Avi Yaron: The Young Engineer, His Inoperable Tumor and His Gift to Medicine

By | August 18, 2019

Imagine one instance that could thwart someone’s path forever. It was a path of urgency. Survival or death. The uncertain future was fueled by the agony of helplessness. This was how Avi Yaron, a young engineer, felt when fraught with the knowledge that his newfound brain tumor could alter his life forever. He was just 26 years old.

Before this happened, Avi had the world at his feet. He was a second-year engineering student having just spent 5 years as an officer in one of the Israeli Army Elite Intelligence Unit. He pursued electrical engineering at the same time, rarely attending a class. He simultaneously launched his first start-up and developed a high-performance digital ignition system to defray the expense of fixing his own motorcycle’s ignition system. The day after he left the army, while he was in school, he opened up his company and started manufacturing and selling that ignition system. Juggling all these responsibilities was normal for Avi. His Israeli service trained him to function at peak performance with only four hours of sleep every second night. His curiosity led him to develop the first microprocessor computer lab while also instructing at the university.

Since I can remember, I was always dismantling things. From a very young age, I would be taking apart alarm clocks, ovens, etc, trying to understand how they worked. It frustrated my parents; however by the age of 6, I was able to start assembling things back together.

By first grade, Avi started building electronic things like toy cars, and by sixth grade, he was eventually able to automate the things in his bedroom so the radio would wake him, the lights would turn on/off and the doors would open and close — on their own. It took a year to complete this; from a few printed boards he created on his own. Memory chips were not available at that time so he used a tape recorder as memory. He was a builder, continuously changing hobbies and learning on his own. Studies were boring and a waste of time. He studied to get the diplomas although he didn’t think he needed them. Avi thought he knew everything.

The Accident

It was 1993 and Avi finished teaching a computer lab. He hopped on his Ducati to drive to his start-up company. Moving at a good clip, he suddenly confronted the renovations on the highway ahead and the numerous vehicles that had managed to stop in time. It was too late. Avi could not stop and his motorcycle and collided into the car ahead of him. He sustained severe head trauma and lost consciousness. Sometime later, he awoke and managed to get home.  He stayed in bed for a few days to recover from the pain. He was insistent he didn’t need a doctor. After two weeks, his father forced Avi to see a neurologist. And that’s when he was met with devastating news.

I always had headaches but I thought this was because I lacked sleep.  The accident allowed the doctor to find the brain tumor… It saved my life. You could say it was fortuitous!

In complete disbelief, Avi sought out the best neurosurgeon in Israel and he confirmed the tumor but also asserted he may have cancer and would need surgery right away to remove it. The doctor said he operated on many such tumors and that Avi would be okay. Only later, during his research would Avi learn of the potential complications. Avi had never questioned doctors’ authority, but this time it was different. Something inside of him made him feel otherwise:

As I drove from Jerusalem back home, I thought about what he said. I remember looking into his eyes and I knew he wasn’t truthful. There was a huge dissonance between his words and his body language. I did not trust him.  I drove home and I promised myself, “He’s not going to operate on me”.

So Avi sought another opinion. The second neurosurgeon confirmed the tumor from the MRI but was steady in his belief there no immediate danger, and recommended Avi undergo another MRI in three months. Avi was shocked. He couldn’t believe the disparity in these two diagnoses. He proceeded to get a third opinion. This time the doctor recommended they proceed with a biopsy to determine if the tumor was malignant.

Three doctors. Three opinions. All decisive but no consistency. Avi did not know whom to trust. So he proceeded to study his condition on his own. He dove in and started learning about the body’s anatomy, biology, chemistry and started reading papers about his condition. He also pursued research on non-invasive technologies to determine his tumor’s malignancy, if anything. During his research, he focused on the location of his tumor. It was located in the ventricle, which was extremely rare. There were only 20 cases worldwide. A year later when Avi discovered his tumor was Neurocytoma, he was excited.

