TEDMED 2011
Quyen Nguyen: Color-coded surgery
Quyen Nguyen: Kirurgija u bojama
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Kirurzi uče iz knjiga koje tipove tkiva prikladno označavaju bojama, ali u stvarnosti to ne izgleda baš tako — sve do sad. Na TEDMED-u Quyen Nguyen demonstrira kako tumori pomoću molekularnih markera mogu svijetliti neonski zeleno i tako kirurzima pokazati točno gdje trebaju napraviti rez.
Quyen Nguyen - Surgeon
Quyen Nguyen uses molecular probes that make tumors -- and just the tumors -- glow, as an extraordinary aid to surgeons. Full bio
Quyen Nguyen uses molecular probes that make tumors -- and just the tumors -- glow, as an extraordinary aid to surgeons. Full bio
Double-click the English transcript below to play the video.
00:15
I want to talk to you
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Želim vam pričati
00:17
about one of the biggest myths in medicine,
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o jednom od najvećih mitova u medicini,
00:19
and that is the idea
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a to je ideja
00:21
that all we need are more medical breakthroughs
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da samo trebamo velika medicinska otkrića
00:24
and then all of our problems will be solved.
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i da će tada svi naši problemi biti riješeni.
00:27
Our society loves to romanticize
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Naše društvo voli romantizirati
00:30
the idea of the single, solo inventor
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ideju o jednom izumitelju
00:32
who, working late in the lab one night,
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koji, radeći jedne noći dokasna u laboratoriju,
00:35
makes an earthshaking discovery,
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dolazi do revolucionarnog otkrića,
00:38
and voila, overnight everything's changed.
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i, eto, sve se promijenilo preko noći.
00:42
That's a very appealing picture,
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To je vrlo privlačna slika,
00:44
however, it's just not true.
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no, to jednostavno nije tako.
00:47
In fact, medicine today is a team sport.
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Medicina je danas zapravo timski sport.
00:50
And in many ways,
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I, na mnogo načina,
00:52
it always has been.
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oduvijek je i bila.
00:54
I'd like to share with you a story
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Htjela bih vam ispričati priču
00:56
about how I've experienced this very dramatically
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o tome kako sam ja to doživjela vrlo dramatično
00:59
in my own work.
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u svom poslu.
01:01
I'm a surgeon,
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Ja sam kirurginja,
01:03
and we surgeons have always had
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a mi kirurzi oduvijek smo
01:05
this special relationship with light.
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svjetlost doživljavali na poseban način.
01:08
When I make an incision inside a patient's body, it's dark.
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Kada napravim rez unutar pacijentova tijela, ondje je mračno.
01:12
We need to shine light to see what we're doing.
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Moramo posvijetliti da bismo vidjeli što radimo.
01:15
And this is why, traditionally,
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I zato, tradicionalno,
01:18
surgeries have always started so early in the morning --
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operacije uvijek počinju rano ujutro --
01:20
to take advantage of daylight hours.
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da bismo iskoristili prednost danjeg svjetla.
01:22
And if you look at historical pictures
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I ako pogledate povijesne slike
01:24
of the early operating rooms,
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prvih operacijskih sala,
01:26
they have been on top of buildings.
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one su bile na vrhovima zgrada.
01:29
For example, this is the oldest operating room in the Western world,
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Na primjer, ovo je najstarija operacijska sala u zapadnome svijetu,
01:31
in London,
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u Londonu,
01:33
where the operating room
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i ona se nalazi
01:35
is actually on top of a church
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na vrhu crkve
01:37
with a skylight coming in.
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i danja svijetlost dopire unutra.
01:39
And then this is a picture
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Zatim, ovo je slika
01:41
of one of the most famous hospitals in America.
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jedne od najpoznatijih bolnica u Americi.
01:44
This is Mass General in Boston.
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Ovo je bolnica Mass General u Bostonu.
01:46
And do you know where the operating room is?
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Znate gdje je operacijska sala?
01:48
Here it is
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Evo je,
01:50
on the top of the building
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na vrhu zgrade,
01:52
with plenty of windows to let light in.
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s mnogo prozora kako bi svjetlost ulazila unutra.
01:55
So nowadays in the operating room,
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U današnje vrijeme, u operacijskim salama
01:57
we no longer need to use sunlight.
