ABOUT THE SPEAKER
Catherine Mohr - Roboticist
Catherine Mohr loves what she does -- she's just not ever sure what it will be next.

Why you should listen

An engineer turned surgeon turned strategist, Catherine Mohr is always on the lookout for new technologies to help improve patient outcomes while trying to stay in her sweet spot -- the steep part of the learning curve.

As VP of Strategy for Intuitive Surgical in Silicon Valley, faculty at Singularity University and advisor to med-tech startups in the UK, the US and her native New Zealand, Mohr follows her self-admittedly geeky passions wherever they lead her, as she designs, makes, writes, tinkers, plays and travels all over the world.

More profile about the speaker
Catherine Mohr | Speaker | TED.com
TED2009

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

Catherine Mohr: Pasado, presente e futuro da cirurxía robotizada

Filmed:
823,312 views

Catherine Mohr, cirurxiá e inventora, repasa a historia da cirurxía e especialmente o seu pasado, previo ao descubrimento dos analxésicos e os antisépticos. Tamén amosa parte do instrumental cirúrxico máis innovador, empregado por destras mans robotizadas para operar a través de pequenos cortes. Fascinante, pero non apto para os máis aprensivos.
- Roboticist
Catherine Mohr loves what she does -- she's just not ever sure what it will be next. Full bio

Double-click the English transcript below to play the video.

