Evolutions and Revolutions: A Career in Surgical Robotics | Costa Nikou | TEDxYouth@Shadyside

thanks max so it was 1995 and I was out

thanks max so it was 1995 and I was out of a job

of a job

of a job I’ve been working for a grad student at

I’ve been working for a grad student at

I’ve been working for a grad student at the robotics Institute at Carnegie

the robotics Institute at Carnegie

the robotics Institute at Carnegie Mellon I was a junior and I worked for

Mellon I was a junior and I worked for

Mellon I was a junior and I worked for him over the summer it was a great

him over the summer it was a great

him over the summer it was a great experience I got to sit in the lab and

experience I got to sit in the lab and

experience I got to sit in the lab and just crank out code for computers and

just crank out code for computers and

just crank out code for computers and robots and I found out that he was

robots and I found out that he was

robots and I found out that he was graduating so I was out of work so I

graduating so I was out of work so I

graduating so I was out of work so I looked up some local opportunities and

looked up some local opportunities and

looked up some local opportunities and fortunately I was able to find another

fortunately I was able to find another

fortunately I was able to find another opening on campus at the Medic robotics

opening on campus at the Medic robotics

opening on campus at the Medic robotics lab it was also called the mr. Cass lab

lab it was also called the mr. Cass lab

lab it was also called the mr. Cass lab of course short for medical robotics and

of course short for medical robotics and

of course short for medical robotics and Peter assisted surgery I didn’t have any

Peter assisted surgery I didn’t have any

Peter assisted surgery I didn’t have any particular interest in surgical robotics

particular interest in surgical robotics

particular interest in surgical robotics or computer aided medicine I was just

or computer aided medicine I was just

or computer aided medicine I was just looking for a way to keep coding and

looking for a way to keep coding and

looking for a way to keep coding and instead of working fast food now mr.

instead of working fast food now mr.

instead of working fast food now mr. Cass lab was founded by Tony to Joya

Cass lab was founded by Tony to Joya

Cass lab was founded by Tony to Joya Tony was a CMU engineer and then ended

Tony was a CMU engineer and then ended

Tony was a CMU engineer and then ended up going to Harvard Medical School and

up going to Harvard Medical School and

up going to Harvard Medical School and he became really prominent orthopedic

he became really prominent orthopedic

he became really prominent orthopedic surgery surgeon here in Pittsburgh he

surgery surgeon here in Pittsburgh he

surgery surgeon here in Pittsburgh he also co-founded the lab because he was

also co-founded the lab because he was

also co-founded the lab because he was interested in robotics Frank O’Gara

interested in robotics Frank O’Gara

interested in robotics Frank O’Gara Mathers was a biomedical engineer that

Mathers was a biomedical engineer that

Mathers was a biomedical engineer that worked at the lab and I found out after

worked at the lab and I found out after

worked at the lab and I found out after the interview process that I got the job

the interview process that I got the job

the interview process that I got the job and wouldn’t be signed to him and our

and wouldn’t be signed to him and our

and wouldn’t be signed to him and our task was to develop a computer assisted

task was to develop a computer assisted

task was to develop a computer assisted surgery simulator and range-of-motion

surgery simulator and range-of-motion

surgery simulator and range-of-motion planner for total hip replacement

planner for total hip replacement

planner for total hip replacement surgery now total hip replacement for

surgery now total hip replacement for

surgery now total hip replacement for those of you who don’t know this is your

those of you who don’t know this is your

those of you who don’t know this is your hip joint usually the way the hip socket

hip joint usually the way the hip socket

hip joint usually the way the hip socket works is you have a layer of cartilage

works is you have a layer of cartilage

works is you have a layer of cartilage over your femoral head and you have a

over your femoral head and you have a

over your femoral head and you have a layer of cartilage in your hip socket

layer of cartilage in your hip socket

layer of cartilage in your hip socket and allows the bones to move very freely

and allows the bones to move very freely

and allows the bones to move very freely relative to one another

relative to one another

relative to one another unfortunately due to arthritis this

unfortunately due to arthritis this

unfortunately due to arthritis this cartilage layer starts to wear down the

cartilage layer starts to wear down the

cartilage layer starts to wear down the bone starts to rub on bone and it starts

bone starts to rub on bone and it starts

bone starts to rub on bone and it starts to hurt a lot so what we need to do is

to hurt a lot so what we need to do is

to hurt a lot so what we need to do is we need to replace the diseased surfaces

we need to replace the diseased surfaces

we need to replace the diseased surfaces with metal and plastic bearings this way

