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

Translator: Bob Prottas Reviewer: Ariana Bleau Lugo

翻译人员: William Yu 校对人员: Fang Yi

The first time I stood in the operating room

当我第一次站在手术室，

and watched a real surgery,

看到一个真正的手术的时候，

I had no idea what to expect.

我不知道自己该期待着什么。

I was a college student in engineering.

我当时是一个工科大学生。

I thought it was going to be like on TV.

我以为会像在电视上看到的。

Ominous music playing in the background,

在背景中播放着不详的音乐,

beads of sweat pouring down the surgeon's face.

汗珠从外科医生的脸冲下。

But it wasn't like that at all.

但其实一点也不一样。

There was music playing on this day,

这一天有着音乐在播放，

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

我想是麦当娜的最有名的歌

And there was plenty of conversation,

也有很多的会话,

not just about the patient's heart rate,

讲的不仅是病人的心脏率，

but about sports and weekend plans.

也有的话题是关于运动和周末计划。

And since then, the more surgeries I watched,

从此，我看的手术越多，

the more I realized this is how it is.

就越发现就是这样的。

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

在某种奇怪的角度上看，做手术和在办公室工作一样。

但是每隔一段时间，

But every so often

the music gets turned down,

音乐会被调低，

everyone stops talking,

每个人都会停止说话，

and stares at exactly the same thing.

然后盯着一样的东西。

And that's when you know that something absolutely critical

那时候，你就知道十分关键

and dangerous is happening.

而且危险的事情要发生了.

The first time I saw that

我第一次见到这个发生的时候，

I was watching a type of surgery

我是在看一种外科手术

called laparoscopic surgery

叫腹腔镜手术.

And for those of you who are unfamiliar,

对于不熟悉的人，

它并非你已常见的

laparoscopic surgery, instead of the large

open incision you might be used to with surgery,

大切口手术，

a laparoscopic surgery is where the surgeon creates

在腹腔镜手术中外科医生

these three or more small incisions in the patient.

会在病人身上切出这样的三个或者更小的口。

And then inserts these long, thin instruments

然后将这些长并且细的仪器

and a camera,

和摄像头一齐塞入，

and actually does the procedure inside the patient.

事实上在病人的体内进行手术。

这是非常好的，因为感染风险更小

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

much less pain, shorter recovery time.

更少的痛苦，更短的修复时间。

但是同时这个仪器也带来了一些不好的，

But there is a trade-off,

因为切口是由一个

because these incisions are created

with a long, pointed device

长并且尖的

called a trocar.

叫做套管针的仪器切出来的。

And the way the surgeon uses this device

外科医生使用该一起的方法是

is that he takes it

他拿着它，

and he presses it into the abdomen

并将其在腹部刺压

until it punctures through.

直至其穿过。

And now the reason why everyone in the operating room

那一天所有手术室中的人

was staring at that device on that day

都盯着那个仪器是因为

was because he had to be absolutely careful

他必须非常小心

not to plunge it through

以避免伤害到

and puncture it into the organs and blood vessels below.

以下的器官以及血管。

这个问题你们一定不陌生

But this problem should seem pretty familiar to all of you

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

我很确定你们以前见过。

(Laughter)

（笑声）

Remember this?

(Applause)

记得这个嘛？

（掌声）

你知道那根吸管

You knew that at any second

that straw was going to plunge through,

不知道什么时候就会穿过

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

你不知道它是否会刺穿另一侧

and straight into your hand,

或是直接刺到你的手上，

or if you were going to get juice everywhere,

或是把果汁弄得到处都是，

但是你们都被吓到了，对不对？

but you were terrified. Right?

每一次你们做这个的时候，

Every single time you did this,

you experienced the same fundamental physics

你们经历了相同的基本物理原理

就像我那天在手术里所看到的那样。

that I was watching in the operating room that day.

结果证明这的确是一个问题。

And it turns out it really is a problem.

In 2003, the FDA actually came out and said

在 2003 年，(美国)食品药物管理局出面说

that trocar incisions might be the most dangerous step

套管针切口可能是小创伤手术中

in minimally invasive surgery.

最危险的一步。

Again in 2009, we see a paper that says

再一次，在 2009 年，我们在报纸上看到

that trocars account for over half

半数以上产生并发症的腹腔镜手术

of all major complications in laparoscopic surgery.

由套管针产生。

哦，顺便说一句

And, oh by the way,

this hasn't changed for 25 years.

