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

53,761 views ・ 2009-06-18

TED


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Prevoditelj: Ilijana Vargovic Radic Recezent: Tilen Pigac - EFZG
00:18
A talk about surgical robots
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Govor o operacijskim robotima
00:21
is also a talk about surgery.
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je također govor o operaciji.
00:24
And while I've tried to make my images not too graphic,
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I dok sam pokušala svoje slike učiniti manje slikovitima,
00:28
keep in mind that surgeons have a different relationship with blood
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nemojte zaboraviti da kirurzi imaju drugačiji odnos prema krvi
00:31
than normal people do,
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nego što ga imaju normalni ljudi.
00:33
because, after all, what a surgeon does to a patient,
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Jer nakon svega, što kirurg učini pacijentu,
00:37
if it were done without consent,
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ako je učinjeno bez pristanka,
00:39
would be a felony.
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postaje kazneno djelo.
00:42
Surgeons are the tailors, the plumbers,
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Kiruzi su krojači, vodoinstalateri,
00:46
the carpenters -- some would say the butchers --
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stolari, neki bi rekli koljači
00:48
of the medical world:
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medicinskog svijeta.
00:50
cutting, reshaping, reforming,
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Rezanje, preoblikovanje, reformacija,
00:53
bypassing, fixing.
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zaobilazak, popravljanje.
00:56
But you need to talk about surgical instruments
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Ali trebate razgovarati o kirurškim instrumentima
01:00
and the evolution of surgical technology together.
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i evoluciji kirurške tehnologije zajedno.
01:04
So in order to give you some kind of a perspective
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Dakle da bih vam dala neku vrstu perspektive
01:07
of where we are right now
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o tome gdje smo dospjeli do sada
01:09
with surgical robots,
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s kirurškim robotima,
01:11
and where we're going to be going in the future,
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i gdje idemo da bismo napredovali u budućnosti,
01:13
I want to give you a little bit of perspective
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želim vam dati malen dio perspektive
01:15
of how we got to this point,
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o tome kako smo došli do ove točke.
01:17
how we even came to believe
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Kako smo uopće povjerovali
01:20
that surgery was OK,
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da je operacija OK,
01:22
that this was something that was possible to do,
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da je ovo nešto što možemo ostvariti,
01:24
that this kind of cutting and reforming was OK.
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da je ova vrsta rezanja i reformacije OK.
01:29
So, a little bit of perspective --
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Dakle, malen dio perspektive --
01:31
about 10,000 years of perspective.
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oko 10.000 godina perspektive.
01:34
This is a trephinated skull.
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Ovo je izbušena lubanja.
01:37
And trephination is simply just cutting a hole in the skull.
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I trepanacija je jednostavno bušenje rupe u lubanji.
01:41
And many, many hundreds of skulls like this
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I puno, puno tisuća lubanja poput ove
01:43
have been found in archaeological sites
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su nađene na arheološkim nalazištima
01:46
all over the world,
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diljem svijeta,
01:48
dating back five to 10 thousand years.
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datirajući unatrag pet do deset tisuća godina.
01:52
Five to 10 thousand years! Now imagine this.
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Pet do deset tisuća godina! Sada zamislite ovo.
01:56
You are a healer in a Stone Age village.
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Iscjelitelj ste u selu u vrijeme kamenog doba.
01:59
And you have some guy that you're not quite sure what's wrong with him --
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I imate nekog tipa za kojeg ne znate sa sigurnošću što mu je
02:02
Oliver Sacks is going to be born way in the future.
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(Oliver Sacks biti će rođen daleko u budućnosti).
02:05
He's got some seizure disorder. And you don't understand this.
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On ima neki poremećaj napadaja. I vi to ne razumijete.
02:08
But you think to yourself,
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Ali si mislite,
02:10
"I'm not quite sure what's wrong with this guy.
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"Nisam baš siguran što je ovom tipu.
02:12
But maybe if I cut a hole in his head I can fix it."
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Ali možda ukoliko mu napravim rupu u glavi moći ću ga popraviti".
02:15
(Laughter)
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(Smijeh)
02:16
Now that is surgical thinking.
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To je dakle kirurško razmišljanje.
02:18
Now we've got the dawn of interventional surgery here.
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Sada imamo zoru intervencijske operacije ovdje.