I lived in uncertainty for many months. Without the certainty of benign or malignant or whether this was a death sentence, knowing is everything. I now knew what I was dealing with.

Surgery

By narrowing it down to the type of tumor, Avi was able to find those neurosurgeons most acquainted with Neurocytoma. Dr. Patrick Kelly, entrepreneur and neurosurgeon, and Chairman at NYU at the time used his invention, computer-assisted brain surgery to operate successfully on eight Neurocytoma cases previously. This deep-seated procedure using a 3D stereoscope with enhancing imaging allowed Dr. Kelly to simulate the surgery via virtual reality beforehand, to ensure surgery was done in a minimally invasive way. 

Avi had the surgery and by all accounts, he was free and clear.  However, a year and a half later he learned they were unable to extract the entire tumor. A tiny residual had remained. Undeterred, Avi flew to New York expecting to rid himself of this once and for all. When Dr. Kelly announced that he wasn’t able to perform the surgery, it left Avi dumbfounded.  Kelly explained that previously he was able to make a tiny opening at the front of his head using the 3D microscope, which required a big opening. For the remnant tumor, this required a miniature stereoscopic camera to see deep inside the brain — something that had yet to be invented.

Avi took solace in knowing his tumor was benign. However, he felt empty and defeated. But not for long. He decided to use this time to do something about it. His natural curiosity drove him to start diving into solutions. For two years, he researched how the brain worked, and how it would properly receive stereoscopy, and approached the companies who attempted to manufacture the smaller microscope and failed. The companies in Germany and Japan, for the most part, used optomechanical stereoscopes that required a bigger opening to the brain.

My intuition was telling me they were all mistaken.  The more I learned neuroscience the more I understood.  One day I came up with a concept that used semi-conductors, nano-optics and algorithms to solve the issue. For the companies supplying optomechanical solutions, this idea was far-fetched. No one was familiar with such a combination.

Small-sized geometrical optical instruments like lenses and microscopes generally cannot focus light into nanometer scales without impacting their image resolution performance, known as the diffraction limit. Nano diffractive optics makes it possible to squeeze light into a nanoscale and coupling this with the electrical properties of semiconductors to enhance envelope of performance, Avi felt he had something. So he left his previous company and hired a Ph.D. physicist at his own expense to develop a solution.

Insect Eyes

It took about a year. The feasibility prototype resided on a big table. Avi relates this solution to an insect eye.

Insects have between 2-8 eyes. Each is completely independent and looks at certain locations, differing from each other. Each eye can also define depth. Because each eye is a matrix of many, many eyes, each focused on different locations, we are able to apply better depth perception to the object. Mammals, on the other hand, have two eyes so the brain will figure out the depth that relates to the difference in angle between the two eyes. The closer we are to an object the better depth definition we have. By combining the properties of the insect to the human eye we now have a single silicon matrix with tiny optics and two holes in front to represent two eyes.

The tabletop prototype was developed and soon received an endorsement from a professor at the Weitzman Institute, a world-renowned research organization focused on scientific innovation.  Investors convinced Avi to take care of his tumor as a condition of their investment. After a few surgeries and another 4 months of recuperation, Avi was able to close a $ 2MM seed investment. He proceeded to get started in building the product. The company known as Visionsense showed promise.  The initial system was built for laparoscopies (abdominal surgeries). It took 1.5 years to receive FDA clearance and they had built their sales organization to bring this solution to the US, Europe and Israel. Soon after, however, the tech bubble burst and the company was forced to downsize. Through major budget-cutting and a series of bridge-financing rounds, Avi was able to keep the company going but he changed the strategy and product to develop on an even smaller chip. 

After two more years and millions of dollars later, the result was the development of a 3 mm chip made up of an array of 800,000 lenses, which absorbed light and distributed it into specific volumetric pathways, and an image-processing algorithm to reconstruct the image as a 3D image.