00:18
A talk about surgical robots
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Unha charla sobre robots cirúrxicos
00:21
is also a talk about surgery.
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tamén o é sobre cirurxía.
00:24
And while I've tried to make my images not too graphic,
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Aínda que intentei que
as imaxes non fosen moi gráficas,
00:28
keep in mind that surgeons have a different relationship with blood
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recorden que os cirurxiáns
ven o sangue dunha maneira diferente
00:31
than normal people do,
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á do resto do mundo,
00:33
because, after all, what a surgeon does to a patient,
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porque, despois de todo,
o traballo dun cirurxián,
00:37
if it were done without consent,
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se se fixese sen consentimento,
00:39
would be a felony.
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sería un crime.
00:42
Surgeons are the tailors, the plumbers,
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Os cirurxiáns son os xastres,
os fontaneiros, os carpinteiros,
00:46
the carpenters -- some would say the butchers --
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--alguén diría que os carniceiros--
00:48
of the medical world:
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do mundo da medicina:
00:50
cutting, reshaping, reforming,
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cortando, remodelando, corrixindo,
00:53
bypassing, fixing.
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derivando, arranxando...
00:56
But you need to talk about surgical instruments
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Pero hai que falar sobre
instrumental cirúrxico
01:00
and the evolution of surgical technology together.
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e a evolución da tecnoloxía cirúrxica
de maneira conxunta.
01:04
So in order to give you some kind of a perspective
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Para darlles unha idea sobre
onde estamos agora
01:07
of where we are right now
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01:09
with surgical robots,
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cos robots cirúrxicos
01:11
and where we're going to be going in the future,
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e cara a onde nos diriximos,
01:13
I want to give you a little bit of perspective
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gustaríame poñelos en situación;
01:15
of how we got to this point,
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dicirlles como chegamos ata aquí,
01:17
how we even came to believe
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como chegamos a pensar
que a cirurxía estaba ben,
01:20
that surgery was OK,
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que era algo posible de facer,
01:22
that this was something that was possible to do,
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01:24
that this kind of cutting and reforming was OK.
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que a forma de traballar era a correcta.
01:29
So, a little bit of perspective --
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Así que, un pouco de perspectiva
01:31
about 10,000 years of perspective.
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--uns 10.000 anos de perspectiva.
01:34
This is a trephinated skull.
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Este é un cranio trepanado.
Trepanar simplemente é
abrir un buraco no cranio.
01:37
And trephination is simply just cutting a hole in the skull.
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Moitos, moitos centos de cranios coma este
01:41
And many, many hundreds of skulls like this
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01:43
have been found in archaeological sites
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se atoparon en escavacións arqueolóxicas,
01:46
all over the world,
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por todo o mundo,
01:48
dating back five to 10 thousand years.
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con antigüidades de entre 5 e 10 mil anos.
Entre 5 e 10 mil anos!
01:52
Five to 10 thousand years! Now imagine this.
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Agora imaxínense isto:
Son curandeiros
nunha aldea da Idade de Pedra
01:56
You are a healer in a Stone Age village.
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01:59
And you have some guy that you're not quite sure what's wrong with him --
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e teñen un mozo
ao que non saben que lle pasa.
02:02
Oliver Sacks is going to be born way in the future.
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--Oliver Sacks aínda non naceu.
02:05
He's got some seizure disorder. And you don't understand this.
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O mozo ten un trastorno convulsivo,
pero aínda non saben o que é isto.
02:08
But you think to yourself,
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Pero pensan para si mesmos:
02:10
"I'm not quite sure what's wrong with this guy.
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"Non sei que é o que lle pasa,
02:12
But maybe if I cut a hole in his head I can fix it."
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pero igual podo curalo se lle fago
un burato no cranio".
02:15
(Laughter)
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(Risas)
02:16
Now that is surgical thinking.
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Iso é o que se chama
pensamento cirúrxico.
02:18
Now we've got the dawn of interventional surgery here.
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Xa estamos no albor
da cirurxía intervencionista.
02:22
What is astonishing about this is,
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O máis abraiante de todo isto,
02:24
even though we don't know really how much of this
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aínda que non sabemos
ata que punto pertencía
02:28
was intended to be religious,
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ao ámbito relixioso,
02:31
or how much of it was intended to be therapeutic,
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ou ata que punto
pretendía ser terapéutico,
02:34
what we can tell is that these patients lived!
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é que podemos dicir
que estes pacientes sobreviviron!
02:37
Judging by the healing on the borders of these holes,
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Xulgando pola curación
dos bordos dos buracos,
02:39
they lived days, months, years following trephination.
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viviron días, meses e incluso anos
tras a trepanación.
02:44
And so what we are seeing is evidence
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Así que o que vemos
é a evidencia
02:47
of a refined technique
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dunha técnica refinada
que se empregaría durante
miles e miles de anos,
02:49
that was being handed down over thousands and thousands of years,
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02:52
