How Robotic Surgery Is Reviving Rural Hospitals

0:00The concept I want to bring in is that you can make rural hospitals safe, you can make them prosperous, better take care of the patient population that depends on them. In most cases, by instituting this robotics platform. Dr. Kyle Soakall is a highly skilled, board-certified, and technology-driven surgeon and the owner of Frontier's Surgical Consultants. Drawing from his expertise in robotic surgery, he focuses on advancing minimally invasive surgical care and helping patients benefit from greater precision, innovation, and improved outcomes. If you're going to operate through a tiny hole in the diaphragm up into the chest, robots amazing. Gotcha. If you're going to operate deep into the pelvis, where there's important stuff all over the place that you don't want to hit, robots amazing. When it comes to safety, what is like the percentage of success rates, I guess, for these robotic surgeries? It's incredibly... It spans the globe like a super high school Internet Elvis.

1:00Ready? Fire. Today, Apple is going to reinvent the bomb. It's not over until I win! The Living Your Legacy Podcast for those who live to leave a legacy. That's a straight way! It's impossible. Oh, that is sensational! Open. She's covered with the way you said, Paul, is the box is not on the planet. You can live your dream! Hey, welcome back everyone to another episode of Living Your Legacy Podcast, where we have the privilege of talking to some of the best entrepreneurs, the disruptors, and, like today, America's best doctors. And so, yeah, we got a special guest with us today. What's your name? Where are you from? And what kind of doctor are you? So, my name is Kyle Sokol. I'm from Rural Wyoming, and I am a robotic surgeon by trade. You're at the front of AI, at the forefront of AI technology?

2:01No, no. So, this robotic surgery was generated before AI, before AI has been in development for about 30 years. The military actually spearheaded it with a DARPA fund, and then it moved into civilian practice. But largely, it's taking over general surgery. Yeah. So, it's revolutionizing general surgery. Now, AI that you talk about, that is coming in hard, but it really hasn't affected the surgical platforms that much. Gotcha, gotcha. So, robotic surgery, I kind of get the picture in my head of a doctor doing surgery remotely through some kind of robot, and I've seen videos of maybe a doctor peeling the skin off of an apple robotically. Yeah. What you saw there was the absolute precision that the robot has. So, when they show that video of peeling the grape, it is taking the skin off the grape, so its precision is to millimeters.

3:01If you notice there's no tremor as well in the hands, which is absolutely quintessential when you do certain specific types of cases. The other piece that you touched on was the teleremote aspect. So, it's teleremote in a few different areas. So, one is the surgeon actually isn't by the patient. The surgeon is in the room, sometimes out of the room, but is at a consult that's hard wire-cabled to the actual robot itself. Gotcha. So, you see the robot docked to the patient. You can look up at the screen and see what's going on at the surgery. Then you have to kind of look around and figure out where the hell the surgeon is. Because you're somewhere in the corner with his shoes off, sitting there and enjoying himself on the consult. That's just one piece of being slightly remote. Now, you can take that and extrapolate it now to a new concept of pure teleremote surgery. What does that look like? That looks like the texturing doing surgeries when you're at a different hospital.

4:02So, surgeon in one area of the state or the city, operating on a patient much further away. Yeah. And then one even further, what about military applications, where there's a surgeon's state side operating in a country half a world away. So, there's all sorts. Now, the part we just spoke about is really in development, but it is being refined and it does exist. Yeah. So, talk to us about how big are these robots? Are there multiple robots for different functions? Or there's just one general robot that handles all the functions? So, there's one main company that makes one main robot really for intra-dominal or intra-thraceic surgery. There's other robots that exist. One's called a MAKO robot that the orthopedic surgeons use for bones, which is absolutely wildly different. They can be interchanged from the robots we use in general surgery, which are defense view platforms. So, they're literally a completely different species.

5:05Yeah. And what do they look like? They're big. Did they look human-like? Or they're just like machines, almost like, yeah. What do they look like? I wish they looked like humans, they would come in and talk. We're not there yet. Not there yet. So, they're not those robots that are doing the flips and the dances, you know, and then they hop into the surgeon's room and then they start doing the surgery. If the patient asks and they haven't seen the robot, that's what I try to convince and it looks like. It's way cooler than what it actually looks like. It really looks like a stick with four arms coming off of it. And it's about the size. It's probably six foot tall. It stands. It's a few hundred pounds. Wow. But really, it just has four arms that you can move that's on a post. Yeah. Right. That you wheel towards the patient. And I'm guessing those four arms are like those robotic arms that they have different sizes of that were kind of first used, I guess, in making cars. And now they use them in entertainment and they use them. I mean, all kinds of aspects.

