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Q. You’re planning to update more surgical instruments; can you talk about what’s next?

A. There are multiple instruments in development. I should point out that the platform technology making Assuage possible also applies to every other tissue in the body. Let me say that again: All surgeries can benefit from making the instruments biomechanically smart. The old battle between “open” procedures and “minimally invasive” procedures is over. The new world is divided between traditional steel and biomechanically intelligent surgery. All surgical procedures can be smarter and less painful, both open and minimal. It’s not just about rib cages. There is about to be an Oklahoma Land Rush across the entire surgical tray and we are already hell-bent for leather.

Chuck Pell

Q. “Pursue surprise” is something you have mentioned, along with the phrase “beginner’s mind.” How does one cultivate that kind of mindset?

A. Pursue Surprise is the recipe. We are all surprised many times a day, in many settings and in many ways. Comedy and magic depend on it – those take us one way, then surprise us – and we are delighted. But, in the day-to-day world, we’ve trained ourselves to ignore Surprise, in order to Get To The Point. Well, the Point is, there’s a better Point.

Surprise is a gift, a resource, a leg up. The feeling of surprise is the sign that your mental world model has just failed to predict something. Surprise says, “You’re wrong about something.” That’s not a bug; it’s the best feature, ever.  Every surprise is a chance to upgrade your model of the world, to improve your sense of What Is, to get a better sense of How Things Work. The most successful people pay attention to surprises. They take a moment to savor the new insight they’ve just experienced, and then they pursue it to find out where it leads. Pursuing surprise leads to things like human flight, computers, chemistry, medicine, science, penicillin (many people were surprised by the anti-microbial action of Penicillium fungi but failed to pursue it), electricity, rocketry –- stuff like that.

Q. Art, filmmaking, paleontology, biomechanics – you have a varied background, to say the least.  How does it all fit in? How did you get here?

A. To me, its like these are different aspects of a single pursuit. Paleontology and biomechanics tell me about convergent evolution, which tells me about which parts of an organism are evolutionary baggage, and which parts are the essential minimum required to accomplish some task.

A good example: Dolphins, tuna, mako sharks and ichthyosaurs all possess similar design features well-suited to a fast-moving, energy-intensive oceanic lifestyle: highly streamlined torpedo-like bodies, falcate fins, lunate caudal fins, and more, but the clincher is this: each has features the others don’t (the evolutionary baggage) that isn’t part of the essential fast-swimmer minimum design package. That stuff, I can ignore if I want to make, say, a fast biomimetic oceanic robot.

Biomechanics is essential for understanding how tissues behave in the moment, how they work as machines physiologically (e.g., at normal strains and stresses) and how they react to huge distortions – a consequence of almost every type of surgery. Biomechanics is a powerful insight machine, which is why I am stunned that it hasn’t been incorporated into modern medicine more than it has – but that, happily, is changing fast.

Where it made sense, I copied nature in designing these instruments. For example, you look at all these different ways animals grab on to to each other without causing injury. What if we worked for that outcome, versus a design approach like a predator’s talons going in and stabbing someone? As an example, an awful lot of surgical instruments sport serious spikes, which aren’t about patient comfort – they’re about not slipping under load. There are other, nicer ways of preventing slipping without sticking spikes into flesh. We’ve got several.

Before we started delving into the details of surgical instrument design, I had the impression that ‘it was all done,’ that everything will have been worked out to the utmost degree of refinement. So, when I glanced at a surgical tray for the first time, I thought, “Holy crap! Maybe I can contribute something here.” I recognized a number of instruments on the modern trays from art history, namely from Ptolemaic Egyptian tomb carvings (120 BCE). I know humans haven’t changed much in 2,000 years, but our scientific understanding of biomechanics sure has!

Pell onstage at TEDMED 2011

Q. By your own admission, you were a geeky kid, and surely that’s helped make you the creator you are today. I worry about kids today having the focus, inner drive and even enough down time to feed their creativity. What do you think? Will we have more or fewer Chuck Pells in our future?