with metal and plastic bearings this way

with metal and plastic bearings this way you can move freely and there’s no more

you can move freely and there’s no more

you can move freely and there’s no more pain it’s pretty key though to get the

pain it’s pretty key though to get the

pain it’s pretty key though to get the components in the right orientation you

components in the right orientation you

components in the right orientation you can imagine if you put these things in

can imagine if you put these things in

can imagine if you put these things in wrong that the implants can start to

wrong that the implants can start to

wrong that the implants can start to bang on one another it can lead to

bang on one another it can lead to

bang on one another it can lead to implant failure but also potentially to

implant failure but also potentially to

implant failure but also potentially to dislocation so how do we avoid

dislocation so how do we avoid

dislocation so how do we avoid dislocation well the way it was done

dislocation well the way it was done

dislocation well the way it was done before

before

before the advent of computer assisted surgery

the advent of computer assisted surgery

the advent of computer assisted surgery we had the type of planning that was

we had the type of planning that was

we had the type of planning that was done on app with acetate templates on

done on app with acetate templates on

done on app with acetate templates on top of an x-ray so basically you do the

top of an x-ray so basically you do the

top of an x-ray so basically you do the 2d x-ray it gets a front picture of the

2d x-ray it gets a front picture of the

2d x-ray it gets a front picture of the joint and then you can use these guys to

joint and then you can use these guys to

joint and then you can use these guys to kind of roughly align but mostly for

kind of roughly align but mostly for

kind of roughly align but mostly for sizing figure out what you were going to

sizing figure out what you were going to

sizing figure out what you were going to do going into the surgery and then from

do going into the surgery and then from

do going into the surgery and then from there you made your decisions within the

there you made your decisions within the

there you made your decisions within the surgery you use really crude mechanical

surgery you use really crude mechanical

surgery you use really crude mechanical guides you can see here on the picture

guides you can see here on the picture

guides you can see here on the picture on the right

on the right

on the right this mechanical guide essentially was

this mechanical guide essentially was

this mechanical guide essentially was used to align the tool to the floor of

used to align the tool to the floor of

used to align the tool to the floor of the operating room it didn’t take into

the operating room it didn’t take into

the operating room it didn’t take into account any variability in the patient’s

account any variability in the patient’s

account any variability in the patient’s anatomy and you had to make assumptions

anatomy and you had to make assumptions

anatomy and you had to make assumptions about how the patient was aligned on the

about how the patient was aligned on the

about how the patient was aligned on the operating table and you can imagine if

operating table and you can imagine if

operating table and you can imagine if you have a 300-pound patient on the

you have a 300-pound patient on the

you have a 300-pound patient on the operating table it’s pretty difficult to

operating table it’s pretty difficult to

operating table it’s pretty difficult to know exactly where their pelvis might be

know exactly where their pelvis might be

know exactly where their pelvis might be so how do we solve this problem well the

