TED2009
Catherine Mohr: Surgery's past, present and robotic future
Catherine Mohr: Prošlost, sadašnjost i robotska budućnost operacije
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Kirurginja i inventorica Catherine Mohr putuje kroz povijest operacije (i njene povijesti prije lijekova protiv bolova i antiseptika), onda demonstrira neke od najnovijih oruđa za operaciju kroz sićušne rezove, obavljene koristeći korisne robotske ruke. Fascinantno -- ali ne za gadljivce.
Catherine Mohr - Roboticist
Catherine Mohr loves what she does -- she's just not ever sure what it will be next. Full bio
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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Govor o operacijskim robotima
00:21
is also a talk about surgery.
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je također govor o operaciji.
00:24
And while I've tried to make my images not too graphic,
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I dok sam pokušala svoje slike učiniti manje slikovitima,
00:28
keep in mind that surgeons have a different relationship with blood
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nemojte zaboraviti da kirurzi imaju drugačiji odnos prema krvi
00:31
than normal people do,
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nego što ga imaju normalni ljudi.
00:33
because, after all, what a surgeon does to a patient,
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Jer nakon svega, što kirurg učini pacijentu,
00:37
if it were done without consent,
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ako je učinjeno bez pristanka,
00:39
would be a felony.
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postaje kazneno djelo.
00:42
Surgeons are the tailors, the plumbers,
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Kiruzi su krojači, vodoinstalateri,
00:46
the carpenters -- some would say the butchers --
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stolari, neki bi rekli koljači
00:48
of the medical world:
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medicinskog svijeta.
00:50
cutting, reshaping, reforming,
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Rezanje, preoblikovanje, reformacija,
00:53
bypassing, fixing.
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zaobilazak, popravljanje.
00:56
But you need to talk about surgical instruments
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Ali trebate razgovarati o kirurškim instrumentima
01:00
and the evolution of surgical technology together.
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i evoluciji kirurške tehnologije zajedno.
01:04
So in order to give you some kind of a perspective
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Dakle da bih vam dala neku vrstu perspektive
01:07
of where we are right now
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o tome gdje smo dospjeli do sada
01:09
with surgical robots,
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s kirurškim robotima,
01:11
and where we're going to be going in the future,
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i gdje idemo da bismo napredovali u budućnosti,
01:13
I want to give you a little bit of perspective
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želim vam dati malen dio perspektive
01:15
of how we got to this point,
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o tome kako smo došli do ove točke.
01:17
how we even came to believe
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Kako smo uopće povjerovali
01:20
that surgery was OK,
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da je operacija OK,
01:22
that this was something that was possible to do,
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da je ovo nešto što možemo ostvariti,
01:24
that this kind of cutting and reforming was OK.
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da je ova vrsta rezanja i reformacije OK.
01:29
So, a little bit of perspective --
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Dakle, malen dio perspektive --
01:31
about 10,000 years of perspective.
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oko 10.000 godina perspektive.
01:34
This is a trephinated skull.
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Ovo je izbušena lubanja.
01:37
And trephination is simply just cutting a hole in the skull.
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I trepanacija je jednostavno bušenje rupe u lubanji.
01:41
And many, many hundreds of skulls like this
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I puno, puno tisuća lubanja poput ove
01:43
have been found in archaeological sites
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su nađene na arheološkim nalazištima
01:46
all over the world,
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diljem svijeta,
01:48
dating back five to 10 thousand years.
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datirajući unatrag pet do deset tisuća godina.
01:52
Five to 10 thousand years! Now imagine this.
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Pet do deset tisuća godina! Sada zamislite ovo.
01:56
You are a healer in a Stone Age village.
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Iscjelitelj ste u selu u vrijeme kamenog doba.
01:59
And you have some guy that you're not quite sure what's wrong with him --
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I imate nekog tipa za kojeg ne znate sa sigurnošću što mu je
02:02
Oliver Sacks is going to be born way in the future.
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(Oliver Sacks biti će rođen daleko u budućnosti).
02:05
He's got some seizure disorder. And you don't understand this.
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On ima neki poremećaj napadaja. I vi to ne razumijete.
02:08
But you think to yourself,
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Ali si mislite,
02:10
"I'm not quite sure what's wrong with this guy.
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"Nisam baš siguran što je ovom tipu.
02:12
But maybe if I cut a hole in his head I can fix it."
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Ali možda ukoliko mu napravim rupu u glavi moći ću ga popraviti".
