TED演講：一個工具，可以解決手術中最危險的一個環(huán)節(jié)

　　The first time I stood in the operating room and watched a real surgery, I had no idea what to expect. I was a college student in engineering. I thought it was going to be like on TV. Ominous music playing in the background, beads of sweat pouring down the surgeon's face. But it wasn't like that at all. There was music playing on this day, I think it was Madonna's greatest hits. (Laughter) And there was plenty of conversation, not just about the patient's heart rate, but about sports and weekend plans. And since then, the more surgeries I watched, the more I realized this is how it is. In some weird way, it's just another day at the office. But every so often the music gets turned down, everyone stops talking, and stares at exactly the same thing. And that's when you know that something absolutely critical and dangerous is happening.

　　我第一次進手術室 觀摩實際手術時， 沒預料會看到什么。 我當時是工科大學生。 我以為會像電視上演的一樣， 播著緊張的背景音樂， 豆大的汗珠由外科醫(yī)生臉上滑落。 但根本不是那樣。 當天的確有播音樂， 我想是瑪?shù)つ鹊慕鹎x輯。(笑聲) 當時還有許多交談， 話題除了病人心率外， 還有運動跟周末計劃。 我手術看得越多， 就越懂那是怎么回事。 從某個古怪角度來看，這跟在辦公室沒兩樣。 但有時， 音樂聲會被轉小， 所有人停止說話， 眼睛盯著同樣的東西。 那時你就知道，有很重要、 很危險的事情正在進行。

　　The first time I saw that I was watching a type of surgery called laparoscopic surgery And for those of you who are unfamiliar, laparoscopic surgery, instead of the large open incision you might be used to with surgery, a laparoscopic surgery is where the surgeon creates these three or more small incisions in the patient. And then inserts these long, thin instruments and a camera, and actually does the procedure inside the patient. This is great because there's much less risk of infection, much less pain, shorter recovery time. But there is a trade-off, because these incisions are created with a long, pointed device called a trocar. And the way the surgeon uses this device is that he takes it and he presses it into the abdomen until it punctures through. And now the reason why everyone in the operating room was staring at that device on that day was because he had to be absolutely careful not to plunge it through and puncture it into the organs and blood vessels below. But this problem should seem pretty familiar to all of you because I'm pretty sure you've seen it somewhere else. (Laughter) Remember this? (Applause) You knew that at any second that straw was going to plunge through, and you didn't know if it was going to go out the other side and straight into your hand, or if you were going to get juice everywhere, but you were terrified. Right? Every single time you did this, you experienced the same fundamental physics that I was watching in the operating room that day. And it turns out it really is a problem. In 2003, the FDA actually came out and said that trocar incisions might be the most dangerous step in minimally invasive surgery. Again in 2009, we see a paper that says that trocars account for over half of all major complications in laparoscopic surgery. And, oh by the way, this hasn't changed for 25 years.

　　首次遇到那狀況時， 我正在觀摩腹腔鏡手術。 為不熟悉的人說明一下， 腹腔鏡手術不像 傳統(tǒng)大切口的手術， 腹腔鏡手術中，外科醫(yī)生 在病人身上開三個以上的切口。 接著插入這些細長、 附攝影機的器材， 并透過它在病患體內進行手術。 這很不錯，因為感染風險低、 較少疼痛，恢復時間也更短。 但這其中有著取舍， 因為開這些切口 用的是個尖長的器械， 叫做穿刺套針。 而外科醫(yī)生用這器械的方法 是他抓著這東西， 然后壓在你的腹部， 直到它穿進去。 這就是為何在手術室的所有人 在當時都盯著那東西看， 因為他必須非常小心 不要穿太過， 以免刺穿下面的臟器和血管。 但這問題大家都很熟， 因為你們八成在其他地方看過了。 (笑聲) 記得這個吧? (掌聲) 你很清楚在某個時間點， 吸管會刺穿， 而你不知是否會穿透， 戳到你的手， 或把果汁噴得到處是。 你怕死了。對吧? 每次你做這件事， 所體驗到的物理原理， 都和我那天在手術室經(jīng)歷的一樣。 這顯然是個大問題。 2003 年，F(xiàn)DA 甚至出面表示： 套針穿刺或許是在微創(chuàng)手術中 最危險的步驟。 2009 年，我們又看到一篇論文說： 腹腔鏡手術的主要并發(fā)癥 有半數(shù)以上和穿刺套針有關。 噢!除此之外， 這件事已經(jīng) 25 年沒變了。

　　So when I got to graduate school, this is what I wanted to work on. I was trying to explain to a friend of mine what exactly I was spending my time doing, and I said, "It's like when you're drilling through a wall to hang something in your apartment. There's that moment when the drill first punctures through the wall and there's this plunge. Right? And he looked at me and he said, "You mean like when they drill into people's brains?" And I said, "Excuse me?" (Laughter) And then I looked it up and they do drill into people's brains. A lot of neurosurgical procedures actually start with a drill incision through the skull. And if the surgeon isn't careful, he can plunge directly into the brain. So this is the moment when I started thinking, okay, cranial drilling, laparoscopic surgery, why not other areas of medicine? Because think about it, when was the last time you went to the doctor and you didn't get stuck with something? Right? So the truth is in medicine puncture is everywhere. And here are just a couple of the procedures that I've found that involve some tissue puncture step. And if we take just three of them — laparoscopic surgery, epidurals, and cranial drilling — these procedures account for over 30,000 complications every year in this country alone. I call that a problem worth solving.

