 Good morning, ladies and gentlemen, and once again, welcome to this morning's webinar, The Future of Digital Surgery. It's a web series hosted by the Digital Surgery Division at Medtronic. Before we get started this morning, we do have a few housekeeping rules that we need to go over with each and every one of you. The first thing that we need to let you know is that this webinar is being recorded and will be distributed to all participants. The system is not intended to direct surgery or aid in diagnosis or treatment of a disease or condition. Finally, the opinions expressed by our guest speakers today are theirs alone and do not necessarily reflect those of Medtronic. Now, once again, let's get started. Thanks so much and thank you to everyone who has joined us live for this third and final edition of our three-part discussion about digital surgery at Medtronic and are focused on delivering digital solutions today and tomorrow that support surgeons and their teams. I'm George Murgatroyd. I'm the Interim General Manager of Digital Surgery, which is a team within surgical robotics, part of Medtronic, and it's a pleasure to be here today to moderate this session. As a leader in medical technology, Medtronic, is at the forefront of innovations that are shaping the future of healthcare and artificial intelligence is an integral part of that. We're using data analytics to try to reduce barriers to care, improve access to the quality of care and work with partners around the world to improve the way surgery is performed. So today over the next hour, we're gonna explore digital technologies from analytics software to AI and discuss how healthcare systems can harness these technologies to create new and exciting possibilities for the future of the operating room. And it promises, I think, to be an exciting hour. We are live. I think in our first webinar, we had a power cut that got in the way halfway through. I think one of our panelists has narrowly avoided a hurricane on the East Coast. So hopefully we will get through the next hour without any natural disasters. And with that said, let's go and meet our brilliant panel. If you go to the previous side, there we go. And we're delighted, honored and very excited to be joined today by three brilliant guests, a pioneering surgeon and technologist, Dr. Santiago Horgan Professor and Chief of Surgery at UC San Diego Health. A senior and influential industry leader, Megan Rosengarten, the president of the Surgical Robotics Unit at Medtronic and a leading scientist and widely published academic Professor Dan Stoyanov, Chief Scientist with Digital Surgery. So I'm gonna go to Professor Horgan, then to Megan and then over to Professor Dan Stoyanov to briefly introduce themselves. So over to yourself, Dr. Horgan for a quick introduction. Hello, George. Thank you so much for the invitation. It's a pleasure to be here today. As you mentioned, I am Chief of MIS at UCSD and the director for the Center for the Future of Surgery, probably one of the biggest training facilities in the country. We have been involved very early with touch surgery and digital solutions. I've been involved with robotics since 1999. Sometimes it's hard to say I've been doing robotics for 22 years, but that's who I am. I am delighted to be with this amazing panel and talk about the future of digital surgery that's what seems to be going and at UCSD where we are very committed to this and we have a great partnership relationship with Medtronics and touch surgery, so we have to talk about the future. Thank you for the invitation. Thank you so much, Dr. Horgan and it's a pleasure to have you with us. And then over to Megan Rosengarten. Hi, George. Thank you for the kind introduction. I was feeling like we were a trio of superheroes as we talked about, so honored to be here with this group. And as you mentioned, I lead our surgical robotics operating unit here at Medtronic and we're focused primarily on what we refer to as soft tissue robotics and those robotic solutions and then also AI solutions for laparoscopic and robotic assisted surgery and have been involved in one way or the other in robotics and AI well over the last decade or so in the healthcare space and again, excited for the conversation today. So thank you. Thank you, Megan. And then over to Professor Stoynov. Thank you, George. And hello everyone. It's a great pleasure to join this esteemed panel today. As George said, I'm chief scientist at digital surgery where it's been really exciting over the past few years to see the transition of some early R&D research going to product and even more exciting over the past year and see how that can be scaled up being part of the Medtronic family. I've been involved in surgical robotics and most predominantly on the AI side of it, not quite as long as Professor Horgan, but almost since about 2001. So 20 years or so now developing algorithms to process surgical video and over the last few years getting into more hardware and so on. So it's been really, really exciting and it is really exciting to be where we are today where we can see some of the work that started all those years ago become robust scalable technology that can be used to enhance healthcare. So very, very excited to be speaking with everyone and to join the discussion today. Thank you so much. And given all your roles, we know how busy you are. So really thank you again for joining us. What promises to be over the next 50 minutes are a really great conversation. So if we go to the next slide, I'll just give everyone who's joined us today a sense of the agenda. So today we'll be discussing the future of surgery. We're going to do this in a series of one-to-one conversations with myself. Firstly, Professor Stoyanov, then Dr Horgan and finally with Megan Rosengarten and then hopefully we'll leave time for some questions and answers before we finish the webinar with the aim to finish the webinar on the hour. So if we go to the next