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  • The first time I stood in the operating room and watched a real surgery, I had no idea what to expect.

    我第一次在手術房看真實的手術時,我完全無法預料會發生什麼事情

  • I was a college student in engineering.

    我是工學院的學生

  • I thought it was going to be like on TV,

    我以為會像電視上形容的

  • ominous music playing in the background, beads of sweat pouring down the surgeon’s face.

    外科醫生的汗珠隨著不祥的背景音樂從臉上滑落

  • But it wasn’t like that at all.

    但並非如此

  • There was music playing on this day. I think it was Madonna’s greatest hits.

    那天有播音樂,我覺得應該是瑪丹娜的精選歌曲

  • And there was plenty of conversation, not just about the patient’s heart rate,

    手術房內有對話聲,但不是只是談論病人的心率多少

  • but about sports and weekend plans.

    還有球賽比得如何、週末要去哪裡玩

  • And since then, the more surgeries I watched, the more I realized this is how it is.

    在那之後,我看越多手術,我越了解手術如何進行

  • In some weird ways, it’s just another day at the office.

    某種奇怪的說法是,那就像是在辦公室度過另一天

  • But every so often, the music gets turned down,

    但每隔一段時間,音樂就被關掉

  • everyone stops talking, and stares at exactly the same thing.

    談話中斷,大家的眼神都盯著同一個目標

  • And that’s when you know that something absolutely critical and dangerous is happening.

    你就會知道那是關鍵又危險的時刻

  • The first time I saw that I was watching a type of surgery called laparoscopic surgery.

    我第一次看到這個景象是在腹腔鏡手術時

  • And for those who are unfamiliar, laparoscopic surgery, instead of the large open incision you might be used to with surgery,

    對外行人解釋 就是 腹腔鏡手術並非大型開放式切口手術

  • a laparoscopic surgery is where the surgeon creates these three or more small incisions in the patient.

    醫生會在做腹腔鏡手術的病患身上開三個或三個以上的小切口

  • And then inserts these long, thin instruments and a camera,

    然後嵌入這些又細又長的儀器和攝影機

  • and actually does the procedure inside the patient.

    在病人體內進行手術

  • This is great because this is much less risk of infections, much less pain, shorter recovery time.

    這手術非常好,因為可以降低感染風險、減輕疼痛感,且病患恢復時間也較短

  • But there is a trade-off,

    但有個交換條件

  • because these incisions are created with a long, pointed device, called the trocar.

    因為這些切口都是用又長又尖的套管針來切割

  • And the way the surgeon uses this device is that he takes it

    外科醫生使用方法是拿著它

  • and he presses it into the abdomen until it punctures through.

    朝腹部推壓直到刺穿腹部

  • And now the reason why everyone in the operating room was staring at that device on that day

    而那天在手術房裡所有人都盯著這個儀器的原因是

  • was because he had to be absolutely careful not to plunge it through and puncture it into the organs and blood vessels below.

    外科醫生必須非常小心,不能刺穿到腹部下面的器官和血管

  • But this problem should seem pretty familiar to all of you,

    你們應該很熟悉這個問題

  • because I’m pretty sure youve seen it somewhere else.

    因為我很確定你們都在其他地方看過這個東西

  • Remember this?

    記得嗎

  • You knew that at any second, that straw was going to plunge through.

    你知道任何一秒鐘都是關鍵 吸管可能隨時會刺穿

  • And you didn’t know if it was going to go out the other side and straight into your hand,

    你不知道它會不會從另外一邊插出 直接刺進手中

  • or if you were going to get juice everywhere,

    讓飲料噴的到處都是

  • but you were terrified. Right?

    但是你會害怕,對不對

  • Every single time you did this, you experienced the same fundamental physics

    每次這樣做,你就能體會我那天在手術房內

  • that I was watching in the operating room that day.

    看到的基礎物理學

  • And it turns out it really is a problem.