6:05There's even robotic bartenders, but they kind of have like the different pivots, right? Yeah. So usually the robots have around seven points of movement, just with the hand piece themselves. And the hands don't look like our hands. Yes. They're specific instruments that you interchange into the arms that function as the hands. Go, go, gadget, whatever. Yeah. But you can articulate around and all sorts of wild stuff. Now, contrast that to what we were doing since the 1980s and 90s, which was called laparoscopic surgery. Picture, at that time, doing surgery with chopsticks that grabbed stuff. Okay. So very limited motion. The ergonomics had to be dead on, meaning that your port placement for your target anatomy had to be dead on. It was actually a lot harder, obviously, to do it with the chopstick method or laparoscopic method. And really a lot of people look at that and say, oh my God, that was probably a transitional technology, right? Because the robot technology just didn't exist at the time.

7:06That truly depends on who you ask, though, because that's the whole controversy right now in surgery is where does robotics fit? Yeah. And you look at that aspect and you're like, wait, I've seen this before. We had that exact same issue when laparoscopic came out. The surgeons that were doing open surgery looked at and said, why am God's name when I do that? I make big incisions. That's no problem. Why do I want to learn how to do this with little adiabidi chops? The best part is laparoscopic surgeons look at robotics and are like, well, I don't need to learn that. Why would I do that? Yeah. There's this sway that's going back and forth in general surgery as to whether this is going to be accepted or not by essentially all cultures in general surgery. The interesting part is that the people that have the strongest negative opinion are the ones that don't use the robot. Yeah. Right? Of course. The ones that have fully immersed themselves in it and use it every day, we are the ones

8:09counting its success saying, look what it's doing for the patient. Of course. That's amazing. Yeah. Not to mention, I kicked my shoes off. I kicked back and that's just not fizziciously saying. It's literally protecting my body from years of strain. It works great for the patient. It works great for the surgeon and works great for the hospital. Yeah. Are you still going inside the room and scrubbing? Yeah. There's a few things you can't get away from yet. You have to scrub, obviously. You got to scrub because you have to place the ports. You still have to place these little trocaros about the diameter of your pinky finger. Probably we use four of them. And almost any case, you can use just four little tiny eight millimeter incisions to accomplish pretty complex stuff. It's how long you've been doing this far. It seems like you are always at the forefront of the robotics surgery technology. How long have you been in the game? I had the luxury of being a military surgeon. Okay. So that started me off in robotics incredibly early in the game. In fact, the residency I was part of was the first residency that mandated proficiency

9:14with robotics in order to graduate. So we were much ahead of the game and I... Well, that's where a lot of the forefront of technology comes from. It comes from military use. Right? I mean, they're already thinking, okay, space missions when shit goes down. Sorry, my language. Yeah, no, you're good. Right? What are we going to do? You know, we're not going to send all the doctors up there, but they're probably already thinking about that as well. Yeah. I mean, come on. So much of our space mission stuff or whatever technology comes from our military. Yeah. So you were to ask me, does that robotic technology have the capacity to move to space 100% yes? That's where we're at right now. Yeah. Now, you look back at the inception of robotics. It was developed by a DARPA fund in the military. So in the concept was... What's DARPA, Stanford? What's DARPA? DARPA is the defense funding that we use for research in the military itself. Some specialty projects go into that. Whether they be national defense or facilitating the military.

10:14So it was government funded at that time. And the original concept was, we're going to use this for austere environments. We're going to plop a robot down in our war zone and we were going to have a surgeon potentially operating half a, half a global way. Yeah. Doing this so that we didn't have to bring the surgeons in. Now, as a combat surgeon myself, once you actually go and start doing front line, you find surgery, you realize just how implausible that is. You are lucky to prep an abdomen and find the pieces to a book waltor, let alone have a $2.7 million one ton robot hanging out there and hoping to dock in which we're leading at that. So the concept of rural was good. The application to military probably we didn't fully understand. Here's the coolest part is that was, that was early 80s. Yeah. When that happened at 90s. And now my whole concept with the robot is, oh my lord, maybe it does belong in rural

11:21environments. Maybe that's where, where it needed to be all along. Our initial concept of the robot was right. But if you look at how the robot evolutionized over that time, first with the military didn't necessarily work the way we wanted it to, then move the civilian like a lot of things, right? And then the big hospital centers grab those robots and said, let's see what cool stuff we can do with them. So they started doing all the procedures with it and performing really proof of concept type operations and and seeing what they can push the envelope with. Now my feeling, my gestalt on this is that if you take that robot that was meant for rural decades ago and plop it into a small town hospital, you can start to get a job at doing absolutely amazing things that you cannot otherwise accomplish there. That's really what set my business off my consulting group off was that entire concept.