02:15
(Laughter)
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(Smijeh)
02:16
Now that is surgical thinking.
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To je dakle kirurško razmišljanje.
02:18
Now we've got the dawn of interventional surgery here.
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Sada imamo zoru intervencijske operacije ovdje.
02:22
What is astonishing about this is,
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Ono što je zaprepašćujuće o ovome je
02:24
even though we don't know really how much of this
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to što iako ne znamo uistinu koliko ovoga
02:28
was intended to be religious,
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je bilo namijenjeno religioznosti,
02:31
or how much of it was intended to be therapeutic,
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ili koliko ovoga je bilo namijenjeno u terapeutske svrhe,
02:34
what we can tell is that these patients lived!
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no ono što možemo reći je da su ovi pacijenti živjeli!
02:37
Judging by the healing on the borders of these holes,
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Sudeći po zacjeljenju na granicama ovih rupa,
02:39
they lived days, months, years following trephination.
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živjeli su danima, mjesecima, godinama poslije trepanacije.
02:44
And so what we are seeing is evidence
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I sada što gledamo je dokaz
02:47
of a refined technique
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rafinirane tehnike,
02:49
that was being handed down over thousands and thousands of years,
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koja je bila u predaji preko tisuću i tisuću godina,
02:52
all over the world.
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diljem svijeta.
02:54
This arose independently at sites everywhere
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Ovo je nađeno samostalno na nalazištima svugdje,
02:56
that had no communication to one another.
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gdje nisu imali komunikaciju međusobno.
02:59
We really are seeing the dawn of interventional surgery.
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Uistinu vidimo zoru intervencijske kirurgije.
03:03
Now we can fast forward many thousands of years
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Sada možemo ubrzati naprijed nekoliko tisuća godina
03:06
into the Bronze Age and beyond.
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u brončano doba i poslije.
03:08
And we see new refined tools coming out.
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I sada vidimo novo rafinirano oruđe koje izlazi.
03:11
But surgeons in these eras are a little bit more conservative
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Ali kirurzi u ovim erama su malo više konzervativni
03:14
than their bold, trephinating ancestors.
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od svojih hrabrih, trepanacijskih predaka.
03:17
These guys confined their surgery
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Ovi su ljudi ograničili svoju kirurgiju
03:19
to fairly superficial injuries.
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na relativno površinske ozljede.
03:21
And surgeons were tradesmen,
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I kirurzi su bili trgovci,
03:23
rather than physicians.
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prije nego doktori.
03:26
This persisted all the way into and through the Renaissance.
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Ovo je bio trend sve do i tokom renesanse.
03:30
That may have saved the writers,
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To je možda spasilo pisce.
03:32
but it didn't really save the surgeons terribly much.
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Ali nije stvarno spasilo kirurge previše.
03:35
They were still a mistrusted lot.
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Još uvijek im se nije vjerovalo previše.
03:38
Surgeons still had a bit of a PR problem,
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Kirurzi su i dalje imali problem s odnosima s javnošću.
03:41
because the landscape was dominated
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Jer je pejzaž bio dominiran
03:43
by the itinerant barber surgeon.
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putujućim kirurgom brijačem.
03:45
These were folks that traveled from village to village, town to town,
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To su bili ljudi koji su putovali od sela do sela, grada do grada,
03:49
doing surgery sort of as a form of performance art.
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radeći operacije kao da su vrsta izvedbene umjetnosti.
03:53
Because we were in the age before anesthesia,
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Jer smo bili u dobu prije anestezije,
03:55
the agony of the patient
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agonija pacijenta,
03:57
is really as much of the public spectacle
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je ustvari toliki javni spektakl
03:59
as the surgery itself.
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kao i sama operacija.
04:02
One of the most famous of these guys, Frere Jacques,
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Jedan od najslavnijih od ovih ljudi, fratar Jacques,
04:05
shown here doing a lithotomy --
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prikazan ovdje kako obavlja litotomiju,
04:08
which is the removal of the bladder stone,
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što znači odstranjenje mokraćnog kamenca,
04:10
one of the most invasive surgeries they did at the time --
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jedne od najinvazivnijih operacija koje su tada radili,
04:12
had to take less than two minutes.
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je morala biti obavljena za manje od dvije minute.
04:15
You had to have quite a flair for the dramatic,
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Morali ste imati dosta osjećaja za dramatiku,
04:17
and be really, really quick.
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i biti vrlo, vrlo brzi.