    它的確是個問題

  • In 2003, the FDA actually came out and said

    在2003年,衛生福利部食品藥物管理署明確公告

  • that trocar incisions might be the most dangerous step in minimally invasive surgery.

    套管針切口可能是微創傷手術中最危險的步驟

  • Again in 2009, we see a paper that says that

    2009年,我們也在報紙上看到

  • trocars account for over half of all major complications in laparoscopic surgery.

    有超過一半的腹腔鏡手術病患因為使用套管針而導致併發症

  • And, oh by the way, this hasn’t changed for 25 years.

    順帶一提,這25年來都還沒改變過

  • So when I got to graduate school, this is what I wanted to work on.

    所以這成為我就讀研究所時最想要研究的主題

  • I was trying to explain to a friend of mine what exactly I was spending my time doing,

    我嘗試和一位朋友解釋我花這麼多時間在做的事情

  • and I said,

    我說

  • It’s like when youre drilling through a wall to hang something in your apartment.

    那就好像你要掛東西在你的房間裡

  • There’s that moment when the drill first punctures through the wall

    而當牆被鑽透的那一刻

  • and there’s this, plunge. Right?”

    就是那時候。對吧

  • And he looked at me and he said,

    他看著我並問

  • You mean like when they drill into people’s brains?”

    你是指醫生也在人們的大腦裡鑽口嗎

  • And I said, “Excuse me?”

    我說 蛤?

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

    之後我查了一下,發現他們是真的在人們的腦袋裡鑽口

  • A lot of neurosurgical procedures actually start with a drill incision through the skull.

    很多神經外科手術的前奏就是在頭蓋骨上鑽個切口

  • And if the surgeon isn’t careful, he can plunge directly into the brain.

    如果外科醫生不夠仔細,他就會直接刺進腦部

  • So this is the moment when I started thinking, okay,

    所以這刺穿的時刻 成為我在思考的問題

  • cranial drilling, laparoscopic surgery, why not other areas of medicine?

    顱鑽、腹腔鏡手術,為什麼不分類為其他醫學領域?

  • Because think about it, when was the last time you went to the doctor and you didn’t get stuck with something? Right?

    原因是 仔細想想,你看醫生時,沒有什麼不得不面對的事情 對吧?

  • So the truth is, in medicine puncture is everywhere.

    事實就是 在醫學領域中 處處是穿刺

  • And here are just a couple of the procedures that I’ve found that involve some tissue puncture step.

    這些是我目前找到的手術中 包含穿刺組織這個步驟

  • And if we take just three of them,

    如果我們把它們分成三部分

  • laparoscopic surgery, epidurals and cranial drillings,

    腹腔鏡手術、硬腦膜和顱鑽

  • these procedures account for over 30,000 complications every year in this country alone.

    這些步驟引發了全國每年超過3萬種的併發症

  • I call that a problem worth solving.

    我認為這是個必須解決的問題

  • So let’s take a look at some of the devices that are used in these types of procedures.

    我們來看看一些有運用在這些步驟上的儀器

  • I’ve mentioned epidurals.

    我已經提過硬腦膜

  • This is an epidural needle.

    這是硬膜外穿刺針

  • It’s used to puncture through the ligaments in the spine and deliver anesthesia during childbirth.

    它被用來穿刺脊椎韌帶及接生新生兒時的麻醉藥

  • Here’s a set of bone marrow biopsy tools.

    這是一組骨髓切片檢查儀器

  • These are actually used to burrow into the bone and collect bone marrow or sample bone lesions.

    這其實是用來探查骨頭、收集骨髓及取德損傷骨頭樣本

  • Here’s a bayonet from the Civil War.

    這是南北戰爭時的刺刀

  • If I had told you it was a medical puncture device, you probably would have believed me.

    如果我告訴你這是一種醫學穿刺工具,你一定會相信

  • Right? Because what’s the difference?

    對吧?哪裡不一樣了?

