Catherine Mohr: Surgery's past, present and robotic future

Translator: Belén García Penerbosa Reviewer: Serv. de Norm. Lingüística U. de Santiago de Compostela

Unha charla sobre robots cirúrxicos

tamén o é sobre cirurxía.

A talk about surgical robots

Aínda que intentei que as imaxes non fosen moi gráficas,

is also a talk about surgery.

recorden que os cirurxiáns ven o sangue dunha maneira diferente

And while I've tried to make my images not too graphic,

á do resto do mundo,

porque, despois de todo, o traballo dun cirurxián,

keep in mind that surgeons have a different relationship with blood

than normal people do,

se se fixese sen consentimento,

because, after all, what a surgeon does to a patient,

sería un crime.

Os cirurxiáns son os xastres, os fontaneiros, os carpinteiros,

if it were done without consent,

would be a felony.

--alguén diría que os carniceiros--

Surgeons are the tailors, the plumbers,

do mundo da medicina:

cortando, remodelando, corrixindo,

the carpenters -- some would say the butchers --

derivando, arranxando...

of the medical world:

cutting, reshaping, reforming,

Pero hai que falar sobre instrumental cirúrxico

bypassing, fixing.

e a evolución da tecnoloxía cirúrxica de maneira conxunta.

But you need to talk about surgical instruments

Para darlles unha idea sobre onde estamos agora

and the evolution of surgical technology together.

cos robots cirúrxicos

So in order to give you some kind of a perspective

e cara a onde nos diriximos,

gustaríame poñelos en situación;

of where we are right now

with surgical robots,

dicirlles como chegamos ata aquí,

and where we're going to be going in the future,

como chegamos a pensar

I want to give you a little bit of perspective

que a cirurxía estaba ben,

of how we got to this point,

que era algo posible de facer,

how we even came to believe

que a forma de traballar era a correcta.

that surgery was OK,

that this was something that was possible to do,

Así que, un pouco de perspectiva

that this kind of cutting and reforming was OK.

--uns 10.000 anos de perspectiva.

Este é un cranio trepanado.

So, a little bit of perspective --

Trepanar simplemente é abrir un buraco no cranio.

about 10,000 years of perspective.

This is a trephinated skull.

Moitos, moitos centos de cranios coma este

And trephination is simply just cutting a hole in the skull.

se atoparon en escavacións arqueolóxicas,

por todo o mundo,

And many, many hundreds of skulls like this

con antigüidades de entre 5 e 10 mil anos.

have been found in archaeological sites

Entre 5 e 10 mil anos!

all over the world,

Agora imaxínense isto:

dating back five to 10 thousand years.

Son curandeiros nunha aldea da Idade de Pedra

Five to 10 thousand years! Now imagine this.

e teñen un mozo ao que non saben que lle pasa.

You are a healer in a Stone Age village.

--Oliver Sacks aínda non naceu.

And you have some guy that you're not quite sure what's wrong with him --

O mozo ten un trastorno convulsivo, pero aínda non saben o que é isto.

Oliver Sacks is going to be born way in the future.

Pero pensan para si mesmos:

"Non sei que é o que lle pasa,

He's got some seizure disorder. And you don't understand this.

pero igual podo curalo se lle fago un burato no cranio".

But you think to yourself,

(Risas)

"I'm not quite sure what's wrong with this guy.

Iso é o que se chama pensamento cirúrxico.

But maybe if I cut a hole in his head I can fix it."

Xa estamos no albor da cirurxía intervencionista.

(Laughter)

Now that is surgical thinking.

O máis abraiante de todo isto,

Now we've got the dawn of interventional surgery here.

aínda que non sabemos ata que punto pertencía

What is astonishing about this is,

ao ámbito relixioso,

even though we don't know really how much of this

ou ata que punto pretendía ser terapéutico,

é que podemos dicir que estes pacientes sobreviviron!

was intended to be religious,

Xulgando pola curación dos bordos dos buracos,

or how much of it was intended to be therapeutic,

viviron días, meses e incluso anos tras a trepanación.

what we can tell is that these patients lived!

