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

譯者: Audrey Liu 審譯者: Ching-Yi Wu

A talk about surgical robots

這是關於外科手術機器的演講,

is also a talk about surgery.

也是關於手術的演講

And while I've tried to make my images not too graphic,

在我試著不要讓畫面太血腥的同時

keep in mind that surgeons have a different relationship with blood

請了解外科醫師對血有和一般人

than normal people do,

不一樣的情感關係

because, after all, what a surgeon does to a patient,

畢竟外科醫師對病人所做的事

if it were done without consent,

如果沒有得到同意

would be a felony.

會是一項嚴重的罪行

Surgeons are the tailors, the plumbers,

外科醫師是裁縫、是水電工

the carpenters -- some would say the butchers --

是木匠，有些人會說他們是

of the medical world:

醫學界的屠夫

cutting, reshaping, reforming,

做切割、重建、改造

bypassing, fixing.

繞道、修補

But you need to talk about surgical instruments

但是你必須要把手術的器具

and the evolution of surgical technology together.

和手術科技的發展放在一起來討論

So in order to give you some kind of a perspective

所以為了要讓你們稍稍了解

of where we are right now

手術用機器,

with surgical robots,

目前發展到哪裡

and where we're going to be going in the future,

還有未來要往哪裡去

I want to give you a little bit of perspective

我要讓你們有些概念

of how we got to this point,

我們是怎麼走到這一步的

how we even came to believe

我們到底是怎麼樣開始相信

that surgery was OK,

動手術是可行的

that this was something that was possible to do,

這件事是有可能做到的

that this kind of cutting and reforming was OK.

這樣的切割和重建是好的

So, a little bit of perspective --

所以，以下是一些觀點

about 10,000 years of perspective.

大約是一萬年以來的觀點

This is a trephinated skull.

這是一個做了頭顱穿洞術的頭骨,

And trephination is simply just cutting a hole in the skull.

頭顱穿洞術就是在頭骨上切開一個洞

And many, many hundreds of skulls like this

在世界各地的考古遺址

have been found in archaeological sites

已經發現成千上百

all over the world,

像這樣的頭骨

dating back five to 10 thousand years.

年代可以回溯到一萬年前

Five to 10 thousand years! Now imagine this.

五千到一萬年前! 現在想像

You are a healer in a Stone Age village.

你是石器時代村落裡的治療師

And you have some guy that you're not quite sure what's wrong with him --

有一個病人你不是很確定他到底怎麼了

Oliver Sacks is going to be born way in the future.

(奧立佛薩克斯將在很久以後的未來才出生)

He's got some seizure disorder. And you don't understand this.

他有癲癇的症狀。雖然你不知道是為什麼,

But you think to yourself,

但是你的腦子裡就想

"I'm not quite sure what's wrong with this guy.

“我不是很確定他怎麼了，

But maybe if I cut a hole in his head I can fix it."

但是如果我在他的頭上開個洞，我就可以把他治好”

(Laughter)

(笑聲)

Now that is surgical thinking.

這就是手術的想法

Now we've got the dawn of interventional surgery here.

現在我們已經知道侵入式手術的開端是什麼

What is astonishing about this is,

真正讓我們驚奇的是

even though we don't know really how much of this

即使我們不知道到底這樣的行為其中有多少是

was intended to be religious,

為了宗教的理由

or how much of it was intended to be therapeutic,

或者這裡頭有多少的目的是為了治療,

what we can tell is that these patients lived!

我們知道的是這些病人都存活下來!

Judging by the healing on the borders of these holes,

從這些洞邊緣的瘉合狀況來看

they lived days, months, years following trephination.

他們在環鋸手術後活了很多天、很多個月、甚至好幾年

And so what we are seeing is evidence

所以我們看到的是一種

of a refined technique

精湛技術的證據

that was being handed down over thousands and thousands of years,

它在世界各地傳承了

all over the world.

好幾千年

This arose independently at sites everywhere

它在各個地點的崛起是個自獨立的

that had no communication to one another.

彼此沒有交流

We really are seeing the dawn of interventional surgery.

我們真正見到了侵入式手術的起源

Now we can fast forward many thousands of years

現在我們可以快轉幾千年

into the Bronze Age and beyond.

到銅器時代以及之後

And we see new refined tools coming out.

