Palter. I’m an ObGyn specialist and also a reproductive endocrinologist
and infertility specialist. I work in New York at Gold Coast IVF, where I’m the
Medical and Scientific Director. I have a particular interest in both clinical treatment
of patients with infertility, but also, outside of that, in technological advancements
in medicine and surgery. One of my passions, really, is looking outside ObGyn, looking
to other specialties, and also looking outside of medicine and finding new technological
advancements that we can then bring together to solve problems for our patients
and to deliver better healthcare. In that role, I’m the founder and editor of http://www.docinthemachine.com
a medical technology blog, where I review a vision of the impact of future technology
AAGL, if I had to describe it, would be a society of innovators. These are people
who want to do things better. It’s not technology for technology’s sake, but it’s
people who challenge the status quo. They don’t accept it and they’re willing to
embrace disruptive technology—something that comes along and changes everything.
And AAGL sees that as excitement and not as a threat. The perfect example I can
give you is 2 years ago, when I gave the general session, the theme was “let me
show you everything that’s going to make what you do obsolete within the next 10
years”. I gave a talk about new technologies that would make all of our standard
surgeries, what these people’s bread and butter is, totally obsolete. And people
came out saying, “You know what, this was so exciting! I’m excited about the future!”
It’s not frightening; it’s what we do here.
Today, what we did at AAGL was I was the keynote speaker at a session on film from
the past to the future; film and medicine; and how they interact. In our session
today, we started with Dr António Setúbal, who traced a fascinating journey from
the past in film and medicine and how they interacted. What people don’t realize
is that shortly after the development of film technology in 1900, surgical films
were being created. Originally, this was for purely educational purposes. What Dr
Setúbal reviewed was that the surgeon who made the first film, Dr Duyen, said after
he filmed in Paris, “What a remarkable invention this is, instead of lecturing to
one person, I can film a surgery and show it to thousands of people and, in one
conference, educate them to do things.” And that he can go back and look at what
he did and learn about his techniques.
I started by looking back to the first films taken through endoscopes, through laparoscopes,
or any kinds of cameras. What we saw was that it really started in the ‘40s with
endoscopy. Between 1940 and 1944, there were some ENT and bronchoscopy images. Then
there started to be German films of laparoscopy that were done with film cameras,
purely to document. As the technology improved, from the ‘30s to the ‘40s to the
‘50s in cinema, what they added was color [and] sound to make it more realistic.
In 1972, here in Las Vegas, was the inaugural meeting of the AAGL. At that meeting,
there’s a presentation of film taken through a laparoscope; that was the first time
many people have seen laparoscopy. What AAGL did, using this new medium of film
and video through a scope was to say, “Now everybody can see a new technology and
everyone could experience it”. So that was shown here and at that same time, I found
some archival footage of even Patrick Steptoe, of Steptoe and Edwards fame, who
did the first in vitro fertilization procedure. He had presentations actually at
AAGL on the ability to extract eggs from the ovary, predating IVF. In the early
1970s, I found films of his saying, “Here we are extracting eggs, and we hope to
someday be able to fertilize them in vitro”.
So from the beginning, AAGL was always on the forefront of technological advancements
in visualization, even when it wasn’t traditional laparoscopic surgery. New innovations
came here. That’s why the organization embraced my passion to say, can you tell
us really what’s going to happen next?
At this meeting, there’s also footage from Surgery in 3D. What it does is that it
gives you depth perception that’s lost in normal laparoscopic surgery. What this
translates into is decreasing learning curves for people who are new endoscopists.
When they use this 3D technology, it’s like they’re operating in a natural environment.
Just like in cinema, you feel like you’re in the real environment. In surgery, you
don’t have to learn new visual cues; you can use the same ones you have.
The other technology that we talked about was improving resolution. I thought, if
HD is good enough, what comes beyond that? Everyone in Hollywood agrees—the
hottest new technology is what’s called 4K, going to 4 times the resolution, going
to where you have perceived resolutions that approach that of just looking with
your native eye. What happens is, when you increase resolution that high, the color
fidelity looks real. You see landscapes and vistas with a beauty and shading that
looks like you’re looking out your window and not like you’re looking at a little
jerky film on your cell phone. It could be blown up and magnified to see vistas
that look beautiful and realistic. And cinema is using it—George Lucas is
using it, Steven Soderbergh. Film is dead, video is dead—this is the future.
It sees light the way I do as a director. So, to me, the first thing that came in
my head was, “Well, for a director who’s looking at the light on an actor’s face,
or shadows in cinema, and color means that much, wouldn’t you want a surgeon to
see reality that looks that real?”
So what we did was we first showed historical footage that we tracked down from
basements and archives, and The National Library of Medicine that hasn’t been looked
at in more than 30 years. We showed how AAGL members, gynecologist laparoscopists,
hooked up giant film cameras to an endoscope. Then we showed HD. And then we showed
4K. We showed the cinematic 4K, now with collaboration from Sony again setting up
the digital 4K cinema, projectors that have never been in a medical venue.
We projected it and people were awestruck, again that we saw an open surgery through
an incision, magnified to 25 feet, with the resolution as if your nose was 2 inches
What I talked about 2 years ago here was the concept of what I called “future vision”,
which is where I think this is all going. The idea that we have gone now as close
to the eye’s resolution as we can, we’ve gone as close as we can go with 3D and
4K. What’s going to be 10 years beyond that? We’re going to augment what we can
see with our native eyes. And we presented that and that was a prize paper here
at the AAGL meeting. Using infrared light and fluorescent light to actually see
disease invisible to your eye.
What happens here, the audience is so forward-thinking, they’re such a quick start
in their approach. When we show them these technologies, instead of being frightened
or say, “Well that’s science fiction or that’s fantasy”, people here, their minds
start racing, “What can I do with this?” And you hear people in the hall setting
up collaborations and new research starting. That’s, for me, what’s so exciting
Again, at the session here last year, I did some new data where I applied that to
surgical innovation. What we found was that surgical tools, the introduction of
new patents or publications, is no longer linear. Starting between the ‘70s and
the ‘90s, it’s hit an exponential curve. So what that means is that we’re now having
ten years of progress for every year. We see that in our exhibit halls here, the
rate of innovation is so large, that when you give people the ideas, they really
run with them. That’s what really makes this venue and this meeting just so thoroughly
exciting for me.