Judging by the healing on the borders of these holes,

Así que o que vemos é a evidencia

they lived days, months, years following trephination.

dunha técnica refinada

que se empregaría durante miles e miles de anos,

And so what we are seeing is evidence

ao longo de todo o mundo.

of a refined technique

A técnica xurdiu de forma independente en diferentes lugares

that was being handed down over thousands and thousands of years,

sen comunicación entre eles.

all over the world.

Dende logo que estamos no albor da cirurxía intervencionista.

This arose independently at sites everywhere

that had no communication to one another.

Agora avanzaremos varios miles de anos,

We really are seeing the dawn of interventional surgery.

ata a Idade de Bronce en diante,

e vemos como aparece novo e refinado instrumental.

Now we can fast forward many thousands of years

Porén, os cirurxiáns destas épocas son un pouco máis conservadores

into the Bronze Age and beyond.

ca os seus atrevidos e trepanadores devanceiros.

And we see new refined tools coming out.

Estas persoas limitaron a súa cirurxía

But surgeons in these eras are a little bit more conservative

a feridas superficiais.

than their bold, trephinating ancestors.

Os cirurxiáns eran comerciantes,

These guys confined their surgery

máis ca médicos.

to fairly superficial injuries.

Isto seguiu así ata pasar o Renacemento,

And surgeons were tradesmen,

rather than physicians.

que puido salvar aos escritores,

pero non prestou atención aos cirurxiáns.

This persisted all the way into and through the Renaissance.

Seguíase desconfiando deles.

That may have saved the writers,

Os cirurxiáns aínda tiñan problemas como relacións públicas,

but it didn't really save the surgeons terribly much.

They were still a mistrusted lot.

porque o panorama dominante

era o dos barbeiros-cirurxiáns ambulantes.

Surgeons still had a bit of a PR problem,

Esta xente viaxaba de aldea en aldea, de cidade en cidade,

because the landscape was dominated

by the itinerant barber surgeon.

operando como forma de arte en vivo.

These were folks that traveled from village to village, town to town,

Neste momento non existía a anestesia,

doing surgery sort of as a form of performance art.

e a dor do paciente

formaba parte dese espectáculo público

tanto como a cirurxía en si mesma.

Because we were in the age before anesthesia,

the agony of the patient

Un dos máis famosos cirurxiáns deste tipo,

is really as much of the public spectacle

Frère Jacques,

as the surgery itself.

aparece aquí realizando unha litotomía

One of the most famous of these guys, Frere Jacques,

--a extracción de cálculos na vexiga,

unha das cirurxías máis invasivas da época--

shown here doing a lithotomy --

que tiña que realizar en menos de dous minutos.

which is the removal of the bladder stone,

Hai que ter talento para o espectáculo

one of the most invasive surgeries they did at the time --

e ser moi, moi rápido.

had to take less than two minutes.

E velaquí está, realizando unha litotomía.

You had to have quite a flair for the dramatic,

Recoñécenselle máis de 4.000 cirurxías deste tipo,

and be really, really quick.

And so here you see him doing a lithotomy.

por toda Europa,

And he is credited with doing over 4,000 of these public surgeries,

o que é realmente impresionante,

tendo en conta que a cirurxía debía ser o último recurso.

wandering around in Europe,

Quen se sometería a ela?

which is an astonishing number,

when you think that surgery must have been a last resort.

Ata a chegada da anestesia e a ausencia de sensibilidade.

I mean who would put themselves through that?

A presentación do inhalador Morton Ether,

Until anesthesia, the absence of sensation.

no Hospital Xeral de Massachusetts, no ano 1847,

marcou o inicio dunha nova era cirúrxica.

With the demonstration of the Morton Ether Inhaler

at the Mass. General in 1847,

A anestesia deulles aos cirurxiáns a liberdade para operar.

a whole new era of surgery was ushered in.

A anestesia deulles a liberdade para experimentar,

Anesthesia gave surgeons the freedom to operate.

para indagar con profundidade o corpo.

Dende logo que foi unha revolución no ámbito da cirurxía.