all over the world.
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ao longo de todo o mundo.
A técnica xurdiu de forma independente
en diferentes lugares
02:54
This arose independently at sites everywhere
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02:56
that had no communication to one another.
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sen comunicación entre eles.
02:59
We really are seeing the dawn of interventional surgery.
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Dende logo que estamos
no albor da cirurxía intervencionista.
03:03
Now we can fast forward many thousands of years
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Agora avanzaremos varios miles de anos,
03:06
into the Bronze Age and beyond.
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ata a Idade de Bronce en diante,
03:08
And we see new refined tools coming out.
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e vemos como aparece
novo e refinado instrumental.
Porén, os cirurxiáns destas épocas
son un pouco máis conservadores
03:11
But surgeons in these eras are a little bit more conservative
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03:14
than their bold, trephinating ancestors.
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ca os seus atrevidos
e trepanadores devanceiros.
Estas persoas limitaron
a súa cirurxía
03:17
These guys confined their surgery
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03:19
to fairly superficial injuries.
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a feridas superficiais.
03:21
And surgeons were tradesmen,
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Os cirurxiáns eran comerciantes,
03:23
rather than physicians.
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máis ca médicos.
03:26
This persisted all the way into and through the Renaissance.
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Isto seguiu así ata pasar o Renacemento,
03:30
That may have saved the writers,
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que puido salvar aos escritores,
03:32
but it didn't really save the surgeons terribly much.
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pero non prestou atención aos cirurxiáns.
03:35
They were still a mistrusted lot.
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Seguíase desconfiando deles.
03:38
Surgeons still had a bit of a PR problem,
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Os cirurxiáns aínda tiñan problemas
como relacións públicas,
03:41
because the landscape was dominated
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porque o panorama dominante
03:43
by the itinerant barber surgeon.
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era o dos barbeiros-cirurxiáns ambulantes.
03:45
These were folks that traveled from village to village, town to town,
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Esta xente viaxaba de aldea en aldea,
de cidade en cidade,
03:49
doing surgery sort of as a form of performance art.
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operando como
forma de arte en vivo.
Neste momento non existía a anestesia,
03:53
Because we were in the age before anesthesia,
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03:55
the agony of the patient
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e a dor do paciente
formaba parte dese espectáculo público
03:57
is really as much of the public spectacle
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03:59
as the surgery itself.
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tanto como a cirurxía en si mesma.
04:02
One of the most famous of these guys, Frere Jacques,
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Un dos máis famosos cirurxiáns deste tipo,
Frère Jacques,
04:05
shown here doing a lithotomy --
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aparece aquí realizando unha litotomía
04:08
which is the removal of the bladder stone,
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--a extracción
de cálculos na vexiga,
04:10
one of the most invasive surgeries they did at the time --
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unha das cirurxías
máis invasivas da época--
04:12
had to take less than two minutes.
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que tiña que realizar en
menos de dous minutos.
Hai que ter talento para o espectáculo
04:15
You had to have quite a flair for the dramatic,
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04:17
and be really, really quick.
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e ser moi, moi rápido.
04:19
And so here you see him doing a lithotomy.
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E velaquí está, realizando unha litotomía.
04:22
And he is credited with doing over 4,000 of these public surgeries,
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Recoñécenselle máis de 4.000
cirurxías deste tipo,
04:26
wandering around in Europe,
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por toda Europa,
04:28
which is an astonishing number,
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o que é realmente impresionante,
04:30
when you think that surgery must have been a last resort.
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tendo en conta que a cirurxía
debía ser o último recurso.
Quen se sometería a ela?
04:34
I mean who would put themselves through that?
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04:37
Until anesthesia, the absence of sensation.
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Ata a chegada da anestesia
e a ausencia de sensibilidade.
A presentación do inhalador Morton Ether,
04:43
With the demonstration of the Morton Ether Inhaler
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04:46
at the Mass. General in 1847,
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no Hospital Xeral de Massachusetts,
no ano 1847,
marcou o inicio dunha nova era cirúrxica.
04:49
a whole new era of surgery was ushered in.
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04:52
Anesthesia gave surgeons the freedom to operate.
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A anestesia deulles aos cirurxiáns
a liberdade para operar.
04:56
Anesthesia gave them the freedom to experiment,
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A anestesia deulles
a liberdade para experimentar,
04:58
to start to delve deeper into the body.
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para indagar con profundidade o corpo.
Dende logo que foi unha revolución
no ámbito da cirurxía.
05:02
This was truly a revolution in surgery.
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05:06
But there was a pretty big problem with this.
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Pero había un gran problema con isto.
05:08
After these very long, painstaking operations,
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Despois destas longas
e minuciosas operacións,
05:11
attempting to cure things they'd never been able to touch before,
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intentando curar cousas
que ata daquela nunca viran,
05:15
the patients died.
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os pacientes morrían.
Morrían por mor de
infeccións xeneralizadas.
05:19
They died of massive infection.