  • So the more I did this research, the more I thought there has to be a better way to do this.

    當我研究越深入,我越覺得需要有更好的辦法來做刺穿

  • And for me, the key to this problem is that all these different puncture devices share a common set of fundamental physics.

    而對我來說,這個問題的關鍵是 所有不同種類的穿刺工具都有同樣物理概念

  • So what are those physics? Let’s go back to drilling through a wall.

    所以到底是那些物理學呢?我們回到鑽牆主題

  • So youre applying a force on the drill toward the wall. Right?

    你正在牆上找一個施力點

  • And Newton says, the wall is going to apply force back, equal and opposite.

    牛頓說當兩個物體互相作用時,彼此施加於對方的力,其大小相等、方向相反

  • So as you drill through the wall, those forces balance.

    所以你在牆上鑽洞,所施的力量相等

  • But then there’s that moment when the drill first punctures through the other side of the wall,

    但如果你刺穿了牆的另一面

  • and right at that moment, the wall can’t push back anymore.

    就在這時,牆永遠不會再施反作用力

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

    但是你的腦袋不會對施力的改變而有任何反應

  • So for that millisecond, or however long it takes you to react, youre still pushing.

    所以一毫秒,或著不論需要多少時間反應,你仍繼續施力

  • and that unbalanced force causes an acceleration,

    那不對等的施力造成加速度

  • and that is the plunge.

    而那時候就會刺穿牆

  • But what ifwhat if right at the moment of puncture,

    但如果在刺穿的時候

  • you could pull that tip back, actually oppose the forward acceleration?

    你可以把工具拉回來,讓向前的加速度反向呢

  • That’s what I set out to do.

    這就是我想做的東西

  • So imagine you have a device and it’s got some kind of sharp tip to cut through tissue.

    想像你有一個儀器 它有一個尖端可以割開組織

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

    將工具拉回的最簡單方法是什麼

  • I chose a spring.

    我使用了彈簧

  • So when you extend that spring, you extend that tip out so it’s ready to puncture tissue.

    當你拉長彈簧,你會把尖端往外拉,準備刺穿組織

  • The spring wants to pull the tip back.

    彈簧會想將工具端拉回

  • So how do you keep the tip in place until the moment of puncture?

    所以你該怎麼讓尖端運作 直到刺穿的那一刻呢

  • I used this mechanism.

    我用了這個機器

  • When the tip of the device is pressed against tissue,

    當裝置的尖端推壓著組織

  • the mechanism expands outward and wedges in place against the wall.

    機器向外延展並楔入 倚著壁面

  • And the friction that’s generated locks it in place and prevents the spring from retracting the tip.

    產生的摩擦就會固定在適當位置並防止彈簧縮回尖端

  • But right at the moment of puncture, the tissue can’t push back on the tip anymore.

    但在刺穿的這一刻,組織再也沒有對尖端的反作用力

  • So the mechanism unlocks and the spring retracts the tip.

    所以機器解除鎖定,彈簧縮回尖端

  • Let me show you that happening in slow motion. This is about 2,000 frames a second,

    我用一秒2千幅的慢動作給大家看

  • and I’d like you to notice the tip that’s right there at the bottom, about to puncture through tissue.

    我希望你去觀察底部即將要刺穿組織的那端

  • And youll see that right at the moment of puncture,

    你會看到刺穿的那一刻

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

    在這裡,機器被頂住而彈簧縮回尖端

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

    我要再讓你看一次更近的畫面

  • So youre going to see the sharp bladed tip,

    你會看到有尖刃的尖端

  • and right when it punctures that rubber membrane, it’s going to disappear into this white blunt sheath.

    而當它準備刺穿橡膠膜時 尖端因進入白色鈍護套而消失

  • Right there.

    就是這裡

  • That happens within four 100th of a second after puncture.