02:22
What is astonishing about this is,
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Ono što je zaprepašćujuće o ovome je
02:24
even though we don't know really how much of this
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to što iako ne znamo uistinu koliko ovoga
02:28
was intended to be religious,
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je bilo namijenjeno religioznosti,
02:31
or how much of it was intended to be therapeutic,
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ili koliko ovoga je bilo namijenjeno u terapeutske svrhe,
02:34
what we can tell is that these patients lived!
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no ono što možemo reći je da su ovi pacijenti živjeli!
02:37
Judging by the healing on the borders of these holes,
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Sudeći po zacjeljenju na granicama ovih rupa,
02:39
they lived days, months, years following trephination.
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živjeli su danima, mjesecima, godinama poslije trepanacije.
02:44
And so what we are seeing is evidence
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I sada što gledamo je dokaz
02:47
of a refined technique
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rafinirane tehnike,
02:49
that was being handed down over thousands and thousands of years,
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koja je bila u predaji preko tisuću i tisuću godina,
02:52
all over the world.
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diljem svijeta.
02:54
This arose independently at sites everywhere
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Ovo je nađeno samostalno na nalazištima svugdje,
02:56
that had no communication to one another.
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gdje nisu imali komunikaciju međusobno.
02:59
We really are seeing the dawn of interventional surgery.
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Uistinu vidimo zoru intervencijske kirurgije.
03:03
Now we can fast forward many thousands of years
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Sada možemo ubrzati naprijed nekoliko tisuća godina
03:06
into the Bronze Age and beyond.
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u brončano doba i poslije.
03:08
And we see new refined tools coming out.
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I sada vidimo novo rafinirano oruđe koje izlazi.
03:11
But surgeons in these eras are a little bit more conservative
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Ali kirurzi u ovim erama su malo više konzervativni
03:14
than their bold, trephinating ancestors.
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od svojih hrabrih, trepanacijskih predaka.
03:17
These guys confined their surgery
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Ovi su ljudi ograničili svoju kirurgiju
03:19
to fairly superficial injuries.
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na relativno površinske ozljede.
03:21
And surgeons were tradesmen,
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I kirurzi su bili trgovci,
03:23
rather than physicians.
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prije nego doktori.
03:26
This persisted all the way into and through the Renaissance.
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Ovo je bio trend sve do i tokom renesanse.
03:30
That may have saved the writers,
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To je možda spasilo pisce.
03:32
but it didn't really save the surgeons terribly much.
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Ali nije stvarno spasilo kirurge previše.
03:35
They were still a mistrusted lot.
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Još uvijek im se nije vjerovalo previše.
03:38
Surgeons still had a bit of a PR problem,
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Kirurzi su i dalje imali problem s odnosima s javnošću.
03:41
because the landscape was dominated
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Jer je pejzaž bio dominiran
03:43
by the itinerant barber surgeon.
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putujućim kirurgom brijačem.
03:45
These were folks that traveled from village to village, town to town,
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To su bili ljudi koji su putovali od sela do sela, grada do grada,
03:49
doing surgery sort of as a form of performance art.
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radeći operacije kao da su vrsta izvedbene umjetnosti.
03:53
Because we were in the age before anesthesia,
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Jer smo bili u dobu prije anestezije,
03:55
the agony of the patient
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agonija pacijenta,
03:57
is really as much of the public spectacle
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je ustvari toliki javni spektakl
03:59
as the surgery itself.
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kao i sama operacija.
04:02
One of the most famous of these guys, Frere Jacques,
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Jedan od najslavnijih od ovih ljudi, fratar Jacques,
04:05
shown here doing a lithotomy --
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prikazan ovdje kako obavlja litotomiju,
04:08
which is the removal of the bladder stone,
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što znači odstranjenje mokraćnog kamenca,
04:10
one of the most invasive surgeries they did at the time --
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jedne od najinvazivnijih operacija koje su tada radili,
04:12
had to take less than two minutes.
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je morala biti obavljena za manje od dvije minute.
04:15
You had to have quite a flair for the dramatic,
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Morali ste imati dosta osjećaja za dramatiku,
04:17
and be really, really quick.
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i biti vrlo, vrlo brzi.
04:19
And so here you see him doing a lithotomy.
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I ovdje ga vidite kako obavlja litotomiju.
04:22
And he is credited with doing over 4,000 of these public surgeries,
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Zaslužan je za preko 4.000 ovakvih javnih operacija,
04:26
wandering around in Europe,
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lutajući po Europi.