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05:23
Surgery didn't hurt anymore,
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A cirurxía xa non doía,
pero mataba moi rápido.
05:25
but it killed you pretty quickly.
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05:27
And infection would continue to claim a majority of surgical patients
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As infeccións eran a principal causa
de morte en operacións
05:32
until the next big revolution in surgery,
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ata a nova gran revolución en cirurxía:
05:35
which was aseptic technique.
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a técnica aséptica.
05:38
Joseph Lister was aepsis's,
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Joseph Lister era o maior defensor
05:41
or sterility's, biggest advocate,
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da asepsia e da esterilidade
05:44
to a very very skeptical bunch of surgeons.
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entre un gran grupo
de cirurxiáns escépticos.
05:47
But eventually they did come around.
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Pero finalmente deixáronse convencer.
05:49
The Mayo brothers came out to visit Lister in Europe.
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Os irmáns Mayo visitaron
a Lister en Europa
e cando volveron á súa clínica en América,
05:53
And they came back to their American clinic and they said
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dixeron que aprenderan
que era tan importante
05:55
they had learned it was as important to wash your hands
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lavar as mans antes de operar
05:58
before doing surgery
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06:00
as it was to wash up afterwards. (Laughter)
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como facelo despois de operar.
(Risas)
06:03
Something so simple.
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Algo tan sinxelo.
06:05
And yet, operative mortality dropped profoundly.
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Agora si, a mortalidade
diminuíu enormemente.
06:09
These surgeries were actually now being effective.
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As operacións estaban sendo efectivas.
06:12
With the patient insensitive to pain,
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Cun paciente insensible á dor
06:16
and a sterile operating field
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e un contorno operatorio estéril,
06:19
all bets were off, the sky was the limit.
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calquera cousa podía pasar,
o ceo era o límite.
06:23
You could now start doing surgery everywhere,
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Agora podíase operar calquera cousa:
06:28
on the gut, on the liver,
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os intestinos, o fígado,
06:31
on the heart, on the brain.
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o corazón, o cerebro...
Transplantes:
06:33
Transplantation: you could take an organ out of one person,
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podías coller un órgano dunha persoa,
poñerllo a outra, e funcionaría.
06:35
you could put it in another person, and it would work.
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06:38
Surgeons didn't have a problem with respectability anymore;
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Os cirurxiáns agora eran respectados,
06:41
they had become gods.
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convertéronse en deuses.
Chegamos á era do
"gran cirurxián, gran incisión"
06:44
The era of the "big surgeon, big incision" had arrived,
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06:49
but at quite a cost,
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pero a que custo,
06:52
because they are saving lives,
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porque estaban salvando vidas,
06:54
but not necessarily quality of life,
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pero non a calidade de vida,
porque a xente sa
non precisa cirurxía normalmente,
06:58
because healthy people don't usually need surgery,
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07:01
and unhealthy people have a very hard time recovering from a cut like that.
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e á xente enferma cústalle moito
recuperarse dun corte coma ese.
07:06
The question had to be asked,
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Tíñanse que facer unha pregunta:
07:08
"Well, can we do these same surgeries
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"Poderíamos facer estas operacións
07:11
but through little incisions?"
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pero a través de pequenas incisións?"
A laparoscopia leva a cabo
este tipo de cirurxía:
07:15
Laparoscopy is doing this kind of surgery:
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07:18
surgery with long instruments through small incisions.
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operar con instrumental longo
a través de pequenas incisións.
07:21
And it really changed the landscape of surgery.
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Isto cambiou enormemente
o mundo da cirurxía.
07:25
Some of the tools for this had been around for a hundred years,
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Parte do instrumental
existía dende había centos de anos
pero só se utilizara como
técnica de diagnóstico ata os 80,
07:29
but it had only been used as a diagnostic technique
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07:31
until the 1980s,
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07:33
when there was changes in camera technologies and things like that,
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cando se produciron cambios
nas cámaras e en material similar,
07:36
that allowed this to be done for real operations.
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que lles permitiu utilizalas para
operacións reais.
Así que o que ven --esta é
a primeira imaxe cirúrxica--
07:41
So what you see -- this is now the first surgical image --
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07:43
as we're coming down the tube, this is a new entry into the body.
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segundo baixamos polo conduto,
é un novo acceso ao corpo.
07:47
It looks very different from what you're expecting surgery to look like.
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É moi diferente de como se espera
que sexa a cirurxía.
07:50
We bring instruments in,
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Introducimos o instrumental
07:52
from two separate cuts in the side,
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dende dúas incisións diferentes
07:54
and then you can start manipulating tissue.
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e xa podemos empezar
a traballar no tecido.
10 anos despois das primeiras
operacións de vesícula
07:58
Within 10 years of the first gallbladder surgeries
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08:01
being done laparoscopically,