这在 25 年里都没变过。

当我读研究生时，

So when I got to graduate school,

this is what I wanted to work on.

这就是我想工作的领域。

I was trying to explain to a friend of mine

我当时试着想我一个朋友解释

what exactly I was spending my time doing,

我花时间在做什么，

and I said,

我说，

这就像你在墙上打个孔

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

然后在你的公寓里挂些东西。

当钻子刺穿墙的那一瞬间

to hang something in your apartment.

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

and there's this plunge. Right?

钻子会扎进去对不对？

他看着我然后说，

你是说就像是钻入大脑一样么？

And he looked at me and he said,

然后我说 你说什么！？

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

然后我调查了一下，医生确实会在脑袋上打孔。

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

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

A lot of neurosurgical procedures

很多神经外科手术

actually start with a drill incision through the skull.

事实上都是从在头骨上钻个洞开始的。

如果外科医生不够小心，

And if the surgeon isn't careful,

he can plunge directly into the brain.

他会直接钻入大脑。

这就是我开始思考的时候，

So this is the moment when I started thinking,

okay, cranial drilling, laparoscopic surgery,

颅骨钻孔，腹腔镜手术，

why not other areas of medicine?

为什么不能是医学的其他领域呢？

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

因为，请想一想，你能想出哪次去看病

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

不是被体内什么东西卡住的呢？

So the truth is

事实是

in medicine puncture is everywhere.

在医疗中，打孔是非常普遍的。

这里只是一部分我所发现的

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

that involve some tissue puncture step.

涉及到组织刺穿的步骤。

如果我们只算上其中的三种--

And if we take just three of them —

腹腔镜手术，硬脑膜外麻醉和颅钻--

laparoscopic surgery, epidurals, and cranial drilling —

these procedures account for over 30,000 complications

这些过程导单单在这个国家

every year in this country alone.

每年就造成了超过 30,000 起并发症。

我认为那个问题是值得解决的。

I call that a problem worth solving.

让我们来看看

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

that are used in these types of procedures.

在这些手术中使用到的设备。

I mentioned epidurals. This is an epidural needle.

我提及到硬膜外麻醉。这是一个硬膜外针头。

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

它是用来刺穿脊椎韧带

and deliver anesthesia during childbirth.

和分娩期间注射麻醉药。

Here's a set of bone marrow biopsy tools.

这是一组骨髓穿刺检查工具。

These are actually used to burrow into the bone

这些实际用于钻入骨头

and collect bone marrow or sample bone lesions.

和收集骨髓或病变骨头的样本。

Here's a bayonette from the Civil War.

下面是来自南北战争中的刺刀。

(Laughter)

（笑声）

If I had told you it was a medical puncture device

如果我告诉你这是医疗穿孔工具

you probably would have believed me.

你也许会信我。

Because what's the difference?

有什么区别呢？

So, the more I did this research

我越进行这项调研

the more I thought there has to be

就越觉得

a better way to do this.

得有更好的办法

And for me the key to this problem

我认为，解决这个问题的关键在于

is that all these different puncture devices

这些医疗设备都有一个

share a common set of fundamental physics.

共通的物理原理。

那些物理原理是什么呢？

So what are those physics?

让我们再回到在墙上钻孔这个话题。

Let's go back to drilling through a wall.

你对墙上的一个钻子施加压力。

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

按照牛顿力学 墙会给出一个相对作用力，

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

equal and opposite.

大小相同 方向相反

So, as you drill through the wall,

钻墙的过程中，

力量是平衡的。

those forces balance.

但是有一个时刻

But then there's that moment

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

当钻子刚刚穿过墙的那一瞬间

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

在那个时刻，墙便不能再施加力。

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

但是你的大脑在那一瞬间来不及反应。

因此在你的大脑做出反应的一毫秒或其他时间内

So for that millisecond,

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

你仍在推钻子，

and that unbalanced force causes an acceleration,

然后那个不平衡的力造成了加速度，

and that is the plunge.

这就是刺入的过程。

但是如果你可以在那一瞬间

But what if right at the moment of puncture

you could pull that tip back,

将针尖拉回来

actually oppose the forward acceleration?

并抵消向前的加速度呢？

That's what I set out to do.

那是我决定去做的

想象你有一个仪器,

So imagine you have a device

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

有着锋利的尖端可以切过软组织。

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

把尖头拉回来的最简单的方式是什么呢？

I chose a spring.