slide, I'll just set the scene briefly, I think, before we tilt the conversation with Dr Stoyanov. So I think most of us would agree that data artificial intelligence and automation provide the potential cornerstone for greater efficiency for more value and offer opportunities to reduce healthcare variability and specifically for today's surgical variability. And as I said at the start at Medtronic, we're taking full advantage of today's rapidly advancing technologies like data analytics, AI and robotics to try to unlock new experiences and opportunities for healthcare professionals, for healthcare systems and ultimately for patients. And I'm lucky enough to work on some of these technologies day-to-day and indeed work with some of the panelists today. At Medtronic we're seeing AI applications across our portfolio, which are meaningfully solving problems for clinicians and for patients, including using AI algorithms for things like cardiac monitoring within the GI space to automatically identify colorectal polyps through to assisting in diabetes management by delivering proactive dosing advice and personalized advice to each individual. And I think we all agree that the future is increasingly digital and we're witnessing firsthand, I suppose, that power of AI in patient care. And these innovative technologies are a vital piece in our plan to move surgery forward and we're really excited to hone in on today key areas such as digital surgery and surgery supported by AI. And it's really interesting both Dan and Dr. Holgen mentioned that the past two decades of working with robotics surgery with AI, it's really interesting in terms of how we might project forward the next two decades and what innovations we may or may not see. So I'm going to start the conversation with Dan Stoyanov, Professor Stoyanov. And we'll kick off with just a quick question, Dan, to see whether you can tell the audience and those who've joined us a bit more about your role at digital surgery. You mentioned your chief scientist. Sounds very exciting. Are you able to bring to life what that means on a day-to-day basis? Thanks, George. I'm not sure I can do that title justice, but I'll try to explain what we do and what the team that I lead does. So I joined digital surgery being really, really excited by the ability to codify surgery and to understand surgical procedures at the time through simulation and through breaking down surgical process and with the idea that we can build AI technology in order to extract this type of codification automatically from video. And so we built an AI team and AI algorithmic technology. And in order to deploy that practically, we needed to solve the challenge of building hardware in order to capture that video. And so we built another team to build hardware and we also have a team looking at different visualization strategies. So if you're able to extract this information, would you be able to enhance the type of visualization that you can deliver in the OR? So that's been my role. And it's really exciting to see some of these early ideas now transition into products. Thanks, Dan. And what do you see as some of the biggest benefits of the technology that your team's been working on? So I can tell you that 20 years ago, because we mentioned this 20 years, 20 years ago, I think if you wanted to get video out of the OR, you may have had to carry a VHS recorder into the OR or a few years later, mini DV recorders. And then working with that video involved digitizing it and then it was very, very difficult to extract any meaningful information from it. It was even difficult to get it into your PowerPoint presentations at the time. I think where we are today is that all of this process has been made very easy, almost automatic. The user interfaces are fantastic. The security, the privacy, cybersecurity of the devices is appropriate for what's needed in the OR. The scalability of the technology is also appropriate. So you don't need to carry hard disks or manage everything in a piecemeal fashion. The data can be sorted. It can be stored in a harmonized way. It can be shared appropriately, again, securely. And really it's that platform and that ease of use that is allowing the technology to scale and potentially to open up some of the possibilities that might be delivered through AI built upon this platform technology. Thanks, Dan. And you mentioned some of those new opportunities. It'd be good to spend a few minutes just discussing some of the problems in surgery you think of your teams focusing on and the problems that your team is going to solve with some of the new features, some of the R&D work that you're undertaking and your team's undertaking. Thank you. I'll obviously leave the clinical problems of surgery to Professor Horgan who knows them much better than I ever will. But I think that some of the capability that we're building is really based around the idea that we can turn surgery into a more quantitatively understood discipline. So we can start extracting quantitative metrics, quantitative information from what occurred during a particular surgical process. And I think that can help us to build the tools that can drive standardization or a true understanding of what is best practice or how you can improve your practice. And then if we project this 10, 20 years into the future, maybe some of those features are going to allow us to link process to an optimal patient outcome and start driving better outcomes for people undergoing interventional treatment. So I think that building that quantitative capability in surgery is really, really important. And of course, once it exists, some of those potential features or some of those algorithms that can extract the information can also be used in order to drive better process during the intervention itself. So not just to analyze and to understand it but potentially to assist the clinical team to make more optimal decisions to avoid risk, to enhance