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20230717-Podcast: A Spy In The Belly

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13 Jul, 2023

Alexandre Anthis with the hydrogel composite material of the sensor patch he developed during his doctoral thesis at ETH Zurich and Empa. (Photograph: Empa)

Alexandre Anthis with the hydrogel composite material of the sensor patch he developed during his doctoral thesis at ETH Zurich and Empa. (Photograph: Empa)

In this episode, we talk about a combined effort between ETH Zurich & the Swiss Federal Lab for Material Science (EMPA) to create “smart” internal bandages for safely patching patients post stomach/intestinal surgery while providing insight to the medical staff about the status of the patch to prevent leakages which can be fatal.

In this episode, we talk about a combined effort between ETH Zurich & the Swiss Federal Lab for Material Science (EMPA) to create “smart” internal bandages for safely patching patients post stomach/intestinal surgery while providing insight to the medical staff about the status of the patch to prevent leakages which can be fatal... 


EPISODE NOTES

(0:42) - A Spy In The Belly


Transcript

Hey Folks, today we're talking about leaks in the stomach after abdominal surgery, it's a much bigger problem than you probably know about. And we also talked about this team that's made a spy in the belly. It's like a high-tech bandage that goes in the abdomen and solves all these problems. Let's jump right into it.

I'm Daniel, and I'm Farbod. And this is the NextByte Podcast. Every week, we explore interesting and impactful tech and engineering content from Wevolver.com and deliver it to you in bite sized episodes that are easy to understand, regardless of your background.

Daniel: What's up everyone, like we said, we're talking all about this research, researchers have made a patch that you can put on during abdominal surgery, it's kind of like a band aid for your intestines inside your stomach after surgery, to me, I was like, well, the world needs this. What do we need this for? Doesn't seem like a little bit of overkill to have band aids when we already have like stitches and sutures and glue and all these other things, right? Turns out, it's actually really, really important. So, in stomach or intestine surgeries, leaks at the stitches are actually pretty frequent. It happens in above 5% of surgeries. And like, if it didn't happen to, or if even if it happened to 5% of people, but the consequences weren't that big. I'd be like, Alright, cool. Like, it's just like a minor complication. Maybe we can fix this pretty easily, right? Turns out that when this happens, it's called a I forget what it's called, actually. But it can cause something called like peritonitis, which is like swelling and infection on the insides of your body. That's like the same thing that happens when your appendix bursts. And if you know anything about like appendicitis after your appendix burst, it's an it's a medical emergency, to come clean up the fluid inside of you, because you can get your blood inflicted, that's life threatening, so 5% of the surgeries, leaks happen at the stitches, 20% of those leaks are life threatening. So again, it's not a huge deal. But the fact that you're thinking about, I might go in for routine stomach surgery, and there's a 1% chance of me dying because of it. If you combine that 5% leak rate and 20% mortality rate, it's actually like pretty risky for you to say like one out of every 100 stomach surgeries you go into are gonna die because of leakage seems like something where we can come up with like a decent solution, like an internal Band Aid and solve a lot of these problems, right?

Farbod: You're absolutely right. And by the way, I think the word you're looking for is evisceration. That's the one, that's the one shout out to Google. But yeah, man, you're right. And like, first I'm reading this, I'm like, alright, you know, they have sutures. And the first thing that came to my mind is all right, we've advanced so much in the medical industry that we have glues now, like, when I was in high school, this kid cut his hand on a bandsaw and blood splatter everywhere. He wasn’t didn't even get stitches, they put like cement glue or whatever in his hands. And it just bound everything back together. It was good to go. Like, why can we do something like that in intestines? Well, apparently, they did. And they came up with something that's like plaster that you would use for your drywall, and they're able to plaster it up. But the proteins, I guess, that they use to create that plaster, react very strongly with the contents of your intestines or your stomach. So, you know, that's like the acid that that just the basket that you have, or the food and the germ of the food that's like going through your stomach to get processed, which means that it can kind of cover it up, but at the same time, it's gonna dissolve pretty quickly, which puts you back in the same place you were before. And that's getting compromised and potentially dying from this. So, it's such a big problem, right? Because we can't patch this thing properly, and there's a chance that's gonna pop open. But what like as exacerbates that problem even more is that doctors have literally no insight after they close you up, right? Like this is a very critical thing. So, they want to make sure they're getting it right. And they do their best during the surgery. But once you're patched up, they have no insight on like, if there's a leak, how big is the leak? Is it badly? Can we do something about it? So, I think what usually happens is that they just keep the patients for an extended period of time at the hospital, keep their eyes on him, make sure they're checking the vitals and then after a period of time be like I guess you're good to go.