　　所以我上研究所時， 就想做這東西。 我試著跟朋友解釋 我到底在忙什么， 我說： 「這就像你為了掛東西 鉆墻壁那樣。 鉆子在鉆穿墻壁那個瞬間 會爆沖一下。對吧?」 然后他看著我說： 「你是說，像他們鉆人腦袋那樣?」 然后我說：「啥?!」(笑聲) 我后來查了一下，發(fā)現(xiàn)他們真會這么做。 很多的神經(jīng)外科手術 第一步就是在你顱骨上鉆個洞。 如果外科醫(yī)生不謹慎， 他有可能會直接戳到腦部。 從那時候我開始思考， 好，顱骨鉆孔、腹腔鏡手術， 那其他醫(yī)學領域呢? 你想想，哪次你去看醫(yī)生 沒被塞點什么，是吧? 事實就是， 在醫(yī)學上，穿刺無所不在。 而這只是我查到的幾種手術， 其中有組織穿刺的步驟。 如果我們只看其中三種── 腹腔鏡手術、硬膜外麻醉、顱骨鉆孔── 而這些手術引發(fā)了超過三萬起的并發(fā)癥， 而這只是這個國家一年的數(shù)字。 我認為這是個值得解決的問題。

　　So let's take a look at some of the devices that are used in these types of procedures. I mentioned epidurals. This is an epidural needle. It's used to puncture through the ligaments in the spine and deliver anesthesia during childbirth. Here's a set of bone marrow biopsy tools. These are actually used to burrow into the bone and collect bone marrow or sample bone lesions. Here's a bayonette from the Civil War. (Laughter) If I had told you it was a medical puncture device you probably would have believed me. Because what's the difference? So, the more I did this research the more I thought there has to be a better way to do this. And for me the key to this problem is that all these different puncture devices share a common set of fundamental physics.

　　讓我們來看一些 用在這類手術的器械。 我提過硬膜外麻醉。這是硬膜外套針。 他用來穿刺脊椎韌帶， 在分娩時注射麻醉藥。 這是組骨髓切片取樣工具， 用來做骨骼穿孔， 并收集骨髓，或做骨骼病變的取樣。 這是南北戰(zhàn)爭的刺刀。 (笑聲) 若我告訴你這是醫(yī)學穿刺器材， 你說不定真會相信我。 因為這沒什么不同嘛! 我越深入研究， 越是覺得 一定有更好的做法。 對我來說，問題的關鍵在于 所有的這些穿刺器材 都遵循同一套物理原理。

　　So what are those physics? Let's go back to drilling through a wall. So you're applying a force on a drill towards the wall. And Newton says the wall is going to apply force back, equal and opposite. So, as you drill through the wall, those forces balance. But then there's that moment when the drill first punctures through the other side of the wall, and right at that moment the wall can't push back anymore. But your brain hasn't reacted to that change in force. So for that millisecond, or however long it takes you to react, you're still pushing, and that unbalanced force causes an acceleration, and that is the plunge. But what if right at the moment of puncture you could pull that tip back, actually oppose the forward acceleration? That's what I set out to do.

　　什么原理呢? 讓我們回到鉆墻壁。 你透過鉆子對墻施加壓力， 牛頓告訴我們，墻壁會給我們反作用力， 等量且反向。 當你正在鉆的時候， 兩力平衡。 但在某個瞬間， 墻壁會被鉆穿， 墻壁將無法再提供反作用力。 但你的大腦還來不及對變化作出反應， 有幾毫秒時間 ──依你的反應速度而定，你還在施加壓力。 而不平衡的力造成加速度， 導致爆沖。 但如果在刺穿瞬間， 你能夠將針尖 往加速的反方向縮回呢? 那就是我要做的。

　　So imagine you have a device and it's got some kind of sharp tip to cut through tissue. What's the simplest way you could pull that tip back? I chose a spring. So when you extend that spring, you extend that tip out so it's ready to puncture tissue, the spring wants to pull the tip back. How do you keep the tip in place until the moment of puncture? I used this mechanism. When the tip of the device is pressed against tissue, the mechanism expands outwards and wedges in place against the wall. And the friction that's generated locks it in place and prevents the spring from retracting the tip. But right at the moment of puncture, the tissue can't push back on the tip anymore. So the mechanism unlocks and the spring retracts the tip. Let me show you that happening in slow motion. This is about 2,000 frames a second, and I'd like you to notice the tip that's right there on the bottom, about to puncture through tissue. And you'll see that right at the moment of puncture, right there, the mechanism unlocks and retracts that tip back. I want to show it to you again, a little closer up. You're going to see the sharp bladed tip, and right when it punctures that rubber membrane it's going to disappear into this white blunt sheath. Right there. That happens within four 100ths of a second after puncture. And because this device is designed to address the physics of puncture and not the specifics of cranial drilling or laparoscopic surgery, or another procedure, it's applicable across these different medical disciplines and across different length scales.

