TEDMED 2011
Quyen Nguyen: Color-coded surgery
Kvajen Ngujen (Quyen Nguyen) Hirurgija obeležena bojama
Filmed:
Readability: 4.2
1,224,438 views
Knjige iz kojih hirurzi uče anatomiju tipično predstavljaju tkiva u različitim bojama, a to ne izgleda baš tako u stvarnosti -- barem ne do sada. Na TEDMED konferenciji Kvajen Ngujen (Quyen Nguyen) nam pokazuje kako molekularni markeri mogu da obeleže tumore neonski zelenom bojom, i tako pokazuju hirurzima gde tačno treba da naprave 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
0
0
2000
Želim da sa vama podelim priču o
00:17
about one of the biggest myths in medicine,
1
2000
2000
jednom od najvećih mitova u medicini,
00:19
and that is the idea
2
4000
2000
koji je uobličen idejom da je
00:21
that all we need are more medical breakthroughs
3
6000
3000
neophodno doći do još više otkrića u medicini
00:24
and then all of our problems will be solved.
4
9000
3000
i tada će svi naši problemi biti rešeni.
00:27
Our society loves to romanticize
5
12000
3000
Našem društvu se sviđa romantičarska
00:30
the idea of the single, solo inventor
6
15000
2000
ideja o jednom usamljenom istraživaču koji
00:32
who, working late in the lab one night,
7
17000
3000
radeći do kasno u noć u laboratoriji
00:35
makes an earthshaking discovery,
8
20000
3000
dolazi do otkrića koje menja svet,
00:38
and voila, overnight everything's changed.
9
23000
4000
i juhu, sve se promeni preko noći.
00:42
That's a very appealing picture,
10
27000
2000
Ta slika je veoma privlačna,
00:44
however, it's just not true.
11
29000
3000
međutim nije istinita.
00:47
In fact, medicine today is a team sport.
12
32000
3000
Činjenica je da je medicina danas timski sport.
00:50
And in many ways,
13
35000
2000
Na mnogo načina je to
00:52
it always has been.
14
37000
2000
oduvek i bila.
00:54
I'd like to share with you a story
15
39000
2000
Želela bih da vam ispričam priču
00:56
about how I've experienced this very dramatically
16
41000
3000
o dramatičnom načinu na koji sam ja to doživela
00:59
in my own work.
17
44000
2000
u svom radu.
01:01
I'm a surgeon,
18
46000
2000
Ja sam hirurg,
01:03
and we surgeons have always had
19
48000
2000
a mi hirurzi smo uvek imali poseban
01:05
this special relationship with light.
20
50000
3000
odnos prema svetlosti.
01:08
When I make an incision inside a patient's body, it's dark.
21
53000
4000
Kada napravim rez unutar tela pacijenta, veoma je mračno.
01:12
We need to shine light to see what we're doing.
22
57000
3000
Neophodno je da osvetlimo to polje kako bismo videli šta radimo.
01:15
And this is why, traditionally,
23
60000
3000
Zbog toga su tradicionalno operacije
01:18
surgeries have always started so early in the morning --
24
63000
2000
uvek počinjale rano ujutru,
01:20
to take advantage of daylight hours.
25
65000
2000
kako bi se iskoristila dnevna svetlost.
01:22
And if you look at historical pictures
26
67000
2000
Ukoliko pogledate stare fotografije
01:24
of the early operating rooms,
27
69000
2000
prvih operacionih sala,
01:26
they have been on top of buildings.
28
71000
3000
one su bile na krovovima zgrada.
01:29
For example, this is the oldest operating room in the Western world,
29
74000
2000
Na primer, ovo je najstarija operaciona sala na zapadu,
01:31
in London,
30
76000
2000
u Londonu,
01:33
where the operating room
31
78000
2000
a operaciona sala se
01:35
is actually on top of a church
32
80000
2000
u principu nalazi u krovu crkve
01:37
with a skylight coming in.
33
82000
2000
gde dnevna svetlost lako prodire.
01:39
And then this is a picture
34
84000
2000
Ovo je slika jedne od
01:41
of one of the most famous hospitals in America.
35
86000
3000
najpoznatijih bolnica u Americi.
01:44
This is Mass General in Boston.
36
89000
2000
To je "Mass General" bolnica u Bostonu.
01:46
And do you know where the operating room is?
37
91000
2000
Da li znate gde je ovde operaciona sala?
01:48
Here it is
38
93000
2000
Ovde je
01:50
on the top of the building
39
95000
2000
na vrhu zgrade
01:52
with plenty of windows to let light in.
40
97000
3000
osvetljena dnevnom svetlošću.