Anesthesia gave them the freedom to experiment,

to start to delve deeper into the body.

Pero había un gran problema con isto.

This was truly a revolution in surgery.

Despois destas longas e minuciosas operacións,

intentando curar cousas que ata daquela nunca viran,

But there was a pretty big problem with this.

After these very long, painstaking operations,

os pacientes morrían.

attempting to cure things they'd never been able to touch before,

Morrían por mor de infeccións xeneralizadas.

the patients died.

A cirurxía xa non doía,

pero mataba moi rápido.

They died of massive infection.

As infeccións eran a principal causa de morte en operacións

Surgery didn't hurt anymore,

but it killed you pretty quickly.

ata a nova gran revolución en cirurxía:

And infection would continue to claim a majority of surgical patients

a técnica aséptica.

until the next big revolution in surgery,

Joseph Lister era o maior defensor

which was aseptic technique.

da asepsia e da esterilidade

entre un gran grupo de cirurxiáns escépticos.

Joseph Lister was aepsis's,

or sterility's, biggest advocate,

Pero finalmente deixáronse convencer.

Os irmáns Mayo visitaron a Lister en Europa

to a very very skeptical bunch of surgeons.

e cando volveron á súa clínica en América,

But eventually they did come around.

dixeron que aprenderan que era tan importante

The Mayo brothers came out to visit Lister in Europe.

lavar as mans antes de operar

And they came back to their American clinic and they said

como facelo despois de operar.

they had learned it was as important to wash your hands

(Risas)

Algo tan sinxelo.

before doing surgery

Agora si, a mortalidade diminuíu enormemente.

as it was to wash up afterwards. (Laughter)

As operacións estaban sendo efectivas.

Something so simple.

And yet, operative mortality dropped profoundly.

Cun paciente insensible á dor

These surgeries were actually now being effective.

e un contorno operatorio estéril,

With the patient insensitive to pain,

calquera cousa podía pasar, o ceo era o límite.

and a sterile operating field

Agora podíase operar calquera cousa:

all bets were off, the sky was the limit.

os intestinos, o fígado,

You could now start doing surgery everywhere,

o corazón, o cerebro...

Transplantes:

podías coller un órgano dunha persoa, poñerllo a outra, e funcionaría.

on the gut, on the liver,

on the heart, on the brain.

Os cirurxiáns agora eran respectados,

Transplantation: you could take an organ out of one person,

you could put it in another person, and it would work.

convertéronse en deuses.

Chegamos á era do "gran cirurxián, gran incisión"

Surgeons didn't have a problem with respectability anymore;

they had become gods.

pero a que custo,

The era of the "big surgeon, big incision" had arrived,

porque estaban salvando vidas,

pero non a calidade de vida,

but at quite a cost,

porque a xente sa non precisa cirurxía normalmente,

because they are saving lives,

but not necessarily quality of life,

e á xente enferma cústalle moito recuperarse dun corte coma ese.

because healthy people don't usually need surgery,

Tíñanse que facer unha pregunta:

and unhealthy people have a very hard time recovering from a cut like that.

"Poderíamos facer estas operacións

pero a través de pequenas incisións?"

The question had to be asked,

"Well, can we do these same surgeries

A laparoscopia leva a cabo este tipo de cirurxía:

but through little incisions?"

operar con instrumental longo a través de pequenas incisións.

Laparoscopy is doing this kind of surgery:

Isto cambiou enormemente o mundo da cirurxía.

surgery with long instruments through small incisions.

Parte do instrumental existía dende había centos de anos

And it really changed the landscape of surgery.

pero só se utilizara como técnica de diagnóstico ata os 80,

Some of the tools for this had been around for a hundred years,

cando se produciron cambios nas cámaras e en material similar,

but it had only been used as a diagnostic technique

que lles permitiu utilizalas para operacións reais.

until the 1980s,

when there was changes in camera technologies and things like that,

Así que o que ven --esta é a primeira imaxe cirúrxica--

that allowed this to be done for real operations.

segundo baixamos polo conduto, é un novo acceso ao corpo.

