How augmented reality could change the future of surgery | Nadine Hachach-Haram

譯者: Lilian Chiu 審譯者: Wang Leung Lee

According to the theories of human social development,

根據人類社會發展的理論，

we're now living through the fourth great epoch

我們現在正處在技術進展的

of technological advancement,

第四個重要時期：

the Information Age.

「資訊時代」。

Connectivity through digital technology is a modern miracle.

透過數位技術造成的連結性， 是現代的奇蹟。

We can say it has broken down barriers of time and space which separate people,

我們可以說，原本會讓人分離的 時間空間阻礙，都被它打破了，

and it's created a condition for an age

它所創造的時代中，

where information, ideas can be shared freely.

資訊、想法都能自由分享。

But are these great accomplishments in digital technology

但這些數位技術的偉大成就已近尾聲，

really the endgame in terms of what can be achieved?

不能再達成更多了嗎？

I don't think so,

我不認為如此，

and today I'd like to share with you

而今天我想要和各位分享

how I believe digital technology can take us to even greater heights.

我為何相信數位技術 可以帶我們再上一層樓。

I'm a surgeon by profession,

我的職業是外科醫生，

and as I stand here today talking to all of you,

今天我站在這裡和各位說話的同時，

five billion people around the world lack access to safe surgical care.

全世界有五十億人無法 取得安全的手術護理。

Five billion people.

五十億人。

That's 70 percent of the world's population,

那是世界人口的 70%，

who according to the WHO's Lancet Commission

世界衛生組織的柳葉刀委員會指出，

can't even access simple surgical procedures

他們甚至在需要簡單外科手術時，

as and when they need them.

都求助無門。

Let's zoom in on Sierra Leone,

讓我們來看看獅子山共和國，

a country of six million people,

這個國家有六百萬人口，

where a recent study showed that there are only 10 qualified surgeons.

一項近期研究指出， 只有十個合格的外科醫生。

That's one surgeon for every 600,000 people.

也就是說每六十萬人 才有一個外科醫生。

The numbers are staggering,

這些數字很嚇人，

and we don't even need to look that far.

而我們甚至不用看那麼遙遠。

If we look around us here in the US,

如果我們看看我們所在的美國，

a recent study reported that we need an extra 100,000 surgeons by 2030

一項近期研究指出，到 2030 年 我們還需要再增加十萬名外科醫生，

to just keep up with the demand for routine surgical procedures.

這樣才能剛好追上 例行外科手術的需求。

At the rate that we're going, we won't be meeting those numbers.

以目前的比率來看， 我們無法達成那個數字。

As a surgeon, this is a global issue that bothers me.

身為外科醫生， 這個全球議題讓我困擾。

It bothers me a lot,

它讓我很困擾，

because I've seen firsthand

因為我曾經第一手見過，

how lack of access to safe and affordable healthcare

無法取得安全且能負擔的健康照護

can blight the lives of ordinary people.

會如何摧殘一般人的生命。

If you're a patient that needs an operation

如果你是需要動手術的病人，

and there isn't a surgeon available,

卻沒有外科醫生有空，

you're left with some really difficult choices:

你就得要做出非常困難的抉擇：

to wait, to travel,

等候、到其他地方，

or not to have an operation at all.

或完全不要動手術。

So what's the answer?

所以答案是什麼？

Well, part of you are carrying some of that solution with you today:

在座有些人今天已把 一部份的解決方案帶在身上了：

a smartphone, a tablet, a computer.

智慧手機、平板電腦、電腦。

Because for me,

因為，對我來說，

digital communications technology has the power to do so much more

數位通訊技術能夠做到的

than just to allow us to shop online,

遠遠超過線上購物、

to connect through social media platforms and to stay up to date.

透過社交媒體平台連結， 及取得最新資訊。

It has the power to help us solve some of the key issues that we face,

它有能力協助我們解決一些 我們面臨的關鍵議題，

like lack of access to vital surgical services.

比如無法取得攸關生死的手術服務。

今天我想要和各位分享個例子，

And today I'd like to share with you

an example of how I think we can make that possible.

來說明我們要如何實現那個想法。

The history of surgery is filled with breakthroughs

手術的歷史充滿了突破，

in how science and technology was able to help the surgeons of the day

在於科學與技術協助當時的外科醫生

面對最大挑戰的方式上不斷突破。

face their greatest challenges.