04:28
which is an astonishing number,
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To je zapanjujući broj,
04:30
when you think that surgery must have been a last resort.
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kada pomislite da je operacija bila zadnje rješenje.
04:34
I mean who would put themselves through that?
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Mislim, tko bi htio proći kroz to?
04:37
Until anesthesia, the absence of sensation.
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Dok nije došla anestezija, izostanak osjetila.
04:43
With the demonstration of the Morton Ether Inhaler
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S demonstracijom Mortonovog eter inhalatora
04:46
at the Mass. General in 1847,
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u Massachusetts bolnici 1847. godine,
04:49
a whole new era of surgery was ushered in.
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uvedena je potpuno nova era operacije.
04:52
Anesthesia gave surgeons the freedom to operate.
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Anestezija je dala kirurzima slobodu operacije.
04:56
Anesthesia gave them the freedom to experiment,
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Anestezija im je dala slobodu eksperimentiranja,
04:58
to start to delve deeper into the body.
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da započnu zaroniti dublje u tijelo.
05:02
This was truly a revolution in surgery.
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Ovo je usitinu bila revolucija u kirurgiji.
05:06
But there was a pretty big problem with this.
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Ali postojao je dosta veliki problem s time.
05:08
After these very long, painstaking operations,
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Poslije ovih vrlo dugih, iscrpljujućih operacija,
05:11
attempting to cure things they'd never been able to touch before,
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pokušavajući izliječiti stvari koje nikad prije nisu mogli dodirnuti,
05:15
the patients died.
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pacijenti bi umrli.
05:19
They died of massive infection.
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Umrli su od masivnih infekcija.
05:23
Surgery didn't hurt anymore,
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Kirurgija nije nikog ozlijedila,
05:25
but it killed you pretty quickly.
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ali vas je brzo ubila.
05:27
And infection would continue to claim a majority of surgical patients
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I infekcija bi nastavila uzimati danak kod većine kirurških pacijenata
05:32
until the next big revolution in surgery,
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sve do sljedeće velike revolucije u kirurgiji.
05:35
which was aseptic technique.
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To je bila aseptička tehnika.
05:38
Joseph Lister was aepsis's,
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Joseph Lister je bio aseptički,
05:41
or sterility's, biggest advocate,
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ili sterilitetni zagovornik,
05:44
to a very very skeptical bunch of surgeons.
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naspram mnogo, mnogo skeptičnih kirurga.
05:47
But eventually they did come around.
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Ali u dogledno vrijeme su se predomislili.
05:49
The Mayo brothers came out to visit Lister in Europe.
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Mayo braća su otišla vidjeti Listera u Europu.
05:53
And they came back to their American clinic and they said
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I vratila su se svojoj američkoj klinici da kažu
05:55
they had learned it was as important to wash your hands
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kako su naučili važnost pranja ruku
05:58
before doing surgery
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prije operacije.
06:00
as it was to wash up afterwards. (Laughter)
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Kako su inače prali ruke poslije operacije.
06:03
Something so simple.
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Nešto toliko jednostavno.
06:05
And yet, operative mortality dropped profoundly.
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Operacijski mortalitet je značajno opao.
06:09
These surgeries were actually now being effective.
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Ove operacije su sada bile efikasne.
06:12
With the patient insensitive to pain,
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S pacijentom koji nije osjećao bol,
06:16
and a sterile operating field
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i sterilnim operacijskim područjem
06:19
all bets were off, the sky was the limit.
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sve oklade su bile skinute, nebesa su bila granica.
06:23
You could now start doing surgery everywhere,
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Sada ste mogli započeti operaciju svugdje,
06:28
on the gut, on the liver,
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na crijevu, na jetri,
06:31
on the heart, on the brain.
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na srcu, na mozgu.
06:33
Transplantation: you could take an organ out of one person,
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Transplantacija: mogli ste izvaditi organ iz jedne osobe,
06:35
you could put it in another person, and it would work.
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mogli ste ga staviti u drugu osobu, i to bi upalilo.
06:38
Surgeons didn't have a problem with respectability anymore;
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Kirurzi više nisu imali problema s poštovanjem.
06:41
they had become gods.
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Postali su bogovi.
06:44
The era of the "big surgeon, big incision" had arrived,
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Era "velikog kirurga, velikog reza" je došla.
06:49
but at quite a cost,
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Ali s velikom cijenom.