so how do we solve this problem well the

so how do we solve this problem well the project we worked on was called hip nav

project we worked on was called hip nav

project we worked on was called hip nav and hip nav included a preoperative

and hip nav included a preoperative

and hip nav included a preoperative planner and a interoperative guidance

planner and a interoperative guidance

planner and a interoperative guidance system the preoperative planner was my

system the preoperative planner was my

system the preoperative planner was my work what we did is we develop a

work what we did is we develop a

work what we did is we develop a cd-based planner that allow us to build

cd-based planner that allow us to build

cd-based planner that allow us to build 3d shapes of the pelvis and the femur in

3d shapes of the pelvis and the femur in

3d shapes of the pelvis and the femur in order to accurately place and align the

order to accurately place and align the

order to accurately place and align the components and we can make adjustments

components and we can make adjustments

components and we can make adjustments according to the native patient’s

according to the native patient’s

according to the native patient’s anatomy and after we did that alignment

anatomy and after we did that alignment

anatomy and after we did that alignment we could fine tune things by basically

we could fine tune things by basically

we could fine tune things by basically doing a rate a preoperative range of

doing a rate a preoperative range of

doing a rate a preoperative range of motion simulation we can move the

motion simulation we can move the

motion simulation we can move the joining through a range of motion and

joining through a range of motion and

joining through a range of motion and see how the positions of the components

see how the positions of the components

see how the positions of the components and the selection of the various

and the selection of the various

and the selection of the various components would affect the range of

components would affect the range of

components would affect the range of motion for the patient so that’s great

motion for the patient so that’s great

motion for the patient so that’s great we have a great plan for the surgeon its

we have a great plan for the surgeon its

we have a great plan for the surgeon its patient specific how are we going to

patient specific how are we going to

patient specific how are we going to make it happen in the operating room

make it happen in the operating room

make it happen in the operating room well the first thing we’re going to do

well the first thing we’re going to do

well the first thing we’re going to do is we’re going to get rid of the

is we’re going to get rid of the

is we’re going to get rid of the mechanical guides because you can

mechanical guides because you can

mechanical guides because you can imagine they don’t work so well then we

imagine they don’t work so well then we

imagine they don’t work so well then we help fit the operating room with an

help fit the operating room with an

help fit the operating room with an optical tracking camera kind of like

optical tracking camera kind of like

optical tracking camera kind of like your Microsoft Kinect but this was 10-15

your Microsoft Kinect but this was 10-15

your Microsoft Kinect but this was 10-15 years earlier than that

years earlier than that

years earlier than that we attached sensors like motion capture

we attached sensors like motion capture

we attached sensors like motion capture sensors to the pelvis we attach it to

sensors to the pelvis we attach it to

sensors to the pelvis we attach it to the tools as well and then what we can

the tools as well and then what we can

the tools as well and then what we can do is we can plug all of that

do is we can plug all of that

do is we can plug all of that information into a computer system that

information into a computer system that

information into a computer system that allows us to do all the math for the

allows us to do all the math for the

allows us to do all the math for the surgeon and then basically tell the

surgeon and then basically tell the

surgeon and then basically tell the surgeon whether or not that his

surgeon whether or not that his

surgeon whether or not that his insertion tools are aligned incorrectly

insertion tools are aligned incorrectly

insertion tools are aligned incorrectly or correctly according to where the

or correctly according to where the

or correctly according to where the pelvis is and this is how it worked in

pelvis is and this is how it worked in

pelvis is and this is how it worked in the operating room this is Shadyside

the operating room this is Shadyside

the operating room this is Shadyside hospital this is doctor the joy on

hospital this is doctor the joy on

hospital this is doctor the joy on right he has his sensors equipped to

right he has his sensors equipped to

right he has his sensors equipped to both his instruments and to the

both his instruments and to the

both his instruments and to the patient’s pelvis you’ve got the tracking

patient’s pelvis you’ve got the tracking

patient’s pelvis you’ve got the tracking camera off of the right or off to the

camera off of the right or off to the

camera off of the right or off to the left it’s monitoring the positions of

left it’s monitoring the positions of

left it’s monitoring the positions of the tools and he sees his readout in the

the tools and he sees his readout in the

the tools and he sees his readout in the operating room now

operating room now

operating room now the capability to track the pelvis and

the capability to track the pelvis and

the capability to track the pelvis and instruments in the operating room was

instruments in the operating room was

instruments in the operating room was unprecedented and what it allowed us to

unprecedented and what it allowed us to

unprecedented and what it allowed us to do is research not about guiding the cup

do is research not about guiding the cup

do is research not about guiding the cup but actually in measuring current

but actually in measuring current

but actually in measuring current practice and so our team won the 1998

practice and so our team won the 1998

practice and so our team won the 1998 hip society award and the ability to

hip society award and the ability to

hip society award and the ability to show that indeed the assumptions that

show that indeed the assumptions that

show that indeed the assumptions that were made before the advent of this type

were made before the advent of this type

were made before the advent of this type of technology were all wrong the pelvis

of technology were all wrong the pelvis

of technology were all wrong the pelvis was not fixed on the operating room

was not fixed on the operating room

was not fixed on the operating room table you needed to take into account

table you needed to take into account

table you needed to take into account patient specific Anatomy and you also

patient specific Anatomy and you also

patient specific Anatomy and you also needed to track your tools in the

needed to track your tools in the

needed to track your tools in the operating room so you can know you did a

operating room so you can know you did a

operating room so you can know you did a good job

good job

good job in fact the type of research that Tony

in fact the type of research that Tony

in fact the type of research that Tony and Franco did along with others in the

and Franco did along with others in the

and Franco did along with others in the field kind of revolutionized the

field kind of revolutionized the

field kind of revolutionized the industry and you can see that Tony and

industry and you can see that Tony and

industry and you can see that Tony and Branco could literally be considered the

Branco could literally be considered the

Branco could literally be considered the authors of the book on computer assisted

authors of the book on computer assisted

authors of the book on computer assisted surgery now Tony and Branco didn’t want

surgery now Tony and Branco didn’t want

surgery now Tony and Branco didn’t want to stop there they weren’t satisfied

to stop there they weren’t satisfied

to stop there they weren’t satisfied with just writing some research papers

with just writing some research papers

with just writing some research papers and doing some good work they wanted to

and doing some good work they wanted to

and doing some good work they wanted to get this out there and so how do you do

get this out there and so how do you do

get this out there and so how do you do that well you make form a company sokka

that well you make form a company sokka

that well you make form a company sokka surgery was spawned out of Carnegie

surgery was spawned out of Carnegie

surgery was spawned out of Carnegie Mellon and its mission was to fund and

Mellon and its mission was to fund and

Mellon and its mission was to fund and make the FDA approval for this product

make the FDA approval for this product

make the FDA approval for this product happen the idea was that we were going

happen the idea was that we were going

happen the idea was that we were going to place this in all the operating room

to place this in all the operating room

to place this in all the operating room we’re going to revolutionize surgery I

we’re going to revolutionize surgery I

we’re going to revolutionize surgery I had a couple friends at work Frisco

had a couple friends at work Frisco

had a couple friends at work Frisco surged again I cans know first hand how

surged again I cans know first hand how

surged again I cans know first hand how hard they work and trying to prepare the

hard they work and trying to prepare the

hard they work and trying to prepare the applications in fact they worked so hard

