Nikolai Begg: A tool to fix one of the most dangerous moments in surgery

Translator: Bob Prottas Reviewer: Ariana Bleau Lugo

Prevoditelj: Maja Covic Recezent: Ivan Stamenković

The first time I stood in the operating room

Prvi puta kada sam se nalazio u operacijskoj sali

and watched a real surgery,

i promatrao pravu operaciju,

I had no idea what to expect.

nisam imao pojma što mogu očekivati.

I was a college student in engineering.

Studirao sam strojarstvo,

I thought it was going to be like on TV.

mislio sam da će biti kao na televiziji.

Ominous music playing in the background,

Zlokobna glazba u pozadini,

beads of sweat pouring down the surgeon's face.

grašci znoja kako klize niz kirurgovo lice.

But it wasn't like that at all.

No, uopće nije bilo tako.

There was music playing on this day,

Taj dan svirala je glazba,

I think it was Madonna's greatest hits. (Laughter)

mislim da su bili Madonnini najveći hitovi. (Smijeh)

And there was plenty of conversation,

I puno se razgovaralo,

not just about the patient's heart rate,

ne samo o pacijentovu radu srca,

but about sports and weekend plans.

već i o sportu i planovima za vikend.

And since then, the more surgeries I watched,

I otada, što sam više operacija promatao,

the more I realized this is how it is.

to sam više shvaćao da to upravo tako izgleda.

In some weird way, it's just another day at the office.

Na neki čudan način, to je kao uobičajen dan u uredu.

But every so often

Ali svako malo

the music gets turned down,

glazba utihne,

everyone stops talking,

razgovor prestane,

and stares at exactly the same thing.

a napeti pogledi su svima jednaki.

And that's when you know that something absolutely critical

Tada znate da se nešto jako kritično

and dangerous is happening.

i opasno događa.

The first time I saw that

Prvi puta kada sam to vidio

I was watching a type of surgery

promatrao sam

called laparoscopic surgery

laparoskopsku operaciju.

And for those of you who are unfamiliar,

Za vas koji niste upućeni,

laparoscopic surgery, instead of the large

laparoskopska operacija, za razliku od velikog

open incision you might be used to with surgery,

otvorenog zahvata koji vjerojatno vežete uz operaciju,

a laparoscopic surgery is where the surgeon creates

zahvat je kod kojeg kirurg napravi

these three or more small incisions in the patient.

tri ili više malih rezova na pacijentu.

And then inserts these long, thin instruments

Onda ugura dugačke tanke instrumente

and a camera,

i kameru,

and actually does the procedure inside the patient.

i obavi operaciju unutar pacijenta.

This is great because there's much less risk of infection,

Ovo je odlično jer postoji mnogo manji rizik od infekcije,

much less pain, shorter recovery time.

manje boli i kraći je oporavak.

But there is a trade-off,

No, tome ima i druga strana,

because these incisions are created

budući da se ovi rezovi rade

with a long, pointed device

dugačkim zašiljenim instrumentom

called a trocar.

koji se zove trokar.

And the way the surgeon uses this device

Kirurg koristi ovaj instrument

is that he takes it

tako da ga uzme

and he presses it into the abdomen

i pritisne u trbuh

until it punctures through.

sve dok ga ne probuši.

And now the reason why everyone in the operating room

Razlog zašto su svi u operacijskoj sali

was staring at that device on that day

zurili u taj instrument tog dana

was because he had to be absolutely careful

bio je što je kirurg morao neizmjerno paziti

not to plunge it through

da njime

and puncture it into the organs and blood vessels below.

ne ošteti organe i žile.

But this problem should seem pretty familiar to all of you

Ovaj problem bi svima vama trebao biti poznat

because I'm pretty sure you've seen it somewhere else.

jer sam siguran da ste ga već negdje imali.

(Laughter)

(Smijeh)

Remember this?

Sjećate li se ovoga?

(Applause)

(Pljesak)

You knew that at any second

Znali ste da će svakog trenutka

that straw was going to plunge through,

slamka probiti opnu,

and you didn't know if it was going to go out the other side

i niste znali hoće li izići na drugi kraj

and straight into your hand,

i ravno u vašu ruku,

or if you were going to get juice everywhere,

ili ćete sve zaliti sokom,

but you were terrified. Right?

no bili ste prestravljeni, zar ne?