06:52
because they are saving lives,
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Jer su spašavali živote,
06:54
but not necessarily quality of life,
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ali ne i nužno kvalitetu života.
06:58
because healthy people don't usually need surgery,
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Jer zdravi ljudi uobičajeno ne trebaju kirurgiju.
07:01
and unhealthy people have a very hard time recovering from a cut like that.
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A nezdravi ljudi imaju vrlo teško vrijeme oporavka od takvog zahvata.
07:06
The question had to be asked,
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Pitanje je moralo biti postavljeno,
07:08
"Well, can we do these same surgeries
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"Dakle, da li možemo napraviti iste operacije
07:11
but through little incisions?"
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ali kroz male rezove?"
07:15
Laparoscopy is doing this kind of surgery:
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Laparoskopija radi takvu vrstu operacije.
07:18
surgery with long instruments through small incisions.
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Kirurgija s dugim instrumentima, kroz male rezove.
07:21
And it really changed the landscape of surgery.
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I stvarno je promijenila pejzaž kirurgije.
07:25
Some of the tools for this had been around for a hundred years,
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Neka od oruđa za ovo su bila prisutna preko stotinu godina.
07:29
but it had only been used as a diagnostic technique
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Ali je korištena kao dijagnostička tehnika
07:31
until the 1980s,
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do osamdesetih,
07:33
when there was changes in camera technologies and things like that,
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s promjenama u tehnologiji kamere i stvarima poput ove,
07:36
that allowed this to be done for real operations.
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koje su dopustile da se ovo radi za prave operacije.
07:41
So what you see -- this is now the first surgical image --
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Dakle ono što vidite -- to je sada prva kirurška slika --
07:43
as we're coming down the tube, this is a new entry into the body.
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kako se spuštamo niz cijev, ovo je novi ulaz u tijelo.
07:47
It looks very different from what you're expecting surgery to look like.
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Izgleda vrlo drugačije od onoga što očekujete kako bi operacija trebala izgledati.
07:50
We bring instruments in,
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Uvodimo instrumente,
07:52
from two separate cuts in the side,
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iz dva različita reza sa strane,
07:54
and then you can start manipulating tissue.
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i onda možete početi manipulirati tkivo.
07:58
Within 10 years of the first gallbladder surgeries
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Unutar deset godina prvih operacija žučnog mjehura,
08:01
being done laparoscopically,
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rađenih laparoskopski,
08:04
a majority of gallbladder surgeries
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većina operacija žučnog mjehura
08:06
were being done laparoscopically --
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su bile rađene laparoskopski.
08:09
truly a pretty big revolution.
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Uistinu, dosta velika revolucija.
08:14
But there were casualties of this revolution.
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Ali bilo je žrtava ove revolucije.
08:18
These techniques were a lot harder to learn
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Te tehnike su bile puno teže za naučiti
08:20
than people had anticipated.
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nego što su to ljudi predvidjeli.
08:22
The learning curve was very long.
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Podučavateljska krivulja je bila vrlo duga.
08:24
And during that learning curve the complications went quite a bit higher.
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Tokom te podučavateljske krivulje, komplikacije su bile puno češće.
08:28
Surgeons had to give up their 3D vision.
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Kirurzi su morali dići ruke od svog trodimenzionalnog vida.
08:30
They had to give up their wrists.
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Morali su se odreći svojih zglobova.
08:32
They had to give up intuitive motion in the instruments.
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Morali su se odreći intuicijskog pokreta instrumenata.
08:37
This surgeon has over 3,000 hours of laparoscopic experience.
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Ovaj kirurg ima preko 3.000 sati laparoskopskog iskustva.
08:43
Now this is a particularly frustrating placement of the needle.
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To je sada podosta frustrirajući položaj igle.
08:48
But this is hard.
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Ali to je teško.
08:50
And one of the reasons why it is so hard
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I jedan od razloga zašto je tako teško
08:53
is because the external ergonomics are terrible.
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je zato što je vanjska ergonomija užasna.
08:57
You've got these long instruments, and you're working off your centerline.
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Imate te duge instrumente i radite na centralnoj liniji.
09:01
And the instruments are essentially working backwards.
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I ti insturmenti u principu rade unatrag.
09:06
So what you need to do, to take the capability of your hand,
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Dakle, ono što morate napraviti, da biste iskoristili upotrebljivost svoje ruke,
09:09
and put it on the other side of that small incision,
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i staviti je na drugu stranu malenog reza,
09:12
is you need to put a wrist on that instrument.