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više ne moramo koristiti sunčevu svjetlost.
02:00
And because we no longer need to use sunlight,
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I baš zbog toga,
02:03
we have very specialized lights
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danas imamo vrlo specijalizirana svjetla
02:05
that are made for the operating room.
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koja su izrađena baš za operacijske sale.
02:07
We have an opportunity
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Imamo mogućnosti
02:09
to bring in other kinds of lights --
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koristiti i druge vrste svjetla --
02:11
lights that can allow us to see
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poput onih koja nam omogućuju da vidimo
02:13
what we currently don't see.
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ono što trenutno ne možemo vidjeti.
02:16
And this is what I think
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I mislim da je upravo u tome
02:18
is the magic of fluorescence.
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čarolija fluorescencije.
02:20
So let me back up a little bit.
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Sad bih se samo malo vratila unatrag.
02:22
When we are in medical school,
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Kad smo na fakultetu,
02:25
we learn our anatomy from illustrations such as this
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učimo anatomiju sa slika poput ove,
02:28
where everything's color-coded.
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gdje je sve označeno bojama.
02:31
Nerves are yellow, arteries are red,
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Živci su žute boje, arterije su crvene,
02:33
veins are blue.
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vene su plave.
02:35
That's so easy anybody could become a surgeon, right?
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To je tako lako da bi svatko mogao postati kirurg, zar ne?
02:39
However, when we have a real patient on the table,
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No, kad imamo pravog pacijenta na stolu,
02:42
this is the same neck dissection --
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ovo je isti taj rez vrata --
02:45
not so easy to tell the difference
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i nije tako lako uočiti razlike
02:47
between different structures.
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između različitih struktura.
02:49
We heard over the last couple days
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U posljednjih nekoliko dana
02:52
what an urgent problem
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čuli smo kako je rak još uvijek
02:54
cancer still is in our society,
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alarmantan problem u našem društvu,
02:56
what a pressing need it is
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koliko je velika potreba
02:58
for us to not have
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da izbjegnemo
03:00
one person die every minute.
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da svake minute netko umre.
03:04
Well if cancer can be caught early,
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Kad rak mogao biti rano otkriven,
03:06
enough such that someone can have their cancer taken out,
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dovoljno da ga možemo izvaditi,
03:11
excised with surgery,
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kirurški odstraniti,
03:13
I don't care if it has this gene or that gene,
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nije me briga ima li ovaj ili onaj gen,
03:15
or if it has this protein or that protein,
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ili ovaj ili onaj protein,
03:17
it's in the jar.
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on je sad u posudi.
03:19
It's done, it's out, you're cured of cancer.
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Gotovo je, vani je, vi ste izliječeni od raka.
03:22
This is how we excise cancers.
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Ovako uklanjamo tumore.
03:24
We do our best, based upon our training
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Radimo najbolje što možemo, na temelju svojeg obrazovanja
03:27
and the way the cancer looks and the way it feels
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i izgleda tumora, konzistencije
03:30
and its relationship to other structures and all of our experience,
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i odnosa s drugim strukturama i cijelim našim iskustvom,
03:33
we say, you know what, the cancer's gone.
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kažemo, znate što, raka više nema.
03:36
We've made a good job. We've taken it out.
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Napravili smo dobar posao. Izvadili smo ga.
03:39
That's what the surgeon is saying in the operating room
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To je ono što kirurg kaže u operacijskoj sali
03:41
when the patient's on the table.
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dok je pacijent na operacijskom stolu.
03:43
But then we actually don't know that it's all out.
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Ali tada mi još ne znamo da je sve vani.
03:46
We actually have to take samples from the surgical bed,
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Moramo uzeti intraoperativni uzorak,
03:49
what's left behind in the patient,
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ono što je ostalo u pacijentu,
03:51
and then send those bits to the pathology lab.
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i poslati to na patološku analizu.
03:55
In the meanwhile, the patient's on the operating room table.
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U međuvremenu, pacijent je još na operacijskom stolu.
03:57
The nurses, anesthesiologist, the surgeon,
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Sestre, anesteziolozi, kirurg,
03:59
all the assistants are waiting around.
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i svi asistenti samo čekaju.
04:01
And we wait.
