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  • A talk about surgical robots

    譯者: Audrey Liu 審譯者: Ching-Yi Wu

  • is also a talk about surgery.

    這是關於外科手術機器的演講,

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

    也是關於手術的演講

  • keep in mind that surgeons have a different relationship with blood

    在我試著不要讓畫面太血腥的同時

  • than normal people do,

    請了解外科醫師對血有和一般人

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

    不一樣的情感關係

  • if it were done without consent,

    畢竟外科醫師對病人所做的事

  • would be a felony.

    如果沒有得到同意

  • Surgeons are the tailors, the plumbers,

    會是一項嚴重的罪行

  • the carpenters -- some would say the butchers --

    外科醫師是裁縫、是水電工

  • of the medical world:

    是木匠,有些人會說他們是

  • cutting, reshaping, reforming,

    醫學界的屠夫

  • bypassing, fixing.

    做切割、重建、改造

  • But you need to talk about surgical instruments

    繞道、修補

  • and the evolution of surgical technology together.

    但是你必須要把手術的器具

  • So in order to give you some kind of a perspective

    和手術科技的發展放在一起來討論

  • of where we are right now

    所以為了要讓你們稍稍了解

  • with surgical robots,

    手術用機器,

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

    目前發展到哪裡

  • I want to give you a little bit of perspective

    還有未來要往哪裡去

  • of how we got to this point,

    我要讓你們有些概念

  • how we even came to believe

    我們是怎麼走到這一步的

  • that surgery was OK,

    我們到底是怎麼樣開始相信

  • that this was something that was possible to do,

    動手術是可行的

  • that this kind of cutting and reforming was OK.

    這件事是有可能做到的

  • So, a little bit of perspective --

    這樣的切割和重建是好的

  • about 10,000 years of perspective.

    所以,以下是一些觀點

  • This is a trephinated skull.

    大約是一萬年以來的觀點

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

    這是一個做了頭顱穿洞術的頭骨,

  • And many, many hundreds of skulls like this

    頭顱穿洞術就是在頭骨上切開一個洞

  • have been found in archaeological sites

    在世界各地的考古遺址

  • all over the world,

    已經發現成千上百

  • dating back five to 10 thousand years.

    像這樣的頭骨

  • Five to 10 thousand years! Now imagine this.

    年代可以回溯到一萬年前

  • You are a healer in a Stone Age village.

    五千到一萬年前! 現在想像

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

    你是石器時代村落裡的治療師

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

    有一個病人你不是很確定他到底怎麼了

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

    (奧立佛薩克斯將在很久以後的未來才出生)

  • But you think to yourself,

    他有癲癇的症狀。雖然你不知道是為什麼,

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

    但是你的腦子裡就想

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

    “我不是很確定他怎麼了,

  • (Laughter)

    但是如果我在他的頭上開個洞,我就可以把他治好”

  • Now that is surgical thinking.

    (笑聲)

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

    這就是手術的想法

  • What is astonishing about this is,

    現在我們已經知道侵入式手術的開端是什麼

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

    真正讓我們驚奇的是

  • was intended to be religious,

    即使我們不知道到底這樣的行為其中有多少是

  • or how much of it was intended to be therapeutic,

    為了宗教的理由

  • what we can tell is that these patients lived!

    或者這裡頭有多少的目的是為了治療,

  • Judging by the healing on the borders of these holes,

    我們知道的是這些病人都存活下來!

  • they lived days, months, years following trephination.

    從這些洞邊緣的瘉合狀況來看

  • And so what we are seeing is evidence

    他們在環鋸手術後活了很多天、很多個月、甚至好幾年

  • of a refined technique

    所以我們看到的是一種

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

    精湛技術的證據

  • all over the world.

    它在世界各地傳承了

  • This arose independently at sites everywhere

    好幾千年

  • that had no communication to one another.

    它在各個地點的崛起是個自獨立的

  • We really are seeing the dawn of interventional surgery.

    彼此沒有交流

  • Now we can fast forward many thousands of years

    我們真正見到了侵入式手術的起源

  • into the Bronze Age and beyond.