If we go back several hundred years,

如果回到數百年前，

an understanding of microbiology

對於微生物學的了解

led to the development of antiseptic techniques,

造成了防腐抗菌技術的發展，

which played a big role in making sure

對於確保病人在手術後還能

patients were able to stay alive postsurgery.

生存下來，這項技術非常重要。

Fast-forward a few hundred years

稍微快轉幾百年，

and we developed keyhole or arthroscopic surgery,

我們發展出了微創或關節鏡手術，

which combines video technology and precision instruments

結合了影像技術和精準的工具

to make surgery less invasive.

來降低手術的侵入性。

And more recently, a lot of you will be aware of robotic surgery,

更近期，許多人 可能聽過機器人手術，

and what robotics brings to surgery is much like modern automated machinery,

機器人學帶給手術的 是類似現代自動化機械裝置、

ultraprecision,

超精度、

the ability to carry out procedures at the tiniest scales

進行最小精準度手術的能力，

with a degree of accuracy that even surpasses the human hand.

比人類雙手能達到的精準度更高。

But robotic surgery also introduced something else to surgery:

但，機器人手術還為手術 帶來了一個新想法：

the idea that a surgeon

外科醫生不見得

doesn't actually have to be standing at the patient's bedside to deliver care,

一定得要站在病人的床邊進行照護，

that he could be looking at a screen

他可以看著螢幕，

and instructing a robot through a computer.

透過電腦來指示機器人進行。

We call this remote surgery.

我們稱之為遙控手術。

It is incumbent on us

我們有責任要找到成本效益高

to find solutions that solve these answers in a cost-effective and scalable way,

又可擴展的方法來解決這些答案，

so that everyone, no matter where they are in the world,

才能讓每個人， 不論在世界的哪個角落，

can have these problems addressed.

都能處理這些問題。

So what if I told you

如果我告訴各位，

that you didn't really need a million-dollar robot

並不需要一台造價百萬美金的機器人

to provide remote surgery?

也能做到遙控手術，如何？

That all you needed was a phone, a tablet, or a computer,

你只需要一隻手機、 一台平板電腦或電腦、

an internet connection,

網路連線、

a confident colleague on the ground

一個有信心的同事在手術室裡，

and one magic ingredient:

還有一項魔法成份：

an augmented reality collaboration software.

擴增實境協同作業軟體。

Using this augmented reality collaboration software,

用這個擴增實境協同作業軟體，

an expert surgeon can now virtually transport himself

專業外科醫生就可以用 虛擬的方式將他自己

into any clinical setting

傳送到任何臨床場景中，

simply by using his phone or tablet or computer,

只要用他的手機、平板或電腦即可，

and he can visually and practically interact in an operation

他可以在一次手術中， 從頭到尾，做視覺上

from start to finish,

和實際上的互動，

guiding and mentoring a local doctor through the procedure step by step.

一步一步引導和指導 當地的醫生完成手術。

Well, enough of me telling you about it.

各位應該聽我說夠了，

I'd now like to show you.

現在讓我來展示給各位看。

We're now going to go live to Dr. Marc Tompkins,

我們現在要跟馬克湯普金斯 醫生做現場連線，

an orthopedic surgeon at the University of Minnesota.

他是明尼蘇達大學的整形外科醫生。

He's going to perform an arthroscopic surgery for us,

他將為我們進行一項關節鏡手術，

a keyhole surgery of the knee,

膝蓋的微創手術，

and I'd like to disclose

我想要公開說明，

that this patient has consented to having their operation streamed.

這位病人同意讓這次的 手術影片被傳輸過來。

I'd also like to point out that in the interest of time,

我也要先說明，因為時間的緣故，

we're just going to go through the first steps,

我們只會做前面幾個步驟，

marking up the patient

給病人做標記，

and just identifying a few key anatomical landmarks.

以及找出幾個關鍵的解剖學位置。

Hello, Dr. Tompkins, can you hear me?

哈囉，湯普金斯醫生，聽得見嗎？

Dr. Mark Tompkins: Good morning, Nadine.

馬克湯普金斯醫生：早安，娜汀。

Nadine Hachach-Haram: Everyone from TED says hello.

娜汀哈恰奇哈蘭： TED 的大家說哈囉。

Audience: Hi.

觀眾：嗨。

NHH: Alright, Dr. Tompkins, let's get started.