12:21Yeah. And then, I mean, you just think, okay, the game is getting smaller and smaller and smaller and then eventually being able to just maybe plop it on a drone and just send it out to wherever, you know, into the, I guess, battlefield, into the bush for doctors without borders or something, you know, who knows, right? And then you can have a whole team of these things, right? So yeah, I mean, it's also interesting when you think of futurism, robotics, right? Because it seems like every six months there's a new robot where, you know, they were just cheesely dancing. Now they're doing, like, first they're doing normal flips. Now I don't even know if it was AI, but I think it was real, but those flips have turned into full blown kung fu, you know, but like smooth kung fu, like I would not want to mess with that. Where it gets scary, but then on the really beautiful amazing side is the surgery, the robotics like that, right? Yeah. How many surgeries have you done? It's definitely in the hundreds.

13:22Wow, there you go. And I'm relatively per se in the game, a young, a young-ish guy. So I'm in my eighth year of practice, excuse me, going on my ninth year of practice. Okay. So practice as a staff surgeon, five of them being in the military and three of them being civilian. Yeah. So now do you only practice robotic surgeries or you're a hybrid, I guess, of normal and robotic? Yeah. I wish I actually did robotic surgeries because it's the funnest thing in the world and you see the difference you make with the patients. If I could dock that on everybody, I would. But no, there's still a lot of procedures that don't require a robot, you know, like skin incisions, soft stuff. Of course. You know, there's certain things that don't require really where the robot gets his bang for his buck is is intra-dominally, intra-thraceically and especially in like deep dark holes. So if you're going to operate through a tiny hole in the diaphragm up into the chest, robots amazing. Gotcha. If you're going to operate deep into the pelvis where there's important stuff all over the

14:22place that you don't want to hit, robots amazing. Yeah. And, and you know, the funniest part that you bring up was, was, you know, like things are revolutionizing so quickly. The problem we're running into with robotic surgery is we are developing new techniques so fast with the same robot, same robot, same patient, same pathology, all that. But the techniques are revolutionized so quickly because it's like the frickin' wild west right now. Like somebody will figure out a better way to do it and you better learn it and then, and then, and then so on and so forth. Yeah. So things aren't changing every decade. They're changing almost every month. Yeah. Yeah. And so if you don't stay on top of that learning curve as a robotic surgeon, yeah, you'll fall behind. Yeah. Like you blink your eyes and you'll fall behind. You have to stay on top of it, but it's, it's not getting that AI anxiety, anxiety, right? Or that futurism anxiety because it's so fast. Also, also some FOMO mixed in there too, right? Yeah. Yeah. Everybody wants to jump on the bandwagon and, and at some point, we need to pause and stop

15:24and say, should we be doing this? Right. And the astronomical, the extra, the, the exponential growth of technology that we've seen in the last 10 years, it equivilates to the last 10,000 years, not even, you know, the last 10,000 years, we went from slapping stones against stones to, to, to getting to a cell phone. Yeah. You do that in minutes. Yeah. From that evolutionary gap of 10,000 years, we do that in minutes. Yeah. Right. So, technological capacity on a cell phone, and there was on the space shuttles that they utilized to go to the, yeah, yeah, yeah. It's absolutely insane the thing, yeah, and I think as long as we get so caught up in this fear of missing out, this, this how far can you push it? At some point, you need to realize we're human-fricken beings, we will weaponize whatever we can. Whatever we can. So whatever we build for good, get ready because it could be coming for the bad. Yeah. Yeah, yeah, yeah. What if humanity is frickin' terrifying the thing. be that movie interspace.

16:25Yeah. We're telling the intertube. We're telling the intertube. All of it. What are you most excited about right now in your field? Yeah. What drives me right now as an individual, as a surgeon and more specifically as a rural robotics surgeon is really utilizing that robotics platform to help build back up rural hospitals. Now, if you could look at any area of medicine that has taken a complete crap kicking, much rural medicine, once a rural community loses its hospital, it largely doesn't come back, right? Whether it closes its doors or it gets gobbled up by a large corporate entity, it's gone, right? A lot of the times that rural community depends on that for almost half their employment, right? That's where people from hundreds of miles sometimes are coming to receive quintessential care. Rural hospitals have been under assault for decades. Why don't we hear a thing about it? That's not sexy. They are. Yeah. The concept I want to bring in is that you can make rural hospitals safe.