我們看到新的更精良的工具出土

But surgeons in these eras are a little bit more conservative

但是這個時期的外科醫師比起他們那些

than their bold, trephinating ancestors.

大膽、做環鋸手術的祖先要保守些

These guys confined their surgery

這些人做的手術只限於

to fairly superficial injuries.

相當表面的損傷

And surgeons were tradesmen,

而且外科醫師是工匠

rather than physicians.

而不是醫生

This persisted all the way into and through the Renaissance.

這狀況一直維持到文藝復興時代結束

That may have saved the writers,

那可能保全了作家

but it didn't really save the surgeons terribly much.

但是對於拯救外科醫師的名聲卻沒有什麼貢獻

They were still a mistrusted lot.

他們仍舊是不被信任的一群

Surgeons still had a bit of a PR problem,

外科醫師依然有些公關上的問題

because the landscape was dominated

因為當時這個領域中稱霸的

by the itinerant barber surgeon.

是四處巡迴的理髮師外科醫生

These were folks that traveled from village to village, town to town,

這些人穿梭在城鎮之間

doing surgery sort of as a form of performance art.

動手術就好像是在種表演藝術,

Because we were in the age before anesthesia,

因為當時仍是麻醉存在之前的年代

the agony of the patient

所以病人的強烈苦痛

is really as much of the public spectacle

其實和手術本身同樣被大眾

as the surgery itself.

視為奇觀

One of the most famous of these guys, Frere Jacques,

其中最出名的，雅各修士

shown here doing a lithotomy --

在這張圖上，正在進行截石術

which is the removal of the bladder stone,

就是取出膀胱的結石

one of the most invasive surgeries they did at the time --

在當時是侵入性最高的手術之一

had to take less than two minutes.

他必須在兩分鐘內做完

You had to have quite a flair for the dramatic,

所以你一定要很戲劇化的炫技,

and be really, really quick.

手法要非常地快

And so here you see him doing a lithotomy.

在這張畫裡，你可以看到雅各修士在做截石術,

And he is credited with doing over 4,000 of these public surgeries,

一般相信他在歐洲遊走

wandering around in Europe,

做過超過四千場大庭廣眾下的手術

which is an astonishing number,

當你的認知是手術一定是最後的手段時

when you think that surgery must have been a last resort.

這個數字就十分驚人

I mean who would put themselves through that?

我的意思是有誰會願意經歷這過程？

Until anesthesia, the absence of sensation.

一直到麻醉這種讓病人沒有知覺的手段出現──

With the demonstration of the Morton Ether Inhaler

1847年，在麻省總醫院

at the Mass. General in 1847,

莫爾頓示範乙醚吸入器後

a whole new era of surgery was ushered in.

外科手術即被帶入一個全新的紀元

Anesthesia gave surgeons the freedom to operate.

麻醉給外科醫師開刀的自由

Anesthesia gave them the freedom to experiment,

麻醉給他們實驗的自由

to start to delve deeper into the body.

讓他們開始對人體進行更深入的探索

This was truly a revolution in surgery.

這真的是手術的一大革新

But there was a pretty big problem with this.

但是這也帶來了一個蠻大的問題

After these very long, painstaking operations,

病人接受這些冗長又辛苦的手術

attempting to cure things they'd never been able to touch before,

目的就是為了要治癒他們以前根本無法碰觸的疾病

the patients died.

但是完成後病人卻死了

They died of massive infection.

他們死於嚴重的感染

Surgery didn't hurt anymore,

手術雖然不再痛苦

but it killed you pretty quickly.

但是它可以迅速的致命

And infection would continue to claim a majority of surgical patients

且感染持續奪走大部份手術病人的生命

until the next big revolution in surgery,

一直到手術的下一個重大革新出現

which was aseptic technique.

就是消毒滅菌技術

Joseph Lister was aepsis's,

約瑟夫李斯特是無菌處理

or sterility's, biggest advocate,

或消毒的最重要提倡者

to a very very skeptical bunch of surgeons.

他對一些對此非常懷疑的外科醫生做宣導

But eventually they did come around.

最後他們終於也改變立場

The Mayo brothers came out to visit Lister in Europe.

梅約兄弟到歐洲來拜訪李斯特

And they came back to their American clinic and they said

在他們回到美國的診所後說到

they had learned it was as important to wash your hands

他們學習到手術前洗手

before doing surgery

和手術後的清洗

as it was to wash up afterwards. (Laughter)

是一樣重要的

Something so simple.

