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

Translator: Bob Prottas Reviewer: Ariana Bleau Lugo

譯者: Kuan-Yi Li 審譯者: Marssi Draw

The first time I stood in the operating room

我第一次進手術室

and watched a real surgery,

觀摩實際手術時，

I had no idea what to expect.

沒預料會看到什麼。

I was a college student in engineering.

我當時是工科大學生。

I thought it was going to be like on TV.

我以為會像電視上演的一樣，

Ominous music playing in the background,

播著緊張的背景音樂，

beads of sweat pouring down the surgeon's face.

豆大的汗珠由外科醫生臉上滑落。

But it wasn't like that at all.

但根本不是那樣。

There was music playing on this day,

當天的確有播音樂，

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

我想是瑪丹娜的金曲選輯。 （笑聲）

And there was plenty of conversation,

當時還有許多交談，

not just about the patient's heart rate,

話題除了病人心率外，

but about sports and weekend plans.

還有運動跟週末計劃。

And since then, the more surgeries I watched,

我手術看得越多，

the more I realized this is how it is.

就越懂那是怎麼回事。

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

從某個古怪角度來看， 這跟在辦公室沒兩樣。

But every so often

但有時，

the music gets turned down,

音樂聲會被轉小，

everyone stops talking,

所有人停止說話，

and stares at exactly the same thing.

眼睛盯著同樣的東西。

And that's when you know that something absolutely critical

那時你就知道，有很重要、

and dangerous is happening.

很危險的事情正在進行。

The first time I saw that

首次遇到那狀況時，

I was watching a type of surgery

我正在觀摩腹腔鏡手術。

called laparoscopic surgery

And for those of you who are unfamiliar,

為不熟悉的人說明一下，

laparoscopic surgery, instead of the large

腹腔鏡手術不像

open incision you might be used to with surgery,

傳統大切口的手術，

a laparoscopic surgery is where the surgeon creates

腹腔鏡手術中，外科醫生

these three or more small incisions in the patient.

在病人身上開三個以上的切口。

And then inserts these long, thin instruments

接著插入這些細長、

附攝影機的器材，

and a camera,

and actually does the procedure inside the patient.

並透過它在病患體內進行手術。

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

這很不錯，因為感染風險低、

much less pain, shorter recovery time.

較少疼痛，恢復時間也更短。

But there is a trade-off,

但這其中有著取捨，

because these incisions are created

因為開這些切口

with a long, pointed device

用的是個尖長的器械，

called a trocar.

叫做穿刺套針。

And the way the surgeon uses this device

而外科醫生用這器械的方法

is that he takes it

是他抓著這東西，

and he presses it into the abdomen

然後壓在你的腹部，

until it punctures through.

直到它穿進去。

And now the reason why everyone in the operating room

這就是為何在手術室的所有人

was staring at that device on that day

在當時都盯著那東西看，

was because he had to be absolutely careful

因為他必須非常小心

not to plunge it through

不要穿太過，

and puncture it into the organs and blood vessels below.

以免刺穿下面的臟器和血管。

But this problem should seem pretty familiar to all of you

但這問題大家都很熟，

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

因為你們八成在其他地方看過了。

(Laughter)

（笑聲）

Remember this?

記得這個吧？

(Applause)

（掌聲）

You knew that at any second

你很清楚在某個時間點，

that straw was going to plunge through,

吸管會刺穿，

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

而你不知是否會穿透，

and straight into your hand,

戳到你的手，

or if you were going to get juice everywhere,

或把果汁噴得到處是。

but you were terrified. Right?

你怕死了。對吧？

Every single time you did this,

每次你做這件事，

you experienced the same fundamental physics

所體驗到的物理原理，

that I was watching in the operating room that day.

都和我那天在手術室經歷的一樣。

And it turns out it really is a problem.

這顯然是個大問題。

In 2003, the FDA actually came out and said

2003 年，FDA 甚至出面表示：

that trocar incisions might be the most dangerous step

套針穿刺或許是在微創手術中

in minimally invasive surgery.

最危險的步驟。

Again in 2009, we see a paper that says

2009 年，我們又看到一篇論文說：

that trocars account for over half

腹腔鏡手術的主要併發症

of all major complications in laparoscopic surgery.

有半數以上和穿刺套針有關。

And, oh by the way,

噢！除此之外，

this hasn't changed for 25 years.