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mediante laparoscopia,
08:04
a majority of gallbladder surgeries
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a maior parte destas operacións
08:06
were being done laparoscopically --
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séguense facendo por laparoscopia
--outra gran revolución,
dende logo.
08:09
truly a pretty big revolution.
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08:14
But there were casualties of this revolution.
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Pero houbo vítimas desta revolución.
Estas técnicas eran moito máis complexas
08:18
These techniques were a lot harder to learn
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08:20
than people had anticipated.
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do que a xente pensaba.
08:22
The learning curve was very long.
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A curva de aprendizaxe foi moi longa
08:24
And during that learning curve the complications went quite a bit higher.
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e no seu transcurso,
as complicacións foron a máis.
08:28
Surgeons had to give up their 3D vision.
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Os cirurxiáns tiveron que
renunciar á visión 3D.
08:30
They had to give up their wrists.
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Tiveron que renunciar ao seu pulso.
08:32
They had to give up intuitive motion in the instruments.
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Aos movementos intuitivos do instrumental.
08:37
This surgeon has over 3,000 hours of laparoscopic experience.
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Este cirurxián ten unhas 3.000 horas
de experiencia laparoscópica.
08:43
Now this is a particularly frustrating placement of the needle.
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Esta introdución da agulla
foi particularmente difícil.
08:48
But this is hard.
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É difícil.
08:50
And one of the reasons why it is so hard
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Unha das razóns polas que é tan difícil
08:53
is because the external ergonomics are terrible.
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é porque a ergonomía externa é terrible.
Teñen este instrumental longo
e traballan fóra do seu eixe central.
08:57
You've got these long instruments, and you're working off your centerline.
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E o instrumental
practicamente funciona ao revés..
09:01
And the instruments are essentially working backwards.
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Así que, o que hai que facer
para coller as capacidades da man
09:06
So what you need to do, to take the capability of your hand,
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09:09
and put it on the other side of that small incision,
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e introducilas no outro lado
desa pequena incisión,
09:12
is you need to put a wrist on that instrument.
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é engadirlle un pulso ao instrumental.
09:17
And so -- I get to talk about robots --
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E así --falando de robots--
09:19
the da Vinci robot
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o robot da Vinci
09:21
put just that wrist on the other side of that incision.
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introduciu ese pulso
no outro lado da incisión.
Aquí pode verse
o funcionamento dese pulso.
09:25
And so here you're seeing the operation of this wrist.
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09:28
And now, in contrast to the laparoscopy,
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Agora, a diferenza da laparoscopia,
09:31
you can precisely place the needle in your instruments,
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pódese colocar
unha agulla no instrumental,
09:34
and you can pass it all the way through
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introducilo polo corte
e seguir a súa traxectoria.
09:37
and follow it in a trajectory.
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09:39
And the reason why this becomes so much easier
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A razón pola cal facilita tanto o traballo
09:41
is -- you can see on the bottom --
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--pódeno ver na parte inferior--
09:44
the hands are making the motions,
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é que as mans fan os movementos
09:47
and the instruments are following those motions exactly.
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e o instrumental cópiaos á perfección.
O que se pon entre
o instrumental e as mans
09:51
Now, what you put between those instruments and those hands,
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09:55
is a large, fairly complicated robot.
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é un complexo robot de grandes dimensións.
09:57
The surgeon is sitting at a console,
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O cirurxián senta á consola
09:59
and controlling the robot with these controllers.
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e controla o robot con eses mandos.
10:03
And the robot is moving these instruments around,
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O robot move o instrumental,
impulsándoo cara ao interior do corpo.
10:06
and powering them, down inside the body.
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10:09
You have a 3D camera, so you get a 3D view.
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Hai unha cámara 3D,
así que temos visión 3D.
10:12
And since this was introduced in 1999,
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Dende que se deu a coñecer en 1999,
10:16
a lot of these robots have been out
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ensambláronse moitos robots deste tipo
10:18
and being used for surgical procedures like a prostatectomy,
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para usarse en intervencións cirúrxicas
como a prostatectomía,
10:22
which is a prostate deep in the pelvis,
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que é un afundimento da próstata na pelve,
10:25
and it requires fine dissection
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que require unha disección fina
10:27
and delicate manipulation
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e unha manipulación delicada
10:29
to be able to get a good surgical outcome.
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para obter un bo resultado cirúrxico.
10:32
You can also sew bypass vessels directly onto a beating heart
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Tamén se poden coser pontes coronarias
directamente nun corazón latexante
10:37
without cracking the chest.
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sen abrir a caixa torácica.
Tan só traballando entre as costelas.
10:40
This is all done in between the ribs.
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10:42
And you can go inside the heart itself
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Incluso se pode introducir
no mesmo corazón
10:45