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I čekamo.
04:03
The pathologist takes that sample,
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Patolog uzme uzorak,
04:05
freezes it, cuts it, looks in the microscope one by one
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zamrzne ga, izreže i pogleda pod mikroskopom jedan po jedan,
04:08
and then calls back into the room.
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i onda telefonira u operacijsku salu.
04:10
And that may be 20 minutes later per piece.
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To može potrajati i po 20 minuta po uzorku.
04:12
So if you've sent three specimens,
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Stoga, ako ste poslali tri uzorka,
04:14
it's an hour later.
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javit će vam se sat vremena kasnije.
04:16
And very often they say,
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Vrlo često patolozi kažu:
04:18
"You know what, points A and B are okay,
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Znate što, uzorci A i B su uredni,
04:21
but point C, you still have some residual cancer there.
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ali u uzorku C još imate ostataka raka.
04:23
Please go cut that piece out."
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Molim vas izrežite taj dio.“
04:26
So we go back and we do that again, and again.
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I tako to radimo opet, i opet.
04:29
And this whole process:
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I cijeli taj postupak :
04:31
"Okay you're done.
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"U redu, gotovo je.
04:33
We think the entire tumor is out."
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Mislimo da je cijeli tumor izvađen.“
04:35
But very often several days later,
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Ali vrlo često, nekoliko dana nakon što je
04:38
the patient's gone home,
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pacijent pušten kući,
04:40
we get a phone call:
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dobijemo poziv:
04:42
"I'm sorry,
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"Žao mi je,
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once we looked at the final pathology,
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u posljednjoj patološkoj analizi,
04:46
once we looked at the final specimen,
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kad smo pogledali i posljednji uzorak,
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we actually found that there's a couple other spots
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zapravo smo uočili da postoji još nekoliko mjesta u uzorku
04:51
where the margins are positive.
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na kojima su rubovi patološki pozitivni.
04:54
There's still cancer in your patient."
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Vaš pacijent još uvijek ima tumorskog tikva u sebi."
04:57
So now you're faced with telling your patient, first of all,
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I sad ste suočeni s činjenicom da morate priopćiti pacijentu, prije svega,
05:00
that they may need another surgery,
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da će možda trebati još jednu operaciju
05:02
or that they need additional therapy
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ili da treba dodatnu terapiju
05:04
such as radiation or chemotherapy.
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poput zračenja ili kemoterapije.
05:08
So wouldn't it be better
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Stoga, ne bi li bilo bolje
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if we could really tell,
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kad bismo mi,
05:12
if the surgeon could really tell,
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kad bi kirurg mogao točno reći
05:15
whether or not there's still cancer on the surgical field?
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ima li ili nema tumorskog tkiva koje treba operirati?
05:18
I mean, in many ways, the way that we're doing it,
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Po mnogočemu, ovako kako mi to trenutno radimo,
05:21
we're still operating in the dark.
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još uvijek operiramo u mraku.
05:25
So in 2004, during my surgical residency,
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2004. godine, tijekom svoje specijalizacije,
05:28
I had the great fortune
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imala sam veliku sreću
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to meet Dr. Roger Tsien,
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upoznati dr. Rogera Chena,
05:33
who went on to win the Nobel Prize for chemistry
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koji je kasnije osvojio Nobelovu nagradu za kemiju
05:36
in 2008.
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2008. godine.
05:38
Roger and his team
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Roger i njegov tim
05:40
were working on a way to detect cancer,
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pokušavali su otkriti način na koji bi detektirali tumor,
05:43
and they had a very clever molecule
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i smislili su jednu
05:45
that they had come up with.
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vrlo pametnu molekulu.
05:47
The molecule they had developed
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Molekula koju su razvili
05:49
had three parts.
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imala je tri dijela.
05:51
The main part of it is the blue part, polycation,
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Glavi dio je plavi dio, polikation,
05:54
and it's basically very sticky
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i doslovno se lijepi
05:56
to every tissue in your body.
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za svako tkivo u vašem tijelu.
05:58
So imagine that you make a solution
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I zamislite da napravite otopinu
06:00
full of this sticky material
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punu ovakvog ljepljivog materijala
06:02
and inject it into the veins of someone who has cancer,
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i ubrizgate ga u vene nekoga tko ima rak,
06:04
everything's going to get lit up.