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je trebate staviti zglob na taj instrument.
09:17
And so -- I get to talk about robots --
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I tako -- Imam priliku govoriti o robotima --
09:19
the da Vinci robot
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da Vinci robot
09:21
put just that wrist on the other side of that incision.
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stavlja samo taj zglob na drugu stranu tog reza.
09:25
And so here you're seeing the operation of this wrist.
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I sada ovdje vidite operaciju tog zgloba.
09:28
And now, in contrast to the laparoscopy,
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I sada, u kontrastu naspram laparoskopije,
09:31
you can precisely place the needle in your instruments,
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možete precizno položiti iglu u svoje instrumente,
09:34
and you can pass it all the way through
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i možete je provesti skroz
09:37
and follow it in a trajectory.
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i slijediti je na putanji.
09:39
And the reason why this becomes so much easier
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Razlog zašto je ovo postalo toliko lakše
09:41
is -- you can see on the bottom --
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je, možete vidjeti na dnu,
09:44
the hands are making the motions,
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da ruke rade pokrete,
09:47
and the instruments are following those motions exactly.
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i instrumenti slijede te pokrete dosljedno.
09:51
Now, what you put between those instruments and those hands,
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Sada, što možete staviti između tih instrumenata i tih ruka,
09:55
is a large, fairly complicated robot.
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je velik, relativno kompliciran robot.
09:57
The surgeon is sitting at a console,
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Kirurg sjedi pri konzoli,
09:59
and controlling the robot with these controllers.
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i kontrolira robota s ovim kontrolama.
10:03
And the robot is moving these instruments around,
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Robot pomiče ove instrumente okolo,
10:06
and powering them, down inside the body.
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i pokreće ih, dolje unutar tijela.
10:09
You have a 3D camera, so you get a 3D view.
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Imate trodimenzionalnu kameru, tako da imate trodimenzionalan prikaz.
10:12
And since this was introduced in 1999,
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I budući da je ovo bilo uvedeno 1999.
10:16
a lot of these robots have been out
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većina ovih robota su izašli
10:18
and being used for surgical procedures like a prostatectomy,
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upotrebljavani za operacijske procedure poput uklanjanja prostate.
10:22
which is a prostate deep in the pelvis,
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To je, prostata duboko u zdjelici,
10:25
and it requires fine dissection
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i potreban je fin rez
10:27
and delicate manipulation
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i delikatna manipulacija
10:29
to be able to get a good surgical outcome.
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da bi se postignuo dobar kirurški rezultat.
10:32
You can also sew bypass vessels directly onto a beating heart
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Možete također zašiti premosne krvne žile na kucajuće srce
10:37
without cracking the chest.
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bez lomljenja prsnog koša.
10:40
This is all done in between the ribs.
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Ovo se sve radi između rebara.
10:42
And you can go inside the heart itself
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I možete doprijeti do unutrašnjosti samog srca
10:45
and repair the valves from the inside.
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i popraviti zaliske iznutra.
10:49
You've got these technologies -- thank you --
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Imate ove tehnologije -- hvala vam --
10:52
(Applause)
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(Pljesak)
10:55
And so you might say, "Wow this is really cool!
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Možete reći, "Opa, ovo je stvarno kul!
10:57
So, smartypants, why isn't all surgery being done this way?"
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Dakle, pametnjakoviću, zašto nije sva kirurgija rađena na ovaj način?"
11:00
And there are some reasons, some good reasons.
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Postoje dobri razlozi za to, neki dobro razlozi.
11:03
And cost is one of them.
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I trošak je jedan od njih.
11:05
I talked about the large, complicated robot.
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Govorila sam o velikom, kompliciranom robotu.
11:07
With all its bells and whistles, one of those robots
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Sa svim zvonima i zvižducima, jedan od tih robota
11:10
will cost you about as much as a solid gold surgeon.
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će vam koštati otprilike koliko i kirurg od čistog zlata.
11:13
More useful than a solid gold surgeon,
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Korisniji od kirurga od čistog zlata,
11:15
but, still, it's a fairly big capital investment.
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ali, ipak, to je dosta velika kapitalna investicija.
11:19
But once you've got it, your procedure costs do come down.
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Ali jednom kad je imate, proceduralni troškovi se smanje.