and repair the valves from the inside.
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e reparar as válvulas dende o interior.
10:49
You've got these technologies -- thank you --
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Teñen toda esta tecnoloxía
(aplausos)
--grazas--
10:52
(Applause)
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10:55
And so you might say, "Wow this is really cool!
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E poden pensar:
"Vaia, isto está moi ben!
10:57
So, smartypants, why isn't all surgery being done this way?"
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Pero a ver listiños, por que
non se fan así todas as operacións?"
11:00
And there are some reasons, some good reasons.
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Hai varias razóns, varias razóns de peso.
11:03
And cost is one of them.
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O custo é unha delas.
11:05
I talked about the large, complicated robot.
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Falei de complexos robots
de grandes dimensións;
11:07
With all its bells and whistles, one of those robots
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con todos os seus compoñentes,
un destes robots
11:10
will cost you about as much as a solid gold surgeon.
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custará tanto como
un cirurxián de ouro puro.
11:13
More useful than a solid gold surgeon,
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Máis útil ca un cirurxián de outro puro,
11:15
but, still, it's a fairly big capital investment.
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pero aínda así,
un investimento desorbitado.
11:19
But once you've got it, your procedure costs do come down.
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Porén, unha vez que se ten,
os custos do procedemento diminúen.
11:25
But there are other barriers.
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Aínda así, hai outras trabas.
11:27
So something like a prostatectomy --
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Algo como unha prostatectomía
--a próstata é pequena
e está nun punto fixo
11:30
the prostate is small, and it's in one spot,
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11:32
and you can set your robot up very precisely
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polo que podes orientar
o robot con precisión
11:35
to work in that one spot.
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para traballar sobre ese punto.
11:37
And so it's perfect for something like that.
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É perfecto para algo así.
11:39
And in fact if you, or anyone you know,
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De feito, se a vostedes,
ou a calquera que coñezan,
11:41
had their prostate taken out in the last couple of years,
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lles extraeron a próstata
nos últimos dous anos,
11:43
chances are it was done with one of these systems.
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hai moitas posibilidades de que
o fixesen deste xeito.
11:47
But if you need to reach more places than just one,
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Pero se houbese que chegar
a máis de un lugar,
11:51
you need to move the robot.
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necesitarían mover o robot.
11:53
And you need to put some new incisions in there.
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Para iso, habería que
realizar novas incisións
11:55
And you need to re-set it up.
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e habería que reprogramalo.
E hai que incluír máis e máis portos.
11:58
And then you need to add some more ports, and more.
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E o problema é que se perde moito tempo,
e que se volve difícil de manexar.
12:02
And the problem is it gets time-consuming, and cumbersome.
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12:05
And for that reason there are many surgeries
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É por isto que moitas das operacións
12:07
that just aren't being done with the da Vinci.
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non se fan co da Vinci.
12:11
So we had to ask the question, "Well how do we fix that?"
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Así que temos que facernos unha pregunta:
"Entón, como arranxamos isto?"
12:16
What if we could change it so that we didn't have to re-set up
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Que pasaría se os puidésemos
cambiar sen reprogramalos
12:20
each time we wanted to move somewhere different?
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cada vez que os houbera
que mover de lugar?
12:22
What if we could bring all the instruments
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Que pasaría se puidésemos incluír
todo o instrumental
12:24
in together in one place?
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nun mesmo lugar?
12:26
How would that change the capabilities of the surgeon?
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Como influiría iso
nas capacidades do cirurxián?
12:30
And how would that change the experience for the patient?
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E como cambiaría iso
a experiencia do paciente?
12:34
Now, to do that,
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Pero para facer iso,
12:36
we need to be able to bring a camera
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temos que ser capaces
de introducir xuntos unha cámara
12:39
and instruments in together through one small tube,
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e o instrumental por un tubo
de pequenas dimensións,
12:43
like that tube you saw in the laparoscopy video.
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como o que vimos no vídeo da laparoscopia.
12:46
Or, not so coincidentally, like a tube like this.
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Ou --e non é casualidade--,
nun tubo coma este.
12:52
So what's going to come out of that tube
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O que tería que saír dese tubo
12:54
is the debut of this new technology,
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é o comezo desta nova tecnoloxía,
12:57
this new robot that is going to be able to reach anywhere.
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este novo robot que será capaz
de chegar a calquera lado.
13:02
Ready? So here it comes.
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Listos?
Velaquí está..
13:06
This is the camera, and three instruments.
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Esta é a cámara, e tres instrumentos.
13:09
And as you see it come out,
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Como poden ver,
13:11
in order to actually be able to do anything useful,
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para que se poida traballar con el,
13:13
it can't all stay clustered up like this.
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non pode estar agrupado deste xeito.
13:16
It has to be able to come off of the centerline
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Débese poder separar do eixe central
13:19
and then be able to work back toward that centerline.
