Frictionless Medicine: Revolutionizing Surgery: Dr. Nels Carroll on Robotics, Healthtech, and Patient-First Care

>> Speaker A: Welcome to Frictionless Marketing, the podcast that dives

deep into the stories of the most innovative brands and the people moving them forward. Our mini series, Frictionless Medicine explores the HCP perspective on today's trends throughout the industry. Today we're joined by Dr. Nels Carroll, a board certified cardiothoracic surgeon at uh, Los Robles Health System. Join host Geeta Patel as Dr. Carol shares insights on staying ahead of trends, the role of marketing and engaging doctors, and his journey from educator to a

pioneer in robotic thoracic surgery. Discover how he leverages technology, data and collaboration to strive for seamless patient First Healthcare. >> Geeta Patel: Dr. Carol, thank you so much for joining us. We're excited to have you here, especially as someone who's at the forefront of tech and AI and medicine. So we'd love to kick things off by just having you share a little bit about yourself and your background and what you're doing right now.

>> Dr. Nels Carroll: Yeah, thank you so much for having me here. I'm, um, excited to speak with you guys. I'm a cardiothoracic surgeon. I work for Los Robles Medical System in Thousand Oaks, California, right outside of la. Did my surgical training in Texas, worked in Washington for a few years before coming here to California. Uh,

big part of my practice is robotic surgery, so certainly a big slant towards technology and pushing some boundaries and some barriers to what has been done towards what we can do. So really excited to be here. >> Geeta Patel: Amazing. What inspired you to get into medicine and specifically into the robotic and tech side of things? >> Dr. Nels Carroll: Well, I had kind of a circuitous route into

medicine. Actually coming out of school, I was in Teach for America, which is, I think of it, kind of like a domestic Peace Corps. I was really enthralled with the mission of serving underserved people, kind of giving them some of the opportunities that I had had through that process of learning how to be an educator. I really became fascinated with the concept of pursuing education in a different arena and that

being medicine. So that's where I kind of made the big jump into wanting to pursue medicine. And then really, it was just a process of trial and error. Real interest in science and a real interest in surgery and refining

processes and through interactions with some particularly excellent teachers and surgeons, realized what we were capable of doing by harnessing some of these resources to improve our processes. >> Geeta Patel: That's amazing. How do you feel like Teach for America has shaped you as a physician in terms of just being able to explain some of the most complex medical issues, but also some of these complex tech procedures with your

patients? How do you feel like that's kind of given you the skills you need to speak with them? Them? >> Dr. Nels Carroll: Oh, I think it's huge. Aside from the technical responsibilities of a surgeon and what you're actually doing at the time of surgery, at least 50% of the job is educating and communicating with patients and with their families. There's really no more vulnerable or scary time than being a patient undergoing open heart surgery or undergoing

surgery for cancer. So it's incumbent upon me, it's incumbent upon us as the medical community, to the way I communicate it. Pull up a chair to the table. Working as a consultant for them, the patient is the chairman of the board. There's a lot of different people that pull up a chair to the table. So it's my job to really explain myself, give background, give context, and make sure that they feel comfortable and confident with what we're doing moving forward so that they can

really just focus on healing and not be worried about things that are out of their control or that they don't understand that we can help them understand that background in education has been pivotal in helping me do my job. >> Geeta Patel: What would you say are some of the biggest hesitations or concerns among patients when you are discussing some of the more advanced surgical procedures using AI and tech? >> Dr. Nels Carroll: Oh, yeah, there's a whole

spectrum. You hear these catchphrases and patients will say, listen, I don't want a robot operating on me, right? I'm coming to you as a surgeon. I don't know this robot, right? So it's just about communicating that. I think for everyone, it's just intuitive. The fears of the unknown. What's really important is just explaining that these are tools that allow us to. Allow me to do my job

better. For example, within the field of lung cancer resection, standard approach in literature 50, 60 years ago was a thoracotomy. A big incision between the ribs, spread the ribs apart, looking directly at the lung, operate on the lung. There was a total seat change when that transitioned to thoracoscopic surgery. So we put in a camera, make smaller incisions, much less painful for the patient, much less time

in the hospital. But then there's really now this total paradigm shift where it's not just a camera, um, but when we say we're doing it robotically, that camera is actually two cameras adjacent to each other, creates a stereoscopic visual input. So it's three dimensional. The degrees of freedom, the range of motion of the instruments is infinitely better than what we can do with standard, we say vats or videoscopic thoracic surgery. So those things are fascinating. They're very

