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

Translator: Bob Prottas Reviewer: Ariana Bleau Lugo

Prevodilac: Predrag Djordjevic Lektor: Mile Živković

The first time I stood in the operating room

Prvi put kada sam stajao u operacionoj sali

and watched a real surgery,

i posmatrao pravu operaciju,

I had no idea what to expect.

nisam imao pojma šta da očekujem.

I was a college student in engineering.

Bio sam student inženjerstva.

I thought it was going to be like on TV.

Mislio sam da će biti kao na televiziji.

Ominous music playing in the background,

Zloslutna muzika koja svira u pozadini,

beads of sweat pouring down the surgeon's face.

kapljice znoja koje se slivaju niz lice hirurga.

But it wasn't like that at all.

Međutim, uopšte nije bilo tako.

There was music playing on this day,

Tog dana je bilo muzike,

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

mislim da su to bili Madonini najveći hitovi. (Smeh)

And there was plenty of conversation,

Bilo je i mnogo razgovora,

not just about the patient's heart rate,

ne samo o pacijentovom pulsu,

but about sports and weekend plans.

već i o sportu i planovima za vikend.

And since then, the more surgeries I watched,

Od tada, što sam više operacija posmatrao,

the more I realized this is how it is.

sve sam više shvatao da to tako izgleda.

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

Na neki čudan način, to je samo još jedan dan u kancelariji.

But every so often

Međutim, ponekad

the music gets turned down,

se muzika isključi,

everyone stops talking,

svi prestanu da pričaju

and stares at exactly the same thing.

i kreću da zure u istu stvar.

And that's when you know that something absolutely critical

Onda znate da će se nešto apsolutno kritično

and dangerous is happening.

i opasno desiti. Kada sam

The first time I saw that

prvi put to video,

I was watching a type of surgery

posmatrao operaciju

called laparoscopic surgery

zvanu laparoskopska operacija.

And for those of you who are unfamiliar,

Za vas koji ste neupućeni,

laparoscopic surgery, instead of the large

kod ove operacije, umesto velikog,

open incision you might be used to with surgery,

otvorenog reza na koji ste možda navikli kod operacija,

a laparoscopic surgery is where the surgeon creates

laparoskopska operacija je ona gde hirurg pravi

these three or more small incisions in the patient.

ova tri ili više malih rezova na pacjentu.

And then inserts these long, thin instruments

Onda ubacuje ove duge, tanke instrumente

and a camera,

i kameru

and actually does the procedure inside the patient.

i u stvari vrši zahvat u samom pacijentu.

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

Ovo je odlično zato što je rizik od infekcije mnogo manji,

much less pain, shorter recovery time.

mnogo je manje bola, a vreme oporavka je kraće.

But there is a trade-off,

Ali postoji i kompromis,

because these incisions are created

zbog toga što se ovi rezovi prave

with a long, pointed device

dugom, zašiljenom spravom

called a trocar.

koja se naziva trokar.

And the way the surgeon uses this device

Hirurg koristi ovu spravu

is that he takes it

tako što je uzme

and he presses it into the abdomen

i pritiska o abdomen

until it punctures through.

sve dok ga ne probije.

And now the reason why everyone in the operating room

Razlog zašto su svi u operacionoj sali

was staring at that device on that day

zurili u tu spravu tog dana

was because he had to be absolutely careful

je zato što je hirurg morao da bude naročito oprezan

not to plunge it through

da ne bi zario

and puncture it into the organs and blood vessels below.

trokar u druge organe i krvne sudove ispod.

Ovaj problem bi trebalo da bude prilično poznat svima

But this problem should seem pretty familiar to all of you

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

zato što sam siguran da ste svi ovo već videli negde.

(Laughter)

(Smeh)

Remember this?

Da li se sećate ovoga?