　　想象你有種器材， 它有用來刺穿組織的針尖。 把針尖縮回的最簡單方法是什么? 我選擇了彈簧。 當彈簧拉伸，針尖便伸出， 就能穿刺組織。 彈簧會想拉回針尖。 你如何在穿透前， 固定住針尖呢? 我采用這機械結構。 當針尖受到組織的反作用力， 這機構會向外撐向內壁。 而其產(chǎn)生的摩擦力 會鎖定針尖，阻止彈簧將它縮回。 但在穿透瞬間， 組織不再提供反作用力。 所以機構解鎖，彈簧將針尖縮回。 看一下慢動作。 這大約每秒 2,000 畫格。 注意針尖的部分， 在畫面下方，即將刺穿組織。 你會發(fā)現(xiàn)在刺穿的瞬間， 在這，機構解鎖，針尖縮回。 我們拉近點再看一次。 你會看到那尖銳的針尖， 在它刺穿橡膠膜的瞬間， 會縮進那個鈍邊白色套管。 在這。 這一切都在百分之四秒內發(fā)生。 而且因為這項設計是遵循穿刺的物理原理 而非針對顱骨鉆孔、 腹腔鏡手術或其他手術， 其適用范圍涵蓋醫(yī)學各領域， 以及各種不同規(guī)模。

　　But it didn't always look like this. This was my first prototype. Yes, those are popsicle sticks, and there's a rubber band at the top. It took about 30 minutes to do this, but it worked. And it proved to me that my idea worked and it justified the next couple years of work on this project. I worked on this because this problem really fascinated me. It kept me up at night. But I think it should fascinate you too, because I said puncture is everywhere. That means at some point it's going to be your problem too. That first day in the operating room I never expected to find myself on the other end of a trocar. But last year, I got appendicitis when I was visiting Greece. So I was in the hospital in Athens, and the surgeon was telling me he was going to perform a laparoscopic surgery. He was going to remove my appendix through these tiny incisions, and he was talking about what I could expect for the recovery, and what was going to happen. He said, "Do you have any questions?" And I said, "Just one, doc. What kind of trocar do you use?"

　　但它不見得長這樣。 這是我作品的原型。 對，那是棒冰棍， 頂部那是橡皮筋。 做這只花 30 分鐘，但成品就有用了。 它證明我的想法可行， 并讓我接下來幾年的付出有所憑據(jù)。 我投入其中， 因為這問題讓我著迷， 甚至使我夜不能眠。 但我想這也該吸引你， 因為穿刺無所不在。 意味著在某個時刻，那也將成為你的問題。 進手術室第一天， 我沒料到有天穿刺套針會用在我身上。 但去年，我在希臘時患上闌尾炎。 我在雅典的醫(yī)院， 外科醫(yī)生告知我 他將進行腹腔鏡手術。 他將透過那些小切口切除闌尾， 接著他告訴我預期的康復狀況、 接下來會做什么。 他說：「你有什么問題嗎?」我說：「只有一個。 你們用的是哪種穿刺套針?」

　　So my favorite quote about laparoscopic surgery comes from a Doctor H. C. Jacobaeus: "It is puncture itself that causes risk." That's my favorite quote because H.C. Jacobaeus was the first person to ever perform laparoscopic surgery on humans, and he wrote that in 1912. This is a problem that's been injuring and even killing people for over 100 years.

　　8:20 關于腹腔鏡手術，我最愛的引語 出自雅各布貝烏斯醫(yī)師： 「造成風險的，是穿刺本身?！?這是我最愛的引語，因為雅各布貝烏斯 是在人體進行腹腔鏡手術的第一人。 而他在 1912 年寫下這句話。 這問題傷害人們，甚至致人于死已超過百年之久。

　　So it's easy to think that for every major problem out there there's some team of experts working around the clock to solve it. The truth is that's not always the case. We have to be better at finding those problems and finding ways to solve them. So if you come across a problem that grabs you, let it keep you up at night. Allow yourself to be fascinated, because there are so many lives to save.

　　你可以安逸地想說，重要問題 已有一群專家不眠不休致力解決。 真相是，事情并非總如此。 我們得找到這樣的問題， 并找方法解決。 所以若你遇到那種「刺眼」的問題，

　　(Applause)