Daniel: Yeah, they want to keep on to like that two-to-three-day period, because that's when the symptoms of peritonitis start to become present. But it's like, it feels like a really, really like a really, really blunt solution to a problem that could be finessed, right? So, to summarize it, you know, when we have stomach or intestine surgeries, leaks at the stitches are actually pretty common. And all of those lead to a lot of additional complications could lead to re operations and 20% of those cases that actually causes death. So, it's a big deal. We've tried doing certain types of glues or plasters or something like that to try and patch it up. Works great at ceiling, except when it's actually starts to leak. The digestive juices start to dissolve it. And again, to make matters worse, like you said as soon as the abdominal cavity is closed, doctors are completely blind to what's going on. And they may not notice leaks until it's too late. And things may progress more from like the, hey, I have some complication stage all the way to like this is really life threatening. So, this team of researchers, it's a combination team from ETH Zurich, as well as EMPA, which is the Swiss Federal Lab for Material Science, they're working together to create this hydrogel patch, right. So, it's made of this biocompatible hydrogel material that can soak up the digestive juices if they happen to leak. So that that one helps with the first pain point we talked about where like, current patches dissolve when the leaks that the stitches start to become present. And then the second half of that is built in non-electronic sensors. And I didn't even like really know that that exists, right? Non-electronic sensors that you can somehow read from outside of the body. That's, to me is like one of the most compelling parts of this entire solution.

Farbod: Absolutely. And I think we should get into the sauce now. So, like, it's a two-parter, like we got a two-parter problem. So, we're gonna have a two-parter solution. The hydrogel is probably part one. And it's amazing in and of itself, like you mentioned, hydrogel allows you it's mostly made of water, and it is able to absorb a lot of liquids very well. So that's great. And it also cross-links with the tissue that you're trying to patch up, which means it has a better adherence to the surrounding area versus something like plaster that you just kind of like slobbing on there or even like the stitching that's you're using to suture someone up? Yep. Great. Now there's the detection side. And this kind of reminds me of, if you remember, back in the day, then we used to like read tons of papers about different antimalarials. One of the popular ones was gold nanoparticles that glowed red. And they weren't like these heat seeking missiles for cancer cells, which means that they would bind themselves to this material. And it would allow doctors to use scanning technology to pick up and know exactly where cancer cells are. Well, this is kind of operating in the same way. You have this hydrogel that's actually infused with salts that react to changes in pH, and specific enzymes that are also found in the digestive tract. Which means that if there is a leakage, you're gonna start seeing some reactions happening in the hydrogel. And the best way to pick this up originally was through ultrasound. So, like, if you've seen like movie shows, of like pregnant women doing the little scan the scan, that's essentially what they're talking about. But as this technology has advanced, they're also able to do CT scans, which are pretty normal for a patient of the hospital, like, you know, very routine, if you're doing an operation of this sort. And they have this, you guys gotta check out the article. They have this picture of what like a good patch looks like and what a bad patch looks like. And even to the eye of someone who got to be in biology and is definitely not a doctor, you're like, Oh, that's a good one, because it's a full ring.

Daniel: You say that's like someone with experience.

Farbod: I'm doing my best, you know, you got to fake it till you make it. But yeah, like the bad one has a hole in it. And the good one doesn't have a hole in it. So, it couldn't have been easier to tell the difference.