11:25
But there are other barriers.
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Ali postoje druge zapreke.
11:27
So something like a prostatectomy --
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Dakle nešto poput vađenja prostate,
11:30
the prostate is small, and it's in one spot,
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prostata je mala, i nalazi se na jednom mjestu.
11:32
and you can set your robot up very precisely
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I možete postaviti svog robota vrlo precizno
11:35
to work in that one spot.
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da radi na tom jednom mjestu.
11:37
And so it's perfect for something like that.
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To je dakle savršeno za nešto takvo.
11:39
And in fact if you, or anyone you know,
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Ustvari, ukoliko vi, ili netko koga poznate,
11:41
had their prostate taken out in the last couple of years,
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je imao svoju prostatu izvađenu u zadnjih nekoliko godina,
11:43
chances are it was done with one of these systems.
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šanse su da je rađeno s jednim od ovih sistema.
11:47
But if you need to reach more places than just one,
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No ako trebate dohvatiti više mjesta od samo jednog,
11:51
you need to move the robot.
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morate pomaknuti robota.
11:53
And you need to put some new incisions in there.
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I morate napraviti više rezova tamo.
11:55
And you need to re-set it up.
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I morate ga resetirati.
11:58
And then you need to add some more ports, and more.
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I morate dodati više ulaza.
12:02
And the problem is it gets time-consuming, and cumbersome.
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Problematika ovog je konzumacija vremena i težina.
12:05
And for that reason there are many surgeries
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Zbog toga, postoje mnoge operacje
12:07
that just aren't being done with the da Vinci.
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koje nisu napravljene uz pomoć da Vincija.
12:11
So we had to ask the question, "Well how do we fix that?"
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Dakle morali smo postaviti pitanje, "Kako da to popravimo?"
12:16
What if we could change it so that we didn't have to re-set up
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Što kada bi to mogli promijeniti tako da ga ne moramo resetirati
12:20
each time we wanted to move somewhere different?
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svaki put kada ga želimo pomaknuti negdje drugdje?
12:22
What if we could bring all the instruments
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Što kada bismo mogli donijeti sve instrumente
12:24
in together in one place?
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zajedno na jedno mjesto?
12:26
How would that change the capabilities of the surgeon?
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Kako bi to promijenilo sposobnosti kirurga?
12:30
And how would that change the experience for the patient?
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I kako bi to promijenilo pacijentovo iskustvo?
12:34
Now, to do that,
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Sada, da bismo to napravili,
12:36
we need to be able to bring a camera
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moramo biti sposobni uvesti kameru,
12:39
and instruments in together through one small tube,
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i instrumente, zajedno kroz jednu malu cijev,
12:43
like that tube you saw in the laparoscopy video.
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poput one cijevi koju ste vidjeli u videu o laparoskopiji.
12:46
Or, not so coincidentally, like a tube like this.
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Ili, ne tako slučajno, poput ovakve cijevi.
12:52
So what's going to come out of that tube
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Dakle ono što će izaći iz takve cijevi
12:54
is the debut of this new technology,
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je izlazak ove nove tehnologije,
12:57
this new robot that is going to be able to reach anywhere.
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ovaj novi robot koji će biti sposoban svugdje doprijeti.
13:02
Ready? So here it comes.
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Spremni? Evo ga.
13:06
This is the camera, and three instruments.
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Ovo je kamera, i tri instrumenta.
13:09
And as you see it come out,
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I dok ga gledate kako izlazi,
13:11
in order to actually be able to do anything useful,
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da biste stvarno bili sposobni učiniti nešto korisno,
13:13
it can't all stay clustered up like this.
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ne može sve ostati zbijeno ovako.
13:16
It has to be able to come off of the centerline
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Mora biti sposobno otići izvan centralne linije
13:19
and then be able to work back toward that centerline.
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i onda biti sposobno raditi natrag prema centralnoj liniji.
13:23
He's a cheeky little devil.
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On je bezobrazan mali vrag.
13:26
But what this lets you do
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Ali ono što vam ovo dopušta
13:28
is gives you that all-important traction,
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je najbitnije vučenje,
13:30
and counter-traction,
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i povlačenje,
13:32
so that you can dissect, so that you can sew,
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da biste mogli zarezati, da biste mogli šivati,
13:34
so that you can do all the things that you need to do,
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da biste mogli sve ono što trebate napraviti,
13:36
all the surgical tasks.