這是多簡單的一件事

And yet, operative mortality dropped profoundly.

但是，手術的致死率就因此明顯降低

These surgeries were actually now being effective.

這些手術事實上現在很有效

With the patient insensitive to pain,

在病人不感覺痛

and a sterile operating field

且在無菌手術室的狀況下

all bets were off, the sky was the limit.

一切都不一樣了，不再有限制

You could now start doing surgery everywhere,

現在你可以在任何地方動手術

on the gut, on the liver,

腸子、肝

on the heart, on the brain.

心臟、腦

Transplantation: you could take an organ out of one person,

移植手術：你可以從一個人身上取出一個器官

you could put it in another person, and it would work.

把它放到另一個人身上，仍可以運作

Surgeons didn't have a problem with respectability anymore;

外科醫生不再有聲望上的問題

they had become gods.

他們變成了神

The era of the "big surgeon, big incision" had arrived,

“大外科醫生開大刀"的時代來臨

but at quite a cost,

但這也付出一定的代價

because they are saving lives,

因為他們雖然救了很多生命

but not necessarily quality of life,

但卻不見得是有品質的生活

because healthy people don't usually need surgery,

這是因為健康的人通常不需開刀

and unhealthy people have a very hard time recovering from a cut like that.

而不健康的人卻很難從這麼大的傷勢中復元

The question had to be asked,

這時我們就會問

"Well, can we do these same surgeries

“嗯，我們是不是可進行同樣的手術

but through little incisions?"

但是不用這麼大的切口呢？”

Laparoscopy is doing this kind of surgery:

內視鏡檢查就是這類的手術

surgery with long instruments through small incisions.

醫師以一根很長的器械穿過很小的切口來進行手術,

And it really changed the landscape of surgery.

這真的改變了外科手術的視野

Some of the tools for this had been around for a hundred years,

其實有些內視鏡的器械已經存在約一百年了,

but it had only been used as a diagnostic technique

但是它只被用來當作診斷的技術

until the 1980s,

一直到 1980 年代

when there was changes in camera technologies and things like that,

當照相機及相關技術有重大突破後

that allowed this to be done for real operations.

這些器械才得以實際應用於手術上,

So what you see -- this is now the first surgical image --

你在這裡看到 ─ 這是第一張手術照片 ─

as we're coming down the tube, this is a new entry into the body.

我們沿著管子往下走，這是一個進入身體的新入口

It looks very different from what you're expecting surgery to look like.

這和你期待的手術的樣子很不一樣

We bring instruments in,

我們分別從側面兩個切口

from two separate cuts in the side,

把器械帶入,

and then you can start manipulating tissue.

現在你就可以開始處理組織

Within 10 years of the first gallbladder surgeries

自從第一次膽囊手術使用內視鏡

being done laparoscopically,

開始的十年內

a majority of gallbladder surgeries

大部分的膽囊手術

were being done laparoscopically --

都是經由內視鏡手術完成

truly a pretty big revolution.

這真的是一項很大的改革

But there were casualties of this revolution.

但是這項改革也造成一些傷亡,

These techniques were a lot harder to learn

內視鏡這項技術比一般人預期的,

than people had anticipated.

要難學習

The learning curve was very long.

學習的時間很長

And during that learning curve the complications went quite a bit higher.

且在學習期間併發症產生的機率偏高

Surgeons had to give up their 3D vision.

外科醫生要放棄原本 3D 的視覺

They had to give up their wrists.

他們要放棄它們的手腕

They had to give up intuitive motion in the instruments.

他們要放棄使用工具的直覺式動作

This surgeon has over 3,000 hours of laparoscopic experience.

這位外科醫生有超過 3000 小時的內視鏡手術經驗

Now this is a particularly frustrating placement of the needle.

從這段可以看到要把針放對很不容易

But this is hard.

這真的很困難

And one of the reasons why it is so hard

為什麼這麼困難的原因之一

is because the external ergonomics are terrible.

是因為在體外器械操作的人體工學很糟糕,

You've got these long instruments, and you're working off your centerline.

工具很長，你得偏離身體中線操作，

And the instruments are essentially working backwards.

而這些器械又主要是以反向操作,

So what you need to do, to take the capability of your hand,

所以你要做的，是在器械上置入類似手腕的關節，

and put it on the other side of that small incision,

這樣就在小切口的另一側，

is you need to put a wrist on that instrument.