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e despois poder reagrupalo.
13:23
He's a cheeky little devil.
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É un diañiño insolente.
13:26
But what this lets you do
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Pero o que permite facer
13:28
is gives you that all-important traction,
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é dar a tracción necesaria,
13:30
and counter-traction,
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e a contratracción,
para que se poida diseccionar,
para que se poida coser,
13:32
so that you can dissect, so that you can sew,
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13:34
so that you can do all the things that you need to do,
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e para que se poida facer
todo o que faga falta;
13:36
all the surgical tasks.
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todas as accións cirúrxicas.
13:38
But it's all coming in through one incision.
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Todo a través dunha incisión.
Non é tan sinxelo.
13:42
It's not so simple.
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Pero merece a pena
pola liberdade que nos achega
13:45
But it's worth it for the freedom that this gives us
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13:48
as we're going around.
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durante todo o proceso.
13:50
For the patient, however,
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Porén, para o paciente,
13:54
it's transparent. This is all they're going to see.
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apenas é nada.
Isto é todo o que van ver.
14:00
It's very exciting to think where we get to go with this.
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É apaixonante pensar
a onde nos vai levar todo isto.
14:04
We get to write the script of the next revolution in surgery.
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Estamos a escribir o guión
da próxima revolución en cirurxía.
Mentres collemos estas capacidades
e decidimos a onde imos ir,
14:09
As we take these capabilities, and we get to go to the next places,
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14:13
we get to decide what our new surgeries are going to be.
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temos que decidir cales
van ser as nosas novas cirurxías.
Creo que coñezo o resto do camiño
14:17
And I think to really get the rest of the way
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14:19
in that revolution,
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nesa revolución;
non só temos que levar
as nosas mans por novos camiños
14:21
we need to not just take our hands in in new ways,
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14:24
we also need to take our eyes in in new ways.
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senón que tamén temos
que levar os nosos ollos.
Temos que ver máis alá da superficie.
14:28
We need to see beyond the surface.
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Temos que ser capaces de
manexar o que estamos cortando
14:30
We need to be able to guide what we're cutting
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dunha maneira máis eficaz.
14:33
in a much better way.
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14:38
This is a cancer surgery.
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Esta é unha operación de cancro.
14:40
One of the problems with this,
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Un dos problemas aquí,
incluso para os cirurxiáns
que traballaron moito con isto,
14:42
even for surgeons who've been looking at this a lot,
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14:44
is you can't see the cancer,
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é que o cancro non se pode ver,
14:47
especially when it's hidden below the surface.
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sobre todo cando está escondido
baixo a superficie.
14:50
And so what we're starting to do
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Así que o que se comeza a facer
14:52
is we're starting to inject specially designed markers
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é inxectar marcadores
especialmente deseñados
14:56
into the bloodstream that will target the cancer.
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no torrente sanguíneo
para identificar o cancro.
14:59
It will go, bind to the cancer.
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Uniranse ao cancro
15:02
And we can make those markers glow.
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e podemos facer que brillen.
15:05
And we can take special cameras,
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Podemos utilizar cámaras especiais
15:07
and we can look at it.
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e podemos velos.
Agora sabemos onde temos que cortar,
15:10
Now we know where we need to cut,
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15:12
even when it's below the surface.
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incluso estando baixo a superficie.
15:15
We can take these markers and we can inject them in a tumor site.
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Podemos coller estes marcadores
e inxectalos onde se atopa o tumor
15:19
And we can follow where they flow out from that tumor site,
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4000
e seguilos por onde vaian
15:23
so we can see the first places where that cancer might travel.
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para ver a que lugares
podería chegar o cancro.
15:29
We can inject these dyes into the bloodstream,
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Podemos inxectar estas tinturas
no torrente sanguíneo
15:32
so that when we do a new vessel
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para que cando fagamos
unha ponte coronaria
e conectemos unha vea ao corazón,
15:35
and we bypass a blockage on the heart,
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2000
15:37
we can see if we actually made the connection,
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vexamos se fixemos ben a conexión
15:40
before we close that patient back up again --
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3000
antes de coser ao paciente
15:43
something that we haven't been able to do
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--algo que non se podía facer antes
15:45
without radiation before.
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3000
sen radiación.
15:48
We can light up tumors
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Podemos iluminar tumores,
15:51
like this kidney tumor,
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2000
como este tumor de ril,
15:53
so that you can exactly see where the boundary is
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para saber exactamente
onde está o límite
15:56
between the kidney tumor and the kidney you want to leave behind,
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4000
entre o tumor e o ril
que queres conservar,
ou entre o tumor de fígado
e o fígado que queres conservar.
16:00
or the liver tumor and the liver you want to leave behind.