process. And I think that's really, really exciting because that will have a very direct impact on patient outcomes and can really improve the way that surgery is conducted. Thanks, Dan. And from what you described there, I suppose AI and the opportunity for artificial intelligence is important in terms of bringing about scale, but I know this is a broad question. How would you describe the artificial intelligence available in healthcare and surgery today? And what do you expect for the future? Maybe not the next 20 years, but over the next 5, 10 years in terms of how AI may start impacting surgery and healthcare. So I think generally AI in healthcare is exciting and it's growing, but I would say it's still fairly nascent. In surgery, it is particularly so. And I think that's because surgery obviously requires a lot of safety. It requires regulation. It requires a lot of diligence. And so transforming surgery or delivering new technology for surgery is a process that takes time. So I think we're in a very exciting time, but we're in the early days of AI and what it may offer for enhanced surgical capabilities. I think over the next 5 years, we're going to see a lot of that capability transition into scalable, robust solutions. So move from a demonstrator that something may be possible into something actually being usable and robust enough to assist the surgeon or the clinical team to perform a certain function. So I think if you look at autonomous vehicles, for example, you would have seen the capability or the idea of autonomous vehicles or autonomous robots many, many decades ago, but it's only really more recently that this capability is becoming something of a reality where these vehicles may be actually rolled out and used by society. And I think over the next 5, maybe 10 years, we will see solutions like this emerge for specialist sub tasks of surgery. I don't think you will see autonomous surgery in the next three, four or five years, but I think certain aspects will be able to be delivered better through AI capabilities. What do you think is required to make that future a reality? I'm kind of thinking of there's potential challenges to introducing new technology into healthcare and not just challenges in terms of developing it, which is what some of your team do. What do you think is required to make that future a reality, the future that you just described? So I think there are still technical challenges that need to be solved. They obviously cannot be underestimated, but I think beyond those, the collaboration with top surgeons, with clinical teams is key. It's crucial in order to really make sure that that technology is deployed in a really, really usable way. I think it's also key to engage with training and with understanding the impact and the human factors that this technology may influence and how it can be really delivered in products that are helping the process rather than just adding new tech in the OR. So I think that engagement and that collaboration is really pivotal. Thank you for kicking us off. Hopefully when we get to the Q&A, we'll be able to hear more about your viewpoints and opinions, but thank you, Dan, for kicking off this first part of the discussion. I think we're going to do a quick poll of the audience before we move to the next section where we're going to be discussing the viewpoints and opinions from Dr. Hogan. So I think, Richard, we're ready to run the quick poll. And this poll is picking up the theme that we've had over the first and second webinars that we run around in terms of surgical video really being fundamental to some of the innovation. We're just asking those on the line, how often you might record your surgical video, whether you are a trainee or a very experienced surgeon, and we'll just give you a few seconds to answer that poll. Perfect, the poll's ended, and we can see the results in terms of a fairly even mix of diversity of those on the line. 12% always recording, 12% usually recording, and the largest portion, just over a third saying they sometimes record video. Thank you very much for responding to that poll. And we're going to now move to Dr. Hogan to say Chair of Chief of Surgery and someone who has, for many years, been really interested in the technological development of surgery. We're delighted to be joined today by Dr. Hogan. Dr. Hogan, are you on the line and with us? I am. Perfect. So thank you so much for joining us today. And for that poll that we just ran, we focused on surgical video in the first few webinars we ran with various surgeons feeding back on the really foundational ways video can support their teams, residents and themselves. So firstly, just to kick off this conversation, I'm interested in the ways you and your department use surgical video in your practice. Yes, thank you, George. And that was a great intro from Dan, you know, when he mentioned that it takes a monumental amount of work to record the video in the operating room. And for a guy that been in academics for 27 years, I went through all those processes. And what we found now since we partnered with Dr. Surgery early in the game, more than two or three years ago, is seamless, right? So we don't rely on anybody. And it used to be an act of God to have a video finished by the end of the day. And in the day of 7A surgery to have all of them uploaded on the website and on the cloud in a seamless way where the faces are not seen, the system shows blanks if it's out of the day, et cetera. It has changed the way we import data and we manage data post-op. So for us, it's very useful. We have always recorded that. In the past, I needed a special nurse, two fellows, and a tech to do that. Now I need nothing. Clearly it has impacted what we do. And the question is how we manage that data, which is the future, right? I see that Dan said it very clearly, very, very well where he says that right now the way we are using digital technology in the operating room is