applications in fact they worked so hard

applications in fact they worked so hard they hit so many dead ends they pivoted

they hit so many dead ends they pivoted

they hit so many dead ends they pivoted and what they ended up doing is instead

and what they ended up doing is instead

and what they ended up doing is instead of trying to build the application

of trying to build the application

of trying to build the application themselves they decide the partner with

themselves they decide the partner with

themselves they decide the partner with an existing navigation system that was

an existing navigation system that was

an existing navigation system that was used for sinus surgery and they try to

used for sinus surgery and they try to

used for sinus surgery and they try to outfit the hip NAB software on that

outfit the hip NAB software on that

outfit the hip NAB software on that system unfortunately that didn’t work

system unfortunately that didn’t work

system unfortunately that didn’t work the companies funding run down my

the companies funding run down my

the companies funding run down my friends got burnout and they shell the

friends got burnout and they shell the

friends got burnout and they shell the company for at least a little while

company for at least a little while

company for at least a little while later I was taken to lunch by Branco I

later I was taken to lunch by Branco I

later I was taken to lunch by Branco I was still working for the lab at the

was still working for the lab at the

was still working for the lab at the time and he took me off the lunch at the

time and he took me off the lunch at the

time and he took me off the lunch at the church brew works Church brew works is

church brew works Church brew works is

church brew works Church brew works is is a fine establishment here in

is a fine establishment here in

is a fine establishment here in Pittsburgh and we

Pittsburgh and we

Pittsburgh and we I had a lunch of pierogies with a

I had a lunch of pierogies with a

I had a lunch of pierogies with a colleague of his name Craig Markovitz

colleague of his name Craig Markovitz

colleague of his name Craig Markovitz Craig Markowitz was a local business guy

Craig Markowitz was a local business guy

Craig Markowitz was a local business guy he was actually instrumental in

he was actually instrumental in

he was actually instrumental in establishing to surgically was need

establishing to surgically was need

establishing to surgically was need adviser to Tony and Franco and they sat

adviser to Tony and Franco and they sat

adviser to Tony and Franco and they sat me down over pierogies and talked to me

me down over pierogies and talked to me

me down over pierogies and talked to me about what they wanted to do what they

about what they wanted to do what they

about what they wanted to do what they wanted to do was to give it one last go

wanted to do was to give it one last go

wanted to do was to give it one last go with kosaka they were going to fund the

with kosaka they were going to fund the

with kosaka they were going to fund the company they were going to shoot for FDA

company they were going to shoot for FDA

company they were going to shoot for FDA approval build it sell it take over the

approval build it sell it take over the

approval build it sell it take over the world so they asked me that they want

world so they asked me that they want

world so they asked me that they want wanted me to join them after all the

wanted me to join them after all the

wanted me to join them after all the citement of Costa Rica and see my

citement of Costa Rica and see my

citement of Costa Rica and see my friends get burnt out and leave the

friends get burnt out and leave the

friends get burnt out and leave the company I said of course I’m in we work

company I said of course I’m in we work

company I said of course I’m in we work with the surge ago we worked on the

with the surge ago we worked on the

with the surge ago we worked on the kidnap project for a number of years we

kidnap project for a number of years we

kidnap project for a number of years we tried to build the FDA approval packet

tried to build the FDA approval packet

tried to build the FDA approval packet we brought in consultants for regulatory

we brought in consultants for regulatory

we brought in consultants for regulatory issues we debugged software we did sales

issues we debugged software we did sales

issues we debugged software we did sales calls we did everything that we could do