    現在我們可以快轉幾千年

  • And we see new refined tools coming out.

    到銅器時代以及之後

  • But surgeons in these eras are a little bit more conservative

    我們看到新的更精良的工具出土

  • than their bold, trephinating ancestors.

    但是這個時期的外科醫師比起他們那些

  • These guys confined their surgery

    大膽、做環鋸手術的祖先要保守些

  • to fairly superficial injuries.

    這些人做的手術只限於

  • And surgeons were tradesmen,

    相當表面的損傷

  • rather than physicians.

    而且外科醫師是工匠

  • This persisted all the way into and through the Renaissance.

    而不是醫生

  • That may have saved the writers,

    這狀況一直維持到文藝復興時代結束

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

    那可能保全了作家

  • They were still a mistrusted lot.

    但是對於拯救外科醫師的名聲卻沒有什麼貢獻

  • Surgeons still had a bit of a PR problem,

    他們仍舊是不被信任的一群

  • because the landscape was dominated

    外科醫師依然有些公關上的問題

  • by the itinerant barber surgeon.

    因為當時這個領域中稱霸的

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

    是四處巡迴的理髮師外科醫生

  • doing surgery sort of as a form of performance art.

    這些人穿梭在城鎮之間

  • Because we were in the age before anesthesia,

    動手術就好像是在種表演藝術,

  • the agony of the patient

    因為當時仍是麻醉存在之前的年代

  • is really as much of the public spectacle

    所以病人的強烈苦痛

  • as the surgery itself.

    其實和手術本身同樣被大眾

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

    視為奇觀

  • shown here doing a lithotomy --

    其中最出名的,雅各修士

  • which is the removal of the bladder stone,

    在這張圖上,正在進行截石術

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

    就是取出膀胱的結石

  • had to take less than two minutes.

    在當時是侵入性最高的手術之一

  • You had to have quite a flair for the dramatic,

    他必須在兩分鐘內做完

  • and be really, really quick.

    所以你一定要很戲劇化的炫技,

  • And so here you see him doing a lithotomy.

    手法要非常地快

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

    在這張畫裡,你可以看到雅各修士在做截石術,

  • wandering around in Europe,

    一般相信他在歐洲遊走

  • which is an astonishing number,

    做過超過四千場大庭廣眾下的手術

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

    當你的認知是手術一定是最後的手段時

  • I mean who would put themselves through that?

    這個數字就十分驚人

  • Until anesthesia, the absence of sensation.

    我的意思是有誰會願意經歷這過程?

  • With the demonstration of the Morton Ether Inhaler

    一直到麻醉這種讓病人沒有知覺的手段出現──

  • at the Mass. General in 1847,

    1847年,在麻省總醫院

  • a whole new era of surgery was ushered in.

    莫爾頓示範乙醚吸入器後

  • Anesthesia gave surgeons the freedom to operate.

    外科手術即被帶入一個全新的紀元

  • Anesthesia gave them the freedom to experiment,

    麻醉給外科醫師開刀的自由

  • to start to delve deeper into the body.

    麻醉給他們實驗的自由

  • This was truly a revolution in surgery.

    讓他們開始對人體進行更深入的探索

  • But there was a pretty big problem with this.

    這真的是手術的一大革新

  • After these very long, painstaking operations,

    但是這也帶來了一個蠻大的問題

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

    病人接受這些冗長又辛苦的手術

  • the patients died.

    目的就是為了要治癒他們以前根本無法碰觸的疾病

  • They died of massive infection.

    但是完成後病人卻死了

  • Surgery didn't hurt anymore,

    他們死於嚴重的感染

  • but it killed you pretty quickly.

    手術雖然不再痛苦

  • And infection would continue to claim a majority of surgical patients

    但是它可以迅速的致命

  • until the next big revolution in surgery,

    且感染持續奪走大部份手術病人的生命

  • which was aseptic technique.