meaningless. And this is the first real step to move forward. Thanks, and how do you think technologies such as Touch Surgery Enterprise, which you mentioned, will or may impact surgical practice in patient care? What improvements do you think they can make in a department and also to individual surgeons as they practice? Well, there are many ways, right? So way number one, a surgeon leaves fellowship or residency and then is out alone in the world operating without any feedback from anybody. And that doesn't happen in any other specialty, I know. I mean, sport people, pilots, et cetera, they get continued active feedback on what they have done. If you look at the plane industry, they will look at the plane pathway and see if the pilot did the right thing during the critical moments of the storm, et cetera. We cannot do that. If we don't record the video, then we don't know what happened with the bleeding if the surgeon was able to react the right way and how we can improve that surgeon. So that one is an easy one, right? The second one is how do we create best practices? How do we standardize operations with data? No, with Dr. Horgan saying that my operation is the very best one, but with data, proving with outcomes and movements in the operation that that movement and that step of operation impacts the outcome of the patient. That is going to make this better. We know from data that if you make a right turn in a freeway at 120 miles an hour, you are most likely to crash, and that way today cars don't even let you do that. They will stop for you. So I think that that one is a second one that will be easily achieved. The other one is how do we define data, videos and machine learning or AI can help us understand that data. This is where we should be doing the operation. This is the best possible operation, which will be pieces of every surgeon. And the other one that is also easy, when you look at what Dan said earlier about autonomous staplers, right? I don't want a stapler with five different colors. If you put in a room 20 surgeons and there are 112 in this talk today, and we ask how do you do sleep gastrectomy? There are going to be 110 combinations of staplers. How do we unify this? How do we make the stapler decide what color and not the surgeon based on the mood that morning? And I know this is very big, but it is a reality. Every time that we do meetings and we pull surgeons, the colors are all over the place and the outcomes are pretty similar. And this is where machine learning is going to impact patient care. I don't know if I'm clear on that, but this is the future. And thank you and some really interesting examples. And it's really interesting to hear. You mentioned some parallels with aviation and pilot training and then also some of the technology in driverless cars. It's always struck me that there's so much health care could learn from and embrace from other sectors. So you mentioned some of the future of surgery and you mentioned you worked in robotics since the late 1990s. So more broadly, I guess what excites you about the future of artificial intelligence and surgery and the new technologies in surgery? I suppose you're training now and coaching surgeons who will be still practicing surgery the midpoint of this century in 2050. So what's most exciting to you about some of the potential development of technology? We want to be able to follow those searchers, right? And without having a human eye criticizing, having the machine giving them data. And their surgeons have big egos, right? And sometimes they don't want to bring data up so they don't get hurt or we don't like to hear no or what you're doing is wrong. But if we have a computer telling us, hey, you can improve here and there, that will be huge. And I think that we're getting close to that. An example is how do we bring experience to young surgeons, right? I am very likely not better technically from what I was 20 years ago, but I'm better from the brain point of view. I can analyze and manage stress much better. And I can look at all the decisions I made before and look at the situation and change based on my experience. What I would like to see that we will see is that that surgeon that is five years out of residency or fellowship will get the same experience through machine learning as the computers. That will tell them in this critical moment, the last 25,000 surgeries I analyzed, this is what they did. And that will bring, because that's what planes do, right? Planes analyze data and bring it to the pilot. And that's not difficult. That I think is tangible, but by uploading tons of videos to the cloud which are scripted, I mean, clearly they are the same cure. We can look at data from different aspects and bring experience back to surgeons. Because, you know, believe it or not, patients like older surgeons. Patients like to see some great hair because they believe that correlate with experience. Well, that's not true all the time, but there is some truth there. I want to bring that experience to the young surgeons. I mean, I never asked a pilot how many flights have you taken. Because I know that that pilot has gone through simulations, hours of training and has equal hours than the young pilot, than the older pilot. Patients are asking surgeons all the time how many surgeries you have done. Well, we need to take that away. Because surgeons should not be only about how many you perform, but the experience of the machines and the context can bring you. Another easy area where this is going to change the game and this is what really excited me the most when I visited touch surgery in London many, many years ago is can machine learning or AI help the flow of the operation? We are relying on your scrub nurse, your scrub tech and your nurse. I am lucky to be old enough to have always the same nurse. But my faculty is not that lucky. And they say you live in your own bubble because when I go to the other room with nurse X, he or