calls we did everything that we could do

calls we did everything that we could do couldn’t get it off the ground

couldn’t get it off the ground

couldn’t get it off the ground didn’t have any major investors didn’t

didn’t have any major investors didn’t

didn’t have any major investors didn’t make any sales we even went further in

make any sales we even went further in

make any sales we even went further in doing alternative research trying to get

doing alternative research trying to get

doing alternative research trying to get research grants we provide shoulder

research grants we provide shoulder

research grants we provide shoulder surgery retried ACL reconstruction

surgery retried ACL reconstruction

surgery retried ACL reconstruction surgery we even tried fetal cardiac

surgery we even tried fetal cardiac

surgery we even tried fetal cardiac interventions which is essentially

interventions which is essentially

interventions which is essentially operating on unborn babies hearts that

operating on unborn babies hearts that

operating on unborn babies hearts that didn’t work either but it helped keep

didn’t work either but it helped keep

didn’t work either but it helped keep the company alive fortunately this is

the company alive fortunately this is

the company alive fortunately this is the co-surgeon google.com/webmasters

Anika didn’t work out what we do have is

Anika didn’t work out what we do have is now a sea change in computer assisted

now a sea change in computer assisted

now a sea change in computer assisted orthopedics if you search for computer

orthopedics if you search for computer

orthopedics if you search for computer assisted orthopedic surgery this is what

assisted orthopedic surgery this is what

assisted orthopedic surgery this is what you see today as opposed to nothing

you see today as opposed to nothing

you see today as opposed to nothing every major implant manufacturer is

every major implant manufacturer is

every major implant manufacturer is associated with computer guidance

associated with computer guidance

associated with computer guidance there’s robotic systems that will put in

there’s robotic systems that will put in

there’s robotic systems that will put in your hip we helped make change in the

your hip we helped make change in the

your hip we helped make change in the industry now mr. casse the lab that we

industry now mr. casse the lab that we

industry now mr. casse the lab that we were working at was medical robotics and

were working at was medical robotics and

were working at was medical robotics and computers of surgery so let’s talk a

computers of surgery so let’s talk a

computers of surgery so let’s talk a little bit about medical robotics if you

little bit about medical robotics if you

little bit about medical robotics if you think about medical robotics this is

think about medical robotics this is

think about medical robotics this is what you think of this is the da Vinci

what you think of this is the da Vinci

what you think of this is the da Vinci robot by Intuitive Surgical it is

robot by Intuitive Surgical it is

robot by Intuitive Surgical it is impressive technology it is extremely

impressive technology it is extremely

impressive technology it is extremely capable it is incredibly accurate it’s

capable it is incredibly accurate it’s

capable it is incredibly accurate it’s fun to play with if you ever get a

fun to play with if you ever get a

fun to play with if you ever get a chance to do a demo of a DaVinci robot I

chance to do a demo of a DaVinci robot I

chance to do a demo of a DaVinci robot I recommend it highly because it’s really

recommend it highly because it’s really

recommend it highly because it’s really fun it’s also very

fun it’s also very

fun it’s also very large and very expensive back in the

large and very expensive back in the

large and very expensive back in the late 90s there was another robot that

late 90s there was another robot that

late 90s there was another robot that was large and expensive this was called

was large and expensive this was called

was large and expensive this was called the Robo dock robot this was also used

the Robo dock robot this was also used

the Robo dock robot this was also used for a hip replacement surgery but it was

for a hip replacement surgery but it was

for a hip replacement surgery but it was made for reaming out the femoral part of

made for reaming out the femoral part of

made for reaming out the femoral part of the surgery the surgeon would basically

the surgery the surgeon would basically

the surgery the surgeon would basically sit back and watched the robot do the

sit back and watched the robot do the

sit back and watched the robot do the work but the robot literally stood

work but the robot literally stood

work but the robot literally stood between the surgeon and the patient so

between the surgeon and the patient so

between the surgeon and the patient so this begs the question why do all these

this begs the question why do all these

this begs the question why do all these robots have to be so big robots don’t

robots have to be so big robots don’t

robots have to be so big robots don’t have to be big what if you could fit in

have to be big what if you could fit in

have to be big what if you could fit in the robot in the palm of your hand this

the robot in the palm of your hand this

the robot in the palm of your hand this is Gabrus and gate was actually a grad

is Gabrus and gate was actually a grad

is Gabrus and gate was actually a grad student with me at CMU while I was

student with me at CMU while I was

student with me at CMU while I was working for the mr. Cass lab I went to

working for the mr. Cass lab I went to

working for the mr. Cass lab I went to school part-time in the robotics

school part-time in the robotics

school part-time in the robotics department gable is a PhD student and he

department gable is a PhD student and he

department gable is a PhD student and he was also assigned to medical robotics so

was also assigned to medical robotics so

was also assigned to medical robotics so this idea was Gabe’s Gabe said what if I

this idea was Gabe’s Gabe said what if I

this idea was Gabe’s Gabe said what if I had a robot that I could hold in my hand

had a robot that I could hold in my hand

had a robot that I could hold in my hand as a surgeon but I could control the

as a surgeon but I could control the

as a surgeon but I could control the robot by moving it around but the

robot by moving it around but the

robot by moving it around but the surgeon would make up for my mistakes

surgeon would make up for my mistakes

surgeon would make up for my mistakes the surgeon would improve my precision

the surgeon would improve my precision

the surgeon would improve my precision and that’s exactly what he proposes his

and that’s exactly what he proposes his

and that’s exactly what he proposes his thesis presentation this was the concept

thesis presentation this was the concept

thesis presentation this was the concept drawing we have the camera again same

drawing we have the camera again same

drawing we have the camera again same sort of tracking camera off to the right

sort of tracking camera off to the right

sort of tracking camera off to the right it’s monitoring the bones it’s

it’s monitoring the bones it’s

it’s monitoring the bones it’s monitoring the surgeons tools but this

monitoring the surgeons tools but this

monitoring the surgeons tools but this time the surgeons tool is smart the

time the surgeons tool is smart the

time the surgeons tool is smart the surgeon’s tool knows when it should cut

surgeon’s tool knows when it should cut

surgeon’s tool knows when it should cut it knows when it should not cut it can

it knows when it should not cut it can

it knows when it should not cut it can start it can stop it can slow down it

start it can stop it can slow down it

start it can stop it can slow down it knows what the plan is and it achieves

knows what the plan is and it achieves

knows what the plan is and it achieves that plan by adapting to the surgeons

that plan by adapting to the surgeons

that plan by adapting to the surgeons motions Gabe called it the PFS precision

motions Gabe called it the PFS precision

motions Gabe called it the PFS precision freehand sculptor I didn’t think it

freehand sculptor I didn’t think it

freehand sculptor I didn’t think it would work luckily though Tony Franco

would work luckily though Tony Franco

would work luckily though Tony Franco and Craig thought it would work they

and Craig thought it would work they

and Craig thought it would work they approached CMU about licensing the

approached CMU about licensing the

approached CMU about licensing the technology and they did and they create

technology and they did and they create

technology and they did and they create a company called blue belt technologies

a company called blue belt technologies

a company called blue belt technologies it was named for the Beltway that here

it was named for the Beltway that here

it was named for the Beltway that here in Pittsburgh is closest to Carnegie

in Pittsburgh is closest to Carnegie

in Pittsburgh is closest to Carnegie Mellon so Craig was my CEO at Caesarea

Mellon so Craig was my CEO at Caesarea

Mellon so Craig was my CEO at Caesarea at the time and it was well within his

at the time and it was well within his

at the time and it was well within his right to say hey Kosta you’re going to

right to say hey Kosta you’re going to

right to say hey Kosta you’re going to work on PFS too so I ended up becoming

work on PFS too so I ended up becoming

work on PFS too so I ended up becoming the first employee of blue belt and even

the first employee of blue belt and even

the first employee of blue belt and even though I didn’t think that the

though I didn’t think that the

though I didn’t think that the technology would work originally it now

technology would work originally it now

technology would work originally it now became my job to make it work so I moved

became my job to make it work so I moved

became my job to make it work so I moved over out of our concern office into a

over out of our concern office into a

over out of our concern office into a new office with Craig over on the corner

new office with Craig over on the corner

new office with Craig over on the corner of Friendship Park and Gabe joined us in