娜汀：好，湯普金斯醫生， 我們開始吧。

So let's start with our incisions and where we're going to make these,

我們先從切口開始，

而切口的位置是在膝蓋肌腱的兩側。

on either side of the patellar tendon.

So if you can make your incisions there and there,

如果你能在那裡和那裡做切口，

that should hopefully get us into the knee.

希望那樣能讓我們進入膝蓋。

MT: All right, I'm going in.

馬克：好，我要進入了。

NHH: Great.

娜汀：很好。

So we're just getting inside the joint now.

我們現在進入了關節內部。

So why don't we go around and have a quick look at the meniscus.

我們何不繞過去 快速看一下半月軟骨。

MT: Perfect.

馬克：好極了。

NHH: Great, so we can see there's a small tear there on the meniscus,

娜汀：很好，所以我們能看到 半月軟骨上的這裡有個小撕裂傷，

but otherwise it looks alright.

其他地方看起來都還好。

And if you turn and head to this direction,

如果你轉動一下，朝向這個方向，

follow my finger,

跟著我的手指，

let's have a quick look at the ACL and the PCL.

咱們來快速看看 前十字韌帶跟後十字韌帶。

That's your ACL there, that looks quite healthy,

那是前十字韌帶，看起來很健康，

no problems there.

那裡沒問題。

So we've just identified that small meniscus tear there,

我們剛剛已經看到了那邊 半月軟骨上的小撕裂傷，

but otherwise the fluid around the joint looks OK as well.

此外，關節周圍的液體 看起來也沒問題。

All right, thank you very much, Dr. Tompkins. Thank you for your time.

好的，非常謝謝你的時間， 湯普金斯醫生。

I'll let you continue.

我就讓你繼續了。

Have a good day. Bye.

祝今天愉快，再見。

(Applause)

（掌聲）

So I hope through this simple demonstration

我希望透過這次簡單的展示，

I was able to illustrate to you just how powerful this technology can be.

能夠向各位說明 這項技術能有多強大。

And I'd like to point out that I wasn't using any special equipment,

我要強調，我沒使用任何特殊裝備，

只有我的筆記型電腦 和很簡單的網路攝影機。

just my laptop and a really simple webcam.

We're so used to using digital technology

我們非常習慣使用數位技術，

to communicate through voice and text and video,

透過聲音、文字、影像做溝通，

but augmented reality can do something so much deeper.

但擴增實境能做的事更深許多。

It allows two people to virtually interact

它讓兩個人能夠 以虛擬的方式做互動，

in a way that mimics how they would collaborate in person.

模仿他們面對面時的協同作業方式。

Being able to show someone what you want to do,

能夠讓對方知道你想要做什麼，

to illustrate and demonstrate and gesture,

能夠圖解、展示、用動作示意，

is so much more powerful than just telling them.

遠比單單告訴對方要強大得多。

And it can make for such a great learning tool,

它能成為非常棒的學習工具，

because we learn better through direct experience.

因為直接經驗能讓學習更有效。

So how is this making a difference around the world?

所以，這要如何 在世界各地造成不同？

Well, back in my teaching hospital,

回到我的教學醫院，

we've been using this to support local district general hospitals

我們一直在用它來支援 當地的地方綜合醫院，

and providing skin cancer surgery and trauma treatment.

提供皮膚癌手術以及創傷治療。

Now, patients can access care at a local level.

病人只要在地方的層級 就能取得照護。

This reduces their travel time, improves their access,

這樣能減少他們的交通時間， 改善他們的使用，

and saves money.

還可以省錢。

We've even started seeing its use in wound care management with nurses

它甚至開始被用在護士的 傷口照護管理上，

and in outpatient management.

以及門診病人管理。

Most recently, and quite exciting,

最近，很讓人興奮的是，

it was used in supporting a surgeon through a cancer removal of a kidney.

它被用來支援一位外科醫生， 進行癌症的腎臟切除手術。

And I'd like to just share with you a very quick video here.

我想快速和各位分享一下影片。

I apologize for some of the gruesome views.

很抱歉會有一些可怕的畫面。

(Video) Doctor 1: OK. Show me again.

（影片）醫生 #1： 好，再讓我看一次。

Doctor 2: If you see here,

醫生 #2：你看這裡，

that's the upper part, the most outer part of your tumor.

那是上半部， 你的腫瘤最外面的部份。

Doctor 1: Yes.