she doesn't know what my next step is. The operation becomes a nightmare. Machine learning touch surgery has the capability of predicting the next step of the operation for that surgeon. And giving on a different monitor to the nurse the message that the next step will be the stapler. And the following step will be the suction inhalation. That will improve the flow of the operation and improve patient safety. That's so interesting. And particularly in terms of your viewpoints of some of the new technologies being able to transform training and coaching of surgeons all the way through to being able to support surgeons and indeed the surgical teams whilst they operate. And as you say to the benefit of patients. Dr. Horgan, thank you so much for that discussion. And as I say, we'll come back to the Q&A in a few minutes. But before we do that, we're going to talk to Megan Rosengarten, president of surgical robotics within Medtronic. And I think you have avoided the hurricane just about on the East Coast today, Megan. Yes, yes. Thankfully, where we are on the East Coast, unfortunately, others not as lucky, but we are here with internet and electricity and water some things like that. Yeah, and we are thinking of all of those impacted today, but thankfully, you've managed to avoid the worst of it. So Megan, it'd be good to kick off this quick discussion. Just for you to tell us a little bit about the recent robotic assisted surgery and news and also the role touch surgery enterprises has played in that. I know there's been some really exciting news recently. So it'd be great to get some oversight for an overview from you on that. Yeah, and I will apologize in advance. I could talk about this forever. So I'm going to try to shorten it down. So as you know, George and Dan have been a part of this and many have seen, we have had some pretty exciting milestones over the summer and kind of starting with late last spring, where we've had now our first patient procedures in the world using the Hugo robotic assisted surgery system. And there are many reasons that's exciting. I think in culmination of almost a decade of work of bringing that to market. Oh, and I was getting a note that it's a little tough to hear me. Can you all hear me? I can hear you. Okay, Megan. You can hear me. Okay, good. Just let me know if not. No, I'll try to switch. But as I was saying, we've had our first in the world patient procedures with the Hugo system this summer. One of the reasons that's really exciting is that has been in parts of the world, mainly Latin America, most of those procedures in countries that have not yet had robotic assisted surgery in some cases. So going back to our beliefs and some of the things that you stated early on, and George, we really are about how do we expand access to quality healthcare to more people around the world. And that quality healthcare in large part, meaning minimally invasive options for us is to see that come to fruition and is really rewarding and exciting. And we've seen those procedures in both urology and gynecology now over the summer. And then that kind of second really exciting piece is the role that touch surgery, as you mentioned, have played in that. So these first procedures have been, we like to call it powered by a touch surgery enterprise. And the feedback that we've gotten from surgeons so far, very similar to what we've heard from Dr. Horgan has been really amazing of the ability to go back and take a look at those initial cases and be able to real time pair video with clinical and surgical tasks with results and take a look at that kind of full spectrum of data has been powerful. And one of the questions we've gotten, which is the question that we love to hear is, hey, can I use this in laparoscopic surgery? Can I use this in other robotic assisted surgery? And the answer is yes. And based on the amazing work of Dan and his team and other members of having a foresight to create a solution that is modality, meaning laparoscopic or robotic assisted agnostic, a modality that is agnostic, but the solution of touch surgery as well as agnostic to manufacturers, meaning you can use almost any visualization system or any image or video producing device with touch surgery enterprise has created this really cool thing that I think we maybe even missed how cool it was going to be that these early adopters of robotics can say, well now I can use touch surgery to record my laparoscopic surgery and my robotic assisted, particularly when I'm new to that robotic game and compare side by side and see what steps am I doing differently and the time it takes for each step and stage has been really powerful as a part of that learning curve for those who are new to robotics overall. It also goes to something that the full Hugo system and solution will really focused on, which is how do we make as many of the components in Hugo as universal as possible. So you can use the tower for laparoscopic surgery. You can use the tower for robotics and that means touch surgery enterprise as a part of that, the visualization system, the energy generator, all of these kind of pieces coming together. So how do we make a tool that yes is bold and has bold innovation, but is not disrupting the needs and the workflow of our surgeons in our hospitals and that's really coming to fruition in large part and due to touch surgery, which is amazing. Thanks Megan and Dr. Hogan obviously gave some really great examples of the potential future of surgery and technology. What role do you see metronic playing in some of that future over the next few years? Yeah, well, and I want to hit on something that Dan mentioned that I really liked. I actually jotted it down Dan, so let me quote you elsewhere for this too. But this idea of the value of data analytics and AI today and that value in the future and I completely agree with the picture that Dan and Dr. Hogan were kind of visualizing that if you go back a decade or two