of Friendship Park and Gabe joined us in

of Friendship Park and Gabe joined us in a part-time manner and we started

a part-time manner and we started

a part-time manner and we started writing code and we start

writing code and we start

writing code and we start building robots so this is the first

building robots so this is the first

building robots so this is the first blue belt sponsored prototype for PFS

blue belt sponsored prototype for PFS

blue belt sponsored prototype for PFS this is called the ugly tool you can see

this is called the ugly tool you can see

this is called the ugly tool you can see that it’s fairly aptly named this tool

that it’s fairly aptly named this tool

that it’s fairly aptly named this tool was great as a proof-of-concept but

was great as a proof-of-concept but

was great as a proof-of-concept but would pinch your fingers if you held it

would pinch your fingers if you held it

would pinch your fingers if you held it wrong

wrong

wrong the next tool is called the TP FS it’s

the next tool is called the TP FS it’s

the next tool is called the TP FS it’s obviously much more attractive

obviously much more attractive

obviously much more attractive unfortunately surgeons didn’t like to

unfortunately surgeons didn’t like to

unfortunately surgeons didn’t like to use it because it weighed 5 pounds also

use it because it weighed 5 pounds also

use it because it weighed 5 pounds also if you ran it for more than a couple

if you ran it for more than a couple

if you ran it for more than a couple minutes it would start to heat up and

minutes it would start to heat up and

minutes it would start to heat up and burn your hands so we had lots of wet

burn your hands so we had lots of wet

burn your hands so we had lots of wet paper towels wrapping around to try to

paper towels wrapping around to try to

paper towels wrapping around to try to get through our experiments so this

get through our experiments so this

get through our experiments so this wasn’t going to work out but it allowed

wasn’t going to work out but it allowed

wasn’t going to work out but it allowed us to get the research more advanced it

us to get the research more advanced it

us to get the research more advanced it allowed us to do some cadaver trials and

allowed us to do some cadaver trials and

allowed us to do some cadaver trials and it allowed Gabe to get his PhD research

it allowed Gabe to get his PhD research

it allowed Gabe to get his PhD research completed once Gabe had his PhD he

completed once Gabe had his PhD he

completed once Gabe had his PhD he decided he was going to go and move to

decided he was going to go and move to

decided he was going to go and move to California and work for intuitive and

California and work for intuitive and

California and work for intuitive and build the Vinci robots ironically enough

build the Vinci robots ironically enough

build the Vinci robots ironically enough so what we did is we hired some more

so what we did is we hired some more

so what we did is we hired some more engineers and we built some more

engineers and we built some more

engineers and we built some more prototypes

prototypes

prototypes fortunately Craig was a master at

fortunately Craig was a master at

fortunately Craig was a master at keeping these small companies funded

keeping these small companies funded

keeping these small companies funded through looking at opportunities in

through looking at opportunities in

through looking at opportunities in local economic development like the life

local economic development like the life

local economic development like the life sciences greenhouse here in Pittsburgh

sciences greenhouse here in Pittsburgh

sciences greenhouse here in Pittsburgh but also in sponsored research coming

but also in sponsored research coming

but also in sponsored research coming from companies this is the NP F s tool

from companies this is the NP F s tool

from companies this is the NP F s tool this was adapted tool for our technology

this was adapted tool for our technology

this was adapted tool for our technology that was applied to spine surgery there

that was applied to spine surgery there

that was applied to spine surgery there are a few doctors at Allegheny general

are a few doctors at Allegheny general

are a few doctors at Allegheny general that were interested in applying this

that were interested in applying this

that were interested in applying this for spine in order to protect the spinal

for spine in order to protect the spinal

for spine in order to protect the spinal cord when you’re doing a laminectomy

cord when you’re doing a laminectomy

cord when you’re doing a laminectomy procedure we also the found

procedure we also the found

procedure we also the found opportunities working with Johnson &

opportunities working with Johnson &

opportunities working with Johnson & Johnson and their implant company Depew

Johnson and their implant company Depew

Johnson and their implant company Depew building yet another anny prototype that

building yet another anny prototype that

building yet another anny prototype that we called the knee FS but again we still