醫生 #1：是的。

Doctor 2: So it's three centimeters deep,

醫生 #2：它的深度有 3cm，

so this should be three centimeters.

這應該是 3cm。

Doctor 1: Yes, yes.

醫生 #1：是，是的。

Doctor 2: OK, so you need to get a 3.5 margin.

醫生 #2：好，所以你得要 切除 3.5 公分，餘地才夠。

Doctor 1: I'm going to show you anyway

醫生 #1：總之，我會做給你看，

and tell me what you think about it.

告訴我你認為如何。

NHH: We're also seeing the use of this technology at a global scale,

娜汀：我們也看到這項技術 被用到全球的規模，

and one of the most heartwarming stories I can recall

我所記得最暖心的故事之一，

is from the town of Trujillo in the north of Lima in Peru,

來自秘魯利馬北邊的楚黑歐小鎮，

where this technology was used to support the provision

當這項技術被用來支援

of cleft lip and palate surgery to children,

孩童的唇裂與顎裂手術，

children from poor backgrounds who didn't have access to health insurance.

幫助來自貧窮背景 且沒有健康保險的孩童。

And in this town, there was a hospital with one surgeon

在這小鎮有一間醫院， 只有一位外科醫生

working hard to provide this care,

很努力在提供這項照護，

Dr. Soraya.

索瑞亞醫生。

Now, Dr. Soraya was struggling under the sheer demand

索瑞亞醫生很辛苦，

因為當地人口的需求太大了，

of her local population,

as well as the fact that she wasn't specifically trained in this procedure.

且她本身並沒有特別 受過這項手術的訓練。

And so, with the help of a charity,

所以，靠一個慈善團體協助，

we were able to connect her with a cleft surgeon in California,

我們得以讓她和加州的 一位唇裂外科醫生連結上，

and using this technology, he was able to guide her and her colleagues

用這項技術，他能夠 指導她和她的同事

through the procedure step by step,

一步一步完成手術，

guiding them, training them and teaching them.

引導他們、訓練他們、教導他們。

Within a few months,

幾個月之內，

they were able to perform 30 percent more operations

他們能夠進行的手術 數目多了 30%，

with less and less complications.

且併發症也越來越少了。

And now Dr. Soraya and her team can perform these operations

現在，索瑞亞醫生和 她的小組有足夠能力

independently, competently and confidently.

能獨立且有信心地進行這些手術。

And I remember one quote from a mother who said,

我記得有位母親說過：

"This technology gave my daughter her smile."

「這項技術把微笑帶給我的女兒。」

For me, this is the real power of this technology.

對我來說，這就是 這項技術真正的力量。

The beauty is that it breaks boundaries.

美好之處在於它跨越了國界。

It transcends all technological difficulties.

它超越了所有技術困難。

It connects people. It democratizes access.

它把人連結在一起， 讓大家都有使用機會。

Wi-Fi and mobile technology are growing rapidly,

無線上網和行動技術正在快速成長，

and they should play a role in boosting surgical provision.

它們應該要在推動 手術提供上有所貢獻。

We've even seen it used in conflict zones where there's considerable risk

我們曾經看過它被用在 衝突地區，在那裡，

in getting specialist surgeons to certain locations.

要專業外科醫生送到 某些特定地點是很危險的。

In a world where there are more mobile devices

在這個世界上，

手機數比人類數還多，

than there are human beings,

it truly has a global reach.

它真的能觸及全球。

Of course, we've still got a long way

當然，還有很長的路要走，

before we can solve the problem of getting surgery to five billion people,

才能解決要把手術 帶給五十億人的問題，

and unfortunately,

不幸的是，

some people still don't have access to internet.

有些人還無法取得網路連結。

But things are rapidly moving in the right direction.

但，現狀正在快速 朝正確的方向發展。

The potential for change is there.

改變的潛力就在那裡。

My team and I are growing our global footprint,

我和我的團隊在全球 留下越來越多的足跡，

and we're starting to see the potential of this technology.

我們才剛開始看到這項技術的潛力。

Through digital technology,

透過數位技術，

through simple, everyday devices that we take for granted,

透過被我們視為理所當然 的簡單日常裝置，

through devices of the future,

透過未來的裝置，

we can really do miraculous things.

我們真的能做出很了不起的事。

Thank you.

謝謝。

(Applause)

（掌聲）