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sve će biti osvijetljeno.
06:06
Nothing will be specific.
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Ništa neće biti specifično.
06:08
There's no specificity there.
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Tu nema nikakve preciznosti.
06:10
So they added two additional components.
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Stoga su dodali dvije dodatne komponente.
06:12
The first one is a polyanionic segment,
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Prva je polianionski segment,
06:15
which basically acts as a non-stick backing
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koja se ponaša doslovno poput neljepljive pozadine,
06:17
like the back of a sticker.
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poput stražnjeg dijela naljepnice.
06:19
So when those two are together, the molecule is neutral
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Kad se spoje te dvije komponente, molekula je neutralna
06:22
and nothing gets stuck down.
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i ništa se ne lijepi za tkivo.
06:24
And the two pieces are then linked
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Ta dva dijela zatim povezuje
06:27
by something that can only be cut
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nešto što se može izrezati
06:30
if you have the right molecular scissors --
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samo ako imate odgovarajuće molekularne škare --
06:32
for example, the kind of protease enzymes
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na primjer, neku vrstu proteaznih enzima
06:34
that tumors make.
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kakve proizvode tumori.
06:36
So here in this situation,
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Dakle, ovdje u ovoj situaciji,
06:38
if you make a solution full of this three-part molecule
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ako napravite otopinu punu ove trodijelne molekule,
06:42
along with the dye, which is shown in green,
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zajedno s bojom, koja je prikazana zelenom bojom,
06:44
and you inject it into the vein
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i ubrizgate je u venu
06:47
of someone who has cancer,
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nekome tko ima rak,
06:49
normal tissue can't cut it.
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normalno tkivo neće je moći rascjepkati.
06:51
The molecule passes through and gets excreted.
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Molekula putuje krvlju i na kraju se izluči.
06:54
However, in the presence of the tumor,
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No, u prisutnosti tumora
06:56
now there are molecular scissors
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postoje molekularne škare
06:58
that can break this molecule apart
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koje mogu razbiti molekulu
07:00
right there at the cleavable site.
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na točno određenom mjestu.
07:02
And now, boom,
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I sada, bum,
07:04
the tumor labels itself
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tumor se označi
07:06
and it gets fluorescent.
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i postaje fluorescentan.
07:08
So here's an example of a nerve
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Evo primjera živca
07:11
that has tumor surrounding it.
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kojega okružuje tumor.
07:13
Can you tell where the tumor is?
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Vidite li gdje je tumor?
07:15
I couldn't when I was working on this.
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Ja nisam kad sam radila na ovome.
07:18
But here it is. It's fluorescent.
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Ali evo ga. Fluorescentan je.
07:20
Now it's green.
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Sada je zelene boje.
07:22
See, so every single one in the audience
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Vidite, sada svatko od vas u publici
07:25
now can tell where the cancer is.
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vidi točno gdje je rak.
07:28
We can tell in the operating room, in the field,
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U operacijskoj sali, na terenu,
07:31
at a molecular level,
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na molekularnoj razini
07:33
where is the cancer and what the surgeon needs to do
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vidimo gdje je tumor, i što sve
07:35
and how much more work they need to do
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i koliko toga mora napraviti kirurg
07:37
to cut that out.
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kako bi ga izrezao.
07:40
And the cool thing about fluorescence
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Izvrsna stvar u fluorescenciji
07:42
is that it's not only bright,
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jest to što uz osvjetljenje
07:45
it actually can shine through tissue.
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može sjati i kroz tkivo.
07:48
The light that the fluorescence emits
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Svjetlost koju emitira fluorescencija
07:51
can go through tissue.
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može prolaziti kroz tkivo.
07:53
So even if the tumor is not right on the surface,
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Čak i ako tumor nije na površini,
07:56
you'll still be able to see it.
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vi ćete ga svejedo moći vidjeti.
07:59
In this movie, you can see
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Na ovom videu možete vidjeti
08:01
that the tumor is green.
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da je tumor zelene boje.
08:04
There's actually normal muscle on top of it. See that?
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Ovdje iznad zapravo je normalno mišićno tkivo. Vidite?
08:07
And I'm peeling that muscle away.