we called the knee FS but again we still

we called the knee FS but again we still didn’t have an fda-approved product we

didn’t have an fda-approved product we

didn’t have an fda-approved product we were a small company chasing funding

were a small company chasing funding

were a small company chasing funding just trying to stay alive to develop a

just trying to stay alive to develop a

just trying to stay alive to develop a technology so we chased other

technology so we chased other

technology so we chased other opportunities we did some work in some

opportunities we did some work in some

opportunities we did some work in some early medical augmented-reality the

early medical augmented-reality the

early medical augmented-reality the project we called image overlaying we

project we called image overlaying we

project we called image overlaying we also got some grant funding in order to

also got some grant funding in order to

also got some grant funding in order to develop a computer-assisted hematoma

develop a computer-assisted hematoma

develop a computer-assisted hematoma evacuation tool does it basically suck

evacuation tool does it basically suck

evacuation tool does it basically suck the blood clot out of your brain if you

the blood clot out of your brain if you

the blood clot out of your brain if you had head trauma we call this one the

had head trauma we call this one the

had head trauma we call this one the brain poker

you play the video please if you click

you play the video please if you click that

oops all right though edit that one out

oops all right though edit that one out in post I guess is that can you play

in post I guess is that can you play

in post I guess is that can you play that video if you click it

all right sorry about that this was our

all right sorry about that this was our last go as a little startup company we

last go as a little startup company we

last go as a little startup company we were trying to promote the PFS not as a

were trying to promote the PFS not as a

were trying to promote the PFS not as a end application we just couldn’t get

end application we just couldn’t get

end application we just couldn’t get enough funding enough wherewithal to do

enough funding enough wherewithal to do

enough funding enough wherewithal to do the FDA route to build our own product

the FDA route to build our own product

the FDA route to build our own product and so our idea is we’re going to

and so our idea is we’re going to

and so our idea is we’re going to promote this as a technology that you

promote this as a technology that you

promote this as a technology that you can bolt on to existing navigation

can bolt on to existing navigation

can bolt on to existing navigation systems so by this point there are a lot

systems so by this point there are a lot

systems so by this point there are a lot of companies doing computer assisted

of companies doing computer assisted

of companies doing computer assisted surgery and we wanted to provide the

surgery and we wanted to provide the

surgery and we wanted to provide the technology we didn’t want to necessarily

technology we didn’t want to necessarily

technology we didn’t want to necessarily build a system from the ground up so

build a system from the ground up so

build a system from the ground up so this is our way of demonstrating how PFS

this is our way of demonstrating how PFS

this is our way of demonstrating how PFS worked you can see that the tool is

worked you can see that the tool is

worked you can see that the tool is extending and retracting starting and

extending and retracting starting and

extending and retracting starting and stopping in order to conform to in this

stopping in order to conform to in this

stopping in order to conform to in this case a partial knee replacement plan

so we worked long and hard we did a lot

so we worked long and hard we did a lot of different prototypes we tried to keep

of different prototypes we tried to keep

of different prototypes we tried to keep the company lasting as long as we could

the company lasting as long as we could

the company lasting as long as we could but eventually our funding ran out

but eventually our funding ran out

but eventually our funding ran out fortunately Craig was able to find one

fortunately Craig was able to find one

fortunately Craig was able to find one more opportunity for us there was a

more opportunity for us there was a

more opportunity for us there was a local super o angel investor that was

local super o angel investor that was

local super o angel investor that was able to fund blue belt with an A round

able to fund blue belt with an A round

able to fund blue belt with an A round and basically take us out of the

and basically take us out of the

and basically take us out of the research lab and make us a real company

research lab and make us a real company

research lab and make us a real company and here’s that real company back in

and here’s that real company back in

and here’s that real company back in 2010 our mission was to actually create

2010 our mission was to actually create

2010 our mission was to actually create PFS as an end-user application get the

PFS as an end-user application get the

PFS as an end-user application get the approvals that we needed and sell this

approvals that we needed and sell this

approvals that we needed and sell this now of course the company got bigger

now of course the company got bigger

now of course the company got bigger from the three-person group that we

from the three-person group that we

from the three-person group that we started off with and so with more people

started off with and so with more people

started off with and so with more people and more resources you need more money

and more resources you need more money

and more resources you need more money so in 2011 we had to get another round

so in 2011 we had to get another round

so in 2011 we had to get another round of funding this time we were actually

of funding this time we were actually

of funding this time we were actually purchased by a health point capital

purchased by a health point capital

purchased by a health point capital which was a private equity group out of

which was a private equity group out of

which was a private equity group out of New York Health Point Capital allow us

New York Health Point Capital allow us

New York Health Point Capital allow us to staff up and focus and really

to staff up and focus and really

to staff up and focus and really concentrate on getting our FDA

concentrate on getting our FDA

concentrate on getting our FDA application in so that we could sell

application in so that we could sell

application in so that we could sell this thing one of the things the health

this thing one of the things the health

this thing one of the things the health point did was they brought in a new CEO

point did was they brought in a new CEO

point did was they brought in a new CEO that had some more international sales

that had some more international sales

that had some more international sales experience his name was Eric timko Eric

experience his name was Eric timko Eric

experience his name was Eric timko Eric is out of Minneapolis but he was okay

is out of Minneapolis but he was okay

is out of Minneapolis but he was okay because he was from Pittsburgh he grew

because he was from Pittsburgh he grew

because he was from Pittsburgh he grew up in saxenburg he’s from Butler County

up in saxenburg he’s from Butler County

up in saxenburg he’s from Butler County and he was okay with us because he was

and he was okay with us because he was

and he was okay with us because he was almost as big a Steeler fan as my mom

the next year after lots of hard work

the next year after lots of hard work getting our European approvals which for

getting our European approvals which for

getting our European approvals which for us it was a little easier to do that

us it was a little easier to do that

us it was a little easier to do that first we did our first demand in Belgium

first we did our first demand in Belgium

first we did our first demand in Belgium off to the right you see me and Brent go

