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 in medicine.

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 away.

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 about this.

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.