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Ja ga odstranjujem.
08:09
But even before I peel that muscle away,
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Ali i prije nego što sam odstranila taj mišić,
08:11
you saw that there was a tumor underneath.
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vidjeli ste da se ispod njega nalazi tumor.
08:14
So that's the beauty of having a tumor
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I upravo u tome je ljepota obilježavanja
08:17
that's labeled with fluorescent molecules.
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tumorskog tkiva fluorescentnim molekulama.
08:20
That you can, not only see the margins
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Tako možete ne samo vidjeti rubove
08:22
right there on a molecular level,
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na molekularnoj razini,
08:24
but you can see it even if it's not right on the top --
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nego ga možete vidjeti čak i kad nije na samoj površini --
08:27
even if it's beyond your field of view.
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čak i ako ga fizički ne vidite.
08:30
And this works for metastatic lymph nodes also.
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Ovo je korisno i u pronalaženju metastaza u limfnim čvorovima.
08:33
Sentinel lymph node dissection
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Odstranjenje „sentinel“ limfnog čvora,
08:35
has really changed the way that we manage breast cancer, melanoma.
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uistinu je promijenilo način na koji liječimo rak dojke, melanom.
08:39
Women used to get
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Žene se nekada podvrgavalo
08:41
really debilitating surgeries
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iscrpljujućim operativnim zahvatima
08:43
to excise all of the axillary lymph nodes.
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kako bi se odstranili svi aksilarni limfni čvorovi.
08:46
But when sentinel lymph node
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Ali kad se u terapijskom protokolu
08:49
came into our treatment protocol,
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pojavila metoda odstranjivana „sentinel“ limfnog čvora,
08:52
the surgeon basically looks for the single node
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omogućila je kirurgu da doslovno traži onaj limfni čvor
08:55
that is the first draining lymph node of the cancer.
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koji prvi prima tumorsku limfnu drenažu.
08:58
And then if that node has cancer,
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Ako taj limfni čvor sadrža tumorske stanice,
09:01
the woman would go on to get
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ženu bi se upućivalo na
09:03
the axillary lymph node dissection.
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odstranjenje aksilarnih limfnih čvorova.
09:05
So what that means
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Ono što ovaj postupak predstavlja
09:07
is if the lymph node did not have cancer,
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jest da ako taj limfni čvor nije sadržavao tumorske stanice,
09:10
the woman would be saved
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žena bi bila pošteđena
09:12
from having unnecessary surgery.
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nepotrebnih operacija.
09:14
But sentinel lymph node, the way that we do it today,
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Ali sa „sentinel“ limfnim čvorom, kako se to danas radi,
09:17
is kind of like having a road map
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to je kao da imate autokartu,
09:19
just to know where to go.
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ko vam govori samo kamo trebate ići.
09:21
So if you're driving on the freeway
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Pa ako vozite autocestom
09:23
and you want to know where's the next gas station,
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i želite znati gdje je iduća benzinska postaja,
09:25
you have a map to tell you that that gas station is down the road.
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imate kartu koja će vam reći da je ta benzinska postaja niže.
09:28
It doesn't tell you whether or not
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Neće vam reći
09:30
the gas station has gas.
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ima li na toj postaji goriva.
09:32
You have to cut it out, bring it back home,
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Vi to trebate odstraniti, odnijeti kući,
09:35
cut it up, look inside
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izrezati, pogledati unutra
09:37
and say, "Oh yes, it does have gas."
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i reći: "Aha, da, ima goriva.“
09:39
So that takes more time.
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A to traje dulje.
09:41
Patients are still on the operating room table.
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Pacijenti su tada još uvijek na operacijskom stolu.
09:43
Anesthesiologists, surgeons are waiting around.
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Anesteziolozi i kirurzi čekaju.
09:45
That takes time.
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To traje.
09:47
So with our technology, we can tell right away.
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S ovom tehnologijom odmah vidimo o čemu se radi.
09:50
You see a lot of little, roundish bumps there.
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Vidite mnogo malih okruglastih kvržica.
09:53
Some of these are swollen lymph nodes
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Neke su natečeni limfni čvorovi,
09:56
that look a little larger than others.
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i izgledaju nešto veće od ostalih.
09:58
Who amongst us hasn't had swollen lymph nodes with a cold?