(Applause)

(Aplauz)

You knew that at any second

Znali ste da svakog trenutka

that straw was going to plunge through,

cevčica može probiti i niste znali

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

da li će probiti i drugu stranu

and straight into your hand,

i zariti se u vašu ruku,

or if you were going to get juice everywhere,

ili ćete prosuti sok svuda,

but you were terrified. Right?

ali bili ste prestrašeni. Zar ne?

Every single time you did this,

Svaki put kada ste radili ovo,

you experienced the same fundamental physics

iskusili ste istu osnovnu fiziku

that I was watching in the operating room that day.

koju sam ja posmatrao u operacionoj sali tog dana.

And it turns out it really is a problem.

Ispostavilo se da je ovo zaista problem.

In 2003, the FDA actually came out and said

2003, Agencija za hranu i lekove je konačno priznala

that trocar incisions might be the most dangerous step

da pravljenje rezova trokarom može biti najopasniji momenat

in minimally invasive surgery.

u minimalno invazivnoj hirurgiji.

Again in 2009, we see a paper that says

Ponovo, u 2009, mogli smo videti izveštaj koji kaže

that trocars account for over half

da su trokari odgovorni za preko polovinu

of all major complications in laparoscopic surgery.

svih većih komplikacija koje se javljaju kod laparaskopskih operacija.

And, oh by the way,

Usput,

this hasn't changed for 25 years.

to se nije promenilo već 25 godina.

So when I got to graduate school,

Kada sam upisao diplomske studije,

this is what I wanted to work on.

želeo sam da radim na ovome.

I was trying to explain to a friend of mine

Pokušavao sam da objasnim jednom prijatelju

what exactly I was spending my time doing,

na šta tačno provodim svoje vreme

and I said,

i rekao sam:

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

"To je kao kada bušiš zid bušilicom

to hang something in your apartment.

ne bi li okačio nešto u svom stanu.

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

Postoji taj trenutak kada bušilica probije zid

and there's this plunge. Right?

i onda se naglo krene u dubinu. Zar ne?"

And he looked at me and he said,

Pogledao me je i rekao mi:

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

"Misliš, kao kada buše ljudima u mozak?"

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

Onda sam ja rekao: "Šta?" (Smeh)

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

Onda sam to potražio i otkrio da se zaista buši ljudima u glavu.

A lot of neurosurgical procedures

Mnogo neurohirurških zahvata

actually start with a drill incision through the skull.

zapravo počinje sa bušenjem reza pravo kroz lobanju.

And if the surgeon isn't careful,

Ako hirurg nije oprezan,

he can plunge directly into the brain.

može da probije direktno u mozak.

So this is the moment when I started thinking,

Tog trenutka sam počeo da razmišljam,

okay, cranial drilling, laparoscopic surgery,

okej, otvaranje lobanje, laparoskopske operacije,

why not other areas of medicine?

zašto ne i druge oblasti medicine?

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

Razmislite malo o tome, kada ste poslednji put

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

otišli kod doktora, a da vas on nije ubo nečim?

So the truth is

Dakle, istina je

in medicine puncture is everywhere.

da je u medicini bušenje svuda.

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

Evo i nekolicine zahvata za koje sam otkrio

that involve some tissue puncture step.

da uključuju neki od koraka bušenja tkiva.

And if we take just three of them —

I ako izdvojimo samo tri -

laparoscopic surgery, epidurals, and cranial drilling —

laparoskopske operacije, epiduralni zahvati i otvaranje lobanje -

these procedures account for over 30,000 complications

ovi zahvati su odgovorni za oko 30 000 komplikacija

every year in this country alone.

svake godine u samo ovoj zemlji.

I call that a problem worth solving.

Za mene je ovo problem koji vredi rešiti.

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

Hajde da pogledamo neke od sprava

that are used in these types of procedures.

koje se koriste u ovim operacijama.

I mentioned epidurals. This is an epidural needle.

Pomenuo sam epidurale. Ovo je igla za davanje epiduralne anestezije.

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

Koristi se da bi se probili ligamenti kičme

and deliver anesthesia during childbirth.

i da bi se dostavila anestezija tokom porođaja.