04:19
And so here you see him doing a lithotomy.
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I ovdje ga vidite kako obavlja litotomiju.
04:22
And he is credited with doing over 4,000 of these public surgeries,
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Zaslužan je za preko 4.000 ovakvih javnih operacija,
04:26
wandering around in Europe,
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lutajući po Europi.
04:28
which is an astonishing number,
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To je zapanjujući broj,
04:30
when you think that surgery must have been a last resort.
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kada pomislite da je operacija bila zadnje rješenje.
04:34
I mean who would put themselves through that?
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Mislim, tko bi htio proći kroz to?
04:37
Until anesthesia, the absence of sensation.
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Dok nije došla anestezija, izostanak osjetila.
04:43
With the demonstration of the Morton Ether Inhaler
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S demonstracijom Mortonovog eter inhalatora
04:46
at the Mass. General in 1847,
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u Massachusetts bolnici 1847. godine,
04:49
a whole new era of surgery was ushered in.
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uvedena je potpuno nova era operacije.
04:52
Anesthesia gave surgeons the freedom to operate.
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Anestezija je dala kirurzima slobodu operacije.
04:56
Anesthesia gave them the freedom to experiment,
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Anestezija im je dala slobodu eksperimentiranja,
04:58
to start to delve deeper into the body.
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da započnu zaroniti dublje u tijelo.
05:02
This was truly a revolution in surgery.
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Ovo je usitinu bila revolucija u kirurgiji.
05:06
But there was a pretty big problem with this.
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Ali postojao je dosta veliki problem s time.
05:08
After these very long, painstaking operations,
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Poslije ovih vrlo dugih, iscrpljujućih operacija,
05:11
attempting to cure things they'd never been able to touch before,
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pokušavajući izliječiti stvari koje nikad prije nisu mogli dodirnuti,
05:15
the patients died.
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pacijenti bi umrli.
05:19
They died of massive infection.
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Umrli su od masivnih infekcija.
05:23
Surgery didn't hurt anymore,
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Kirurgija nije nikog ozlijedila,
05:25
but it killed you pretty quickly.
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ali vas je brzo ubila.
05:27
And infection would continue to claim a majority of surgical patients
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I infekcija bi nastavila uzimati danak kod većine kirurških pacijenata
05:32
until the next big revolution in surgery,
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sve do sljedeće velike revolucije u kirurgiji.
05:35
which was aseptic technique.
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To je bila aseptička tehnika.
05:38
Joseph Lister was aepsis's,
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Joseph Lister je bio aseptički,
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or sterility's, biggest advocate,
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ili sterilitetni zagovornik,
05:44
to a very very skeptical bunch of surgeons.
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naspram mnogo, mnogo skeptičnih kirurga.
05:47
But eventually they did come around.
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Ali u dogledno vrijeme su se predomislili.
05:49
The Mayo brothers came out to visit Lister in Europe.
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Mayo braća su otišla vidjeti Listera u Europu.
05:53
And they came back to their American clinic and they said
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I vratila su se svojoj američkoj klinici da kažu
05:55
they had learned it was as important to wash your hands
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kako su naučili važnost pranja ruku
05:58
before doing surgery
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prije operacije.
06:00
as it was to wash up afterwards. (Laughter)
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Kako su inače prali ruke poslije operacije.
06:03
Something so simple.
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Nešto toliko jednostavno.
06:05
And yet, operative mortality dropped profoundly.
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Operacijski mortalitet je značajno opao.
06:09
These surgeries were actually now being effective.
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Ove operacije su sada bile efikasne.
06:12
With the patient insensitive to pain,
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S pacijentom koji nije osjećao bol,
06:16
and a sterile operating field
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i sterilnim operacijskim područjem
06:19
all bets were off, the sky was the limit.
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sve oklade su bile skinute, nebesa su bila granica.
06:23
You could now start doing surgery everywhere,
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Sada ste mogli započeti operaciju svugdje,
06:28
on the gut, on the liver,
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na crijevu, na jetri,
06:31
on the heart, on the brain.
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na srcu, na mozgu.
06:33
Transplantation: you could take an organ out of one person,
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Transplantacija: mogli ste izvaditi organ iz jedne osobe,
06:35
you could put it in another person, and it would work.
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mogli ste ga staviti u drugu osobu, i to bi upalilo.
06:38
Surgeons didn't have a problem with respectability anymore;
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Kirurzi više nisu imali problema s poštovanjem.
06:41
they had become gods.
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Postali su bogovi.