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Tko od nas nije imao natečene limfne čvorove kad je bio prehlađen?
10:01
That doesn't mean that there's cancer inside.
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To ne znači da imate tumor.
10:03
Well with our technology,
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Ali, s našom tehnologijom,
10:05
the surgeon is able to tell immediately
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kirurg može odmah odrediti
10:08
which nodes have cancer.
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koji su limfni čvorovi zahvaćeni tumorom.
10:10
I won't go into this very much,
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Neću previše ulaziti u to,
10:12
but our technology, besides being able
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ali ova tehnologija, osim sposobnosti
10:14
to tag tumor and metastatic lymph nodes with fluorescence,
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obilježavanja tumora i metastaza metodama fluorescencije,
10:18
we can also use the same smart three-part molecule
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može koristiti te iste pametne trodijelne molekule
10:22
to tag gadolinium onto the system
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za označavanje gadolinija u sustavu,
10:25
so you can do this noninvasively.
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i to vam omogućava da odredite tumor neinvazivnim putem.
10:27
The patient has cancer,
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Kad pacijent ima rak,
10:29
you want to know if the lymph nodes have cancer
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vi želite znati jesu li limfni čvorovi zahvaćeni
10:31
even before you go in.
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i prije samog zahvata.
10:33
Well you can see this on an MRI.
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To možete vidjeti na MRI-u.
10:36
So in surgery,
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Dakle, u kirurgiji
10:38
it's important to know what to cut out.
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važno je znati što trebate izrezati.
10:41
But equally important
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No, jednako je važno
10:43
is to preserve things
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očuvati strukture
10:46
that are important for function.
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bitne za normalnu funkciju.
10:49
So it's very important to avoid inadvertent injury.
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Vrlo je bitno izbjeći nehotične ozljede.
10:52
And what I'm talking about
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Ono na što mislim
10:54
are nerves.
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jesu živci.
10:56
Nerves, if they are injured,
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Živci, ako su oštećeni,
10:58
can cause paralysis,
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mogu prouzrokovati paralizu
11:00
can cause pain.
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i bol.
11:03
In the setting of prostate cancer,
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Ovisno o položaju raka prostate,
11:05
up to 60 percent of men
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čak do 60% muškaraca
11:07
after prostate cancer surgery
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nakon operacije raka prostate
11:09
may have urinary incontinence
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može imati urinalnu inkontinenciju
11:11
and erectile disfunction.
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i erektilnu disfunkciju.
11:13
That's a lot of people to have a lot of problems --
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To je mnogo ljudi s mnogo problema --
11:16
and this is even in
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a to se događa
11:18
so-called nerve-sparing surgery,
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čak i tijekom operacija očuvanja živaca,
11:20
which means that the surgeon is aware of the problem,
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kad je kirurg svjestan problema,
11:24
and they are trying to avoid the nerves.
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i pokušava izbjeći oštećenje živaca.
11:26
But you know what, these little nerves are so small,
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Ali znate što, ti živci u kontekstu raka prostate
11:29
in the context of prostate cancer,
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toliko su mali
11:32
that they are actually never seen.
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da se praktički nikada ne mogu uočiti.
11:34
They are traced
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Njih se locira
11:36
just by their known anatomical path
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temeljem znanja o anatomiji živaca
11:38
along vasculature.
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i njihovom putu uz krvne žile.
11:40
And they're known because somebody has decided to study them,
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A to je poznato jer ih je netko odlučio proučavati,
11:44
which means that we're still learning
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što znači da još uvijek učimo
11:46
about where they are.
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gdje se oni nalaze.
11:48
Crazy to think that we're having surgery,
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Ludo je pomisliti da operiramo,
11:51
we're trying to excise cancer, we don't know where the cancer is.
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pokušavamo odstraniti tumor, a ne znamo gdje se on točno nalazi.
11:54
We're trying to preserve nerves; we can't see where they are.
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Pokušavamo očuvati živce; ne vidimo gdje su oni točno.
11:57
So I said, wouldn't it be great
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I tako sam ja rekla, ne bi li bilo sjajno
11:59
if we could find a way
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kad bismo mogli pronaći način
12:01
to see nerves with fluorescence?
