Analyze surgical video footage to improve patient outcomes

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Surgeons have highly sophisticated tools in the modern operating room, including cameras on their tools that show video images inside the body.

But after surgery, whether it took minutes or hours, that visual footage is typically discarded on the assumption that surgeons won’t have time to review all of that video.

Tamir Wolf, CEO of Israeli and Silicon Valley startup Theator, says that’s a big mistake.

Real-time video footage during an operation can reveal what went right and what went wrong. It can be used for training or to help surgeons improve their skills by tapping into a visual database of best practices.

Wolf tells ISRAEL21c that Theator is about, above all else, leveling the playing field so everyone can get the best possible care.

In today’s world, where you live can often determine whether you live, explains Wolf. Not just in Africa or rural India, but also in the United States, even in metropolitan areas like New York City.

Wolf points to a New York Times article that summarized: Go to the wrong hospital and you’re three times more likely to die.

Two hospitals, two different outcomes

That message was driven home when Wolf, who served as a medic for 10 years in the Israeli navy, diagnosed both his boss and his wife with appendicitis over the span of a few months in 2015.

Wolf took each of them to different New York City hospitals. But the approaches to their treatment and care seemed worlds apart. Poor decision-making led to avoidable complications, near-death experiences, and an extended hospital stay for my boss, while in my wife’s case, after surgery, we were home in less than 12 hours.

A study in the journal Pediatrics found that black children in the United States are three times more likely to die after surgery than their white counterparts, based in part on the medical facilities they have access to.

Of the seven million people who experience complications after surgery and die each year, at least 50 percent of those deaths and complications are preventable, according to a paper released by the National Center for Biotechnology Information.

I couldn’t stop thinking: How can we leverage technology to address this problem? Wolf remembers. How can we level the playing field, increase surgeon performance and improve patient care?

Highlight reels

Theator is Wolf’s answer.

Instead of discarding surgical videos, Theator analyzes the footage to summarize the procedure so a surgeon can review the highlights in minutes.

The analysis uses artificial intelligence and computer vision to compare what is seen in the video against a database of approximately 30,000 hours of footage of other surgeons performing the same procedure.

Theator identifies crucial elements in the video keywords, key actions and any safety milestones that should be met.

Results can be viewed on any device, and annotations and smart filters allow the user to advance quickly to critical moments.

It’s all automated and happens in real time, says Wolf.

The Theators system analyzed more than 800 million frames of video, curated 120,000 intraoperative moments, and generated 7,000 visual operational reports.

Available in Israel, Canada and the United States Theators first US site was the renowned Mayo Clinic — the platform also structures video in real time.

Patient and staff faces are blurred to protect privacy so video can be live streamed to caregivers outside the OR via the Theator app. Procedure steps are identified and coded to provide remote observers with insights that can help optimize hospital outcomes and efficiency.

No workflow changes

Theator requires no changes to your existing OR workflow.

The hardware and infrastructure are already there, Wolf explains. For example, an oscilloscope used for an endoscopy already has a camera at the tip.

Theator plans to cover all types of surgeries, though the company is focusing for now on colorectal, bariatric, gynecological, and urological surgeries.

The 50-person Theator, founded in 2018, has its R&D in Israel with marketing and sales in Palo Alto. The company raised nearly $40 million, including 22andMe CEO Anne Wojcicki and Zebra Medical Vision cofounder Eyal Gura.

The Theators team, including co-founders Tamir Wolf and Dotan_Asselmann below left. Photo courtesy of Theator

Wolf previously cofounded Nitinotes, which aims to replace bariatric surgery with a suture system that can reduce the size of the stomach through an endoscope inserted through the mouth. This company is still active.

He says Theator is the only company focused solely on giving surgeons quick access to video footage. Some of the medtech giants, from Johnson & Johnson to Medtronic, are dabbling, he says.

Theator is adopting a business-to-business Software-as-a-Service (SaaS) approach; customers pay a subscription based on the number of authorized operating rooms.

Wolf believes that within a few years, surgical video review will become the gold standard in the industry. We are creating the technical platform to embody this data-driven approach.

But it’s his team that Wolf is most proud of. We’re four years old and we haven’t had a single individual decide to leave us, he says proudly. This is both a testament to the culture Wolf has cultivated within the company and the life-saving mission undertaken by its leaders.

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