So what you see -- this is now the first surgical image --

É moi diferente de como se espera que sexa a cirurxía.

as we're coming down the tube, this is a new entry into the body.

Introducimos o instrumental

dende dúas incisións diferentes

It looks very different from what you're expecting surgery to look like.

e xa podemos empezar a traballar no tecido.

We bring instruments in,

10 anos despois das primeiras operacións de vesícula

from two separate cuts in the side,

and then you can start manipulating tissue.

mediante laparoscopia,

Within 10 years of the first gallbladder surgeries

a maior parte destas operacións

séguense facendo por laparoscopia

being done laparoscopically,

--outra gran revolución, dende logo.

a majority of gallbladder surgeries

were being done laparoscopically --

Pero houbo vítimas desta revolución.

truly a pretty big revolution.

Estas técnicas eran moito máis complexas

But there were casualties of this revolution.

do que a xente pensaba.

A curva de aprendizaxe foi moi longa

e no seu transcurso, as complicacións foron a máis.

These techniques were a lot harder to learn

than people had anticipated.

The learning curve was very long.

Os cirurxiáns tiveron que renunciar á visión 3D.

And during that learning curve the complications went quite a bit higher.

Tiveron que renunciar ao seu pulso.

Aos movementos intuitivos do instrumental.

Surgeons had to give up their 3D vision.

They had to give up their wrists.

Este cirurxián ten unhas 3.000 horas de experiencia laparoscópica.

They had to give up intuitive motion in the instruments.

This surgeon has over 3,000 hours of laparoscopic experience.

Esta introdución da agulla foi particularmente difícil.

É difícil.

Now this is a particularly frustrating placement of the needle.

Unha das razóns polas que é tan difícil

é porque a ergonomía externa é terrible.

But this is hard.

And one of the reasons why it is so hard

Teñen este instrumental longo e traballan fóra do seu eixe central.

is because the external ergonomics are terrible.

E o instrumental practicamente funciona ao revés..

You've got these long instruments, and you're working off your centerline.

Así que, o que hai que facer para coller as capacidades da man

And the instruments are essentially working backwards.

e introducilas no outro lado desa pequena incisión,

So what you need to do, to take the capability of your hand,

é engadirlle un pulso ao instrumental.

and put it on the other side of that small incision,

E así --falando de robots--

is you need to put a wrist on that instrument.

o robot da Vinci

introduciu ese pulso no outro lado da incisión.

And so -- I get to talk about robots --

Aquí pode verse o funcionamento dese pulso.

the da Vinci robot

put just that wrist on the other side of that incision.

Agora, a diferenza da laparoscopia,

pódese colocar unha agulla no instrumental,

And so here you're seeing the operation of this wrist.

And now, in contrast to the laparoscopy,

introducilo polo corte

e seguir a súa traxectoria.

you can precisely place the needle in your instruments,

A razón pola cal facilita tanto o traballo

and you can pass it all the way through

--pódeno ver na parte inferior--

and follow it in a trajectory.

é que as mans fan os movementos

And the reason why this becomes so much easier

is -- you can see on the bottom --

e o instrumental cópiaos á perfección.

the hands are making the motions,

O que se pon entre o instrumental e as mans

and the instruments are following those motions exactly.

é un complexo robot de grandes dimensións.

Now, what you put between those instruments and those hands,

O cirurxián senta á consola

is a large, fairly complicated robot.

e controla o robot con eses mandos.

O robot move o instrumental,

The surgeon is sitting at a console,

and controlling the robot with these controllers.

impulsándoo cara ao interior do corpo.

And the robot is moving these instruments around,

Hai unha cámara 3D, así que temos visión 3D.

and powering them, down inside the body.

Dende que se deu a coñecer en 1999,

You have a 3D camera, so you get a 3D view.

ensambláronse moitos robots deste tipo

And since this was introduced in 1999,

para usarse en intervencións cirúrxicas como a prostatectomía,

a lot of these robots have been out

que é un afundimento da próstata na pelve,

and being used for surgical procedures like a prostatectomy,

que require unha disección fina

e unha manipulación delicada

which is a prostate deep in the pelvis,

para obter un bo resultado cirúrxico.

and it requires fine dissection

Tamén se poden coser pontes coronarias directamente nun corazón latexante

and delicate manipulation

to be able to get a good surgical outcome.

sen abrir a caixa torácica.

