ISRAEL AT WAR - DAY 149

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How cutting-edge Israeli med tech is boosting survival rates of war wounded

AI reviews scans at Sheba Medical Center and sends alerts to doctors’ phones, while at Hadassah, wounded soldiers recover quickly after surgeons remove bullets with robots

Renee Ghert-Zand is the health reporter and a feature writer for The Times of Israel.

Dr. Gal Yaniv sits next to his computer at Sheba Medical Center that shows how Aidoc platform used AI to identify potentially lethal tiny aneurysm in brain of Nova festival victim and immediately notified relevant medical staff to take action, December 28, 2023. (Renee Ghert-Zand/Times of Israel)
Dr. Gal Yaniv sits next to his computer at Sheba Medical Center that shows how Aidoc platform used AI to identify potentially lethal tiny aneurysm in brain of Nova festival victim and immediately notified relevant medical staff to take action, December 28, 2023. (Renee Ghert-Zand/Times of Israel)

A 23-year-old woman was shot multiple times by Hamas terrorists from Gaza as they savagely attacked the outdoor Supernova music festival near Kibbutz Re’im on October 7. One of the bullets penetrated the woman’s left eye and lodged in the right side of her brain.

By the end of that horrific day, the terrorists had butchered 1,200 people in southern Israel, mainly civilians. An additional 240 were taken hostage to Gaza. Thousands of others, like the woman from the festival, were injured and rushed to Israeli hospitals.

Fortunately, the young woman survived.

She and other wounded civilians and soldiers have not only doctors and other medical staff to thank for saving their lives, but also new Israeli-developed medical technologies.

The death rate among wounded soldiers in the current war is 6.7 percent, which is less than half the rate during the Second Lebanon War and 2.5% less than that during Operation Protective Edge in the summer of 2014.

This can be attributed to faster evacuations from the battlefield to hospitals (an average of one hour and 6 minutes faster) and better protective equipment. However, medical advances based on new technologies developed since earlier conflicts also play a critical role in boosting the survival rate.

Illustrative: Lahak-United Hatzalah medivac teams fly air rescue missions across Israel’s south on October 7, 2023. (Courtesy United Hatzalah)

Artificial intelligence streamlines patient treatment

Upon arrival at Sheba Medical Center in Ramat Gan, the woman from the music festival underwent a variety of scans, and a bleed was detected in one of the arteries in her brain.

“I got a notification when any patient with a brain bleed came in that day,” said Dr. Gal Yaniv, head of endovascular surgery at Sheba.

That notification came not as a call from his colleagues at the hospital, but via an automatic alert to his computer and an app on his phone thanks to an artificial intelligence platform called Aidoc.

Every scan done at Sheba is pushed through a dedicated server programmed with Aidoc’s pathology-detecting technology. A radiologist will also read the scan, but Aidoc acts faster and is critically important when every lifesaving moment counts.

“Time is life. Aidoc sends the push notification to the relevant doctor wherever they are for treating the problem. When they get it, they can see the patient’s scans and begin streamlining their treatment plan and the necessary intervention immediately,” Yaniv said.

“In a mass casualty event like October 7 and the war, Aidoc is especially useful in assisting us to triage and prioritize care for patients,” Yaniv said.

Yaniv is co-founder and chief medical officer at Aidoc, which provides 17 AI solutions for radiology (X-rays, computed tomography, and ultrasound). The company was established at Sheba in 2016 and has been used at the hospital since 2018. Now some 1,200 hospitals worldwide are using the platform.

Thanks to this advanced AI technology, Sheba’s neurovascular team was able to act quickly in the Supernova victim’s case. An angiogram detected a tiny aneurysm in a small distal vessel in her brain that had to be closed immediately to prevent a dangerous re-rupture, which would have likely led to death.

“Fortunately, everything was caught in time and treated properly and the young woman is now recovering from this and her other wounds in our rehabilitation center,” Yaniv said.

Using surgical robots to remove bullets and shrapnel

Prof. Leon Kaplan performs robot-guided minimally invasive spine surgery to remove a bullet from an injured IDF soldier at Hadassah Medical Center, December 2023. (Courtesy of Hadassah)

At Hadassah Medical Center in Jerusalem, Dr. Josh Schroeder, head of the spinal deformities surgery department, has used robots in his work for the last decade.

“Robotic spine surgery to treat scoliosis and other deformities is our bread and butter. The robot guides us in the placement of pedicle screws, for example,” Schroeder said.

While surgical robotic technology has been around a while, Schroeder, along with Prof. Leon Kaplan, and Prof. Meir Liebergall, used it in a novel way in late December to treat a soldier who had a bullet stuck in his sacrum, the large triangular bone at the base of the spine.

Leaving the bullet in the body was not an option, as it would affect the nerves going down the leg and could also lead to lead poisoning.

“The soldier was initially brought to another hospital, and they said they could only operate by opening up the body. We said we could do robotically-assisted minimally invasive surgery. It would take no more than one and a half hours instead of half a day. And the recovery would be much easier and quicker,” Schroeder said.

The Hadassah surgeons used the Mazor robotic guidance system sold by the Israeli company Medtronic. Hadassah has one such robot at each of its Jerusalem campuses. The surgery to remove the bullet from the soldier was done at the Ein Kerem hospital.

Bullet removed from injured IDF soldier by Hadassah Medical Center spine surgeons using robot-guided minimally invasive surgery, December 2023. (Courtesy of Hadassah)

The team uploaded computed tomography scans from before the surgery and two “fluoro shots” (X-rays) taken in surgery. The robot merged all this input and calculated the exact location for the surgeons to go in and extract the bullet.

“We’ve also used the robot to do minimally invasive surgery to fix fractures in soldier’s spines, remove shrapnel, and treat various injuries of October 7 victims,” Schroeder said.

“We can do this because the robot gives us the perfect trajectory for going in to fix the problem,” he said.

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