Daniel: I'm with you, man, I had similar takeaways here. I was like there's two main ingredients in this secret sauce. The first part of it is this patch is made of materials that can soak up the fluid. That's a big deal right there right off the bat because it addresses the initial pain point, we talked about where the current patches actually dissolve when there's too much gastric fluid. So, in this case, it's preventing the fluid from leaking all inside the body and causing peritonitis. And then that's also the life-threatening scenario when the gastric fluid leaks all inside the body and causes a blood infection. So prevents the life-threatening outcomes from happening right off the bat, which is awesome. But even more so than that. We've got the second aspect here, which is like detectability, it improves the detectability of these leaks. And I was super compelled by this. So, I dove even deeper than what the article that we got linked. I started like opening the technical papers and trying to crack out and just figure out exactly what happened what's happening here. So, we said they've got like some combination of like salts and proteins in there that react to the changes in acidity. It's a combination of salts and this thing called tantalum oxide, which is insoluble and it is specifically designed to react with the acidity from the gastric fluids. If you think about it, you've got like stomach acid inside you. It reacts with the stomach acid and generates bubbles of CO2 inside the body. At first, I was like dude, that must be painful to have like bubbles of CO2 floating about inside you. But the CO2 actually gets trapped by the hydrogel, too. So, what we're able to detect from outside the body is actually when a reaction happens, some bubbles pop up inside the hydrogel. And that creates a structural difference that can be detected from outside the body. Like you mentioned, using either a CT scan or an ultrasound imaging that's super valuable because it doesn't matter which hospital you're at. It's more likely to that like the hospital you're at has either one CT scan or ultrasound imaging. It's not the type of scenario where you go to most hospitals and they don't have either so it gives a lot of flexibility to doctors trying to do a quick triage and understand “Are we having the leakage there”, but the part that was like the cherry on top for me on top of the sundae with all the secret sauce is the fact that they connected this using computer vision to a Python algorithm that can algorithmically evaluate the CT scans and the ultrasound images to tell whether or not there has been leakage on the gut. So, in addition to like, like you said, even if you're a B- student in biology, it's easy for you to look at the image and determine that they've also created a way to connect this to an algorithm. So, we don't even have to trust your poor, poor judgment, man, the computer can tell us right off the bat.

Farbod: Thank God for taking me out of the equation. weight off my shoulders,

Daniel: No, but honestly, it's pretty compelling that they will human error almost completely out of the equation there. They've got a way to algorithmically evaluate it. To me, it's like, they've got all the reliability of having an electronic sensor there to detect what's going on. Except that there's actually no wires, it's non-invasive. There's no electronics involved, you've just got a computer that's able to non-invasively, read the physical sensors that are inside the body.

Farbod: I mean, you know how passionate I am about automation. So, I'm not going to go into that tangent. But like quickly, high level thinking about it, it makes total sense that again, the doctors are doing the best that they can while they're doing the operation. And once they patch it up, it's great that we can like offload that monotonous, yet very critical work of figuring out like, is this patient, okay? To someone that doesn't need to be a surgeon, right? Like you have the patch, that's figuring out if there's a leak, and then you have the algorithm that's running and analyzing the results to be like, yes, there's a leak, or no, there's no leak. And this bleeds very nicely into the kind of so what section, like you know, they've made these changes, they've done all this, but what does this translate to in terms of like, impact to the patients or this process. So, we've already kind of covered the doctor side, makes your life easier, and gives them more of coverage in terms of, you know, how much insight they have into the patient's progress, post patch up. But on the patient side, you also have, you can go in and be more comfortable because there's a reduced risk of complications with a surgery like this, you have probably a reduced number of days that you have to stay at the hospital because now they're not just kind of winging it and hoping that you're okay, and nothing happens in the next two or three days, you just kind of know that you're good. And if needed, you can get a routine checkup, like the next week or something like that, to make sure that the CT scans are still looking good. And then probably most important to our American listeners, reduced healthcare costs, you know, those hospital bills can rack up. And being able to, again, streamline these processes allows us to use less of the doctor's time, use less of the hospital resources, get home quicker. And we're doing that with this approach without compromising on anything. In fact, we're making the process better for you safer for you, cheaper for you. So, it's mostly a win around the board, right? Like, it makes everybody happy.

Daniel: I agree there, man. And I particularly want to dive into the part where you talk about decreasing the length of the hospital stays, which reduces the healthcare costs in general, right? Obviously, reduced complications is the goal. But the byproduct of this being the fact that people might not have to stay in the hospital as long as a big deal. I looked in there like pretty decent home ultrasound machines. Like imagine your doctor sends you home with an ultrasound machine that cost less than $1,000. So, imagine something that a hospital could stock a couple of them, lend them out to the patient to take them home. And the patient can like, I don't know, use a mobile app on their phone with this algorithm to look at the ultrasound imaging that they got themselves to determine to make sure you know, you don't have to come in for a checkup a week later, you can monitor at home every 12 hours, if you want to be sure that there aren't any complications. And you can do it at home with this ultrasound machine, snap a photo of it, put it through this photo algorithm and then it can tell you whether or not your sutures are leaking or not. If they are, you can get it addressed really quickly. But hopefully it doesn't happen at all, or it happens much less frequently. And then the consequences that happen as a result of that are a lot less minimal, right? We don't have this 20% chance of dying, once your intestines start to leak.