interesting. But what matters to the patient is it hurts

less, the surgery is more accurate, the surgery is safer, they recover more quickly. Those are the things that matter. So I think keeping things in context and making it relatable is hugely important. >> Geeta Patel: No, that's really interesting when you talk about these advancements and, uh, it seems like since you're on the forefront of a lot of this, thinking about the peers in this field, are they as open to adopting these new methods? Do you feel like there are certain groups of

physicians that are a little bit more open than others? And how does literature and how things are being communicated to them, um, impacting their adoption of these practices? >> Dr. Nels Carroll: Well, I think that's a really good question. Within any practice, any profession, when you're trying to move things forward, at times there's resistance. It has to do not so much with focusing on that as it does with being true to the process. In that if you're offering a, uh, safer,

more effective process, it speaks for itself. I think communicating and building within the medical community to bring people on board, to make them aware. Part of what I really appreciate about the opportunity to talk to you guys in the context of marketing, you know, from my perspective within medicine, nothing that I do has to do with sales. So marketing, for me isn't about sales, but it's about communicating, it's about sharing.

Within our medical community, people are so overwhelmed with information, especially our primary care physicians. They're being inundated from all these different specialists. And I'm one of those specialists, you know, so when I meet a, uh, primary care physician, a family medicine doc, for the first time, I'm coming to the office and I'm saying, hey, I'm Dr. Carol. You know, I'm a cardiothoracic surgeon. Initially, they might just gloss over, like, okay, I just met with a

urologist yesterday. I'm going to meet with a neurosurgeon tomorrow. There's a new, uh, radiation oncologist that's coming to my office this afternoon. Like, how do I put all this into context? It's an ongoing pursuit, but to share that information. You know, I had a pivotal lesson in that as a medical student. Worked with a really fantastic surgeon, T. Sloan guy, that's his name. Really phenomenal robotic cardiac surgeon. Taught me so much, has

continues to be a mentor. But we actually published his experience with building or recruiting into what he was doing. Because as a robotic mitral valve surgeon, it's a real niche. Oftentimes he had to get the word out to patients to let them know, hey, here's an alternative. You know, rather than a sternotomy, we can do this minimally, invasively. We can offer you a really tremendous

surgery. So that continues to be in my mind about the importance of not just going one foot in front of the other, but sharing what we're doing and working and building and growing. And just one other thought to go along with that. It's. I'm not under any illusions that as I step into a new medical community, I'm, um, bringing a whole wealth of knowledge and nobody gets

it. You know, the guys who've been doing thoracic surgery for 20 years, 30 years, 40 years, have seen so much and have so much tremendous information and wisdom

that they can help me with. So I think it's about bringing a little bit different experience, bringing it to the table, working together, and then moving forward. >> Geeta Patel: I mean, that's really great insight. I heard you say sharing is really important, so I kind of want to take a second to also just share and, um, talk a little bit about your recent accomplishments. You recently completed the first ever robotic chest wall reconstruction in all of Southern

California. I just want to make sure I get this right. And the first ever single anesthetic robotic lung cancer resection in Ventura County. Is that correct? Correct. Okay, first of all, let's take a moment to say that is incredible. Um, just to be first ever and to be on the cutting edge and to do this is wonderful. I heard you say it's important to communicate and share a lot

of this. And a lot of times what we do from a marketing standpoint is figure out how we can empower our patients to also get educated on these topics so that they're coming to their surgeons, that they're coming to their physicians and discussing some of these options. I'd love to hear from you on how you're sharing some of those great milestones with potential patients and trying to market it outside, or communicate it, if you will, outside of the physician world.

>> Dr. Nels Carroll: Well, that's. Thank you. Yeah, I mean, these are really exciting. Uh, I think as a clinician, you're just kind of confronted with the situation, and you think about, what's the best way I can do this? And then when you come up with a creative strategy and it works, that's really exciting. And then you want to build from that. Just to be totally frank, how do we share that is something that we're very much grappling with. You know, the chest

wall reconstruction. So a Little bit of context had a gentleman riding a motorcycle collided with a deer, fractured 10 ribs. So he had 10 rib fractures, multiple displaced rib fractures. The consequence of that is he was dependent on a lot of oxygen, a lot of pain medicine. He was able to get up and breathe deeply

and walk around. So the traditional approach to reconstructing that is to make a big incision all the way along the back towards the side, and to actually divide a lot of muscles and screw titanium plates into the ribs. That works, but it's painful and you want to be better. So the next step is to do that thoracoscopically. We talked about vat surgery, and so what we did is we took it the next step and did it robotically. The biggest incision that we made on this Jose, 2

