Israeli AI Analyzes Surgical Videos to Improve Patient Outcomes

A US-Israeli startup uses AI and computer vision to provide surgeons and surgeons-in-training with invaluable highlights and insights that could save lives.

By Brian Blum, Israel21c

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

But after the 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 that video.

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

Video footage taken in real time during an operation can reveal what went right as well as 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 meant, above all, to level the playing field so everyone can get the best possible care.

“In today’s world, where you live can often determine if you live,” Wolf explains. “That’s not just in Africa or rural India but in the US, too – even in metropolitan areas like New York City.”

Wolf points to a New York Times article that summed up: “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 physician for 10 years in the Israeli navy, diagnosed both his boss and his wife with appendicitis within 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 a prolonged hospital stay for my boss, whereas in my wife’s case, we were home, after surgery, in under 12 hours.”

A study in the journal Pediatrics found that Black children in the U.S. are three times more likely to die after surgery compared to their white counterparts, in part based on which medical facilities they have access to.

Of the seven million people a year who suffer from complications following surgery and die, at least 50% of these deaths and complications are preventable, according to a paper published by the National Center for Biotechnology Information.

“I couldn’t stop thinking: ‘How do we leverage technology to tackle this?’” Wolf recalls. “How do we level the playing field, augment surgeon performance and improve patient care?”

Highlight reels

Theator is Wolf’s answer.

Rather than discarding surgical videos, Theator analyzes the footage to summarize the procedure so that a surgeon can review the highlights in just minutes.

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

Theator identifies the crucial elements in the video – key words, key actions and any safety milestones that should be achieved.

Results can be viewed on any device, and smart annotation and filtering enables the user to fast-forward to critical moments quickly.

“It’s all automated and occurs in real time,” Wolf says.

Theator’s system has analyzed more than 800 million frames of video, curated 120,000 intraoperative moments and generated 7,000 visual operative reports.

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

Patient and staff faces are blurred to protect privacy so that the video can be livestreamed to healthcare stakeholders outside the operating room via the Theator app. The steps of the procedure are identified and codified to provide those watching remotely with insights that can help optimize outcomes and hospital efficiency.

No change to workflow

Theator doesn’t require changes to the existing operating room workflow.

“The hardware and infrastructure are already there,” Wolf explains. For example, a scope used for an endoscopy already has a camera at its tip.

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

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

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

He asserts that Theator is the only company solely focused on enabling surgeons to quickly access video footage. Some of the med-tech giants, from Johnson & Johnson to Medtronic, “are dabbling in it,” he says.

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

Wolf believes that within just a few years, reviewing surgical videos “will become the gold standard in the field. We are creating the technical platform to embody this data-driven approach.”

But it’s his team that Wolf is most proud of. “We are four years old, and we haven’t had a single individual opt to leave us,” he says proudly. That’s both a testament to the culture Wolf has cultivated within the company and the lifesaving mission its executives have embarked upon.