    這發生在刺穿後的百分之四秒

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

    而因為這個儀器是被設計用在物理學上的穿刺

  • and not the specifics of cranial drilling or laparoscopic surgery or another procedure,

    而不是顱鑽、腹腔鏡手術或其他手術

  • it’s applicable across these different medical disciplines and across different length scales.

    它廣泛應用在不同的醫學訓練及不同的規模

  • But it didn’t always look like this.

    但它並不是一開始就這樣

  • This was my first prototype.

    這是我的第一個原型

  • Yes, those are popsicle sticks and there’s a rubber band at the top.

    那些是冰棒棍 有個橡皮筋綁在上面

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

    我花了約30分鐘完成它 它真的能操作

  • And it proved to me that my idea worked and justified the next couple years of work on this project.

    它證實了我的想法 並調整了之後幾年的計畫方向

  • I worked on this because this problem really fascinated me. It kept me up at night.

    我研究這個是因為我很著迷於這個問題 它讓我睡不著

  • But I think it should fascinate you too,

    我覺得它應該也會讓你們著迷

  • because I said puncture is everywhere,

    因為生活裡處處是穿刺

  • that means at some point, it’s going to be your problem too.

    那表示在某一時刻,它也會成為的問題

  • That first day in the operating room I never expected to find myself on the other end of a trocar.

    第一天進入手術房時 我完全沒想過我會對套管針有興趣

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

    但去年,我去希臘時得了盲腸炎

  • So I was in the hospital in Athens, and the surgeon was telling me he was going to perform a laparoscopic surgery.

    我住在雅典的醫院裡,外科醫生告訴我,他將進行腹腔鏡手術

  • He was going to remove my appendix through these tiny incisions.

    他將我的盲腸移出這些小傷口

  • And he was talking about what I could expect for the recovery and what was going to happen.

    他告訴我復原的種種,還有即將會發生的事情

  • He said, “Do you have any questions?”

    他問我有沒有任何問題

  • And I said, “Just one doc. What kind of trocar do you use?”

    我說:「醫生,我只有一個問題,你用哪種套管針?」

  • So my favourite quote about laparoscopic surgery comes from a doctor H. C. Jacobaeus.

    我最喜歡腹腔鏡手術外科醫生H. C. Jacobaeus所說的話

  • It is puncture itself that causes risk.”

    「穿刺本身造成風險」

  • And that’s my favorite quote because H. C. Jacobaeus was the first person to ever perform laparoscopic surgery on humans,

    那是我最喜歡的名言是因為H. C. Jacobaeus是第一位在人類身上進行腹腔鏡手術的醫生

  • and he wrote that in 1912.

    而他在1912年寫下這句話

  • So this is a problem that’s been injuring and even killing people for over 100 years.

    而這個問題在100多年來已經讓人們身受其害,甚至因此死亡

  • So it’s easy to think that for every major problem out there, there’s some team of experts working around the clock to solve it.

    我們很容易地認為 每個問題都有專家、團隊 日以繼夜地處理著

  • The truth is that’s not always the case.

    事實是並非總是如此

  • We have to be better at finding those problems and finding ways to solve them.

    我們必須有更好的方法來找出問題並解決

  • So if you come across a problem that grabs you,

    所以如果你遇到纏著你的問題

  • let it keep you up at night.

    就熬夜與它奮鬥吧

  • Allow yourself to be fascinated,

    希望你會迷上它

  • because there are so many lives to save.

    因為世界上有很多生命需要救援

  • Thank you.

    謝謝大家

The first time I stood in the operating room and watched a real surgery, I had no idea what to expect.

我第一次在手術房看真實的手術時,我完全無法預料會發生什麼事情

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B1 中級 中文 美國腔 TED 手術 外科 彈簧 醫生 儀器

【TED】尼古拉.貝格: 讓手術關鍵時刻更安全的工具 (Nikolai Begg: A tool to fix one of the most dangerous moments in surgery)

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    Go Tutor 發佈於 2014 年 10 月 21 日
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