這件事已經 25 年沒變了。

So when I got to graduate school,

所以我上研究所時，

this is what I wanted to work on.

就想做這東西。

I was trying to explain to a friend of mine

我試著跟朋友解釋

what exactly I was spending my time doing,

我到底在忙什麼，

and I said,

我說：

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

「這就像你為了掛東西

to hang something in your apartment.

鑽牆壁那樣。

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

鑽子在鑽穿牆壁那個瞬間

and there's this plunge. Right?

會爆衝一下。對吧？」

And he looked at me and he said,

然後他看著我說：

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

「你是說， 像他們鑽人腦袋那樣？」

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

然後我說：「啥？！」 （笑聲）

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

我後來查了一下， 發現他們真會這麼做。

A lot of neurosurgical procedures

很多的神經外科手術

actually start with a drill incision through the skull.

第一步就是在你顱骨上鑽個洞。

And if the surgeon isn't careful,

如果外科醫生不謹慎，

he can plunge directly into the brain.

他有可能會直接戳到腦部。

So this is the moment when I started thinking,

從那時候我開始思考，

okay, cranial drilling, laparoscopic surgery,

好，顱骨鑽孔、腹腔鏡手術，

why not other areas of medicine?

那其他醫學領域呢？

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

你想想，哪次你去看醫生

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

沒被塞點什麼，是吧？

So the truth is

事實就是，

in medicine puncture is everywhere.

在醫學上，穿刺無所不在。

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

而這只是我查到的幾種手術，

that involve some tissue puncture step.

其中有組織穿刺的步驟。

And if we take just three of them —

如果我們只看其中三種──

laparoscopic surgery, epidurals, and cranial drilling —

腹腔鏡手術、硬膜外麻醉、 顱骨鑽孔──

these procedures account for over 30,000 complications

而這些手術引發了 超過三萬起的併發症，

every year in this country alone.

而這只是這個國家一年的數字。

I call that a problem worth solving.

我認為這是個值得解決的問題。

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

讓我們來看一些

that are used in these types of procedures.

用在這類手術的器械。

I mentioned epidurals. This is an epidural needle.

我提過硬膜外麻醉。 這是硬膜外套針。

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

他用來穿刺脊椎韌帶，

and deliver anesthesia during childbirth.

在分娩時注射麻醉藥。

Here's a set of bone marrow biopsy tools.

這是組骨髓切片取樣工具，

These are actually used to burrow into the bone

用來做骨骼穿孔，

and collect bone marrow or sample bone lesions.

並收集骨髓， 或做骨骼病變的取樣。

Here's a bayonette from the Civil War.

這是南北戰爭的刺刀。

(Laughter)

（笑聲）

If I had told you it was a medical puncture device

若我告訴你這是醫學穿刺器材，

you probably would have believed me.

你說不定真會相信我。

Because what's the difference?

因為這沒什麼不同嘛！

So, the more I did this research

我越深入研究，

the more I thought there has to be

越是覺得

一定有更好的做法。

a better way to do this.

And for me the key to this problem

對我來說，問題的關鍵在於

is that all these different puncture devices

所有的這些穿刺器材

share a common set of fundamental physics.

都遵循同一套物理原理。

So what are those physics?

什麼原理呢？

Let's go back to drilling through a wall.

讓我們回到鑽牆壁。

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

你透過鑽子對牆施加壓力，

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

牛頓告訴我們， 牆壁會給我們反作用力，

equal and opposite.

等量且反向。

So, as you drill through the wall,

當你正在鑽的時候，

those forces balance.

兩力平衡。

But then there's that moment

但在某個瞬間，

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

牆壁會被鑽穿，

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

牆壁將無法再提供反作用力。

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

但你的大腦還來不及 對變化作出反應，

So for that millisecond,

有幾毫秒時間

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

──依你的反應速度而定， 你還在施加壓力。

and that unbalanced force causes an acceleration,

而不平衡的力造成加速度，

and that is the plunge.

導致爆衝。

But what if right at the moment of puncture

但如果在刺穿瞬間，

you could pull that tip back,

你能夠將針尖

actually oppose the forward acceleration?

往加速的反方向縮回呢？

That's what I set out to do.

那就是我要做的。

So imagine you have a device

想像你有種器材，

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

它有用來刺穿組織的針尖。

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

把針尖縮回的最簡單方法是什麼？

I chose a spring.