Every single time you did this,

Svaki put kada ste to radili,

you experienced the same fundamental physics

iskusili ste istu temeljnu fiziku

that I was watching in the operating room that day.

koju sam ja promatrao u sali taj dan.

And it turns out it really is a problem.

I to zaista jest problem.

In 2003, the FDA actually came out and said

Američka agencija za hranu i lijekove 2003. godine izjavila je

that trocar incisions might be the most dangerous step

da su rezovi trokarom vjerojatno najopasniji korak

in minimally invasive surgery.

u najmanje invazivnoj operaciji.

Again in 2009, we see a paper that says

U 2009. mogli smo vidjeti rad u kojem se tvrdilo

that trocars account for over half

da su trokari odgovorni za preko polovicu

of all major complications in laparoscopic surgery.

svih velikih komplikacija u laparoskopskoj kururgiji.

And, oh by the way,

I, usput rečeno,

this hasn't changed for 25 years.

to se nije promijenilo u 25 godina.

So when I got to graduate school,

I kada sam diplomirao,

this is what I wanted to work on.

želio sam se baviti time.

I was trying to explain to a friend of mine

Pokušavao sam objasniti prijatelju

what exactly I was spending my time doing,

na čemu sam točno radio,

and I said,

i rekao sam,

"It's like when you're drilling through a wall

"To je kao kada bušiš zid

to hang something in your apartment.

kako bi objesio nešto u stanu.

There's that moment when the drill first punctures through the wall

To je trenutak kada bušilica prvo probuši zid

and there's this plunge. Right?

i potom nastupa onaj uron, zar ne?"

And he looked at me and he said,

Pogledao me i rekao,

"You mean like when they drill into people's brains?"

"Misliš, kao kad buše ljudima u mozak?"

And I said, "Excuse me?" (Laughter)

I uzvratio sam, "Molim?" (Smijeh)

And then I looked it up and they do drill into people's brains.

Zatim sam provjerio i otkrio da zaista buše ljudima mozak.

A lot of neurosurgical procedures

Mnogo neurokirurških zahvata

actually start with a drill incision through the skull.

zapravo započinju bušenjem kroz lubanju.

And if the surgeon isn't careful,

Ako kirurg nije oprezan,

he can plunge directly into the brain.

može pogoditi ravno u mozak.

So this is the moment when I started thinking,

Tog trena počeo sam razmišljati,

okay, cranial drilling, laparoscopic surgery,

"uredu, bušenje lubanje, laparoskopska kirurgija,

why not other areas of medicine?

zašto ne i druga područja medicine?"

Because think about it, when was the last time you went to the doctor

Razmislite, kada ste zadnji put otišli liječniku

and you didn't get stuck with something? Right?

i niste zapeli s nečime? Zar ne?

So the truth is

Istina je da

in medicine puncture is everywhere.

u medicini ubod znači sve.

And here are just a couple of the procedures that I've found

Ovdje je samo nekoliko zahvata koje sam pronašao

that involve some tissue puncture step.

koji uključuju prodiranje kroz tkivo.

And if we take just three of them —

Ako uzmemo samo tri -

laparoscopic surgery, epidurals, and cranial drilling —

laparoskopska kirurgija, epiduralna injekcija i bušenje lubanje -

these procedures account for over 30,000 complications

ovi zahvati odgovorni su za preko 30.000 komplikacija

every year in this country alone.

svake godine samo u ovoj zemlji.

I call that a problem worth solving.

Smatram da je to problem koji treba riješiti.

So let's take a look at some of the devices

Pogledajmo neke od instrumenata

that are used in these types of procedures.

koji se koriste kod ovih zahvata.

I mentioned epidurals. This is an epidural needle.

Spomenuo sam epiduralnu injekciju. Ovo je epiduralna igla.

It's used to puncture through the ligaments in the spine

Koristi se za ubod kroz ligamente u kralježnici

and deliver anesthesia during childbirth.

i daje anesteziju tijekom poroda.

Here's a set of bone marrow biopsy tools.

Ovdje vidimo instrumente za biopsiju koštane srži.

These are actually used to burrow into the bone

Koriste se kako bi se zarilo u kost

and collect bone marrow or sample bone lesions.

i prikupilo koštanu srž ili uzorak koštanih lezija.

Here's a bayonette from the Civil War.

Ovo je bajuneta iz Američkog građanskog rata.

