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  • Over the last 13 years --

    過去 13 年中 --

  • one, three, 13 years --

    1,3,13 年 --

  • I've been part of an exceptional team at InSightec in Israel

    我曾是以色列 InSightec 公司和其來自世界各地的伙伴

  • and partners around the world

    的一個優秀小組的成員,

  • for taking this idea, this concept,

    我們把非侵入式的手術

  • noninvasive surgery,

    這個想法、這個概念,

  • from the research lab to routine clinical use.

    從研究實驗室中推行到例行性的臨床使用上。

  • And this is what I'll tell you about.

    而這就是我將要告訴大家的東西。

  • 13 years --

    13 年 --

  • for some of you, you can empathize with that number.

    對你們一些人而言,也許會有種同情的感覺。

  • For me, today, on this date,

    對我而言,今天這個日子,

  • it's like a second bar mitzvah experience.

    就像是第二次的成年禮一樣。

  • (Laughter)

    (笑聲)

  • So this dream

    而這個夢想

  • is really enabled

    已經藉由

  • by the convergence

    兩項技術的結合

  • of two known technologies.

    而成真了。

  • One is the focused ultrasound,

    其中一項是聚焦超音波,

  • and the other one is the

    另一項則是

  • vision-enabled magnetic resonance imaging.

    視覺化的磁振造影技術。

  • So let's first talk about focused ultrasound.

    讓我們先談談聚焦超音波。

  • And I hold in my hand

    我手中所拿著的是

  • a tissue-mimicking phantom.

    一個組織模型。

  • It is made out of silicon.

    它是用矽做成的。

  • It is transparent, made just for you.

    它是透明的, 特別為大家製造的。

  • So you see, it's all intact,

    如你所見,它是完好無缺,

  • completely transparent.

    完全透明的。

  • I'll take you now to the acoustic lab.

    我現在帶你來到聲效實驗室。

  • You see the phantom within the aquarium.

    你可以看見模型被放在玻璃缸裡。

  • This is a setup I put in a physics lab.

    這是我放在物理實驗室的一套設備。

  • On the right-hand side,

    在右手邊,

  • you see an ultrasonic transducer.

    你可以看見一台超音波轉換器。

  • So the ultrasonic transducer

    當這個超音波轉換器

  • emits basically an ultrasonic beam

    對著模型聚焦

  • that focuses inside the phantom.

    發射出超音波束。

  • Okay, when you hear the click,

    好,當你聽見「啪」一聲,

  • this is when the energy starts to emit

    這表示能量開始被傳送出來,

  • and you see a little lesion form

    然後你可以看見在模型裡面

  • inside the phantom.

    出現小小的損傷。

  • Okay, so everything around it

    而它周圍的其他位置

  • is whole and intact.

    則都完好無缺。

  • It's just a lesion formed inside.

    損傷只在內部形成。

  • So think about, this is in your brain.

    想像一下,這東西在你的大腦內。

  • We need to reach a target inside the brain.

    我們需要觸及大腦中的這個目標物。

  • We can do it without harming any tissue.

    我們可以在不傷及任何組織的前提下做到。

  • So this is, I think,

    所以,我想,

  • the first kosher Hippocratic surgical system.

    這是第一個符合猶太戒律的希波克拉提斯手術系統。

  • (Laughter)

    (笑聲)

  • Okay, so let's talk a little bit about ultrasound,

    接著我們來談談超音波,

  • the force of ultrasound.

    超音波的力量。

  • You know all about imaging, right, ultrasound imaging.

    大家都聽過造影,對,超音波的造影。

  • And you know also about lithotripsy --

    也聽過震波碎石 --

  • breaking kidney stones.

    震碎腎臟結石。

  • But ultrasound can be shaped

    但超音波可以被塑造成

  • to be anything in between,

    介於這兩者之間的東西,

  • because it's a mechanical force.

    因為它是一種機械式的力量。

  • Basically, it's a force acting on a tissue

    基本上,它的一種作用在

  • that it transverses.

    它所橫越過的組織上的力量。

  • So you can change the intensity, the frequency,

    所以你可以改變超音波的強度、頻率、

  • the duration, the pulse shape of the ultrasound

    週期、波形等

  • to create anything

    來創造出

  • from an airbrush to a hammer.

    像噴鎗以至鎚頭的任何東西。

  • And I am going to show you

    接下來我將會給你演示

  • multiple applications in the medical field

    藉由聚焦,

  • that can be enabled

    完全的聚焦,

  • just by focusing,

    在醫療領域中

  • physically focusing.