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sve kirurške obveze.
13:38
But it's all coming in through one incision.
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Ali sve to dolazi kroz jedan rez.
13:42
It's not so simple.
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Nije to tako jednostavno.
13:45
But it's worth it for the freedom that this gives us
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Ali je isplativo zbog slobode koju nam daje
13:48
as we're going around.
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dok idemo okolo.
13:50
For the patient, however,
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Za pacijenta, doduše,
13:54
it's transparent. This is all they're going to see.
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je transparentno. Ovo je sve što će vidjeti.
14:00
It's very exciting to think where we get to go with this.
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Vrlo je uzbudljivo razmišljati gdje možemo dospijeti s ovime.
14:04
We get to write the script of the next revolution in surgery.
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Možemo pisati scenarij sljedeće revolucije u kirurgiji.
14:09
As we take these capabilities, and we get to go to the next places,
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Dok razmatramo ove sposobnosti, i dospijevamo na sljedeća mjesta,
14:13
we get to decide what our new surgeries are going to be.
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odlučujemo koje će biti naše nove operacije.
14:17
And I think to really get the rest of the way
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Mislim da dospijeti do kraja ovog puta
14:19
in that revolution,
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u toj revoluciji,
14:21
we need to not just take our hands in in new ways,
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moramo ne samo iskoristiti naše ruke na nove načine,
14:24
we also need to take our eyes in in new ways.
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moramo također iskoristiti naše oči na nove načine.
14:28
We need to see beyond the surface.
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Moramo vidjeti ispod površine.
14:30
We need to be able to guide what we're cutting
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Morami biti sposobni voditi ono što režemo
14:33
in a much better way.
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na puno bolji način.
14:38
This is a cancer surgery.
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Ovo je operacija raka.
14:40
One of the problems with this,
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Jedan od problema s ovime,
14:42
even for surgeons who've been looking at this a lot,
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čak i za kirurge koji su ovo razmatrali puno,
14:44
is you can't see the cancer,
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je da ne možete vidjeti rak,
14:47
especially when it's hidden below the surface.
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posebice kada je skriven ispod površine.
14:50
And so what we're starting to do
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Stoga ono što smo započeli raditi
14:52
is we're starting to inject specially designed markers
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je ubacivanje posebno dizajniranih markera
14:56
into the bloodstream that will target the cancer.
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u krvotok koji će označiti rak.
14:59
It will go, bind to the cancer.
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Otići će se spojiti s rakom.
15:02
And we can make those markers glow.
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I možemo te markere osvijetliti.
15:05
And we can take special cameras,
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I možemo uzeti specijalne kamere,
15:07
and we can look at it.
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i gledati na to.
15:10
Now we know where we need to cut,
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Sada znamo gdje trebamo rezati,
15:12
even when it's below the surface.
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čak i kada je ispod površine.
15:15
We can take these markers and we can inject them in a tumor site.
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Možemo uzeti te markere i ubaciti ih na područje tumora.
15:19
And we can follow where they flow out from that tumor site,
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Možemo slijediti gdje istječu od položaja tumora,
15:23
so we can see the first places where that cancer might travel.
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stoga možemo vidjeti prva mjesta gdje je tumor dospio.
15:29
We can inject these dyes into the bloodstream,
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Možemo ubaciti ove boje u krvotok,
15:32
so that when we do a new vessel
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tako da kada zašijemo novi zalistak
15:35
and we bypass a blockage on the heart,
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i zaobiđemo blokadu na srcu,
15:37
we can see if we actually made the connection,
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možemo vidjeti da li smo stvarno napravili spoj,
15:40
before we close that patient back up again --
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prije nego što zatvorimo pacijenta ponovno.
15:43
something that we haven't been able to do
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Nešto što nismo mogli napraviti,
15:45
without radiation before.
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bez radijacije, prije.
15:48
We can light up tumors
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Možemo osvijetliti tumore
15:51
like this kidney tumor,
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poput ovog bubrežnog tumora
15:53
so that you can exactly see where the boundary is
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da bi točno vidjeli gdje je granica
15:56
between the kidney tumor and the kidney you want to leave behind,
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između bubrežnog tumora, i bubrega kojeg želite ostaviti na mjestu.
16:00
or the liver tumor and the liver you want to leave behind.
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Ili tumor jetre, i jetra je ono što želite ostaviti na mjestu.