Here's a set of bone marrow biopsy tools.

Ovo je komplet sprava za biopsiju koštane srži.

Ove sprave se u stvari koriste da se zariju u kost

These are actually used to burrow into the bone

and collect bone marrow or sample bone lesions.

i pokupe koštanu srž ili da bi se uzeo uzorak lezija kostiju.

Here's a bayonette from the Civil War.

Evo bajoneta iz Građanskog rata.

(Laughter)

(Smeh)

If I had told you it was a medical puncture device

Da sam vam rekao da je ovo medicinska alatka za probijanje,

you probably would have believed me.

verovatno biste mi poverovali.

Because what's the difference?

U čemu je razlika, zaista?

So, the more I did this research

Što sam više istraživao,

the more I thought there has to be

to sam više mislio da mora

a better way to do this.

da postoji bolji način da se ovo uradi.

And for me the key to this problem

Za mene je ključ ovog problema

is that all these different puncture devices

to što sve ove sprave za bušenje

share a common set of fundamental physics.

imaju zajedničke fizičke karakteristike.

So what are those physics?

Pa, koje su to karakteristike?

Let's go back to drilling through a wall.

Vratimo se na bušenje zida.

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

Vi primenjujete silu na bušilicu, u smeru zida.

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

Njutn kaže da će zid reagovati

equal and opposite.

istom silom, ali u suprotnom smeru.

So, as you drill through the wall,

Tako da, dok bušite kroz zid,

those forces balance.

te sile se balansiraju.

But then there's that moment

Međutim, postoji onaj trenutak

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

kad bušilica konačno probije na drugu stranu,

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

i upravo u tom trenutku zid više ne može da se odupre sili.

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

Međutim, vaš mozak još nije uspeo da reaguje na promenu.

So for that millisecond,

Tokom te milisekunde,

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

ili koliko god da treba da reagujete, vi i dalje gurate,

and that unbalanced force causes an acceleration,

i ta neizbalansirana sila uzrokuje ubrzanje

and that is the plunge.

i to je zarivanje.

But what if right at the moment of puncture

Međutim, šta ako biste mogli, baš u trenutku probijanja

you could pull that tip back,

da povučete nazad taj vrh,

actually oppose the forward acceleration?

upravo suprotno smeru ubrzanja?

That's what I set out to do.

To je ono što sam naumio da uradim.

So imagine you have a device

Zamislite da imate spravu

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

koja ima neku vrstu zaoštrenog vrha kojim probija tkiva.

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

Koji je najjednostavniji način da povučete taj vrh unazad?

I chose a spring.

Ja sam odabrao oprugu.

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

Kada razvučete tu oprugu, taj vrh ste izbacili napolje

so it's ready to puncture tissue,

tako da je spreman da probija tkiva,

the spring wants to pull the tip back.

a opruga teži da ga povuče natrag.

How do you keep the tip in place

Kako da zadržite vrh u mestu

until the moment of puncture?

do momenta probijanja?

I used this mechanism.

Ja sam iskoristio ovaj menanizam.

When the tip of the device is pressed against tissue,

Kada je vrh sprave pritisnut o tkivo,

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

mehanizam se širi i učvrsti se u odnosu na zid.

And the friction that's generated

Trenje koje se stvara

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

ga zaključa u mestu i ne dozvoljava opruzi da vrati vrh unazad.

But right at the moment of puncture,

Ali tačno u trenutku probijanja,

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

tkivo više ne može da se odupire vrhu.

So the mechanism unlocks and the spring retracts the tip.

Mehanizam se otključava i opruga povlači vrh unazad.

Let me show you that happening in slow motion.

Ovako to izgleda na usporenom snimku.

This is about 2,000 frames a second,

Ovo je snimano na oko 2000 sličica po sekundi

and I'd like you to notice the tip

i voleo bih da primetite vrh

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

koji je upravo na dnu i samo što nije probio tkivo.

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

Primetićete da se, upravo u trenutku probijanja,

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

tačno tada, mehanizam otključava i povlači vrh unazad.