inches. We plated from the inside. We also did a cryonerve ablation the morning after surgery. He's breathing room air, he's walking, he's taking Tylenol. For that patient, it's phenomenal. It's exciting because you see the potential to improve the process. We didn't divide any muscle. We spread the muscle fibers. We do these little finite things to really improve the process. But how do you share that? I don't really have an answer for that because it's just an area of growth, I guess, for

me. And I shared that with our hospital. And they still are grappling with that a month later and haven't come up with anything to share that. Maybe because it seems a little esoteric or they're not familiar with it. The single anesthetic lung cancer is really a paradigm shift too. Just thinking patient first. So a patient might have a screening CT scan, a suspicious nodule. They're referred to a doctor, they're referred to another to get a biopsy, they're referred to another to get some

testing done. They go get some other imaging done. They're referred to a surgeon in our community. On average, then it takes between 60 and 90 days from the time of initial suspicion to treatment. So with a single anesthetic event, what we're now doing, patient gets a suspicious CT scan. I'll see them within a week and get some other imaging done. We'll have a discussion within another week. We go to surgery, patient goes to

sleep. I'll do a robotic navigational bronchoscopy and mediastinal staging. The pathologist is in the room with me, can tell me right away if it's cancer. If it's cancer while the patient's asleep. Proceed directly to complete Anatomic resection. So I'll take out the cancer, take out the lymph nodes, do nerve blocks, put in a drain. Two hours later, patient wakes up. 90% of the time, they go home the following morning. When they go home the next day, we answer two

questions. Was it cancer? Yes. What do we do about it? It's done. And especially with these early stage lung cancers, totally revolutionizes that experience for the patient. So rather than having three months of first wondering, then knowing that you have cancer, but not knowing the implication, and then worrying and waiting and worrying and going on WebMD and getting more worried, here, we're truncating that whole experience.

So within two weeks, you find out what it is, you're treated, you go home and you take Tylenol for a week. And at the end of that experience, you can put in the rearview mirror. You know, that's what we talk about, that single anesthetic event. It's really exciting. But I think we're still grappling with how do you even take all that information and share it, uh, share that with our community doctors, share it with our patients. So even the hospital, still not

really sure how they're going to share that. It's a work in progress. >> Geeta Patel: Well, just hearing both those patient experiences and stories immediately helped me truly understand the power of what you're doing. And, um, I'm blown away. It's really incredible. I do think that there's something within the patient testimonials and those patient stories, especially as someone who does focus groups with patients. Often you hear about the process.

They worry about recovery, they worry about pain. Those are oftentimes the biggest concerns that they have is what's going to happen after. And it seems like that could be an interesting starting point. I do want to switch gears a little bit about just how you're learning about what's new and what's possible. How are you getting your information about, uh, the latest in medtech and AI when it comes to your field? >> Dr. Nels Carroll: Yeah, that's a great question. It's very much

a, uh, ongoing changing dynamic. There's so many things happening in the field. For me personally, it's relying on mentors and friends and anecdotal information. There's a gentleman by the name of Yui Nguyen, who is a really fantastic thoracic surgeon, works in Portland, Oregon, taught me everything I know about robotic thoracic surgery. And he continues to be a source of

information. But conferences, professional societies, for us in our world, the sts, the aats, those are very much where People are pushing those boundaries, but a lot of it has to do with a million things get published. Which things do you trust? You have to dig a little deeper to the person behind the article. That just comes from communication and relationships. I'm a young guy and I certainly am still very much learning how to navigate all of that and growing in that process.

But I think having an ear to the ground on the thoracic side or the cancer world, we very much are multidisciplinary. We have a tumor board discussion. So every patient with lung cancer that needs to be discussed or worked through. I'm meeting with medical oncology, radiation oncology, pathology, radiology, diagnostic radiology. We have a tumor navigator. We have these meetings, and there's so much robust information coming from all these

different disciplines. Again, it comes down to being open, to participating and to asking more questions so that I can be responsible as an advocate for the patient. Uh, especially because I'm, um, as all of us taking on a lot of responsibility. If I'm going to make an incision, I owe it to the patient to be entirely prepared for the consequences of those

actions. Kind of a muddy answer to a fairly clear question, but I think it just has to do with keeping my eyes and ears open and communicating and admitting that there's a lot that I don't know so that I can find answers to those questions. >> Geeta Patel: It sounds like, um, we hear a lot about how valuable conferences are because it gives you all a moment to just stop and really focus on what's new, the new data, and to your point, who's

publishing it and what that study looks like. We've heard that quite a bit. It sounds like for this field in particular,

what's unique that we haven't heard as much is advocating for it and having other physicians advocating for it, for the future of the program and for the spread of that data. I think that's very interesting and unique to the MedTech and AI space. I'm curious to know what your thoughts are on the future. I say that with 10 years from now, do you see this being the common practice, or do you still see that because there's so much advancement happening that it's still going to be a slower adoption?