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prikazivanja živaca uz pomoć fluorescencije?
12:04
And at first this didn't get a lot of support.
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I u početku nisam imala mnogo potpore.
12:08
People said, "We've been doing it this way for all these years.
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Ljudi su govorili: "Radimo na ovakav način već godinama.
12:10
What's the problem?
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U čemu je problem?
12:12
We haven't had that many complications."
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Nismo imali previše komplikacija.“
12:15
But I went ahead anyway.
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Ali ja sam svejedno nastavila.
12:17
And Roger helped me.
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A Roger mi je pomogao.
12:19
And he brought his whole team with him.
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I poveo je sa sobom cijeli svoj tim.
12:22
So there's that teamwork thing again.
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I tako, opet se tu pojavio onaj timski rad.
12:26
And we eventually discovered molecules
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Na kraju smo otkrili molekule
12:29
that were specifically labeling nerves.
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koje specifično obilježavaju živce.
12:31
And when we made a solution of this,
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Kad smo napravili otopinu tih molekula,
12:33
tagged with the fluorescence
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obilježenih fluorescentnim bojama,
12:35
and injected in the body of a mouse,
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i ubrzgali ih u tijelo miša,
12:38
their nerves literally glowed.
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njihovi živci doslovno su sjali.
12:40
You can see where they are.
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Možete vidjeti gdje se oni nalaze.
12:42
Here you're looking at a sciatic nerve of a mouse,
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Ovdje vidite ishijadični živac miša
12:46
and you can see that that big, fat portion you can see very easily.
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i taj veliki dio vrlo je lako uočiti.
12:49
But in fact, at the tip of that where I'm dissecting now,
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Ali zapravo, na vrhu gdje ja trenutno režem,
12:52
there's actually very fine arborizations
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nalaze se vrlo fini ogranci
12:55
that can't really be seen.
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koji se baš i ne mogu vidjeti.
12:57
You see what looks like little Medusa heads coming out.
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Vidite nešto što izgleda poput malih Meduzinih glava.
13:01
We have been able to see nerves
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Sada smo u mogućnosti vidjeti živce
13:03
for facial expression, for facial movement, for breathing --
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odgovorne za izraze lica, pokrete lica, disanje --
13:06
every single nerve --
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živce, sve do jednoga --
13:08
nerves for urinary function around the prostate.
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živce za mokraćnu funkciju koji se nalaze oko prostate.
13:11
We've been able to see every single nerve.
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U mogućnosti smo vidjeti doslovno svaki živac.
13:14
When we put these two probes together ...
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Kada stavimo ove dvije sonde zajedno…
13:18
So here's a tumor.
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Evo ga, tumor.
13:20
Do you guys know where the margins of this tumor is?
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Znate li gdje su rubovi ovog tumora?
13:23
Now you do.
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Sada znate.
13:26
What about the nerve that's going into this tumor?
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Što je sa živcem koji ulazi u tumor?
13:29
That white portion there is easy to see.
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Onaj bijeli ogranak lako je vidjeti.
13:31
But what about the part that goes into the tumor?
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Ali što s dijelom koji ulazi u tumor?
13:33
Do you know where it's going?
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Znate li gdje se on nalazi?
13:35
Now you do.
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Sada znate.
13:37
Basically, we've come up with a way
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Doslovno smo pronašli način
13:39
to stain tissue
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da obojimo tkivo
13:41
and color-code the surgical field.
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i bojama označimo kirurško polje.
13:43
This was a bit of a breakthrough.
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To je na neki način veliko otkriće.
13:46
I think that it'll change the way that we do surgery.
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Mislim da će ono promijeniti način na koji funkcionira kirurgija.
13:50
We published our results
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Objavili smo rezultate
13:52
in the proceedings of the National Academy of Sciences
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u radovima s Nacionalne akademije znanosti
13:54
and in Nature Biotechnology.
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i u časopisu "Nature Biotechnology".
13:56
We received commentary in Discover magazine,
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Komentirali su nas u časopisima "Discover"
13:59
in The Economist.
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i "The Economist".
14:01
And we showed it to a lot of my surgical colleagues.
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Pokazali smo to i mnogim mojim kolegama kirurzima.
14:04
They said, "Wow!
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Rekli su: "Wow!