    所能做到的各種應用。

  • So this idea

    使用控制聚焦超音波

  • of harnessing focused ultrasound to treat lesions in the brain

    來治療大腦裡的患處

  • is not new at all.

    並不是全新的想法。

  • When I was born, this idea was already conceived

    這個想法在我出生時

  • by pioneers such as the Fry brothers

    就已經被一些前輩提出,例如 Fry 兄弟們,

  • and Lars Leksell,

    以及 Lars Leksell,

  • who is know actually

    他實際上正是

  • as the inventor of the gammaknife.

    加馬刀(利用放射線聚焦)的發明人。

  • But you may not know

    不過你可能不知道

  • that he tried to perform lobotomies in the brain,

    他曾經在1950年代,

  • noninvasively,

    嘗試利用聚焦超音波

  • with focused ultrasound in the '50s.

    進行非侵入式的前腦葉白質切除術。

  • He failed,

    他失敗了,

  • so he then invented the gammaknife.

    之後他就發明了加馬刀。

  • And it makes you ponder

    這會讓你疑惑

  • why those pioneers failed.

    為什麼這些前輩們會失敗。

  • And there was something fundamental

    他們缺少了一些

  • that they were missing.

    很基本的東西。

  • They were missing the vision.

    他們缺少了視覺影像。

  • It wasn't until the invention of the MR

    直到磁振造影被發明出來,

  • and really the integration of MR

    並且真正將磁振造影

  • with focused ultrasound

    結合聚焦超音波

  • that we could get the feedback --

    使我們得到

  • both the anatomical and the physiological

    解剖學和生理學上的回饋

  • in order to have a completely noninvasive, closed-loop

    藉以達到完全非侵入式,封閉循環的

  • surgical procedure.

    手術程序。

  • So this is how it looks, you know,

    這就是在今天,我們所看到

  • the operating room of the future today.

    未來的手術室的樣子。

  • This is an MR suite with a focused ultrasound system.

    這是搭配了聚焦超音波系統的磁振造影設備。

  • And I will give you several examples.

    我將會給大家看一些範例。

  • So the first one is in the brain.

    第一個例子是在大腦之中。

  • One of the neurological conditions

    一種神經系統的疾病

  • that can be treated with focused ultrasound

    是可以用聚焦超音波來治療的

  • are movement disorders,

    是運動障礙症,

  • like Parkinson's or essential tremor.

    像帕金森氏症或是原發性顫抖症等。

  • What is typical to those conditions,

    這些問題的典型症狀是,

  • to essential tremor for example,

    以原發性顫抖症為例,

  • is inability

    在喝湯或吃麥片時

  • to drink or eat cereal or soup

    無法做到

  • without spilling everything all over you,

    不把東西灑得到處都是,

  • or write legibly so people can understand it,

    或是無法端正寫字讓大家看懂,

  • and be really independent in your life

    以及無法不靠別人的幫助

  • without the help of others.

    只靠自己過生活。

  • So I'd like you to meet John.

    我想讓大家看看 John。

  • John is a retired professor of history

    John 是退休的歷史教授,

  • from Virginia.

    住在維吉尼亞。

  • So he suffered from essential tremor for many years.

    他罹患原發性顫抖症許多年了。

  • And medication didn't help him anymore.

    藥物治療無法再給他任何幫助。

  • And many of those patients refused to undergo surgery

    許多患這種病的人拒絕接受

  • to have people cut into their brain.

    讓人切割大腦的手術。

  • And about four or five months ago,

    在 4~5 個月前,

  • he underwent an experimental procedure.

    他接受了一次實驗性的療程。

  • It is approved under an FDAIDE

    這獲得美國食品藥品管理局(FDA)的臨床試驗醫療器材豁免(IDE)批准,

  • at the University of Virginia

    在夏洛特斯維爾的

  • in Charlottesville

    維吉尼亞大學裡面進行,

  • using focused ultrasound

    使用聚焦超音波

  • to ablate a point in his thalamus.

    消融他視丘葉片中的一點。

  • And this is his handwriting.

    這是他的筆跡。

  • "On June 20th," if you can read it,

    「在 6 月 20 號」 如果你有看見的話,

  • "2011."