17:31You can make them prosperous and you can better take care of the patient population that depends on them. In most cases, by instituting this robotics platform, just like talking about the chopsticks before, it's really hard to dissect a vessel that will tear with chopsticks. It's really hard to peel a grape with chopsticks, and probably impossible. It's also hard to get these great surgeons to live in those rural areas. Yes. Oh my God. That's a completely other piece. So if they could live in downtown Miami, but if you'd be helping the guy in North Dakota, I sure. Yeah. Well, a picture being able to bring in a robot where you can do very complex cases, but you don't have to do that many. You don't have to do 50 a year to stay proficient like you do with laparoscopic, right? Sometimes do two. Sometimes do three. It increases your versatility in robotics without requiring the high volume nature that you require with laparoscopic in larger cities. So now all of a sudden, you can perform almost all the procedures you want as long as it's

18:33safe. You can do it. And then, yeah, your second point, how the hell do you even get people there? Because when you look at general surgeons, right? Are they robotic trained as the first question? Second question, are they going into fellowship? 70% of general surgeons go into fellowship, which almost immediately precludes them from going rural. Now they have to stay in a bigger hospital just to feed their subspecialty, right? So the rural surgeon is dying. And we need to bring it back. And the best part of it, the military concept that we had so many years ago that we thought we got wrong when full circle back to a larger hospital. And now, in my opinion, should be plopped right where it was originally supposed to be in the middle of nowhere, helping out rural communities. Yeah. I guess a few quick questions, you know, like when it comes to safety, what is like the percentage of success rates, I guess, for these robotic surgeries? It's incredibly difficult to mess up.

19:35And that's a good thing. And I should probably knock on some wood with that, right? Because you never want to get complacent in surgery. If you're selecting that patient correctly, you have your wits about you. You know your skill set and you know your bailouts. Yeah, you can operate. Yeah. You can operate and you can do it successfully. Really, it's complacency that kills. So you never want to cross that threshold. And there's always a time, right? When you see a surgeon that looks at something and says, I don't think we should do this, right? That's showing a tremendous amount of knowledge, right? And it's showing also a lot of integrity with that surgeon. Yeah. And it's the famous saying, right? It takes six years to learn how to operate. It takes 10 years to learn when to operate and it takes a lifetime to learn when not to operate. Right. So that's sometimes the hardest piece is what you should and should not do. And obviously, timing is important in that. But the success rates, I mean, they're amazing. They're amazing. What is your day today kind of duties do?

20:36What are you doing? So I still work at what I consider to be the initial catalyst that started this. And catch was in rural Wyoming. Yeah. That is the first hospital I went to added the military with this idea that let's see what happens if we institute a full-blown robotics program in a small hospital that kind of is is marginal at its finances, right? Yeah. And it absolutely was amazing to watch. It bettered the community so much more. It gave amazing healthcare. It provided revenue to the hospital. So it maintained its independence, right? And then all of a sudden, we had talent knocking down the door wanting to come to this hospital that you look a year ago, nobody could find on a map. Or that's from a medical school. Yeah. So it was amazing just how quickly the transition was with that. I'm pretty sure always work there. It's my community, that's where my kids are growing up. Well, Wyoming's blowing up a tech community as well, right?

21:38Yeah. So are you seeing any benefits from that? If there is something going on, I'm not aware of it. Yeah, okay. And that's not uncommon because Wyoming, like a short distance is 50 miles, right? Everything's so spread far away. It's hard to keep up with what exactly is going on in other avenues. But what the consulting group does, I still maintain my full-time job. The consulting group will go out and help rural hospitals. We have to make sure it's the right fit. We don't want to waste their time. We don't want them to waste our time. If they're the right fit and they'll benefit from a robotics program perfect, we'll go in and we'll help every way possible. We will integrate into the community. So we're not just this rent a surgeon or this warm body that comes over just to cover something that really doesn't care as much. Yeah. We're there to make that place better, sustainably better. But when we leave, we're not needed anymore. Yeah, the program holds itself out. That's really what I think the key to the successes with the consulting group.

22:40It's something to be at the forefront of technology, robotics, you know? So yeah, well, thank you so much for joining our program today. Where can people find you? So they can find us on Facebook right now. Okay, we're actually building out our frontier surgical platform online. What we actually did is we kept this a little bit clandestined. We didn't want this necessarily to be a big entity and then we realized, oh my lord, a lot of people need our help, right? A lot of people would benefit from this. So we're building out frontier surgical consultants right now. You can find us online. We should have our Instagram up and we should have our Facebook running soon enough. Okay. And then they can find you also on LinkedIn or Instagram. So LinkedIn and Instagram, again, I remained a little bit of a clandestined guy. I wanted to keep a low profile during this. But again, as we proliferate, I think we do got to get the word out. So watch out for anything Kyle Sokol, S-OK-OL, especially at a Wyoming and the Midwest.

23:41And I don't think people will be just weighted. Sure. And then real quick, just telling the name of your consulting again. Yeah, so it's frontier surgical consultants. All right, perfect. Well, thanks you for joining us and yeah, it's been a pleasure, man. Thanks so much. All right. So we're going to be doing this again. And like I said, talking to some of these great doctors this morning, I had a great talk with the show America's best builders. But yeah, you guys got to keep on tuning. I'm sure his episode when it launches is going to be a phenomenal one. But if you're into talking about the future of surgery and robotics, yeah, stay into Kyle's episode. So we'll see you again, everyone. Cheers.