14:06
I have patients
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Imam pacijente
14:08
who would benefit from this.
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kojima bi ovo pomoglo.
14:10
I think that this will result in my surgeries
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Mislim da će pomoću ovoga
14:12
with a better outcome
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moje operacije imati bolje ishode
14:14
and fewer complications."
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i manje komplikacija."
14:17
What needs to happen now
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Ono što se sada treba dogoditi,
14:19
is further development of our technology
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jest daljnje napredovanje naše tehnologije
14:22
along with development
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zajedno s napredovanjem
14:24
of the instrumentation
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instrumenata
14:26
that allows us to see
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koji nam omogućavaju da vidimo
14:28
this sort of fluorescence in the operating room.
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tu fluorescenciju u operacijskoj sali.
14:31
The eventual goal
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Krajnji cilj je
14:33
is that we'll get this into patients.
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primijeniti to na pacijentima.
14:36
However, we've discovered
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No, otkrili smo
14:39
that there's actually no straightforward mechanism
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da zapravo ne postoji izravan mehanizam
14:41
to develop a molecule
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za razvitak molekule
14:43
for one-time use.
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za jednokratnu upotrebu.
14:45
Understandably, the majority of the medical industry
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Razumljivo, većina medicinske industrije
14:48
is focused on multiple-use drugs,
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usredotočena je na lijekove za višestruko korištenje,
14:52
such as long-term daily medications.
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poput dugoročnih, svakodnevnih lijekova.
14:55
We are focused on making this technology better.
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Mi smo usredotočeni na poboljšanje ove tehnologije.
14:58
We're focused on adding drugs,
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Usmjereni smo na dodavanje lijekova,
15:01
adding growth factors,
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čimbenika rasta,
15:03
killing nerves that are causing problems
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uništavanje živaca koji kompliciraju situaciju,
15:05
and not the surrounding tissue.
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a ne okolno tkivo.
15:08
We know that this can be done and we're committed to doing it.
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Znamo da se to može postići i posvećeni smo tom cilju.
15:12
I'd like to leave you with this final thought.
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Htjela bih završiti s ovom posljednjom mišlju.
15:16
Successful innovation
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Uspješne inovacije
15:18
is not a single breakthrough.
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nisu pojedinačna otkrića.
15:21
It is not a sprint.
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Nisu utrka.
15:24
It is not an event for the solo runner.
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Nisu događaji za solo trkače.
15:28
Successful innovation
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Uspješne inovacije
15:30
is a team sport, it's a relay race.
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timski su sport, štafeta.
15:33
It requires one team for the breakthrough
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One zahtijevaju jedan tim koji će omogućiti veliko otkriće
15:37
and another team
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i drugi tim
15:39
to get the breakthrough accepted and adopted.
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koji će omogućiti prihvaćanje i usvajanje tog otkrića.
15:41
And this takes the long-term steady courage
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A to zahtjeva dugoročnu, čvrstu hrabrost
15:44
of the day-in day-out struggle
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koja će se dan za danom boriti
15:46
to educate, to persuade
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da educiraju, da uvjere
15:49
and to win acceptance.
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i da dobiju pristanak.
15:52
And that is the light that I want to shine
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I upravo to je svjetlost kojom želim osvijetliti
15:54
on health and medicine today.
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zdravlje i današnju medicinu.
15:56
Thank you very much.
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Hvala vam.
15:58
(Applause)
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(Pljesak)
ABOUT THE SPEAKER
Quyen Nguyen - SurgeonQuyen Nguyen uses molecular probes that make tumors -- and just the tumors -- glow, as an extraordinary aid to surgeons.
Why you should listen
Dr. Quyen Nguyen’s research (working with Roger Tsien, Nobel Laureate in Chemistry) is focused on the development of fluorescently labeled probes for molecular navigation during surgery. Their first collaborative effort yielded a “smart” probe that makes tumors margins fluoresce, or “glow” and thus easier for surgeons to see and remove accurately during surgery. Their most recent joint effort resulted in another type of probe that can make nerves “glow” during surgery, thus helping surgeons repair injured nerves and avoid inadvertent injury.
She is a professor of surgery and director of the Facial Nerve Clinic at the University of California, San Diego.
Quyen Nguyen | Speaker | TED.com