我選擇了彈簧。

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

當彈簧拉伸，針尖便伸出，

so it's ready to puncture tissue,

就能穿刺組織。

the spring wants to pull the tip back.

彈簧會想拉回針尖。

How do you keep the tip in place

你如何在穿透前，

until the moment of puncture?

固定住針尖呢？

I used this mechanism.

我採用這機械結構。

When the tip of the device is pressed against tissue,

當針尖受到組織的反作用力，

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

這機構會向外撐向內壁。

And the friction that's generated

而其產生的摩擦力

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

會鎖定針尖，阻止彈簧將它縮回。

But right at the moment of puncture,

但在穿透瞬間，

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

組織不再提供反作用力。

So the mechanism unlocks and the spring retracts the tip.

所以機構解鎖，彈簧將針尖縮回。

Let me show you that happening in slow motion.

看一下慢動作。

This is about 2,000 frames a second,

這大約每秒 2,000 畫格。

and I'd like you to notice the tip

注意針尖的部分，

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

在畫面下方，即將刺穿組織。

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

你會發現在刺穿的瞬間，

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

在這，機構解鎖，針尖縮回。

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

我們拉近點再看一次。

You're going to see the sharp bladed tip,

你會看到那尖銳的針尖，

and right when it punctures that rubber membrane

在它刺穿橡膠膜的瞬間，

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

會縮進那個鈍邊白色套管。

Right there.

在這。

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

這一切都在百分之四秒內發生。

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

而且因為這項設計是 遵循穿刺的物理原理

and not the specifics of cranial drilling

而非針對顱骨鑽孔、

or laparoscopic surgery, or another procedure,

腹腔鏡手術或其他手術，

it's applicable across these different medical disciplines

其適用範圍涵蓋醫學各領域，

and across different length scales.

以及各種不同規模。

But it didn't always look like this.

但它不見得長這樣。

This was my first prototype.

這是我作品的原型。

Yes, those are popsicle sticks,

對，那是冰棒棍，

and there's a rubber band at the top.

頂部那是橡皮筋。

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

做這只花 30 分鐘，但成品就有用了。

And it proved to me that my idea worked

它證明我的想法可行，

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

並讓我接下來幾年的 付出有所憑據。

I worked on this because

我投入其中，

this problem really fascinated me.

因為這問題讓我著迷，

It kept me up at night.

甚至使我夜不能眠。

But I think it should fascinate you too,

但我想這也該吸引你，

because I said puncture is everywhere.

因為穿刺無所不在。

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

意味著在某個時刻， 那也將成為你的問題。

That first day in the operating room

進手術室第一天，

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

我沒料到有天 穿刺套針會用在我身上。

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

但去年，我在希臘時 患上闌尾炎。

So I was in the hospital in Athens,

我在雅典的醫院，

and the surgeon was telling me

外科醫生告知我

he was going to perform a laparoscopic surgery.

他將進行腹腔鏡手術。

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

他將透過那些小切口切除闌尾，

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

接著他告訴我預期的康復狀況、

and what was going to happen.

接下來會做什麼。

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

他說：「你有什麼問題嗎？」 我說：「只有一個。

What kind of trocar do you use?"

你們用的是哪種穿刺套針？」

So my favorite quote about laparoscopic surgery

關於腹腔鏡手術，我最愛的引語

comes from a Doctor H. C. Jacobaeus:

出自雅各貝烏斯醫師：

"It is puncture itself that causes risk."

「造成風險的，是穿刺本身。」

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

這是我最愛的引語， 因為雅各貝烏斯

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

是在人體進行 腹腔鏡手術的第一人。

and he wrote that in 1912.

而他在 1912 年寫下這句話。

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

這問題傷害人們， 甚至致人於死已超過百年之久。

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

你可以安逸地想說，重要問題

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

已有一群專家不眠不休致力解決。

The truth is that's not always the case.

真相是，事情並非總如此。

We have to be better at finding those problems

我們得找到這樣的問題，

and finding ways to solve them.

並找方法解決。

So if you come across a problem that grabs you,

所以若你遇到那種 「刺眼」的問題，

let it keep you up at night.

讓自己夜以繼日地投入吧！

Allow yourself to be fascinated,

讓自己為其著迷，

because there are so many lives to save.

因為有太多的生命，正待幫助。

(Applause)

（掌聲）