You can also sew bypass vessels directly onto a beating heart

Tan só traballando entre as costelas.

Incluso se pode introducir no mesmo corazón

without cracking the chest.

e reparar as válvulas dende o interior.

This is all done in between the ribs.

And you can go inside the heart itself

Teñen toda esta tecnoloxía

(aplausos) --grazas--

and repair the valves from the inside.

E poden pensar: "Vaia, isto está moi ben!

You've got these technologies -- thank you --

Pero a ver listiños, por que non se fan así todas as operacións?"

(Applause)

Hai varias razóns, varias razóns de peso.

And so you might say, "Wow this is really cool!

So, smartypants, why isn't all surgery being done this way?"

O custo é unha delas.

Falei de complexos robots de grandes dimensións;

And there are some reasons, some good reasons.

con todos os seus compoñentes, un destes robots

And cost is one of them.

custará tanto como un cirurxián de ouro puro.

I talked about the large, complicated robot.

With all its bells and whistles, one of those robots

Máis útil ca un cirurxián de outro puro,

pero aínda así, un investimento desorbitado.

will cost you about as much as a solid gold surgeon.

More useful than a solid gold surgeon,

Porén, unha vez que se ten, os custos do procedemento diminúen.

but, still, it's a fairly big capital investment.

But once you've got it, your procedure costs do come down.

Aínda así, hai outras trabas.

Algo como unha prostatectomía

--a próstata é pequena e está nun punto fixo

But there are other barriers.

polo que podes orientar o robot con precisión

So something like a prostatectomy --

para traballar sobre ese punto.

the prostate is small, and it's in one spot,

É perfecto para algo así.

and you can set your robot up very precisely

De feito, se a vostedes, ou a calquera que coñezan,

to work in that one spot.

lles extraeron a próstata nos últimos dous anos,

And so it's perfect for something like that.

hai moitas posibilidades de que o fixesen deste xeito.

And in fact if you, or anyone you know,

had their prostate taken out in the last couple of years,

Pero se houbese que chegar a máis de un lugar,

chances are it was done with one of these systems.

necesitarían mover o robot.

But if you need to reach more places than just one,

Para iso, habería que realizar novas incisións

e habería que reprogramalo.

you need to move the robot.

E hai que incluír máis e máis portos.

And you need to put some new incisions in there.

And you need to re-set it up.

E o problema é que se perde moito tempo, e que se volve difícil de manexar.

And then you need to add some more ports, and more.

É por isto que moitas das operacións

non se fan co da Vinci.

And the problem is it gets time-consuming, and cumbersome.

And for that reason there are many surgeries

Así que temos que facernos unha pregunta: "Entón, como arranxamos isto?"

that just aren't being done with the da Vinci.

Que pasaría se os puidésemos cambiar sen reprogramalos

So we had to ask the question, "Well how do we fix that?"

cada vez que os houbera que mover de lugar?

What if we could change it so that we didn't have to re-set up

Que pasaría se puidésemos incluír todo o instrumental

nun mesmo lugar?

each time we wanted to move somewhere different?

Como influiría iso nas capacidades do cirurxián?

What if we could bring all the instruments

in together in one place?

E como cambiaría iso a experiencia do paciente?

How would that change the capabilities of the surgeon?

Pero para facer iso,

And how would that change the experience for the patient?

temos que ser capaces de introducir xuntos unha cámara

e o instrumental por un tubo de pequenas dimensións,

Now, to do that,

we need to be able to bring a camera

como o que vimos no vídeo da laparoscopia.

and instruments in together through one small tube,

Ou --e non é casualidade--, nun tubo coma este.

like that tube you saw in the laparoscopy video.

Or, not so coincidentally, like a tube like this.