我选择使用弹簧。

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

当你拉伸弹簧时，针头会伸出

so it's ready to puncture tissue,

在正要刺穿组织时

弹簧会往回收。

the spring wants to pull the tip back.

How do you keep the tip in place

你怎样才能保持针头的位置

until the moment of puncture?

直到刺穿的那一时刻呢？

我用这种机制。

I used this mechanism.

When the tip of the device is pressed against tissue,

当仪器的尖端压着组织时，

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

这个机械向外扩张并顶住墙壁。

And the friction that's generated

所产生的摩擦力

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

使仪器被固定住，并防止弹簧收回针尖。

But right at the moment of puncture,

但是在刺穿得那一瞬间，

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

组织不能再将针尖向回推。

So the mechanism unlocks and the spring retracts the tip.

因此这个机械解锁，弹簧便收回针尖。

Let me show you that happening in slow motion.

让我展示给你们它的慢镜头。

This is about 2,000 frames a second,

这大概有每秒 2,000 帧，

and I'd like you to notice the tip

我想让你们注意一下针尖部位

就在那的底部位置，正要刺穿软组织。

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

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

你会看见在刺穿得瞬间，

就在那里，机械装置解锁并收回针尖。

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

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

我要给你们再看一遍，这一次近一些。

You're going to see the sharp bladed tip,

你会看到那锋利的刀尖，

and right when it punctures that rubber membrane

就在它刺穿橡胶薄膜的瞬间

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

它便会消失在白色的保护套中。

就在那里。

Right there.

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

那发生在刺穿后的百分之一秒。

因为这个仪器不是为了纯物理刺穿而设计的

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

and not the specifics of cranial drilling

也不是专门为颅骨钻孔

or laparoscopic surgery, or another procedure,

或腹腔镜手术或其它医疗步骤而设计，

it's applicable across these different medical disciplines

这在不同的医学领域

and across different length scales.

和不同的长度范围都可被应用。

但其中还会有变数。

But it didn't always look like this.

This was my first prototype.

这是我的第一个原型。

Yes, those are popsicle sticks,

是的那些是冰棒棍，

在顶端是橡皮筋。

and there's a rubber band at the top.

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

这只花了我大概30分钟，但是成功了。

And it proved to me that my idea worked

这证明了我的想法是正确的，

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

这也证实了剩下几年在这个项目上需要做的工作。

I worked on this because

我研究这个是因为

this problem really fascinated me.

这个问题真的使我着迷。

It kept me up at night.

这个主意让我晚上睡不着。

但我认为它也应该让你着迷，

But I think it should fascinate you too,

因为我说过穿孔在哪里都会发生。

because I said puncture is everywhere.

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

这也就意味着在某个时刻它会成为你的问题。

在手术室的第一天

That first day in the operating room

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

我从来没有想过套针会被用在我身上。

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

但是去年，我在访问希腊的途中得了阑尾炎。

我在雅典的医院里，

So I was in the hospital in Athens,

and the surgeon was telling me

医生告诉我，他要

he was going to perform a laparoscopic surgery.

做一个腹腔镜手术。

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

他准备从那些小的切口中移除我的阑尾，

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

他告诉我将来的康复情况

以及可能发生的后果。

and what was going to happen.

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

他说：“你还有别的问题么？”我说”只有一个。

What kind of trocar do you use?"

你用什么样的套针？”

So my favorite quote about laparoscopic surgery

关于腹腔镜手术我最喜欢的一句话是

H.C.雅各布斯医生所说的：

comes from a Doctor H. C. Jacobaeus:

"It is puncture itself that causes risk."

“是刺穿自身导致危险。”

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

那是我最喜欢的一句话 因为

H.C.雅各布斯医生是第一位实行腹腔镜手术的人，

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

and he wrote that in 1912.

他在 1912 年写下了这句话。

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

在超过 100 年中，这是一个伤害甚至杀害人们的问题。

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

所以这不难想象，对于每一个重要的问题

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

会有某个队伍的专家不分昼夜地工作去解决它。

The truth is that's not always the case.

但事实并不是这样的。

我们需要更善于发现问题

We have to be better at finding those problems

and finding ways to solve them.

并找到解决它们的方法。

所以如果你遇到一个吸引你的问题，

So if you come across a problem that grabs you,

let it keep you up at night.

让自己在夜里反复思量它

Allow yourself to be fascinated,

允许自己被它吸引，

because there are so many lives to save.

因为又很多生命等着你去拯救。

(Applause)

（掌声）