利用手的靈巧度。

And so -- I get to talk about robots --

所以在這 我有機會來聊聊手術用機器,

the da Vinci robot

達文西機器的設計,

put just that wrist on the other side of that incision.

讓類似手腕的關節得以放到切口的另一邊,

And so here you're seeing the operation of this wrist.

你在這可以看到這個關節的操作,

And now, in contrast to the laparoscopy,

現在，相對於內視鏡手術

you can precisely place the needle in your instruments,

你可以準確的把針放到工具上

and you can pass it all the way through

而且讓針穿過整個組織，

and follow it in a trajectory.

並讓針延著切口的軌跡縫合。

And the reason why this becomes so much easier

為什麼會變得這麼容易是因為

is -- you can see on the bottom --

你可以在畫面下方看到,

the hands are making the motions,

當手在移動時，

and the instruments are following those motions exactly.

工具可以精確的描摹手部的動作,

Now, what you put between those instruments and those hands,

你放在那些工具和那些手之間的

is a large, fairly complicated robot.

是一台很大且相當複雜的機器,

The surgeon is sitting at a console,

外科醫生坐在操縱臺

and controlling the robot with these controllers.

用這些控制器來控制機器,

And the robot is moving these instruments around,

在病人身體裡面，藉著操作機器,

and powering them, down inside the body.

醫生得以移動手術器械，並給予動力,

You have a 3D camera, so you get a 3D view.

你會有個 3D 相機，所以你可以看到 3D 畫面

And since this was introduced in 1999,

自從 1999 年問世以來

a lot of these robots have been out

生產了很多這類的機器,

and being used for surgical procedures like a prostatectomy,

且用在外科手術上，像是攝護腺切除術

which is a prostate deep in the pelvis,

就是說，攝護腺是為在骨盆內較深的地方

and it requires fine dissection

所以它需要精細的切割

and delicate manipulation

並且要很小心地操作

to be able to get a good surgical outcome.

才能得到很好的手術結果

You can also sew bypass vessels directly onto a beating heart

你也可以不用打開胸腔

without cracking the chest.

就在跳動的心臟縫上繞道用的血管,

This is all done in between the ribs.

這都是在肋骨之間完成的

And you can go inside the heart itself

你可以進入心臟

and repair the valves from the inside.

從內部修補瓣膜

You've got these technologies -- thank you --

現在這些技術都有了-- 謝謝 --

(Applause)

(鼓掌)

And so you might say, "Wow this is really cool!

所以你可能會覺得，“哇! 這真酷!”

So, smartypants, why isn't all surgery being done this way?"

“可是如果你真的這麼厲害，為什麼不是所有的手術都可以這樣做?”

And there are some reasons, some good reasons.

這是有原因的，有些理由很充分

And cost is one of them.

成本是其中之一

I talked about the large, complicated robot.

我說的是複雜的大型機器,

With all its bells and whistles, one of those robots

為它那些花俏的附屬配件，一組機器的花費,

will cost you about as much as a solid gold surgeon.

幾乎跟一個真的頂尖外科醫師一樣,

More useful than a solid gold surgeon,

也許比外科醫師有用

but, still, it's a fairly big capital investment.

但是它還是一項龐大的投資

But once you've got it, your procedure costs do come down.

不過一但你擁有它，手術程序上的成本的確會下降

But there are other barriers.

當然還是有其他的障礙存在

So something like a prostatectomy --

所以像是攝護腺切除術

the prostate is small, and it's in one spot,

攝護腺很小而且就位在一個點上

and you can set your robot up very precisely

你可以很精準地設定機器

to work in that one spot.

只在那一點上工作

And so it's perfect for something like that.

所以對這類手術是非常合適的

And in fact if you, or anyone you know,

事實上，如果你或你認識的人

had their prostate taken out in the last couple of years,

在過去這幾年中把攝護腺切除

chances are it was done with one of these systems.

很可能就是用這其中的一種系統做的

But if you need to reach more places than just one,

但是如果你的手術部位不只一個,

you need to move the robot.

你就需要移動機器

And you need to put some new incisions in there.

而且你會需要新的切口

And you need to re-set it up.

你需要重新設定

And then you need to add some more ports, and more.

你會需要增加更多的連接點以及其他的物件

And the problem is it gets time-consuming, and cumbersome.

