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Welcome everyone to the
Becker's Healthcare podcast
series. I'm Ryan Mohammed,

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she her pronouns with Becker's Healthcare.

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I'm thrilled to have with me today Dr.
Ryan Mader of Corwell Health Doctor.

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So nice to talk with
you today. How are you?

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I'm great. Thank you for having me on.

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Yes, of course. I'm so glad that
you're here today. Uh, to begin,

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would you mind please introducing
yourself and telling us a bit about your

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background?

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Uh, sure. So, uh, my name is, uh,
Ryan Mader. I am a, uh, practicing,

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uh, interventional cardiologist,
and I serve as the, uh,

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director of the cath lab and the section
chief of interventional cardiology at

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Corwell Health in, uh,
grand Rapids, Michigan.

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Perfect. Thank you. Um,

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and so the next question that I wanted
to talk to you about is how can tele

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robotic surgery close the gaps in
access to care and health disparities

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a across the u us if you
have an answer for that.

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Yeah, so, um,

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I've been working on tele robotic
research now for almost a decade.

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And, uh,

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the problem that we're trying to address
with this research are really these

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disparities that exist, uh,
not just in the United States,

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but around the world in rural,
uh, underserved locations,

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where the type of care that is delivered
is not the same as we deliver in

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places, you know, in urban
settings or suburban settings.

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And so the goal of this
is to try to, you know,

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develop tele REbotics to eliminate those
geographic disparities in care. And,

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and one of the issues, you know,

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that exists right now in the United States
is that if, if you're a patient, uh,

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living in a rural area and you present
to a hospital with heart attack or

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stroke, the type of treatment that you
get in that rural hospital is gonna be

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significantly different than the type
of treatment that you're offered,

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you know, in an urban or suburban
hospital. And that's unfortunate because,

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you know,

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the state-of-the-art treatment for a
heart attack is to go into the heart with

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catheters, find the blockage, and,

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and do an intervention where we do
angioplasty and stenting to open up that

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blockage. And many rural
hospitals just don't have the, uh,

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either the expertise,
uh, or the technology to,

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to do that and offer that to their
patients. And so, um, you know,

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when you aren't offered a, you
know, stent procedure, uh, you know,

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for your heart attack, uh,

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and you just get medications alone that's
associated with the higher risk of,

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of death, uh, it's associated with,
you know, uh, having a larger, uh,

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heart attack and more damage done
to your heart and a higher risk of,

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of living a life with, uh, congestive
heart failure in the long run.

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And so there are substantial
benefits to opening up, uh,

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blockages in the setting of a
heart attack with, with, uh,

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stents and angioplasty. And unfortunately,
that's just not offered, uh,

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everywhere right now.

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And so that's something that we're trying
to develop the ability to deliver to

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those, uh, rural areas,
uh, by using tele REbotics.

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Wonderful. Yeah,

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I'm so glad you discussed the challenges
in the location of the treatment. Um,

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I'm sure that could be a very challenging
time for the patients impacted as

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well. And for you, doctor,

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where do you see the physician ment
of tele robotic surgery trending right

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now? What are the
opportunities and the risk?

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Yeah, and so, well, the research
that we've done, you know,

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today really shows that we have the
technical ability to do this now. And so,

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uh, we started this research
again almost a decade ago now,

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where we showed that it was feasible
to use a robotic system to fix a

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patient's heart, even when we weren't
sitting in the same room as the patient.

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So in that initial research,

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we actually wheeled the
robotic controls out of the,

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the room where the patient was and,

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and showed that we could successfully
fix that patient's artery, uh,

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despite not being in the same room
as the patient. And that was the,

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the first study that, that we had
done, uh, to explore, you know,

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whether tele robotics was gonna be a
way that we could potentially treat PE

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patients from, you know,
over long distances. And,
you know, whereas, you know,

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heart surgeries are traditionally done
with the physician standing right next to

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the patient. That initial,
uh, study that we conducted,

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we were about 55 feet away
from the patient. And, and
that was a major leap, uh,

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you know, forward in, in demonstrating
the, the, you know, potential of,

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of this, uh, tele robotic therapy. Uh,
we did subsequent research then that,

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uh, you know, evaluated whether we
could do this over distance of miles.

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And so we developed, uh,
ex vivo simulator models,

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and then we did some animal work where
we were, um, stenting, uh, live animals,

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uh, from distances of over
a hundred miles away and,

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and showed that that was successful.
And then, uh, in, in 2018,

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a physician in India, Dr. Taja
Patel actually, uh, you know,

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used the setup that we had developed
and tested here in Grand Rapids and

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actually, uh, stented, uh, five, uh,

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humans from a distance of about 20 miles
away showing that it was successful.

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Uh, and so that was a, again,

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I think another major leap forward
showing the feasibility of doing long

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distance, you know, tele robotic
procedures, uh, on living humans.

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And then we spent much of the time
in 2019 in a collaboration with, uh,

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the robotics company and with, uh,
Verizon Wireless to actually study, uh,

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you know, is to ask the question,

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is there a distance that is too long
right now to reach a patient using tele

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robotics?

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And so we set up a transcontinental
model where I was sitting at robotic

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controls in Boston and
actually controlling a
robotic arm in San Francisco.

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And, uh,

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and over that distance across the
country showed that we could actually do,

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you know, a heart, uh,
based, uh, procedure, not
on, not on a living patient,

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but on actually a simulator and
showed that we could do it completely

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successfully. And so, you know,

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because we were able to do that
successfully in that model, we think that,

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you know,

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we can reach almost any location within
the continental United States that has

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adequate, you know, uh,
internet, uh, capacity. Um,

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and so we're designing studies now
to really look at this, uh, you know,

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and really take this to the next level
where we might eventually be able to

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offer this, uh, inpatients.

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Yeah. Thank you so much for sharing,
you know, some of your research.

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I know that that can take a long time to
conduct, but the results you, you know,

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shared certainly show hope
for many. And as you know,

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technology is helping many healthcare
professionals and patients around the U S

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A, um, however,

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what advice do you have for surgeons
who are on the fence about telerotic

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surgery?

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Yeah, I, I think we're gonna see greater
and greater adoption of, you know, of,

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you know, all aspects of
telemedicine. And I think the,

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the pandemic really catapulted, you know,

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US healthcare and healthcare in other
countries to, to adopt, you know,

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telemedicine, you know, technologies
to, to deliver care at a distance.

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And, um, you know,

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that I think that was one of the
beneficial things to come out of,

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out of the pandemic as awful as
it was. But, you know, I, I've,

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I've seen greater adoption not just
within the healthcare community,

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but also within, you know, kind of, uh,

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patients where patients I think are
more willing than ever to, to, you know,

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accept, you know, telemedicine as a,
as a viable treatment option. And,

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you know, tele robotic surgery is just
a, a, a, you know, an offshoot of,

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of telemedicine. And so I, I do
anticipate that even, you know,

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for physicians who may be
on the fence about this,

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that I'm hopeful that with the
research that we do in the future,

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that we'll be able to
demonstrate that this is an a,

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a safe and effective therapy,

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and eventually be able to convince those
physicians that this is something that

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they could provide, you know,
patients who are far away from them.

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Wonderful. Yeah. Thank you so much
for those final thoughts. Doctor,

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this has been an amazing discussion. Uh,

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so I wanna thank you so much for coming
on Becker's Healthcare and I look

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forward to connecting with you again soon.

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Great. Well thank you
very much for your time.

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Thank you.