06:44
The era of the "big surgeon, big incision" had arrived,
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Era "velikog kirurga, velikog reza" je došla.
06:49
but at quite a cost,
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Ali s velikom cijenom.
06:52
because they are saving lives,
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Jer su spašavali živote,
06:54
but not necessarily quality of life,
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ali ne i nužno kvalitetu života.
06:58
because healthy people don't usually need surgery,
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Jer zdravi ljudi uobičajeno ne trebaju kirurgiju.
07:01
and unhealthy people have a very hard time recovering from a cut like that.
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A nezdravi ljudi imaju vrlo teško vrijeme oporavka od takvog zahvata.
07:06
The question had to be asked,
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Pitanje je moralo biti postavljeno,
07:08
"Well, can we do these same surgeries
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"Dakle, da li možemo napraviti iste operacije
07:11
but through little incisions?"
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ali kroz male rezove?"
07:15
Laparoscopy is doing this kind of surgery:
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Laparoskopija radi takvu vrstu operacije.
07:18
surgery with long instruments through small incisions.
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Kirurgija s dugim instrumentima, kroz male rezove.
07:21
And it really changed the landscape of surgery.
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I stvarno je promijenila pejzaž kirurgije.
07:25
Some of the tools for this had been around for a hundred years,
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Neka od oruđa za ovo su bila prisutna preko stotinu godina.
07:29
but it had only been used as a diagnostic technique
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Ali je korištena kao dijagnostička tehnika
07:31
until the 1980s,
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do osamdesetih,
07:33
when there was changes in camera technologies and things like that,
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s promjenama u tehnologiji kamere i stvarima poput ove,
07:36
that allowed this to be done for real operations.
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koje su dopustile da se ovo radi za prave operacije.
07:41
So what you see -- this is now the first surgical image --
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Dakle ono što vidite -- to je sada prva kirurška slika --
07:43
as we're coming down the tube, this is a new entry into the body.
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kako se spuštamo niz cijev, ovo je novi ulaz u tijelo.
07:47
It looks very different from what you're expecting surgery to look like.
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Izgleda vrlo drugačije od onoga što očekujete kako bi operacija trebala izgledati.
07:50
We bring instruments in,
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Uvodimo instrumente,
07:52
from two separate cuts in the side,
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iz dva različita reza sa strane,
07:54
and then you can start manipulating tissue.
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i onda možete početi manipulirati tkivo.
07:58
Within 10 years of the first gallbladder surgeries
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Unutar deset godina prvih operacija žučnog mjehura,
08:01
being done laparoscopically,
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rađenih laparoskopski,
08:04
a majority of gallbladder surgeries
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većina operacija žučnog mjehura
08:06
were being done laparoscopically --
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su bile rađene laparoskopski.
08:09
truly a pretty big revolution.
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Uistinu, dosta velika revolucija.
08:14
But there were casualties of this revolution.
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Ali bilo je žrtava ove revolucije.
08:18
These techniques were a lot harder to learn
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Te tehnike su bile puno teže za naučiti
08:20
than people had anticipated.
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nego što su to ljudi predvidjeli.
08:22
The learning curve was very long.
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Podučavateljska krivulja je bila vrlo duga.
08:24
And during that learning curve the complications went quite a bit higher.
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Tokom te podučavateljske krivulje, komplikacije su bile puno češće.
08:28
Surgeons had to give up their 3D vision.
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Kirurzi su morali dići ruke od svog trodimenzionalnog vida.
08:30
They had to give up their wrists.
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Morali su se odreći svojih zglobova.
08:32
They had to give up intuitive motion in the instruments.
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Morali su se odreći intuicijskog pokreta instrumenata.
08:37
This surgeon has over 3,000 hours of laparoscopic experience.
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Ovaj kirurg ima preko 3.000 sati laparoskopskog iskustva.
08:43
Now this is a particularly frustrating placement of the needle.
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To je sada podosta frustrirajući položaj igle.
08:48
But this is hard.
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Ali to je teško.
08:50
And one of the reasons why it is so hard
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I jedan od razloga zašto je tako teško
08:53
is because the external ergonomics are terrible.
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je zato što je vanjska ergonomija užasna.
08:57
You've got these long instruments, and you're working off your centerline.
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Imate te duge instrumente i radite na centralnoj liniji.
09:01
And the instruments are essentially working backwards.
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I ti insturmenti u principu rade unatrag.