>> Dr. Nels Carroll: So great question. It's something that we all kind of wonder about. What's. Where are we going forward? My practice really is one foot in two worlds because there's a thoracic side of things. Lung cancer. Absolutely. Robotic thoracic surgery is more and more common. In training, trainees are coming out with that experience, they're sharing that and they're building from that, and it's growing. And the benefits are just

irrefutable. In the cardiac side of things, too, there's going to be a tremendous amount of change. One of the things that we continue to wonder about is the transition from open cardiac surgery to these transcatheter processes. So as a patient, the concept of a transcatheter, meaning, for example, the aortic valve in the heart is very prone to aging because it's in the high pressure area of the heart. The aortic valve tends to calcify, becomes

stenotic. And the natural history of that is that, uh, valve needs to be replaced or else the life expectancy declines precipitously. Historically, to replace that valve, we had to open the chest, arrest the heart, take that valve out, and sew in a new one. And that's still a really good surgery. But what we have developed as a medical community is the ability to replace that valve through

a catheter. So much like, you know, I described to a patient, you know, you've seen a ship in a bottle and you look at that and you say, how the heck did they get that into that bottle, through that narrow little neck? Well, it was folded delicately

in a way that allowed it to fit through there. We now have engineered these valves in a way that we can fold them down, put them into a very narrow catheter, introduce it to an artery in the hip, slide it up into position, release it, pushes the old valve out of the way and the new valve is functional in its place. We call that TAVR Transcatheter Aortic Valve Replacements. TAVR initially was just for really high risk folks who couldn't tolerate open

surgery. And then we've seen where with more experience and more refinement of technique and technology, these valves work very well. So we've gone from offering them just to high risk patients to intermediate risk patients. And now we're looking at more and more applications, younger patients, healthier patients. The implications of that are really, uh, a burgeoning topic

of discussion. For example, Medtronic is a company that makes a really terrific valve, and we've seen through recent the SMART trial data that particularly for a small annulus, which it's a narrow space and you're replacing it with this valve, the Medtronic valve works great. So we've got this excellent data that really is kind of pushing our thinking to when is the right time for surgery and when is the

right time for a transcatheter option. We always want to offer the patient the least morbid, least painful procedure, but at the same time, we want to offer the most durable, most effective treatment. So it really takes a lot of longitudinal data and a lot of thoughtful collaboration to find the sweet spot for that. Where that will go in the future is really interesting, especially as we branch out into other

valves. I have, uh, a tremendous good fortune of working with Dr. Cybul Carr, who's a absolute international expert in structural heart or transcatheter interventions for valvular disease. We're pushing the boundaries on some tricuspid valve interventions, mitral valve interventions, things that we once thought we could only do

surgically. And I think seeing that progress and seeing the experience and courage of guys like Dr. Carr to help us try things and push forward really brings a lot of confidence that that area of medicine is only going to continue to grow. Certainly there's still always going to be a role for surgery. And the more thoughtful and collaborative we are, the more effectively we can

utilize surgery and transcatheter interventions together. So, uh, lots to be discussed, lots to see, but really exciting. >> Geeta Patel: Yeah, it sounds like we're a lot closer in some fields than others than we think. So it is very exciting. Well, I just want to close by thanking you so much for your time and just sharing

all these advancements with us. It's very exciting to see where we're headed in the medical world and how much innovation has happened over the last 10 to 15 years to get us to a place of less pain, less invasiveness. And I think your work has a lot and is contributing a lot to this and we're all very grateful for it. So thank you. >> Dr. Nels Carroll: Well, thank you. Thank you so much for having me. Honestly, I learned a lot from you guys and so

I appreciate you giving me an opportunity to speak. I love to connect and learn more from other folks as we're all trying to do the same thing. We're trying to improve our patients lives. So thank you so much. >> Speaker A: Thank you for listening to this episode of the Frictionless Marketing podcast. For a complete transcript of this conversation or more information on Prompt, please Visit us at ahmeetprompt.co. if you found this episode insightful, share it with your connections

on LinkedIn. To learn more about how to make marketing frictionless. Purchase Friction Fatigue by Prompt CEO Paul Dyer online and at booksellers worldwide. Frictionless Marketing is a production from Prompt, the leading earned first creative marketing and communications agency. Grounded in the present, yet attuned to the future. Produced and distributed by simpler media productions.