Farbod: That's a great hot take. I totally agree with you. And again, like safety and health is the most important thing. I think anyone you know, if you offer them more money or their health care, I was gonna take their health, but after you know, you're okay. The next thing that's going to hit you is the hospital bill and no one wants to be in debt like that. So, reducing that and coming up with ways, again, with automation technology, that we can make people's lives easier and affordable, opens this kind of care up to a lot of people and makes those that are already, you know, experiencing this issue and have a need for this kind of process being less of a burden, both like on the risk side and on the time slash cost investment side. So, I don't know, it makes me happy. But obviously, like everything we talked about, we want to know, is this stuck in academia? Or is it making its way to us? What's happening here is are we gonna see this in our lifetime? And it looks like this research has actually generated a whole lot of interest. So, these folks are now looking into the next steps of what it means to advance this application in practice, what I think that means is, you know, we've theoretically proved that this, this product in a laboratory setting, now we have to do human trials, that's typically the way it goes, based on my understanding of pharmaceuticals in the medical industry. But I don't know, I'm hopeful, I think they've been able to demonstrate the value of this pretty well. And I wouldn't be surprised, again, if we see this in the not-so-distant future.

Daniel: I want to like temper everyone's expectations, though not so distant future, especially in the medical realm could be a long time. I'm not sure of the average like time from laboratory model all the way through to human trials. And then to mass acceptance, it probably depends a lot to, you know, depending on the field that this is tending to address. But I will say, they have tested in a live piglet model and prove themselves out. So, it's not just like, in vitro, they've done it in vivo in a live piglet model. So, I'm hoping that through these next steps in medical practice, with the interest that they've garnered an industry, they're able to accelerate this, you know, out into the field. Again, the whole point, at least for you and I, of being technologists, of being engineers, is to help improve people's lives, right to do things that make an impact in the world. It would be really awesome if this team from ETH Zurich and EMPA can get there, you know, get their developments out into the world quickly and save a lot of people who are experiencing these complications due to stomach related surgeries. You know, it's a problem that I didn't know a ton about at the surface. But I've learned the research for this. It's striking to me how impactful this could possibly be.

Farbod: I'm with you, man. And look, you know, neural link did the pig testing too. So, you should probably expect this the same time that you expect nearly about that. That's the general timeline that will suffer folks.

Daniel: Yeah, we can put computers in our brain faster than we can patch leaks in our stomach.

Farbod: Yeah. Before we wrap it up, you want to do a quick like ELI5, wrap up in 30 seconds to a minute just to like, you know, get those juices all together. Pun not intended.

Yeah, that's a bad pun there. But I tried. I try it.

Daniel: Let's do it. So, I didn't know this. You probably didn't know this. But in stomach or intestines, surgeries. There's leaks at the surgeries that are pretty frequent happens in more than 5% of surgeries. And then in 20% of those cases is really life threatening. So, there's a big problem here. Current technology isn't really great at solving it. These patches either dissolve when gastric fluid touches it. Or as soon as the abdominal cavity is closed, doctors can't tell what's going on. So, these researchers from ETH Zurich made a patch out of this special hydrogel material that's put on these abdominal surgery ruins after the stitches are put into place. Helps seal the wounds after surgery. But it's also got this really cool sensor technology built in that can help doctors tell if dangerous leaks are happening. The goal here is then to help detect when leaks are happening, prevent them from getting bad and then save people's lives. who would otherwise be experiencing this life-threatening stomach leaks after surgeries.

Farbod: Money. Absolutely money. There's so money you don't even know it.

Daniel: There you go, swingers’ reference for everyone

Farbod: You haven't seen it? You gotta watch it. By the way, just realize second to last episode was also wearables. And it was a wearable that was also a patch. There's a trend happening there.

Daniel: We're patching it up people.

Farbod: That was a good pun. I gotta get up to your level. All right, everyone. Thank you so much for listening and enduring our puns. And until next time, I guess. See you then.

Daniel: Yep.

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That's all for today The NextByte Podcast is produced by Wevolver, and to learn more about the topics with discussed today visit Wevolver.com.

If you enjoyed this episode, please review and subscribe, via Apple podcasts Spotify or one of your favorite platforms. I'm Farbod and I'm Daniel. Thank you for listening and we'll see you in the next episode.


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