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

Želim ponovo da vam pokažem to, malo bliže.

You're going to see the sharp bladed tip,

Videćete vrh sa oštrom ivicom

and right when it punctures that rubber membrane

i tačno kada probije ovu gumenu membranu,

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

nestaće u ovom belom, tupom omotaču.

Right there.

Upravo tu.

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

To se dešava samo četiri stotinke nakon probijanja.

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

Kako je ova sprava napravljena da reaguje na fizičke karakteristike probijanja

and not the specifics of cranial drilling

a ne na specifičnosti otvaranja lobanje

or laparoscopic surgery, or another procedure,

ili laparoskopske operacije ili nekog drugog zahvata,

it's applicable across these different medical disciplines

ona je upotrebljiva nevezano za ove različite medicinske discipline

and across different length scales.

i u različitoj meri.

But it didn't always look like this.

Međutim, nije uvek ovako izgledala.

This was my first prototype.

Ovo je bio moj prvi prototip.

Yes, those are popsicle sticks,

Da, ovo su štapići od sladoleda,

and there's a rubber band at the top.

a ono na vrhu je obična gumica.

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

Trebalo mi je oko 30 minuta da ovo uradim, ali je radilo.

And it proved to me that my idea worked

I dokazalo mi je da moja ideja radi

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

i opravdala je nekoliko narednih godina rada na ovom projektu.

I worked on this because

Radio sam na ovome zato što me je

this problem really fascinated me.

ovaj problem zaista fascinirao.

It kept me up at night.

Noću sam ostajao budan zbog njega.

But I think it should fascinate you too,

Mislim da, takođe, treba i vas da fascinira,

because I said puncture is everywhere.

jer, kao što sam rekao, ubodi su svuda.

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

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

That first day in the operating room

Tog prvog dana u operacionoj sali

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

nisam očekivao da ću se ikada naći na drugoj strani trokara.

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

Međutim, prošle godine sam dobio upalu slepog creva dok sam bio u Grčkoj.

So I was in the hospital in Athens,

Bio sam u bolnici u Atini

and the surgeon was telling me

i hirurg mi je rekao

he was going to perform a laparoscopic surgery.

da će izvesti laparoskopsku operaciju.

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

Trebao je da ukloni moje slepo crevo kroz ove male rezove

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

i rekao mi je šta mogu da očekujem tokom oporavka

and what was going to happen.

i šta će se desiti.

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

Upitao je: "Imate li nekih pitanja?", a ja sam rekao: "Samo jedno, doco.

What kind of trocar do you use?"

Koju vrstu trokara ćete upotrebljavati?"

So my favorite quote about laparoscopic surgery

Moj omiljeni citat vezan za laparoskopske operacije

comes from a Doctor H. C. Jacobaeus:

je od doktora H. K. Jakobejusa:

"It is puncture itself that causes risk."

"Upravo je ubod taj koji donosi rizik".

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

To je moj omiljeni citat zato što je H. K. Jakobejus

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

prva osoba koja je ikada izvela laparoskopsku operaciju na ljudima

and he wrote that in 1912.

i ovo je napisao 1912.

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

To je problem koji je povređivao i čak i ubijao ljude više od 100 godina.

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

Lako je misliti da, za svaki veći problem koji postoji,

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

postoji i tim eksperata koji rade danonoćno ne bi li ga rešili.

The truth is that's not always the case.

U stvari, to nije uvek slučaj.

We have to be better at finding those problems

Moramo biti bolji u nalaženju tih problema

and finding ways to solve them.

i nalaženju načina da iste rešimo.

So if you come across a problem that grabs you,

Ako naiđete na problem koji vas obuzima,

let it keep you up at night.

dozvolite mu da vas drži budnim tokom noći.

Allow yourself to be fascinated,

Dozvolite sebi da budete fascinirani,

because there are so many lives to save.

zato što postoji mnogo života koje treba spasiti.

(Applause)

(Aplauz)