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 you’ve 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 you’re 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 you’re 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, you’re 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 if…what 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 you’ll 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 you’re 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