問題就出在時間變長，且笨重難處理

And for that reason there are many surgeries

就因為這原因，所以有很多手術

that just aren't being done with the da Vinci.

不用達文西來進行

So we had to ask the question, "Well how do we fix that?"

這樣我們就會問，“要怎麼解決呢?”

What if we could change it so that we didn't have to re-set up

如果我們可以把它變成當移動到不同位置時

each time we wanted to move somewhere different?

可以不用重新設定會怎麼樣?

What if we could bring all the instruments

如果我們可以把所有的工具

in together in one place?

都帶到同一個位置會怎麼樣?

How would that change the capabilities of the surgeon?

這些會對外科醫生的能力有什麼改變?

And how would that change the experience for the patient?

這些對病患的經歷又有什麼影響?

Now, to do that,

要做到這

we need to be able to bring a camera

我們要能帶著相機

and instruments in together through one small tube,

和工具一起經過一條小小的管子進入

like that tube you saw in the laparoscopy video.

就像你在內視鏡手術影片中看到的

Or, not so coincidentally, like a tube like this.

或是，跟現在畫面上看到的管子一樣。

So what's going to come out of that tube

所以從那條管子出來的

is the debut of this new technology,

就是這個新技術的處女秀

this new robot that is going to be able to reach anywhere.

這個新的機器人將可以到達任何地方

Ready? So here it comes.

準備好了嗎? 好，現在開始囉

This is the camera, and three instruments.

這個是相機，和三種工具

And as you see it come out,

你可以看到他們伸出來

in order to actually be able to do anything useful,

為了要能真的做些有用的事

it can't all stay clustered up like this.

它們不能像這樣擠在一起

It has to be able to come off of the centerline

要可以離開中線

and then be able to work back toward that centerline.

也要可以往中線回移

He's a cheeky little devil.

它就是那個厚臉皮的小鬼

But what this lets you do

但是它可以讓你做的

is gives you that all-important traction,

就是給你所有重要的牽引

and counter-traction,

和抗牽引

so that you can dissect, so that you can sew,

這樣你才可以切開、縫合

so that you can do all the things that you need to do,

可以做所有你要做的事

all the surgical tasks.

跟所有的手術工作

But it's all coming in through one incision.

然而，手術都只透過一個切口進行，

It's not so simple.

並不是這麼簡單,

But it's worth it for the freedom that this gives us

卻因為這樣的設計，讓我們能自由的移動器械，

as we're going around.

一切都是值得的

For the patient, however,

然而對病患來說

it's transparent. This is all they're going to see.

它很清楚簡單。他們就只會看到的這個部份

It's very exciting to think where we get to go with this.

想想看我們可以用這來做什麼，就令人很興奮

We get to write the script of the next revolution in surgery.

我們可以為手術的下一個革新寫劇本

As we take these capabilities, and we get to go to the next places,

當我們在運用這些能力的同時，我們可以到下一境界

we get to decide what our new surgeries are going to be.

我們可以決定新的手術是什麼

And I think to really get the rest of the way

我想，要真的達到改革的

in that revolution,

新境界

we need to not just take our hands in in new ways,

我們不但是要往新方向著手

we also need to take our eyes in in new ways.

我們也要開拓新的視野

We need to see beyond the surface.

我們要能看穿表面

We need to be able to guide what we're cutting

我們要能對切割

in a much better way.

做更好的指引

This is a cancer surgery.

這是一個癌症手術

One of the problems with this,

這裡發生的問題之一

even for surgeons who've been looking at this a lot,

就是你看不到癌症

is you can't see the cancer,

即使是經驗老到的外科醫生也一樣

especially when it's hidden below the surface.

特別是當它藏在表面下

And so what we're starting to do

所以我們一開始要做的

is we're starting to inject specially designed markers

就是要注射特殊設計的標記

into the bloodstream that will target the cancer.

到血液中，它會以癌症為標記目標

It will go, bind to the cancer.

移動並附著到癌細胞上，

And we can make those markers glow.

我們可以讓這些標記發光

And we can take special cameras,

然後我們用特殊的相機

and we can look at it.

來觀察它

Now we know where we need to cut,

現在我們就知道要在哪裡切割

even when it's below the surface.

即便是它在表面下

We can take these markers and we can inject them in a tumor site.