(Laughter)

(Smijeh)

If I had told you it was a medical puncture device

Da sam vam rekao da je to medicinski instrument za punkciju

you probably would have believed me.

vjerojatno biste mi povjerovali.

Because what's the difference?

Jer, u čemu je razlika?

So, the more I did this research

I što sam više to istraživao

the more I thought there has to be

to sam više vjerovao da treba postojati

a better way to do this.

bolji način da se to napravi.

And for me the key to this problem

Za mene je ključno rješenje problema

is that all these different puncture devices

da svi ovi različiti instrumenti za punkciju

share a common set of fundamental physics.

dijele zajednički skup temeljne fizike.

So what are those physics?

Kakva je to fizika?

Let's go back to drilling through a wall.

Vratimo se bušenju kroz zid.

So you're applying a force on a drill towards the wall.

Primijenjujete silu na bušilicu prema zidu.

And Newton says the wall is going to apply force back,

A Newton kaže da će i zid zauzvrat primijeniti silu,

equal and opposite.

jednaku i suprotnu.

So, as you drill through the wall,

I kako bušite kroz zid,

those forces balance.

te sile postižu ravnotežu.

But then there's that moment

No onda se događa onaj trenutak

when the drill first punctures through the other side of the wall,

kada bušilica po prvi puta probija drugu stranu zida,

and right at that moment the wall can't push back anymore.

i u tom trenutku zid više ne može odolijevati.

But your brain hasn't reacted to that change in force.

No vaš mozak ne reagira na tu promjenu u sili.

So for that millisecond,

Tako da u toj milisekundi,

or however long it takes you to react, you're still pushing,

ili koliko god vam treba da reagirate, još uvijek gurate,

and that unbalanced force causes an acceleration,

i ta neuravnotežena sila uzrokuje akceleraciju,

and that is the plunge.

i to je taj uron.

But what if right at the moment of puncture

A što ako biste u tom trenutku probijanja

you could pull that tip back,

mogli povući vrh bušilice unatrag,

actually oppose the forward acceleration?

suprotno od akceleracije prema naprijed?

That's what I set out to do.

Upravo to sam krenuo napraviti.

So imagine you have a device

Zamislite da imate uređaj

and it's got some kind of sharp tip to cut through tissue.

koji ima oštri vrh za probijanje tkiva.

What's the simplest way you could pull that tip back?

Koji bi bio najjednostavniji način da taj vrh povučete unazad?

I chose a spring.

Ja sam odabrao oprugu.

So when you extend that spring, you extend that tip out

Kada proširite tu oprugu, izučete van i taj vrh

so it's ready to puncture tissue,

tako da može probiti tkivo,

the spring wants to pull the tip back.

a opruga ga želi povući unazad.

How do you keep the tip in place

Kako da zadržimo vrh na mjestu

until the moment of puncture?

do trenutka punkcije?

I used this mechanism.

Ja koristim ovaj mehanizam.

When the tip of the device is pressed against tissue,

Kada vrh uređaja pritišće tkivo,

the mechanism expands outwards and wedges in place against the wall.

mehanizam se širi prema van i uglavljuje na mjestu uza zid.

And the friction that's generated

A trenje koje pritom nastaje

locks it in place and prevents the spring from retracting the tip.

uglavljuje ga na mjestu i sprečava oprugu da povuče vrh unazad.

But right at the moment of puncture,

No točno u trenutku punkcije,

the tissue can't push back on the tip anymore.

tkivo više ne može odolijevati vrhu.

So the mechanism unlocks and the spring retracts the tip.

Tako se mehanizam otvara i opruga povlači vrh unazad.

Let me show you that happening in slow motion.

Pokazat ću vam to u usporenoj snimci.

This is about 2,000 frames a second,

Ovo je oko 2.000 sličica u sekundi,

and I'd like you to notice the tip

primijetite vrh

that's right there on the bottom, about to puncture through tissue.

točno ovdje na dnu, neposredno prije nego što će probiti tkivo.

And you'll see that right at the moment of puncture,

Vidjet ćete da točno u trenutko punkcije,

right there, the mechanism unlocks and retracts that tip back.

točno ovdje, mehanizam se otvara i povlači vrh unazad,

I want to show it to you again, a little closer up.

Želim vam to ponovo pokazati izbliza.

You're going to see the sharp bladed tip,

Vidjet ćete naoštreni vrh,

and right when it punctures that rubber membrane

i točno kada probuši tu gumenu opnu

it's going to disappear into this white blunt sheath.

nestat će u svojoj tupoj bijeloj futroli.