09:06
So what you need to do, to take the capability of your hand,
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Dakle, ono što morate napraviti, da biste iskoristili upotrebljivost svoje ruke,
09:09
and put it on the other side of that small incision,
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i staviti je na drugu stranu malenog reza,
09:12
is you need to put a wrist on that instrument.
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je trebate staviti zglob na taj instrument.
09:17
And so -- I get to talk about robots --
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I tako -- Imam priliku govoriti o robotima --
09:19
the da Vinci robot
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da Vinci robot
09:21
put just that wrist on the other side of that incision.
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stavlja samo taj zglob na drugu stranu tog reza.
09:25
And so here you're seeing the operation of this wrist.
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I sada ovdje vidite operaciju tog zgloba.
09:28
And now, in contrast to the laparoscopy,
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I sada, u kontrastu naspram laparoskopije,
09:31
you can precisely place the needle in your instruments,
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možete precizno položiti iglu u svoje instrumente,
09:34
and you can pass it all the way through
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i možete je provesti skroz
09:37
and follow it in a trajectory.
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i slijediti je na putanji.
09:39
And the reason why this becomes so much easier
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Razlog zašto je ovo postalo toliko lakše
09:41
is -- you can see on the bottom --
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je, možete vidjeti na dnu,
09:44
the hands are making the motions,
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da ruke rade pokrete,
09:47
and the instruments are following those motions exactly.
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i instrumenti slijede te pokrete dosljedno.
09:51
Now, what you put between those instruments and those hands,
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Sada, što možete staviti između tih instrumenata i tih ruka,
09:55
is a large, fairly complicated robot.
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je velik, relativno kompliciran robot.
09:57
The surgeon is sitting at a console,
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Kirurg sjedi pri konzoli,
09:59
and controlling the robot with these controllers.
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i kontrolira robota s ovim kontrolama.
10:03
And the robot is moving these instruments around,
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Robot pomiče ove instrumente okolo,
10:06
and powering them, down inside the body.
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i pokreće ih, dolje unutar tijela.
10:09
You have a 3D camera, so you get a 3D view.
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Imate trodimenzionalnu kameru, tako da imate trodimenzionalan prikaz.
10:12
And since this was introduced in 1999,
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I budući da je ovo bilo uvedeno 1999.
10:16
a lot of these robots have been out
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većina ovih robota su izašli
10:18
and being used for surgical procedures like a prostatectomy,
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upotrebljavani za operacijske procedure poput uklanjanja prostate.
10:22
which is a prostate deep in the pelvis,
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To je, prostata duboko u zdjelici,
10:25
and it requires fine dissection
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i potreban je fin rez
10:27
and delicate manipulation
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i delikatna manipulacija
10:29
to be able to get a good surgical outcome.
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da bi se postignuo dobar kirurški rezultat.
10:32
You can also sew bypass vessels directly onto a beating heart
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Možete također zašiti premosne krvne žile na kucajuće srce
10:37
without cracking the chest.
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bez lomljenja prsnog koša.
10:40
This is all done in between the ribs.
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Ovo se sve radi između rebara.
10:42
And you can go inside the heart itself
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I možete doprijeti do unutrašnjosti samog srca
10:45
and repair the valves from the inside.
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i popraviti zaliske iznutra.
10:49
You've got these technologies -- thank you --
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Imate ove tehnologije -- hvala vam --
10:52
(Applause)
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(Pljesak)
10:55
And so you might say, "Wow this is really cool!
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Možete reći, "Opa, ovo je stvarno kul!
10:57
So, smartypants, why isn't all surgery being done this way?"
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Dakle, pametnjakoviću, zašto nije sva kirurgija rađena na ovaj način?"
11:00
And there are some reasons, some good reasons.
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Postoje dobri razlozi za to, neki dobro razlozi.
11:03
And cost is one of them.
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I trošak je jedan od njih.
11:05
I talked about the large, complicated robot.
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Govorila sam o velikom, kompliciranom robotu.
11:07
With all its bells and whistles, one of those robots
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Sa svim zvonima i zvižducima, jedan od tih robota
11:10
will cost you about as much as a solid gold surgeon.
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će vam koštati otprilike koliko i kirurg od čistog zlata.
11:13
More useful than a solid gold surgeon,
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Korisniji od kirurga od čistog zlata,
11:15
but, still, it's a fairly big capital investment.
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ali, ipak, to je dosta velika kapitalna investicija.
11:19
But once you've got it, your procedure costs do come down.
