Pittsburgh CREATES: Research, Training, and Innovation in Surgical Technology

The science and art of surgery — the techniques and technologies, the training and teaching methods — have steadily progressed over millennia, from the crudest of forms to the highly sophisticated, technological discipline that continues to evolve and advance today.

Evolving and advancing the technological platforms that surgeons use now and those to come in the future, how surgeons are trained to perform surgery at its fundamental levels, how the marvel of robotic surgery will advance, and how new modalities such as machine learning and advanced imaging technologies will augment a surgeon’s practice is the mission of Pittsburgh CREATES, a new collaborative start-up from the University of Pittsburgh and partners UPMC and Carnegie Mellon University.

The scope of what Pittsburgh CREATES has laid out for itself in advancing surgical platform design and development, teaching surgeons how to use these platforms, and augmenting these platforms with new advances in technology is broad, multidisciplinary, and independent of any one surgical discipline. The mission goes far beyond just the worlds of robotic and minimally invasive platforms and the world of otolaryngology, where many of Pittsburgh CREATES members practice as physicians and researchers.

Starting with surgical robotics, a formerly niche field which has evolved to become a $1.53 billion industry, Pittsburgh CREATES will pursue opportunities in computer-assisted image guidance, remote sensing, machine learning, and other technologies that will advance surgical practice and improve patient care and outcomes.

Umamaheswar Duvvuri, MD, PhD, who serves as the medical director of Pittsburgh CREATES, has a long, extensive history in the practice, design, teaching, and refinement of minimally invasive endoscopic and robotic surgical platforms. As director of robotic surgery in the Division of Head and Neck Surgery in the Department of Otolaryngology, and as director of the Center for Advanced Robotics Training (CART) at the University of Pittsburgh, Dr. Duvvuri has established himself as one of the leading practitioners, educators, and innovators in the field.

Together with Max A. Fedor, the executive director of Pittsburgh CREATES, and a staff of specialists working alongside an executive committee made up of a group of surgeons, administrators, and executives from both UPMC and the University of Pittsburgh, Pittsburgh CREATES has made rapid advances in its work since its launch in April 2018.

While Pittsburgh CREATES as an entity is new, the thinking behind it, the resources and expertise, the visionary leadership steering its course have existed for some time. Pittsburgh CREATES is a new embodiment of everything that its partners have been doing and accomplishing for a very long time. It’s the next logical step in the progressive growth and expansion of the ideas of its leaders and collaborators.

“Pittsburgh CREATES offers the opportunity to bring the unique strengths of our region to companies that are laying the groundwork for significant health care improvement in the surgical domain,” says Mr. Fedor. “Our goal is to work with our strong network of industry partners to find new and disruptive ways to improve outcomes, while driving down the cost of surgical interventions through technology.”

Industry Collaborations and Consultative Work

Innovation in a vacuum is typically not efficient, and it is even less so in the world of surgical device and platform design. Collaboration between the end users — the surgeons — and the engineers and industry members who bring technologies to market and the clinic is paramount. Bringing clinicians together with industry and engineers can make the development process more robust and expansive, and at the same time create more immediate and lasting value to the end users of the technology, and the patients who benefit from these efforts and advances.

The Pittsburgh CREATES collaborative functions much like an institute or even a company. “One of our goals is to reach out to industry entities via business development pathways to bring in partners who will collaborate with our physicians. This is different than the traditional university/industry partnerships that happen through academic research. We do have that pathway, and we fully anticipate that we will have some collaborative or sponsored research projects evolve as time goes on, but we also have this great ability to function in a more consultative manner with industry because of our collective clinical expertise and resources,” says Mr. Fedor.

Pittsburgh Trains the Current and Next Generation of Surgeons

Training surgeons is a big component of Pittsburgh CREATES. It has also been a huge part of Dr. Duvvuri’s past work in the Department of Otolaryngology and specifically in the UPMC Center for Advanced Robotics Training, where he has trained surgeons from all over the world on how to use robotic surgical platforms.