O que tería que saír dese tubo

é o comezo desta nova tecnoloxía,

este novo robot que será capaz de chegar a calquera lado.

So what's going to come out of that tube

is the debut of this new technology,

Listos?

this new robot that is going to be able to reach anywhere.

Velaquí está..

Esta é a cámara, e tres instrumentos.

Ready? So here it comes.

Como poden ver,

para que se poida traballar con el,

This is the camera, and three instruments.

non pode estar agrupado deste xeito.

And as you see it come out,

Débese poder separar do eixe central

in order to actually be able to do anything useful,

it can't all stay clustered up like this.

e despois poder reagrupalo.

It has to be able to come off of the centerline

É un diañiño insolente.

and then be able to work back toward that centerline.

Pero o que permite facer

é dar a tracción necesaria,

He's a cheeky little devil.

e a contratracción,

para que se poida diseccionar, para que se poida coser,

But what this lets you do

is gives you that all-important traction,

e para que se poida facer todo o que faga falta;

and counter-traction,

todas as accións cirúrxicas.

so that you can dissect, so that you can sew,

Todo a través dunha incisión.

so that you can do all the things that you need to do,

Non é tan sinxelo.

all the surgical tasks.

But it's all coming in through one incision.

Pero merece a pena pola liberdade que nos achega

It's not so simple.

durante todo o proceso.

Porén, para o paciente,

But it's worth it for the freedom that this gives us

as we're going around.

apenas é nada.

Isto é todo o que van ver.

For the patient, however,

É apaixonante pensar a onde nos vai levar todo isto.

it's transparent. This is all they're going to see.

Estamos a escribir o guión da próxima revolución en cirurxía.

It's very exciting to think where we get to go with this.

Mentres collemos estas capacidades e decidimos a onde imos ir,

We get to write the script of the next revolution in surgery.

temos que decidir cales van ser as nosas novas cirurxías.

As we take these capabilities, and we get to go to the next places,

Creo que coñezo o resto do camiño

we get to decide what our new surgeries are going to be.

nesa revolución;

non só temos que levar as nosas mans por novos camiños

And I think to really get the rest of the way

senón que tamén temos que levar os nosos ollos.

in that revolution,

we need to not just take our hands in in new ways,

Temos que ver máis alá da superficie.

Temos que ser capaces de manexar o que estamos cortando

we also need to take our eyes in in new ways.

dunha maneira máis eficaz.

We need to see beyond the surface.

We need to be able to guide what we're cutting

Esta é unha operación de cancro.

in a much better way.

Un dos problemas aquí,

incluso para os cirurxiáns que traballaron moito con isto,

This is a cancer surgery.

é que o cancro non se pode ver,

One of the problems with this,

sobre todo cando está escondido baixo a superficie.

even for surgeons who've been looking at this a lot,

is you can't see the cancer,

Así que o que se comeza a facer

é inxectar marcadores especialmente deseñados

especially when it's hidden below the surface.

no torrente sanguíneo para identificar o cancro.

And so what we're starting to do

is we're starting to inject specially designed markers

Uniranse ao cancro

into the bloodstream that will target the cancer.

e podemos facer que brillen.

Podemos utilizar cámaras especiais

It will go, bind to the cancer.

e podemos velos.

And we can make those markers glow.

Agora sabemos onde temos que cortar,

And we can take special cameras,

incluso estando baixo a superficie.

and we can look at it.

Podemos coller estes marcadores e inxectalos onde se atopa o tumor

Now we know where we need to cut,

even when it's below the surface.

e seguilos por onde vaian

We can take these markers and we can inject them in a tumor site.

para ver a que lugares podería chegar o cancro.

And we can follow where they flow out from that tumor site,

so we can see the first places where that cancer might travel.