A. More. We are re-recognizing the value of letting kids make things with bare hands, of savoring being wrong as an insight engine, of getting outside and exploring nature. My parents were strict in some ways, but in others they let me dive deep into projects (that, in retrospect, I’m amazed I survived). Combine kids’ expanding sense of offline learning with Google, Wikipedia, Make magazine, mobile devices, social networking, gamification, worldwide comms, GPS, apps, better AI, a new space industry and the sweeping trend towards cheap, ubiquitous 3D printing, and you’ve got an explosion of inspiration and opportunity. I’m not rare – I’m the vanguard. It’ll be deeply surprising if we’re not stunned daily by the show of enhanced accomplishments of ever-younger kids. I mean, if it’s now a 5th-grade science project to send balloon cameras to the edge of space, what can’t we do? We mustn’t teach the old assumptions to the next generation, because so many of the old assumptions are dead wrong. Imagine a generation of kids growing up pursuing surprise: there will be undergrads on Mars before you know it. I’m betting on it, actually.

Q. How do you stay so productive?

A. I barely sleep. My whole life I’ve gotten about four hours a night. There’s too much to do!  I’ll hate it when I’m dead, because fortune will no doubt have the temerity to wait just that long to reveal fun things like an outbreak of world peace, or alien contact, or cheap anti-gravity, or warp drives, or inter-dimensional travel, or true AI, or the like.

Part of what motivates me is that if any of these things are ever physically possible “in the future,” then they are physically possible right now, this minute. The main thing preventing us from discovering these things is our point of view, which is based on assumptions, most hidden from us. Pursue surprise with enough vigor and the unlikely will become possible, obvious, and even inevitable – and fun. The only thing stopping us is our imagination, and I can imagine quite a bit. I plan to discover as much as possible before I go, and give it to the worlds.

Click here to watch Chuck Pell’s talk at TEDMED 2011, and the audience Q&A following.

Chuck Pell: Scientist, painter, sculptor, inventor.

Q. The first product your company, Physcient, plans to introduce is called Assuage, a robotic rib spreader for heart and lung surgery that helps prevent common surgical complications like cracked ribs and nerve damage. It’s replacing a hand-cranked design that hasn’t changed since 1936. 1936! What has been keeping us from taking a step back and rethinking those designs? Is surgery some kind of mystical field, some kind of sacred cow?

Physcient's Assauge

A.We’ve left our brilliant surgeons a 1936 design that is amazingly primitive given what we know about biomechanics in 2012. Traditional surgical instruments need to catch up with doctors’ amazing talents and training. As a society, we’ve accepted for 100 years that surgical holes must be profoundly damaging and painful. Physcient respectfully disagrees! In one step, we’ve jumped 75 years into the future – the future of 2012, versus 1936. As an example, our group is the first to ever measure the forces of thoracic retraction, so we’re the first to see those signals, the first to understand them, and the first to capitalize on what they can do for patients.

Current model of a hand-crank rib spreader -- a design unchanged in 75 years.

Our robot senses and responds thousands of times each second, so that it can detect the subtle signs of imminent tissue damage and react many times before a human could detect anything’s amiss. This is what the military calls a force multiplier: It enhances the operator’s capabilities. We change the tool, not the procedure. The instruments should just get better so the surgeon gets to be better, so the patients can hurt less and heal faster.

Q. Have the health/medicine experiences of others in your life shaped the work you’re currently doing, and the innovations you want to see?

A. Yes! My father is gone, probably because he watched my Uncle Earl get cracked open three times. (He’s gone now, too.) Look, everybody is a patient and everybody is pre-operative. And we’re becoming more aware that these surgeries are way more painful than everyone first admits.

The common source of damage appears to be the basic assumptions embodied in the sometimes centuries-old design of the instruments. The results? When patients talk to each other in confidence, they say, “I feel like I’ve been hit by a truck.” Or, “Next time, I’d rather just die.” It doesn’t have to be that way.

When you wake up alive after an operation and the surgeon asks, “How are you doing?” the polite thing to say is, “Thank you for saving my life.” No one says what my Uncle Earl told me, “I feel so bad I want to grab the surgeon with my bare hands.” He was alive, but he was upset at how bad he felt for some time. I was so shocked, that statement stuck with me.

As soon as people find out that major surgery doesn’t have to cause such pain, they won’t sit still for the old way of doing things. They’ll want a better way. I would. So, I design instruments like I’m going to have surgery next week. We’ll shoot for the moon: Surgery should be as pleasant as we can make it, before, during, and after. The fear of waking during painful major surgery should become a thing of the past.

Q. Where are you with Assuage? When will it be clinically available?

A. Assuage should be available within 18 months of closing our current round.

Please stop by tomorrow for part two of our interview with Chuck Pell.  Click here to watch his TEDMED 2011 talk.

Who needs the scientific method? Vast stores of available data and research-for-hire firms are simply waiting for motivated people to ask the right questions, says Atul Butte, Chief of Systems Medicine at Stanford University.