Right there.

Točno ovdje.

That happens within four 100ths of a second after puncture.

To se događa unutar 4 stotinke sekunde poslije punkcije.

And because this device is designed to address the physics of puncture

Budući da je ovaj instrument napravljen da odgovara fizikalnim zakonima punkcije

and not the specifics of cranial drilling

a ne pojedinostima bušenja lubanje

or laparoscopic surgery, or another procedure,

ili laparoskopskoj operaciji, ili nekom drugom zahvatu,

it's applicable across these different medical disciplines

primijenjiv je u različitim medicinskim disciplinama

and across different length scales.

i u različitim mjerama duljine.

But it didn't always look like this.

No nije uvijek ovako izgledao.

This was my first prototype.

Ovo je bio moj prvi prototip.

Yes, those are popsicle sticks,

Da, ono su štapići sladoleda,

and there's a rubber band at the top.

a na vrhu je gumena traka.

It took about 30 minutes to do this, but it worked.

Trebalo je oko 30 minuta da se to napravi, ali je djelovalo.

And it proved to me that my idea worked

Dokazalo je da moja ideja funkcionira

and it justified the next couple years of work on this project.

i opravdalo je sljedećih nekoliko godina rada na ovom projektu.

I worked on this because

Radio sam na tome

this problem really fascinated me.

jer me ovaj problem zaista fascinirao.

It kept me up at night.

Nisam mogao spavati zbog njega.

But I think it should fascinate you too,

No, mislim da bi trebao fascinirati i vas,

because I said puncture is everywhere.

jer sam već rekao da bušenja ima svugdje.

That means at some point it's going to be your problem too.

To znači da će u jednom trenutku to biti i vaš problem.

That first day in the operating room

Onaj prvi dan u operacijskoj sali

I never expected to find myself on the other end of a trocar.

nisam očekivao da ću se naći s druge stane trokara.

But last year, I got appendicitis when I was visiting Greece.

No, prošle godine tijekom posjeta Grčkoj dobio sam upalu slijepog crijeva.

So I was in the hospital in Athens,

Bio sam u bolnici u Ateni,

and the surgeon was telling me

i kirurg mi je objašnjavao

he was going to perform a laparoscopic surgery.

da će napraviti laparoskopski zahvat.

He was going to remove my appendix through these tiny incisions,

Uklonit će mi slijepo crijevo kroz sitne rezove,

and he was talking about what I could expect for the recovery,

i pričao je što mogu očekivati od oporavka

and what was going to happen.

i što će se dogoditi.

He said, "Do you have any questions?" And I said, "Just one, doc.

Rekao je, "Imate li ikakvih pitanja?" A ja sam odgovorio, "Samo jedno, doktore."

What kind of trocar do you use?"

Kakav trokar koristite?

So my favorite quote about laparoscopic surgery

Moj najomiljeniji citat o laparoskopiji

comes from a Doctor H. C. Jacobaeus:

je onaj doktora H. C. Jacobaeusa,

"It is puncture itself that causes risk."

"Sama punkcija izaziva rizik."

That's my favorite quote because H.C. Jacobaeus

To mi je najdraži citat jer je H. C. Jacobaeus

was the first person to ever perform laparoscopic surgery on humans,

bio prva osoba koja je izvela laparoskopski zahvat na ljudima,

and he wrote that in 1912.

a to je napisao 1912.

This is a problem that's been injuring and even killing people for over 100 years.

Ovo je problem koji je ozljeđivao i čak ubijao ljude već 100 godina.

So it's easy to think that for every major problem out there

Lako je vjerovati da za svaki veliki problem

there's some team of experts working around the clock to solve it.

postoji tim stručnjaka koji neprestano radi kako bi ga riješili.

The truth is that's not always the case.

Prava istina je da to nije uvijek tako.

We have to be better at finding those problems

Moramo biti uspješniji u nalaženju tih problema

and finding ways to solve them.

i otkrivanju njihovih rješenja.

So if you come across a problem that grabs you,

Ako naiđete na problem koji vas je zaintrigirao,

let it keep you up at night.

zbog kojeg ne spavate noću,

Allow yourself to be fascinated,

dopustite si da vas fascinira,

because there are so many lives to save.

jer toliko života treba biti spašeno.

(Applause)

(Pljesak)