Podemos inxectar estas tinturas no torrente sanguíneo

para que cando fagamos unha ponte coronaria

e conectemos unha vea ao corazón,

We can inject these dyes into the bloodstream,

vexamos se fixemos ben a conexión

so that when we do a new vessel

antes de coser ao paciente

and we bypass a blockage on the heart,

--algo que non se podía facer antes

we can see if we actually made the connection,

sen radiación.

before we close that patient back up again --

Podemos iluminar tumores,

something that we haven't been able to do

without radiation before.

como este tumor de ril,

para saber exactamente onde está o límite

We can light up tumors

entre o tumor e o ril que queres conservar,

like this kidney tumor,

so that you can exactly see where the boundary is

ou entre o tumor de fígado e o fígado que queres conservar.

between the kidney tumor and the kidney you want to leave behind,

Nin sequera temos que limitarnos

or the liver tumor and the liver you want to leave behind.

a esta visión macro.

Temos sondas microscópicas flexibles

And we don't even need to confine ourselves

que se poden introducir no corpo

to this macro vision.

para ver as células directamente.

We have flexible microscopic probes

Aquí estamos vendo nervios.

that we can bring down into the body.

Estes son nervios, aí no fondo, e esta, a sonda microscópica

And we can look at cells directly.

suxeita á man robotizada, aí arriba.

I'm looking at nerves here. So these are nerves you see, down on the bottom,

Ata agora todo é un prototipo.

and the microscope probe that's being held by the robotic hand, up at the top.

Pero para o paciente dunha operación, os nervios si que importan.

So this is all very prototypey at this point.

Porque lle permiten manter a continencia,

But you care about nerves, if you are a surgical patient.

o control sobre a vexiga e as funcións sexuais

tras a operación, o que é moi importante para el.

Because they let you keep continence,

bladder control, and sexual function after surgery,

all of which is generally fairly important to the patient.

Coa combinación destas tecnoloxías podemos ver e abranguer todo isto.

So, with the combination of these technologies

Podemos curar a enfermidade

we can reach it all, and we can see it all.

e deixar ao paciente dunha soa peza,

intacto e funcional despois de todo.

We can heal the disease.

And we can leave the patient whole and intact

Pois ben, falei do paciente

como se fose, dalgún xeito,

and functional afterwards.

un ente abstracto alleo a esta sala.

Now, I've talked about the patient

E non é así.

as if the patient is, somehow, someone abstract

Moitos de vostedes, quizais todos vostedes,

outside this room.

terán, ou xa tiveron, que facerlle fronte a unha diagnose de cancro,

And that is not the case.

Many of you, all of you maybe,

unha enfermidade cardíaca ou a algunha disfunción orgánica

will at some point, or have already, faced a diagnosis of cancer,

que os levará a unha cita cun cirurxián.

or heart disease, or some organ dysfunction

E cando chegue este momento

that's going to buy you a date with a surgeon.

--porque a estas enfermidades non lles importa

And when you get to that point --

cantos libros escribiron,

cantas empresas fundaron,

I mean, these maladies don't care

o premio Nobel que aínda non gañaron

how many books you've written,

ou canto tempo contaban pasar cos seus fillos.

how many companies you've started,

Estas enfermidades veñen por todos nós.

that Nobel Prize you have yet to win,

how much time you planned to spend with your children.

A perspectiva que lles ofrezo, dunha cirurxía máis sinxela,

vai facer que o diagnóstico sexa menos aterrador?

These maladies come for us all.

And the prospect I'm offering you, of an easier surgery ...

Nin sequera sei se é o que quero.

is that going to make that diagnosis any less terrifying?

Porque facerlle fronte á túa propia morte

I'm not sure I really even want it to.

obríganos a reavaliar as prioridades

Because facing your own mortality

e a reconsiderar os obxectivos vitais,

causes a re-evaluation of priorities,

de forma moi diferente.

En ningún momento querería privalos desta revelación.

and a realignment of what your goals are in life, unlike anything else.

No seu lugar, o que quero

And I would never want to deprive you of that epiphany.

é que estean dunha peza, intactos

What I want instead,

e funcionais abondo como para saír e salvar o mundo

is for you to be whole, intact,

cando decidan que iso é o que queren.

and functional enough to go out and save the world,

E ese é o meu desexo para o seu futuro.

after you've decided you need to do it.

Grazas

And that is my vision for your future.

(Aplausos)

Thank you.

(Applause)