    「2011年」

  • This is his handwriting

    這是他在治療當天早上

  • on the morning of the treatment

    進行磁振造影之前

  • before going into the MR

    所留下的筆跡。

  • So now I'll take you through

    接下來我要讓大家了解

  • [what] a typical procedure like that looks like,

    像這種手術的典型流程是怎樣的,

  • [what] noninvasive surgery looks like.

    無侵入式的手術是怎樣的。

  • So we put the patient on the MR table.

    我們讓病人躺在磁振造影的檯子上。

  • We attach a transducer, in this case, to the brain,

    在這個案例裡,我們把轉換器接到大腦上,

  • but if it will be a different organ,

    如果是不同的器官,

  • it will be a different transducer attached to the patient.

    就會把不同的轉換器接到病人身上。

  • And the physician

    接著主治醫師

  • will then take a regular MR scan.

    會進行常規的磁振造影掃描。

  • And the objective of that?

    目的是什麼呢?

  • I don't have a pointer here,

    我手邊沒有投影筆,

  • but you see the green, sort of rectangle or trapezoid?

    不過你可以看見這綠色、類似矩形或梯形的部份?

  • This is the sort of general area of the treatment.

    這是進行治療的大概區域。

  • It's a safety boundary

    這是目標物周圍的

  • around the target.

    安全範圍。

  • It's a target in the thalamus.

    它是在視丘內的一個目標。

  • So once those pictures are acquired

    一旦取得了這些照片後,

  • and the physician has drawn

    主治醫師畫出了

  • all the necessary safety limits and so on,

    所有必要的安全限制範圍等等,

  • he selects basically a point --

    他基本上選取一點 --

  • you see the round point in the middle where the cursor is --

    你看到在游標的位置,中間的一個圓點 --

  • and he presses this blue button called "sonicate."

    然後他按下這個叫做「超音波降解」的藍色按鈕。

  • We call this instance of injecting the energy,

    我們稱這注入能量的步驟,

  • we call it sonication.

    我們稱它為超音波降解。

  • The only handwork the physician does here

    主治醫師唯一需要動手的

  • is moving a mouse.

    是移動這隻滑鼠。

  • This is the only device he needs in this treatment.

    這是他在這項治療中唯一用到的器具。

  • So he presses "sonicate," and this is what happens.

    他按下超音波降解,跟著就會出現以下的情況。

  • You see the transducer, the light blue.

    你看看那個轉換器,淺藍色的地方。

  • There's water in between the skull and the transducer.

    在頭顱和轉換器之間注有水。

  • And it does this burst of energy.

    然後它放出巨大能量。

  • It elevates the temperature.

    它提升溫度。

  • We first need to verify

    首先我們必須確認

  • that we are on target.

    我們命中了目標。

  • So the first sonication

    所以第一次超音波降解

  • is at lower energy.

    是使用較低的能量。

  • It doesn't do any damage,

    這不會造成任何傷害,

  • but it elevates the temperature

    它只是讓溫度上升

  • by a few degrees.

    幾度而已。

  • And one of the unique capabilities

    使用磁振造影

  • that we leverage with the MR

    其中一項獨特的能力就是

  • is the ability to measure temperature noninvasively.

    可以進行非侵入式溫度量測。

  • This is really a unique capability of the MR.

    這確實是磁振造影的獨特之處。

  • It is not being used

    它並不是被用作

  • in regular diagnostic imaging.

    常規的造影診斷。

  • But here we can get

    但這裡我們可以取得

  • both the anatomical imaging and the temperature maps in real time.

    實時的解剖造影和溫度分佈圖。

  • And you can see the points there on the graph.

    你可以看見圖中的這些點。

  • The temperature was raised

    溫度暫時地

  • to 43 degrees C temporarily.

    上升到攝氏 43 度。

  • This doesn't cause any damage.

    這並不會造成任何傷害。

  • But the point is we are right on target.

    但重點是,我們準確的命中目標。

  • So once the physician verifies

    一旦主治醫師確認了

  • that the focus spot is on the target he has chosen,

    聚焦點是在他所選取的目標上,

  • then we move to perform

    接著就會進行

  • a full-energy ablation

    一次最高能量的消融治療,

  • like you see here.

    就像你在這裡看到的一樣。

  • And you see the temperature rises

    你看見溫度上升

  • to like 55 to 60 degrees C.

    到達約攝氏 55 至 60 度。

  • If you do it for more than a second,

    如果持續超過 1 秒鐘,

  • it's enough to basically destroy

    基本上足以

  • the proteins of the cells.