Visionsense decided to license the technology to companies in other fields — robotic, spine, colonoscopy and cardiac surgery. Dr. Ted Schwartz, a renowned surgeon at Cornell University, and someone, who had followed Visionsense for some time, convinced Avi to develop a transnasal solution that would allow him to reach brain tumors through the sinus cavities. The company was progressing nicely.

Then came the impact from the 2008 financial crisis and the company was forced to downsize again. The medical world was not ready for 3D technology.  A year later, the movie, Avatar, was released and it was then that the world came to accept this new notion of 3D. By 2009, Visionsense had reached global sales, with US sales force and distributorships in Europe and Asia. 

Dr. Nelson Oyesiku, Professor of Neurosurgery and Medicine at Emory Healthcare used Visionsense’s 3D Endoscope in the Emory Pituitary Centre.  He speaks of the solution this way:

Traditionally there were two ways of operating on these types of [pituitary] tumors:  with a 2D endoscope and 3D microscope. 3D tells you where you are in space and this is critical in an area where you are surrounded by blood vessels and nerves. The last thing you want is stumbling into an artery because you didn’t know it was that close. The 3D endoscope takes from these two tools and marries the best features of both in one instrument. Emory was one of the very first institutions to deploy the 3D endoscope into its operations

Over time, Visionsense’s countless use cases and successful surgeries have been documented:  3D endoscopic AVM, 3D endoscopic Clival Biopsy, 3D endoscopic supraorbital approach, Fluorescence Guided Lap Chole, and Totally Endoscopic Mitral Valve Repair using 3D Videoscope

As Avi notes, this journey continues to be early to market:

Even today this technology is crazily far-fetched. It is a completely different way of thought. After all these years, few have managed to multiplex under the diffraction limit (“blur spot”). There are also a lot of trade-offs between technologies and most of them are on the edge of whatever is even possible.  We needed to play these trade-off to achieve what we have. We had to develop new techniques in the FAB, to manufacture the chip and then the nano-optics, testing large volumes using image processing. We had multiple technological disciplines within our team — something lacking even in large companies like Storz & Aesculap — world experts in optomechanics.

Some of these companies have tried to develop similar Visionsense technologies and have failed in the process. Over time, they became Visionsense partners.  

When the path, which someone takes is motivated by something entirely personal, they have the patience to see it through. For Avi, 19 years after this experience, through personal and business hurdles, he’s learned a valuable lesson about nascent technology.

Our company almost died twice. I realized the market has its own dynamics. You can’t push the markets. They have to be ready. The majority of our funding was spent on market education, not R&D. Eventually, new technologies will demand significant time and money to educate physicians/practitioners in new ways of doing things. By then, the technology may become obsolete. That is the opportunity… and the risk. 

One of the reasons we succeeded was I hired people smarter than me. I did not disturb their work but gave them the vision & support to succeed.  It was not only important to me, this was important for all of us, as a team.

The next path for Avi?  Using AI to predict emotional weakness & enhance individual resilience. After selling Visionsense, still unsatisfied, Avi came to believe that the root cause of most diseases was emotional. “Chronic” emotions may be our first notification signal when something is wrong. He believes the future of medicine is making a personalized predictive preventative system, to keep people healthy & happy.

Most people are too stressed from life intensity at work, school or home, lack of sleep, lack of proper nutrition, etc. These will hasten disease development. So if I can retrain the brains with neuroplasticity to cope with the stress through the parasympathetic system, we might not need to invest in so many efforts with chronic diseases; we will strengthen the healthy instead of fixing the broken…

Avi has advised, invested and incubated solutions in the field of “neuro wellness”: stress mechanisms, mood mechanisms, stress immunity, etc. 

Again, ahead of his time, Avi has the curiosity, and the patience to see this through. After all, he’s learned, he’s applying his lessons one careful step at a time.

Forbes – Healthcare