“We embrace the idea of training within a simulated surgical environment. Within Pittsburgh CREATES, we have two surgical suites we can use to train physicians to do certain types of surgical procedures with robotic platforms. Currently, one lab has an Intuitive Surgical da Vinci robot, and the other one has a Medrobotics Flex Robotic System. The labs are flexible spaces we
can configure for a number of possible setups, and surgeons can practice on either cadavers or physical models, with curricula that have been designed to measure the skills that are required to perform the procedure,” says Mr. Fedor.

“We see this as a means of evolving best practices and training techniques. Innovation in the education and credentialing of surgeons through the use of simulation and other technology-based approaches flattens the learning curve, leading to improved consistency, productivity, and outcomes,” says Jonas Johnson, MD, FACS, chair of the Department of Otolaryngology and member of the Pittburgh CREATES executive committee.

“Surgery should be democratic, it should be egalitarian, it should be accessible to everybody. It shouldn’t be limited to just the select few people who happen to live in a place that has access to these kinds of resources, or that have the money to do this. So I think about robotics as a democratization of surgery,” explains Dr. Duvvuri. This is one of the reasons that much effort and resources are being allocated to not only help design and test simulation-based teaching tools with industry partners, but also to increase the number of surgeons who are able to effectively use these platforms for their patients. There are some parts of the world, and even many parts of the United States, where the expertise and resources to accomplish this simply do not exist. However, by creating innovative ways to train surgeons — be it directly through hands-on experience in Pittsburgh or through other means such as remote monitoring and training — Pittsburgh CREATES will help to spread the usability and practicality of robotic surgery to places in need.

Where and What Is the Future?

Pittsburgh CREATES and its leadership team are by definition forward-thinking, and are researching and working on technologies that will one day make it to the surgical operating theatre, the clinic, and the classroom.

Robotic surgical platforms in their current state are really master-slave systems at the control of the surgeon. They do what they are told, by and large. This of course will change in time as the world of machine learning and artificial intelligence grow and help to create new generations of tools that can function semi-autonomously. The benefits of this extend not only to practice surgery but also to how surgeons are trained, and how their training can be quantified.

Pittsburgh CREATES is working on related technologies that no doubt will one day improve the ability to do surgery. For example, molecular imaging during surgery has the potential to highlight the molecular characteristics of tumors, for example, so the surgeon can much more accurately delineate where a tumor stops and where normal tissue begins. This has the potential for a more accurate initial surgery, perhaps cutting down on repeat procedures. It may one day better delineation which tumors are likely to be metastatic or aggressive. Used correctly, this kind of technology could have enormous potential to increase the accuracy of surgical care and create much more value for health systems and patients alike.

“We also have research happening right now on a new generation of robotics that will use artificial intelligence to improve existing platforms and help create semi- or autonomous robots. This won’t happen in the next two or three years, but long-term it will occur, and it will improve how we care for patients. And that is what it is about. Technology is great, but if it does not improve how we treat patients, and how well these patients do with our treatments, in my opinion the technology is useless. Value to the patient — and high value at that — is really the only metric that matters at the end of the day. This ought to be our guiding principle in the design or enhancement of any system we create or modify,” says Dr. Duvvuri.

To learn more about the Pittsburgh CREATES mission, plans, and current activities and partnerships, and for more biographic information on its leadership and partners, please visit PittsburghCreates.Pitt.Edu.

Pittsburgh CREATES Leadership and Staff

Max A. Fedor, Executive Director
Umamaheswar Duvvuri, MD, PhD, Medical Director
Daniel S. Battista, Director, Center for Advanced Robotic Training
Nehal J. Bhojak, Director, Strategic Business Initiatives
Jill E. Fournier, Academic and Financial Administrator
Naama Balass, Administrative Project Assistant