decades, there was promise. There was a lot of promise and a lot of beliefs in that promise of the role that data and analytics and therefore artificial intelligence could play within healthcare, but it was really belief and hope and you kind of had to hold on to that and you kind of look at where we are as a community at the time now. It's that demonstrable that Dan mentioned, you're starting to see it. It is not necessarily just future and kind of far looking out. I would also say we're not quite at the future is now, right? There's still a lot of steps as I was getting to that, but the part of what has been so nice about the touch surgery solution is it's been designed with both the today, meaning what are those meaningful problems, complex and simple that we can solve right now. So we add value based on what we're hearing is a need from surgeons and hospital administrators with also that eye to the future. It's going to be something that's going to help us continue to advance to things that I think are quite spectacular. And to your question of that sort of future that metronic plays, we're looking at how do we do some of those things that look like anatomical structure identification and navigation using image processing of landmarks in the body to help with that. And all of that sort of adding up to some of the picture of standardization that Dr. Horgan painted, as well as I had to smile as we're talking about stapling reloads, wouldn't it be nice to not have to decide between black and purple and et cetera, when you're in that surgery. And that part of the role of a touch surgery enterprise solution today that's helping with surgical video management is also helping us collectively surgeons, hospitals, vendors and manufacturers and partners develop technologies that will get to that goal of yes, we can actually assist with clinical decision making real time, take some of the burden off of the less, less valuable tasks that are on the mind of the clinician by assisting or automating some of that while letting the focus really be on the patient and the complex and tough tasks that are attained. Thanks so much, Megan. And thank you so much to Dr. Horgan, Professor Soinov and Megan for those conversations and we're hopefully now going to open it up to some Q&A, which I think should be really great. So I'm going to hand over to Rich just to take us through and take the audience through the practicalities of the Q&A. Okay, ladies and gentlemen, once again, the Q&A tab should be located at the bottom of your screen where all of your meeting controls are. You should see that and then the tab should come up and once you do, you can type out your question and if you so choose, you can submit it anonymously. If you have any questions, please feel free to raise your hand. Thank you so much, Richard. And we've got a first question for Dr. Horgan. Come in. So I'll try and read this without fluffing the lines. So Dr. Horgan, you spoke about how digital surgery technology like touch surgery enterprise can help accelerating the learning curve for upcoming surgeons. What impact can that have on your hospital and what does it mean for patients around the world if that technology can scale? It has a huge impact. If we can bring management data to the surgeon alive when they are doing the operations and give me advice on the right or left. That's critical. I think that when I see my younger faculty or my fellows operating, they are good but when they encounter a challenge, they look back at me and say right or left. And that will happen in the real life when they go out to practice. I want to be able to bring experience back to surgeons and I think that that's the impact of digital solutions. That's exactly like Megan was saying earlier. Can you compare your laparoscopic technique that you do so well with the robotic technique? What do you do different that was impacted by using a new technology that should have not been impacted by that? Or yes. And we are not used to that feedback. I'm going to talk about my life as a golfer. I learned to play golf as a kid. I never got any visual feedback. I changed my game five years ago because I was getting old. And now I am a five handicap because I was getting optical feedback constantly. They were recording me. They were telling me this is what you're doing right, this is what you're doing wrong. We don't have that in the operating room. So how do we make surgeons better without impacting their ego? Digital solutions. That's a machine telling you, hey, and that's going to impact patient care. It's showing you that your movement was not the right one and it can be improved a little bit. So I am very excited about the future. For the first time I see that we can impact more, more patients by training better surgeons. Because as a surgeon, as a mentor, I can train maybe one or two a year. Through digital solutions, we can proctor thousands and continue proctoring through their career. And that is exciting. That's fantastic. I don't know whether and I know we'll make him want to add anything to that. I could see a few notes. So you may be in full agreement. Yeah, I'm definitely in full agreement. That was the one thing of my head nods. Dr. Hergen on your commenters were that it's echoing things we're hearing elsewhere, which is almost this move from surgery and surgeons as artistry and artists to high performing athletes. And I think as an industry and as a group, we've maybe ignored that for too long and thought that there would actually be pushback of getting more visual data from surgeons and wanting to kind of say in that realm of artists and therefore variability, as opposed to now we're seeing this pull for no, I'm an athlete that I want to continue to get better for myself and for my patients. So I just think that's something that's really interesting and only coming about in the last five to 10 years. And just to that point, this is the time. And I think we're all kind