    消滅細胞中的蛋白質了。

  • This is the outcome from a patient perspective --

    這是從病人角度看到的結果 --

  • same day after the treatment.

    就在治療完成當天。

  • This is an immediate relief.

    問題立刻就被解決了。

  • (Applause)

    (掌聲)

  • Thank you.

    謝謝大家。

  • John is one of [about] a dozen

    John 是許多有膽量、

  • very heroic, courageous people

    有勇氣自願接受這個研究的

  • who volunteered for the study.

    約12個參加者中之一。

  • And you have to understand

    你必須了解,

  • what is in people's mind

    當這些人願意接受這個風險時,

  • when they are willing to take the risk.

    他們的心裡在想些什麼。

  • And this is a quote from John after he wrote it.

    這裡引用了 John 所寫下的內容。

  • He said, "Miraculous."

    他說「太神奇了」。

  • And his wife said, "This is the happiest moment of my life."

    他的妻子說「這是我這一生中最開心的時刻」。

  • And you wonder why.

    你也許感到疑惑。

  • I mean, one of the messages I like to carry over

    我想傳達給大家其中一個訊息是,

  • is, what about defending quality of life?

    有沒有想過維護生活質素?

  • I mean, those people lose their independence.

    我是說,這些人失去了獨立性。

  • They are dependent on others.

    他們必須依靠其他人。

  • And John today is fully independent.

    然而現在,John 完全不需要依靠別人了。

  • He returned to a normal life routine.

    他回復到一個正常生活了。

  • And he also plays golf,

    他也打打高爾夫球,

  • like you do in Virginia

    就像你們在維吉尼亞

  • when you are retired.

    退休後所做的一樣。

  • Okay, so you can see here the spot.

    你可以看到這邊的班點處。

  • It's like three millimeters in the middle of the brain.

    在大腦中約 3 mm 的東西。

  • There's no damage outside.

    在外面並沒有任何的損傷。

  • He suffers from no neurodeficit.

    他沒有受到任何神經損傷。

  • There's no recovery needed, no nothing.

    不需要復健,什麼都不需要。

  • He's back to his normal life.

    他已恢復正常生活。

  • Let's move now

    接著我們繼續

  • to a more painful subject.

    談談一個更痛苦的題目。

  • Pain is something

    疼痛是一種

  • that can make your life miserable.

    讓你的生命很不舒服的東西。

  • And people are suffering from all kinds of pain

    而人們正承受著種種的疼痛,

  • like neuropathic pain, lower-back pain

    例如神經痛、下背痛、

  • and cancer pain from bone metastases,

    以及癌症骨擴散的疼痛,

  • when the metastases get to your bones,

    當癌細胞擴散到你的骨頭時,

  • sometimes they are very painful.

    有時候是會非常痛楚的。

  • All those I've indicated

    我所指出的這些全部狀況

  • have already been shown

    都已經被證實

  • to be successfully treated

    可用聚焦超音波

  • by focused ultrasound

    成功治療

  • relieving the pain, again, very fast.

    很快速的解除疼痛。

  • And I would like to tell you

    接著我想告訴大家

  • about PJ.

    關於 PJ 的故事。

  • He's a 78 year-old farmer

    他是一位 78 歲的農夫,

  • who suffered from -- how should I say it? --

    患上 -- 該怎麼說呢? --

  • it's called pain in the butt.

    那被稱為臀部疼痛的病症。

  • He had metastases in his right buttock,

    他的癌細胞擴散到了右臀,

  • and he couldn't sit

    即使靠著藥物治療

  • even with medication.

    他仍然沒辦法坐下來。

  • He had to forgo all the farm activities.

    他必須放棄所有農田的工作。

  • He was treated with radiation therapy,

    他接受了放射線治療,

  • state-of-the-art radiation therapy,

    最先進的放射線治療,

  • but it didn't help.

    不過沒用。

  • Many patients like that favor radiation therapy.

    許多像他一樣的病人偏向使用放射線治療。

  • And again, he volunteered

    不過,他自願參與

  • to a pivotal study

    我們在世界各地進行的

  • that we ran worldwide,

    也在美國進行的

  • also in the U.S.

    一個關鍵性的研究,

  • And his wife actually took him.

    事實上是由他妻子帶他來的。

  • They drove like three hours

    他們從農場

  • from their farm to the hospital.

    開了 3 個小時的車到醫院。

  • He had to sit on a cushion,

    他必須坐在一個軟墊上,

  • stand still, not move,

    完全不能移動,