16:04
And we don't even need to confine ourselves
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I ne trebamo čak ni ograničiti sebe
16:07
to this macro vision.
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na ovaj makro vid.
16:10
We have flexible microscopic probes
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Imamo fleksibilne mikroskopske sonde
16:12
that we can bring down into the body.
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koje možemo spustiti u tijelo.
16:15
And we can look at cells directly.
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I možemo gledati stanice direktno.
16:18
I'm looking at nerves here. So these are nerves you see, down on the bottom,
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Ovdje gledam na živce. Ove živce koje vidite, dolje na dnu,
16:21
and the microscope probe that's being held by the robotic hand, up at the top.
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i mikroskopska sonda koju drži robotska ruka, gore na vrhu.
16:25
So this is all very prototypey at this point.
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Sve je ovo vrlo prototipizirano na dosadnjašnoj razini.
16:28
But you care about nerves, if you are a surgical patient.
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Ali stalo vam je do živaca, ako ste kirurški pacijent.
16:31
Because they let you keep continence,
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Jer oni vam dopuštaju zadržati
16:34
bladder control, and sexual function after surgery,
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kontrolu nad mjehurom, i seksualnom funkcijom poslije operacije.
16:38
all of which is generally fairly important to the patient.
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Sve što je generalno dosta važno pacijentu.
16:44
So, with the combination of these technologies
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Dakle, s kombinacijom ovih tehnologija
16:48
we can reach it all, and we can see it all.
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možemo doprijeti do svega, vidjeti sve.
16:52
We can heal the disease.
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Možemo izliječiti bolesti.
16:55
And we can leave the patient whole and intact
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I možemo ostaviti pacijenta cijelog i netaknutog
16:59
and functional afterwards.
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i funkcionalnog naposljetku.
17:03
Now, I've talked about the patient
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Sada, govorila sam o pacijentu
17:05
as if the patient is, somehow, someone abstract
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kao da je pacijent, nekako, netko abstraktan
17:08
outside this room.
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izvan sobe.
17:10
And that is not the case.
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No to nije slučaj.
17:13
Many of you, all of you maybe,
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Mnogi od vas, možda svi,
17:16
will at some point, or have already, faced a diagnosis of cancer,
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će u jednom trenutku, ili već jesu, biti suočeni s dijagnozom raka,
17:19
or heart disease, or some organ dysfunction
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ili bolesti srca, ili druge disfunkcije organa
17:22
that's going to buy you a date with a surgeon.
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koja će vam kupiti sastanak s kirurgom.
17:25
And when you get to that point --
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I kad dođete do tog trena --
17:29
I mean, these maladies don't care
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mislim, te bolesti ne mare
17:32
how many books you've written,
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koliko ste knjiga napisali,
17:35
how many companies you've started,
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koliko kompanija stvorili,
17:37
that Nobel Prize you have yet to win,
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tu Nobelovu nagradu koju tek imate dobiti,
17:39
how much time you planned to spend with your children.
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koliko vremena ste planirali provesti sa svojom djecom.
17:43
These maladies come for us all.
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Te bolesti dolaze svima nama.
17:46
And the prospect I'm offering you, of an easier surgery ...
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Budućnost koju vam nudim, jednostavnije operacije ...
17:48
is that going to make that diagnosis any less terrifying?
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da li će to učiniti tu dijagnozu manje stravičnom?
17:53
I'm not sure I really even want it to.
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Nisam ni sigurna da li želim da to učini.
17:57
Because facing your own mortality
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Jer suočeni s vlastitom smrtnošću
18:00
causes a re-evaluation of priorities,
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uzrokuje ponovnu procjenu prioriteta,
18:03
and a realignment of what your goals are in life, unlike anything else.
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i novu poredanost naših životnih ciljeva, više nego bilo što drugo.
18:08
And I would never want to deprive you of that epiphany.
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Nikada vas ne bih htjela lišiti te spoznaje.
18:13
What I want instead,
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Umjesto toga, želim,
18:16
is for you to be whole, intact,
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da budete potpuni, netaknuti,
18:21
and functional enough to go out and save the world,
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i funkcionalni dovoljno da odete i spasite svijet,
18:26
after you've decided you need to do it.
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nakon što odlučite da to morate napraviti.
18:29
And that is my vision for your future.
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To je moja vizija za vašu budućnost.
18:32
Thank you.
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Hvala vam.
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