of sitting back and saying, wow, it's a little ridiculous that we haven't been recording surgery that we haven't been incorporating this. And so solving that problem of, well, why not? And it really is, it's been hard. It's cumbersome. It's clumsy. The technology hasn't suited that. I think that's one of the things I'm most excited whenever you have an elegant solution that's meeting a real need whose time has come and it'll make a difference. Wow, that's a really cool spot to be in. Thanks, Megan. And a question came in on that and it may be worth unpacking it a bit. So the question is, according to the poll earlier, there are surgeons that are maybe disinterested in recording or uploading surgical video. How do you view this and what are the ways to maybe change attitudes towards recording video? It's quite a big question, but I think an important one. So I'll open up. Dr. Holgen, you came off mute and then maybe to Dan and Megan. Yes. So, you know, attorneys have a skirt surgeon, right? And every time we think about recording a video, we're thinking about, OK, that attorney is going to come in and get my video and criticize me. But it's a quality improvement. And so those videos are totally fair. They're identified and to quality improvement, they have no access. And those things, we need to teach surgeons that having a black box in their body, not a real black box to aspire them, but to improve them as surgeons, to improve the system and to improve patient safety. And it will take a cultural change to do that. OK, because it took us a long time to understand that this is needed and we do it and no one complains about it and we are happy about it. But we all understand that we are trying to improve as physicians, as a team in the operating room and to improve at the end of the day patient outcomes and increase patient safety. And when you look from that point of view, then you are not that scared because that's the word. I like to see how I perform. I like to see what I did better. And it is going to take a culture change and these solutions that are seamless, that as it was presented earlier by Dan, is de-identified, is secure, is in the cloud. I mean, you cannot go and find yourself, OK, this is your operation. You know what happened? It's in the cloud. But you can get a lot of benefits. Megan was very good at saying, you know, this is art, but that surgery should not be art. It should be more broad. You know, when we learn that we, when we standardize a technique that we're doing with leucastrectomy, patient outcomes are better. So it needs to happen. It's time. I think I completely agree with what Dr. Horton said. And I think touch surgery enterprise is potentially the beginning of providing something that's useful in order to drive that culture change. So I think the more useful that we can make such platforms and such technology, the more features that benefit the surgical team, the more enthusiasm there will be to participate and to upload and to record and the more adoption that there will be. And of course it becomes an ecosystem. So the more adoption there is, the more insight we'll be able to provide back. And thank you. Thank you, Dr. Horton. There's a question here coming from Megan may well have been spurred by the conversation about staplers, which is tell us about the role of the instrumentation on the Hugo robotic system. Yeah, happy, happy to do that. There wasn't a plant, but glad to get the question there. And so, you know, a few things over the role of instrumentation on Hugo is, is massive. Right. And if we wouldn't be here with Hugo, if we hadn't started as a leader in laparoscopic surgery. And if we didn't have a many, many, many decades long, 60 60 years focus on how do we advance minimally invasive surgery. And that's sort of, you know, what Medtronic at its core has been about for quite a long long time of how do we continually help support the move from open surgery to traditional laparoscopic surgery and now to robotic assisted. And we bring with that, that core know how and expertise that's born not only from our own internal teams and our engineering teams, but also from surgeons who we partner with over the years and to develop that and say, okay, now what does best in class instrumentation look like for robotic assisted surgery. And then going back to that point of wherever possible, it's the same technology on purpose and you know, either the same IP and know how in order to make devices like ligature and tri staple and now applicable for robotic assisted surgery and spots where it's literally the same, literally the same stapling reloads that you can take off the shelf for a laparoscopic case, and that kind of gets back and I'm going to lose the second to touch surgery of this idea of, you know, we want to have these bold innovations that solve meaningful problems and we want them to be easy to adopt. And I think sometimes as an industry, we forget that part of ease of adoption and how do you kind of make this something that all the way to enjoyable to use, but at a minimum, not a hassle and not a headache. And that's again a part of where touch surgery comes in so much about everything we talked about and going back to that pool and even for folks who don't currently often or at all record video. I'm very curious and we talked to people who tried and then gave it up and the why and it wasn't a belief that it wasn't important. It was a pain. It was a pain to do that because kind of solving for that and we put that into our instrumentation and philosophy as well as what's not cause unnecessary compromise in instrumentation of using the technology that you already believe in and trust in laparoscopic surgery is really critical. And then the last piece I'd say is sort of role of instrumentation as it relates to both Hugo and touch surgery is all of the work that Dan and his team has done to use image processing and AI to automatically identify the tools that are used