    一直到手術的下一個重大革新出現

  • Joseph Lister was aepsis's,

    就是消毒滅菌技術

  • or sterility's, biggest advocate,

    約瑟夫李斯特是無菌處理

  • to a very very skeptical bunch of surgeons.

    或消毒的最重要提倡者

  • But eventually they did come around.

    他對一些對此非常懷疑的外科醫生做宣導

  • The Mayo brothers came out to visit Lister in Europe.

    最後他們終於也改變立場

  • And they came back to their American clinic and they said

    梅約兄弟到歐洲來拜訪李斯特

  • they had learned it was as important to wash your hands

    在他們回到美國的診所後說到

  • before doing surgery

    他們學習到手術前洗手

  • as it was to wash up afterwards. (Laughter)

    和手術後的清洗

  • Something so simple.

    是一樣重要的

  • And yet, operative mortality dropped profoundly.

    這是多簡單的一件事

  • These surgeries were actually now being effective.

    但是,手術的致死率就因此明顯降低

  • With the patient insensitive to pain,

    這些手術事實上現在很有效

  • and a sterile operating field

    在病人不感覺痛

  • all bets were off, the sky was the limit.

    且在無菌手術室的狀況下

  • You could now start doing surgery everywhere,

    一切都不一樣了,不再有限制

  • on the gut, on the liver,

    現在你可以在任何地方動手術

  • on the heart, on the brain.

    腸子、肝

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

    心臟、腦

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

    移植手術:你可以從一個人身上取出一個器官

  • Surgeons didn't have a problem with respectability anymore;

    把它放到另一個人身上,仍可以運作

  • they had become gods.

    外科醫生不再有聲望上的問題

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

    他們變成了神

  • but at quite a cost,

    “大外科醫生開大刀"的時代來臨

  • because they are saving lives,

    但這也付出一定的代價

  • but not necessarily quality of life,

    因為他們雖然救了很多生命

  • because healthy people don't usually need surgery,

    但卻不見得是有品質的生活

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

    這是因為健康的人通常不需開刀

  • The question had to be asked,

    而不健康的人卻很難從這麼大的傷勢中復元

  • "Well, can we do these same surgeries

    這時我們就會問

  • but through little incisions?"

    “嗯,我們是不是可進行同樣的手術

  • Laparoscopy is doing this kind of surgery:

    但是不用這麼大的切口呢?”

  • surgery with long instruments through small incisions.

    內視鏡檢查就是這類的手術

  • And it really changed the landscape of surgery.

    醫師以一根很長的器械穿過很小的切口來進行手術,

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

    這真的改變了外科手術的視野

  • but it had only been used as a diagnostic technique

    其實有些內視鏡的器械已經存在約一百年了,

  • until the 1980s,

    但是它只被用來當作診斷的技術

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

    一直到 1980 年代

  • that allowed this to be done for real operations.

    當照相機及相關技術有重大突破後

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

    這些器械才得以實際應用於手術上,

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

    你在這裡看到 ─ 這是第一張手術照片 ─

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

    我們沿著管子往下走,這是一個進入身體的新入口

  • We bring instruments in,

    這和你期待的手術的樣子很不一樣

  • from two separate cuts in the side,

    我們分別從側面兩個切口

  • and then you can start manipulating tissue.

    把器械帶入,

  • Within 10 years of the first gallbladder surgeries

    現在你就可以開始處理組織

  • being done laparoscopically,

    自從第一次膽囊手術使用內視鏡

  • a majority of gallbladder surgeries

    開始的十年內

  • were being done laparoscopically --

    大部分的膽囊手術

  • truly a pretty big revolution.

    都是經由內視鏡手術完成

  • But there were casualties of this revolution.

    這真的是一項很大的改革

  • These techniques were a lot harder to learn

    但是這項改革也造成一些傷亡,

  • than people had anticipated.

    內視鏡這項技術比一般人預期的,

  • The learning curve was very long.

    要難學習

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

    學習的時間很長

  • Surgeons had to give up their 3D vision.

    且在學習期間併發症產生的機率偏高

  • They had to give up their wrists.

    外科醫生要放棄原本 3D 的視覺