off to the right you see me and Brent go

off to the right you see me and Brent go and Eric and Adam and John are from our

and Eric and Adam and John are from our

and Eric and Adam and John are from our European group and also dr. belham ins

European group and also dr. belham ins

European group and also dr. belham ins front-and-center who performed the first

front-and-center who performed the first

front-and-center who performed the first live Navia taste on a patient at the end

live Navia taste on a patient at the end

live Navia taste on a patient at the end of that year we did all the paperwork

of that year we did all the paperwork

of that year we did all the paperwork necessary for our FDA approval and in

necessary for our FDA approval and in

necessary for our FDA approval and in fact that FDA approval paperwork

fact that FDA approval paperwork

fact that FDA approval paperwork included studies that showed that we

included studies that showed that we

included studies that showed that we were actually as good if not better than

were actually as good if not better than

were actually as good if not better than the big robot competition that was out

the big robot competition that was out

the big robot competition that was out there and we were far better than any of

there and we were far better than any of

there and we were far better than any of the mechanical instruments that our

the mechanical instruments that our

the mechanical instruments that our technology was intended to replace the

technology was intended to replace the

technology was intended to replace the next year we started to blow up our

next year we started to blow up our

next year we started to blow up our minneapolis operations we actually had a

minneapolis operations we actually had a

minneapolis operations we actually had a manufacturing and sales corporate

manufacturing and sales corporate

manufacturing and sales corporate operations center in minneapolis and so

operations center in minneapolis and so

operations center in minneapolis and so we were kind of a two-headed monster

we were kind of a two-headed monster

we were kind of a two-headed monster pittsburgh state research and

pittsburgh state research and

pittsburgh state research and development

development

development the appleís built and sold the units we

the appleís built and sold the units we

the appleís built and sold the units we also did our hundredth case the

also did our hundredth case the

also did our hundredth case the following year we declined to 500 cases

following year we declined to 500 cases

following year we declined to 500 cases this is solely the Pittsburgh group here

this is solely the Pittsburgh group here

this is solely the Pittsburgh group here you can see that we were getting bigger

you can see that we were getting bigger

you can see that we were getting bigger getting better

getting better

getting better we’re in dancing into other areas of

we’re in dancing into other areas of

we’re in dancing into other areas of surgery when went back to total hip

surgery when went back to total hip

surgery when went back to total hip replacement surgery we went forward into

replacement surgery we went forward into

replacement surgery we went forward into total knee replacement surgery and we

total knee replacement surgery and we

total knee replacement surgery and we finally had enough critical mass to take

finally had enough critical mass to take

finally had enough critical mass to take the obligatory trip on the Gateway

the obligatory trip on the Gateway

the obligatory trip on the Gateway clipper and by a thousandth case in 2015

clipper and by a thousandth case in 2015

clipper and by a thousandth case in 2015 we were a real deal in orthopedics

we were a real deal in orthopedics

we were a real deal in orthopedics people were starting to talk about us

people were starting to talk about us

people were starting to talk about us we’re getting analysts visit us our

we’re getting analysts visit us our

we’re getting analysts visit us our booth at the local there at the global

booth at the local there at the global

booth at the local there at the global conferences and orthopedics so the only

conferences and orthopedics so the only

conferences and orthopedics so the only thing left for Bluebell we were selling

thing left for Bluebell we were selling

thing left for Bluebell we were selling product we were getting surgeries done

product we were getting surgeries done

product we were getting surgeries done on patient was market validation that’s

on patient was market validation that’s

on patient was market validation that’s Craigan Branco and the market validation

Craigan Branco and the market validation

Craigan Branco and the market validation came in 2016

came in 2016

came in 2016 Bluebell was purchased by Smith & Nephew

Bluebell was purchased by Smith & Nephew

Bluebell was purchased by Smith & Nephew with the nephew was the number four

with the nephew was the number four

with the nephew was the number four orthopaedic company in the world and

orthopaedic company in the world and

orthopaedic company in the world and they’ve assimilated us we are now a year

they’ve assimilated us we are now a year

they’ve assimilated us we are now a year in but there was still one more personal

in but there was still one more personal

in but there was still one more personal milestone that I had to achieve my dad

milestone that I had to achieve my dad

milestone that I had to achieve my dad getting an a bo knee here in Pittsburgh

so this talk is supposed to be about

so this talk is supposed to be about revolutions I can’t claim to be any kind

revolutions I can’t claim to be any kind

revolutions I can’t claim to be any kind of a revolutionary as I said I didn’t

of a revolutionary as I said I didn’t

of a revolutionary as I said I didn’t believe in the idea at first but I think

believe in the idea at first but I think

believe in the idea at first but I think that what you can do is you can identify

that what you can do is you can identify

that what you can do is you can identify a great group of people and if there is

a great group of people and if there is

a great group of people and if there is a revolutionary idea out there that you

a revolutionary idea out there that you

a revolutionary idea out there that you can glom on to this great group and you

can glom on to this great group and you

can glom on to this great group and you can get together and you can start a

can get together and you can start a

can get together and you can start a revolution and make it work thank you

revolution and make it work thank you

revolution and make it work thank you very much

very much

very much [Applause]