in surgery. So getting to this point of in the future that across surgical procedures, not only can you have automatic annotation and detection of surgical steps, but you also can have automatic detection of the tool that was used in that step and then later be able to compare the usage of those tools across different manufacturers, different modalities and see did that matter for an outcome and was that variability warranted. I think all of that comes together makes for this super awesome and sort of triangle of AI instrumentation and a robotic platform that's really exciting. Thanks so much. Again, we're coming close on time. There's one question that's come in that I can answer which is will the video recordings automatically deliver the full surgical procedure to my phone and are they de-identified? Yes. I don't need to put that to the panel. But I think we've got time for one more. And this has come in, which is there was a comparison to driverless cars. Where are we in surgery compared to the automobile industry? Parking sensors, power steering, GPS, question mark. So maybe close us out on that comparison. I'll maybe close it to Dan first and then maybe Megan and Dr. Horgan may have used. But Dan, comparison to surgery and the automobile industry? I think we're, I mean, it's a really, really tough comparison to make. And I think we don't have as much automation. So I think maybe a robot is the same as power steering on the car. So it's a better instrument than manual straight stick instruments, right? But obviously much more advanced because a surgical robot has probably the same complexity as a car with many, many thousands of components. I think in terms of AI, we're in a much more nascent space than the car industry is. And if you look at the scale and the amount of data that companies like Tesla, just to name one, have been collecting and the number of years that they've been doing it for, I think in surgery we've got a lot of work to do in order to scale things. But we're at the place where it's possible. So by having platform technology like the surgery enterprise, it's becoming possible. And I think that's really, really exciting because we now can tackle these problems. Whereas previously we were constantly stumbling because we weren't even getting off the roadblock if you like, because just the scale of it wasn't possible. I want to echo if I can what Dan just said, you know. But I have seen machine learning identifying the parts of operation without us giving any input. So the software is getting there to understand the steps of operation. I think that we have any support before. There was no money going into exploring this digital solution. Now there is. And I think that companies have really focused on really bringing digital solutions to the operating room. And that's going to impact everything. Tesla have been doing it for many, many years. We are just starting, but I have seen a lot of progress. We have seen say she's being very involved and taking a leadership as a society. And I think that is a good time to be in the digital world and mention. Thank you, Megan. Yeah, Georgia, I would add one like a just answer to the question. It's such a fun question too. I think that we're at powered windows and almost automatic transmission. So I think, and if I think it's very early, but think about both those things. We're pretty powerful powered windows and automatic transmission. Right. So I think that they're again, solving real problems. It's back to Dan's demonstrable, you know, value and things in the place now, but it's very, very early, you know, with that, and then the, the sort of funness of that theoretical question, I can tell you, we ask ourselves that literal question all the time. And we phrase it as what can we learn from the automotive industry and how they are pursuing autonomous driving that is applicable from a technology standpoint and also honestly a regulatory standpoint. And by that, I mean, I think that our technology and our capabilities and technology are going to surpass our readiness as a culture and an organization and kind of a community to adopt some of these technologies. So continuing to work on what are, what's the evidence that we need to see to make sure and need to provide to make sure that these are accurate and safe is very similar to what you see in a regulated industry like automotive. And the other piece that we look to automotive industry and a lot of our partners, external partners, serve that industry as well of what are the types of technologies like edge computing, like 5G, like all the things that we talk about that are going to enable doing things faster that are really, really required in surgery so you can have real-time computing power that are going to be required before you get into something that looks like autonomy of different tasks. And I believe that Dr. Horton mentioned this earlier today. I very much think that's going to be automation of non-critical tasks, more workflow and things like that that don't add value for a highly trained clinician to do or suffer from variability of different users so that changing out of the OR staff had you kind of solved there. I think that's where we'll start to see automation long before we get into something that looks like surgery and surgical tasks being automated. Thank you so much, Megan for that and Dr. Horton and Dan Stoyanov. We've come to time. Thank you so much to everyone around the world who's dialed in to watch this live. Thank you so much to our panellists, Dan Stoyanov who's tuned in and being part of this final edition of our Touch Surgery Enterprise webinar series. I'm told here to say please do follow us on LinkedIn and Twitter and head over to the Medtronic Surgical Robotics Digital Surgery page to learn more about our digital surgery solutions. I wish everyone a good rest of the day. Thank you so much to our panellists. Thank you to everyone who's dialed in and take care.