我們可以把這些標記注射到癌症部位

And we can follow where they flow out from that tumor site,

然後我們就可以追蹤，看它們從癌症部位流向何處

so we can see the first places where that cancer might travel.

這樣我們就知道癌細胞可能最先轉移到哪裡

We can inject these dyes into the bloodstream,

我們可以把這些染劑注入到血液中

so that when we do a new vessel

這樣，當我們在縫合新血管

and we bypass a blockage on the heart,

或是在有梗塞的心臟上做繞道手術時，

we can see if we actually made the connection,

我們就可以在病患縫合前

before we close that patient back up again --

看到是不是有接通

something that we haven't been able to do

這些是我們以前

without radiation before.

沒有辦法不靠放射線才能做到的事

We can light up tumors

我們可以讓腫瘤發光

like this kidney tumor,

像這個腎臟腫瘤

so that you can exactly see where the boundary is

這樣就可以清楚的看到

between the kidney tumor and the kidney you want to leave behind,

哪裡是腎腫瘤和要保留的腎臟部位間的界線

or the liver tumor and the liver you want to leave behind.

或是肝腫瘤和要保留部位的肝臟

And we don't even need to confine ourselves

我們甚至不需要把自己侷限在

to this macro vision.

這肉眼可見的地方

We have flexible microscopic probes

我們有很靈活的顯微探針

that we can bring down into the body.

可以深入體內

And we can look at cells directly.

這樣我們可以直接觀察細胞

I'm looking at nerves here. So these are nerves you see, down on the bottom,

現在看到的是神經，你看到的下方是神經

and the microscope probe that's being held by the robotic hand, up at the top.

然後上面的是機械手拿著的顯微探針

So this is all very prototypey at this point.

這目前仍舊是最初期的發展型態

But you care about nerves, if you are a surgical patient.

但如果你是動手術的病患，你會擔心神經

Because they let you keep continence,

因為它讓你在手術後仍保有控制力

bladder control, and sexual function after surgery,

控制膀胱以及性功能等

all of which is generally fairly important to the patient.

對病患來說這些一切都是很重要的

So, with the combination of these technologies

所以，有了這些技術的組合

we can reach it all, and we can see it all.

我們就可以到想到的地方、看要看的東西

We can heal the disease.

我們可以治癒疾病

And we can leave the patient whole and intact

而且我們讓病患維持整體及完整

and functional afterwards.

並在術後功能正常

Now, I've talked about the patient

現在我所描述的病患

as if the patient is, somehow, someone abstract

好像是這個房間外面

outside this room.

某個模糊抽象的個體

And that is not the case.

其實不是這樣

Many of you, all of you maybe,

你們之中很多人、可能所有的人

will at some point, or have already, faced a diagnosis of cancer,

會在將來某時間點，或已經面對了癌症、

or heart disease, or some organ dysfunction

心臟病、或其他器官不正常的診斷

that's going to buy you a date with a surgeon.

那就給了你和外科醫生約會的機會

And when you get to that point --

當你到了那個時候 --

I mean, these maladies don't care

我是說，這些疾病是不會管你

how many books you've written,

寫了多少書

how many companies you've started,

創立了幾個公司

that Nobel Prize you have yet to win,

還沒獲得諾貝爾獎

how much time you planned to spend with your children.

計畫要花多少時間陪伴你的小孩

These maladies come for us all.

這些疾病我們每個人都可能發生

And the prospect I'm offering you, of an easier surgery ...

那我所提供的這些比較簡易手術的希望

is that going to make that diagnosis any less terrifying?

真的會讓這些診斷變得比較不可怕嗎?

I'm not sure I really even want it to.

我不知道我是不是真的想這樣

Because facing your own mortality

因為面對你自己的死亡

causes a re-evaluation of priorities,

讓你重新檢視事物的優先順序

and a realignment of what your goals are in life, unlike anything else.

以及重新定位人生的目標，這是其他事無法做到的

And I would never want to deprive you of that epiphany.

我也不想剝奪你覺悟的權利

What I want instead,

我反而想要

is for you to be whole, intact,

在你決定你需要這些手術後

and functional enough to go out and save the world,

你可以保持整體、完整

after you've decided you need to do it.

而且功能正常足以到外面去拯救世界

And that is my vision for your future.

這就是我所看見的各位的未來

Thank you.

謝謝大家

(Applause)

(鼓掌)