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Ali jednom kad je imate, proceduralni troškovi se smanje.
11:25
But there are other barriers.
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Ali postoje druge zapreke.
11:27
So something like a prostatectomy --
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Dakle nešto poput vađenja prostate,
11:30
the prostate is small, and it's in one spot,
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prostata je mala, i nalazi se na jednom mjestu.
11:32
and you can set your robot up very precisely
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I možete postaviti svog robota vrlo precizno
11:35
to work in that one spot.
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da radi na tom jednom mjestu.
11:37
And so it's perfect for something like that.
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To je dakle savršeno za nešto takvo.
11:39
And in fact if you, or anyone you know,
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Ustvari, ukoliko vi, ili netko koga poznate,
11:41
had their prostate taken out in the last couple of years,
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je imao svoju prostatu izvađenu u zadnjih nekoliko godina,
11:43
chances are it was done with one of these systems.
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šanse su da je rađeno s jednim od ovih sistema.
11:47
But if you need to reach more places than just one,
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No ako trebate dohvatiti više mjesta od samo jednog,
11:51
you need to move the robot.
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morate pomaknuti robota.
11:53
And you need to put some new incisions in there.
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I morate napraviti više rezova tamo.
11:55
And you need to re-set it up.
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I morate ga resetirati.
11:58
And then you need to add some more ports, and more.
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I morate dodati više ulaza.
12:02
And the problem is it gets time-consuming, and cumbersome.
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Problematika ovog je konzumacija vremena i težina.
12:05
And for that reason there are many surgeries
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Zbog toga, postoje mnoge operacje
12:07
that just aren't being done with the da Vinci.
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koje nisu napravljene uz pomoć da Vincija.
12:11
So we had to ask the question, "Well how do we fix that?"
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Dakle morali smo postaviti pitanje, "Kako da to popravimo?"
12:16
What if we could change it so that we didn't have to re-set up
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Što kada bi to mogli promijeniti tako da ga ne moramo resetirati
12:20
each time we wanted to move somewhere different?
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svaki put kada ga želimo pomaknuti negdje drugdje?
12:22
What if we could bring all the instruments
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Što kada bismo mogli donijeti sve instrumente
12:24
in together in one place?
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zajedno na jedno mjesto?
12:26
How would that change the capabilities of the surgeon?
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Kako bi to promijenilo sposobnosti kirurga?
12:30
And how would that change the experience for the patient?
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I kako bi to promijenilo pacijentovo iskustvo?
12:34
Now, to do that,
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Sada, da bismo to napravili,
12:36
we need to be able to bring a camera
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moramo biti sposobni uvesti kameru,
12:39
and instruments in together through one small tube,
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i instrumente, zajedno kroz jednu malu cijev,
12:43
like that tube you saw in the laparoscopy video.
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poput one cijevi koju ste vidjeli u videu o laparoskopiji.
12:46
Or, not so coincidentally, like a tube like this.
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Ili, ne tako slučajno, poput ovakve cijevi.
12:52
So what's going to come out of that tube
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Dakle ono što će izaći iz takve cijevi
12:54
is the debut of this new technology,
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je izlazak ove nove tehnologije,
12:57
this new robot that is going to be able to reach anywhere.
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ovaj novi robot koji će biti sposoban svugdje doprijeti.
13:02
Ready? So here it comes.
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Spremni? Evo ga.
13:06
This is the camera, and three instruments.
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Ovo je kamera, i tri instrumenta.
13:09
And as you see it come out,
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I dok ga gledate kako izlazi,
13:11
in order to actually be able to do anything useful,
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da biste stvarno bili sposobni učiniti nešto korisno,
13:13
it can't all stay clustered up like this.
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ne može sve ostati zbijeno ovako.
13:16
It has to be able to come off of the centerline
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Mora biti sposobno otići izvan centralne linije
13:19
and then be able to work back toward that centerline.
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i onda biti sposobno raditi natrag prema centralnoj liniji.
13:23
He's a cheeky little devil.
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On je bezobrazan mali vrag.
13:26
But what this lets you do
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Ali ono što vam ovo dopušta
13:28
is gives you that all-important traction,
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je najbitnije vučenje,
13:30
and counter-traction,
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i povlačenje,
13:32
so that you can dissect, so that you can sew,
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da biste mogli zarezati, da biste mogli šivati,
13:34
so that you can do all the things that you need to do,
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da biste mogli sve ono što trebate napraviti,
13:36
all the surgical tasks.