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4000
16:04
And we don't even need to confine ourselves
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3000
Nin sequera temos que limitarnos
16:07
to this macro vision.
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a esta visión macro.
Temos sondas microscópicas flexibles
16:10
We have flexible microscopic probes
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16:12
that we can bring down into the body.
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que se poden introducir no corpo
16:15
And we can look at cells directly.
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para ver as células directamente.
16:18
I'm looking at nerves here. So these are nerves you see, down on the bottom,
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Aquí estamos vendo nervios.
Estes son nervios, aí no fondo,
e esta, a sonda microscópica
16:21
and the microscope probe that's being held by the robotic hand, up at the top.
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suxeita á man robotizada, aí arriba.
16:25
So this is all very prototypey at this point.
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Ata agora todo é un prototipo.
16:28
But you care about nerves, if you are a surgical patient.
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Pero para o paciente dunha operación,
os nervios si que importan.
16:31
Because they let you keep continence,
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3000
Porque lle permiten manter a continencia,
16:34
bladder control, and sexual function after surgery,
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4000
o control sobre a vexiga
e as funcións sexuais
tras a operación, o que é
moi importante para el.
16:38
all of which is generally fairly important to the patient.
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6000
16:44
So, with the combination of these technologies
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Coa combinación destas tecnoloxías
podemos ver e abranguer todo isto.
16:48
we can reach it all, and we can see it all.
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16:52
We can heal the disease.
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Podemos curar a enfermidade
16:55
And we can leave the patient whole and intact
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e deixar ao paciente dunha soa peza,
intacto e funcional despois de todo.
16:59
and functional afterwards.
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17:03
Now, I've talked about the patient
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Pois ben, falei do paciente
17:05
as if the patient is, somehow, someone abstract
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como se fose,
dalgún xeito,
un ente abstracto
alleo a esta sala.
17:08
outside this room.
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17:10
And that is not the case.
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E non é así.
Moitos de vostedes,
quizais todos vostedes,
17:13
Many of you, all of you maybe,
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terán, ou xa tiveron, que facerlle fronte
a unha diagnose de cancro,
17:16
will at some point, or have already, faced a diagnosis of cancer,
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3000
17:19
or heart disease, or some organ dysfunction
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unha enfermidade cardíaca
ou a algunha disfunción orgánica
17:22
that's going to buy you a date with a surgeon.
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que os levará a unha cita cun cirurxián.
17:25
And when you get to that point --
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E cando chegue este momento
17:29
I mean, these maladies don't care
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--porque a estas enfermidades
non lles importa
17:32
how many books you've written,
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3000
cantos libros escribiron,
17:35
how many companies you've started,
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2000
cantas empresas fundaron,
o premio Nobel
que aínda non gañaron
17:37
that Nobel Prize you have yet to win,
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2000
17:39
how much time you planned to spend with your children.
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4000
ou canto tempo contaban
pasar cos seus fillos.
17:43
These maladies come for us all.
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Estas enfermidades veñen por todos nós.
17:46
And the prospect I'm offering you, of an easier surgery ...
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A perspectiva que lles ofrezo,
dunha cirurxía máis sinxela,
17:48
is that going to make that diagnosis any less terrifying?
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vai facer que o diagnóstico sexa
menos aterrador?
17:53
I'm not sure I really even want it to.
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Nin sequera sei se é o que quero.
17:57
Because facing your own mortality
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Porque facerlle fronte á
túa propia morte
18:00
causes a re-evaluation of priorities,
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obríganos a reavaliar as prioridades
18:03
and a realignment of what your goals are in life, unlike anything else.
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e a reconsiderar
os obxectivos vitais,
de forma moi diferente.
18:08
And I would never want to deprive you of that epiphany.
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5000
En ningún momento querería
privalos desta revelación.
18:13
What I want instead,
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3000
No seu lugar, o que quero
18:16
is for you to be whole, intact,
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5000
é que estean dunha peza, intactos
18:21
and functional enough to go out and save the world,
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e funcionais abondo
como para saír e salvar o mundo
cando decidan que iso é o que queren.
18:26
after you've decided you need to do it.
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3000
18:29
And that is my vision for your future.
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E ese é o meu desexo para o seu futuro.
18:32
Thank you.
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Grazas
18:34
(Applause)
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15000
(Aplausos)

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ABOUT THE SPEAKER
Catherine Mohr - Roboticist
Catherine Mohr loves what she does -- she's just not ever sure what it will be next.

Why you should listen

An engineer turned surgeon turned strategist, Catherine Mohr is always on the lookout for new technologies to help improve patient outcomes while trying to stay in her sweet spot -- the steep part of the learning curve.

As VP of Strategy for Intuitive Surgical in Silicon Valley, faculty at Singularity University and advisor to med-tech startups in the UK, the US and her native New Zealand, Mohr follows her self-admittedly geeky passions wherever they lead her, as she designs, makes, writes, tinkers, plays and travels all over the world.

More profile about the speaker
Catherine Mohr | Speaker | TED.com