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sve kirurške obveze.
13:38
But it's all coming in through one incision.
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Ali sve to dolazi kroz jedan rez.
13:42
It's not so simple.
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Nije to tako jednostavno.
13:45
But it's worth it for the freedom that this gives us
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Ali je isplativo zbog slobode koju nam daje
13:48
as we're going around.
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dok idemo okolo.
13:50
For the patient, however,
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Za pacijenta, doduše,
13:54
it's transparent. This is all they're going to see.
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je transparentno. Ovo je sve što će vidjeti.
14:00
It's very exciting to think where we get to go with this.
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Vrlo je uzbudljivo razmišljati gdje možemo dospijeti s ovime.
14:04
We get to write the script of the next revolution in surgery.
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Možemo pisati scenarij sljedeće revolucije u kirurgiji.
14:09
As we take these capabilities, and we get to go to the next places,
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Dok razmatramo ove sposobnosti, i dospijevamo na sljedeća mjesta,
14:13
we get to decide what our new surgeries are going to be.
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odlučujemo koje će biti naše nove operacije.
14:17
And I think to really get the rest of the way
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Mislim da dospijeti do kraja ovog puta
14:19
in that revolution,
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u toj revoluciji,
14:21
we need to not just take our hands in in new ways,
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moramo ne samo iskoristiti naše ruke na nove načine,
14:24
we also need to take our eyes in in new ways.
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moramo također iskoristiti naše oči na nove načine.
14:28
We need to see beyond the surface.
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Moramo vidjeti ispod površine.
14:30
We need to be able to guide what we're cutting
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Morami biti sposobni voditi ono što režemo
14:33
in a much better way.
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na puno bolji način.
14:38
This is a cancer surgery.
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Ovo je operacija raka.
14:40
One of the problems with this,
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Jedan od problema s ovime,
14:42
even for surgeons who've been looking at this a lot,
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čak i za kirurge koji su ovo razmatrali puno,
14:44
is you can't see the cancer,
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je da ne možete vidjeti rak,
14:47
especially when it's hidden below the surface.
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posebice kada je skriven ispod površine.
14:50
And so what we're starting to do
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Stoga ono što smo započeli raditi
14:52
is we're starting to inject specially designed markers
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je ubacivanje posebno dizajniranih markera
14:56
into the bloodstream that will target the cancer.
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u krvotok koji će označiti rak.
14:59
It will go, bind to the cancer.
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Otići će se spojiti s rakom.
15:02
And we can make those markers glow.
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I možemo te markere osvijetliti.
15:05
And we can take special cameras,
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I možemo uzeti specijalne kamere,
15:07
and we can look at it.
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i gledati na to.
15:10
Now we know where we need to cut,
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Sada znamo gdje trebamo rezati,
15:12
even when it's below the surface.
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čak i kada je ispod površine.
15:15
We can take these markers and we can inject them in a tumor site.
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Možemo uzeti te markere i ubaciti ih na područje tumora.
15:19
And we can follow where they flow out from that tumor site,
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Možemo slijediti gdje istječu od položaja tumora,
15:23
so we can see the first places where that cancer might travel.
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stoga možemo vidjeti prva mjesta gdje je tumor dospio.
15:29
We can inject these dyes into the bloodstream,
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Možemo ubaciti ove boje u krvotok,
15:32
so that when we do a new vessel
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tako da kada zašijemo novi zalistak
15:35
and we bypass a blockage on the heart,
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i zaobiđemo blokadu na srcu,
15:37
we can see if we actually made the connection,
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možemo vidjeti da li smo stvarno napravili spoj,
15:40
before we close that patient back up again --
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prije nego što zatvorimo pacijenta ponovno.
15:43
something that we haven't been able to do
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Nešto što nismo mogli napraviti,
15:45
without radiation before.
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bez radijacije, prije.
15:48
We can light up tumors
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Možemo osvijetliti tumore
15:51
like this kidney tumor,
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poput ovog bubrežnog tumora
15:53
so that you can exactly see where the boundary is
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da bi točno vidjeli gdje je granica
15:56
between the kidney tumor and the kidney you want to leave behind,
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između bubrežnog tumora, i bubrega kojeg želite ostaviti na mjestu.
16:00
or the liver tumor and the liver you want to leave behind.
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Ili tumor jetre, i jetra je ono što želite ostaviti na mjestu.
16:04
And we don't even need to confine ourselves
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I ne trebamo čak ni ograničiti sebe
16:07
to this macro vision.
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na ovaj makro vid.
16:10
We have flexible microscopic probes
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Imamo fleksibilne mikroskopske sonde
16:12
that we can bring down into the body.
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koje možemo spustiti u tijelo.
16:15
And we can look at cells directly.
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I možemo gledati stanice direktno.
16:18
I'm looking at nerves here. So these are nerves you see, down on the bottom,
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Ovdje gledam na živce. Ove živce koje vidite, dolje na dnu,
16:21
and the microscope probe that's being held by the robotic hand, up at the top.
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i mikroskopska sonda koju drži robotska ruka, gore na vrhu.
16:25
So this is all very prototypey at this point.
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Sve je ovo vrlo prototipizirano na dosadnjašnoj razini.
16:28
But you care about nerves, if you are a surgical patient.
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Ali stalo vam je do živaca, ako ste kirurški pacijent.
16:31
Because they let you keep continence,
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Jer oni vam dopuštaju zadržati
16:34
bladder control, and sexual function after surgery,
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kontrolu nad mjehurom, i seksualnom funkcijom poslije operacije.
16:38
all of which is generally fairly important to the patient.
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Sve što je generalno dosta važno pacijentu.
16:44
So, with the combination of these technologies
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Dakle, s kombinacijom ovih tehnologija
16:48
we can reach it all, and we can see it all.
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možemo doprijeti do svega, vidjeti sve.
16:52
We can heal the disease.
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Možemo izliječiti bolesti.
16:55
And we can leave the patient whole and intact
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I možemo ostaviti pacijenta cijelog i netaknutog
16:59
and functional afterwards.
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i funkcionalnog naposljetku.
17:03
Now, I've talked about the patient
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Sada, govorila sam o pacijentu
17:05
as if the patient is, somehow, someone abstract
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kao da je pacijent, nekako, netko abstraktan
17:08
outside this room.
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izvan sobe.
17:10
And that is not the case.
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No to nije slučaj.
17:13
Many of you, all of you maybe,
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Mnogi od vas, možda svi,
17:16
will at some point, or have already, faced a diagnosis of cancer,
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će u jednom trenutku, ili već jesu, biti suočeni s dijagnozom raka,
17:19
or heart disease, or some organ dysfunction
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ili bolesti srca, ili druge disfunkcije organa
17:22
that's going to buy you a date with a surgeon.
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koja će vam kupiti sastanak s kirurgom.
17:25
And when you get to that point --
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I kad dođete do tog trena --
17:29
I mean, these maladies don't care
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mislim, te bolesti ne mare
17:32
how many books you've written,
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koliko ste knjiga napisali,
17:35
how many companies you've started,
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koliko kompanija stvorili,
17:37
that Nobel Prize you have yet to win,
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tu Nobelovu nagradu koju tek imate dobiti,
17:39
how much time you planned to spend with your children.
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koliko vremena ste planirali provesti sa svojom djecom.
17:43
These maladies come for us all.
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Te bolesti dolaze svima nama.
17:46
And the prospect I'm offering you, of an easier surgery ...
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Budućnost koju vam nudim, jednostavnije operacije ...
17:48
is that going to make that diagnosis any less terrifying?
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da li će to učiniti tu dijagnozu manje stravičnom?
17:53
I'm not sure I really even want it to.
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Nisam ni sigurna da li želim da to učini.
17:57
Because facing your own mortality
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Jer suočeni s vlastitom smrtnošću
18:00
causes a re-evaluation of priorities,
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uzrokuje ponovnu procjenu prioriteta,
18:03
and a realignment of what your goals are in life, unlike anything else.
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i novu poredanost naših životnih ciljeva, više nego bilo što drugo.
18:08
And I would never want to deprive you of that epiphany.
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Nikada vas ne bih htjela lišiti te spoznaje.
18:13
What I want instead,
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Umjesto toga, želim,
18:16
is for you to be whole, intact,
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da budete potpuni, netaknuti,
18:21
and functional enough to go out and save the world,
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i funkcionalni dovoljno da odete i spasite svijet,
18:26
after you've decided you need to do it.
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nakon što odlučite da to morate napraviti.
18:29
And that is my vision for your future.
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To je moja vizija za vašu budućnost.
18:32
Thank you.
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Hvala vam.
18:34
(Applause)
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(Pljesak)
ABOUT THE SPEAKER
Catherine Mohr - RoboticistCatherine 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.
Catherine Mohr | Speaker | TED.com