01:55
So nowadays in the operating room,
41
100000
2000
Danas nam nije neophodna dnevna svetlost
01:57
we no longer need to use sunlight.
42
102000
3000
u operacionim salama.
02:00
And because we no longer need to use sunlight,
43
105000
3000
Obzirom da više ne moramo da koristimo dnevnu svetlost,
02:03
we have very specialized lights
44
108000
2000
posedujemo veoma posebna svetla
02:05
that are made for the operating room.
45
110000
2000
koja su napravljena za operacione sale.
02:07
We have an opportunity
46
112000
2000
Imamo mogućnosti da
02:09
to bring in other kinds of lights --
47
114000
2000
instaliramo različite vrste svetlosti,
02:11
lights that can allow us to see
48
116000
2000
svetlost koja nam omogućava da vidimo
02:13
what we currently don't see.
49
118000
3000
ono što trenutno ne možemo da vidimo.
02:16
And this is what I think
50
121000
2000
U tome se krije, ja mislim,
02:18
is the magic of fluorescence.
51
123000
2000
magija fluorescencije.
02:20
So let me back up a little bit.
52
125000
2000
Objasniću vam to malo.
02:22
When we are in medical school,
53
127000
3000
U toku studija medicine
02:25
we learn our anatomy from illustrations such as this
54
130000
3000
mi učimo anatomiju iz ilustracija kao što su ove,
02:28
where everything's color-coded.
55
133000
3000
gde je sve obeleženo bojama.
02:31
Nerves are yellow, arteries are red,
56
136000
2000
Nervi su žute boje, arterije su crvene,
02:33
veins are blue.
57
138000
2000
vene su plave.
02:35
That's so easy anybody could become a surgeon, right?
58
140000
4000
To je toliko lako da bi svako mogao da bude hirurg, zar ne?
02:39
However, when we have a real patient on the table,
59
144000
3000
Međutim, kada pravi pacijent leži na stolu,
02:42
this is the same neck dissection --
60
147000
3000
ovo je ista ta disekcija vrata,
02:45
not so easy to tell the difference
61
150000
2000
nije tako lako uočiti razliku
02:47
between different structures.
62
152000
2000
među različitim strukturama.
02:49
We heard over the last couple days
63
154000
3000
Čuli smo nekoliko puta u toku proteklih dana
02:52
what an urgent problem
64
157000
2000
da je rak veoma hitan problem
02:54
cancer still is in our society,
65
159000
2000
u našem društvu,
02:56
what a pressing need it is
66
161000
2000
da je zaista neophodno
02:58
for us to not have
67
163000
2000
da smanjimo stopu smrtnosti
03:00
one person die every minute.
68
165000
4000
od jedne osobe u minuti.
03:04
Well if cancer can be caught early,
69
169000
2000
Ukoliko se rak dijagnozira rano,
03:06
enough such that someone can have their cancer taken out,
70
171000
5000
toliko rano da se rak može izvaditi iz tela,
03:11
excised with surgery,
71
176000
2000
operaciijom,
03:13
I don't care if it has this gene or that gene,
72
178000
2000
ne zanima me da li ima ovaj ili onaj gen,
03:15
or if it has this protein or that protein,
73
180000
2000
ili ima ovaj ili onaj protein,
03:17
it's in the jar.
74
182000
2000
nalazi se u tegli.
03:19
It's done, it's out, you're cured of cancer.
75
184000
3000
Završeno je, izvađen je, izlečen si od raka.
03:22
This is how we excise cancers.
76
187000
2000
Ovako vadimo tkivo raka.
03:24
We do our best, based upon our training
77
189000
3000
Mi damo sve od sebe, na osnovu onoga što znamo
03:27
and the way the cancer looks and the way it feels
78
192000
3000
i toga kako rak izgleda, kako se pacijent oseća,
03:30
and its relationship to other structures and all of our experience,
79
195000
3000
na osnovu odnosa raka i ostalih organa i našeg iskustva,
03:33
we say, you know what, the cancer's gone.
80
198000
3000
kažemo, znate šta, rak je uklonjen.
03:36
We've made a good job. We've taken it out.
81
201000
3000
Uradili smo dobar posao. Izvadili smo ga.
03:39
That's what the surgeon is saying in the operating room
82
204000
2000
To je ono što hirurg kaže pacijentu
03:41
when the patient's on the table.
83
206000
2000
koji leži na operacionom stolu u sali.
03:43
But then we actually don't know that it's all out.
84
208000
3000
Mi u tom trenutku u stvari ne znamo da li smo sve izvadili.
03:46
We actually have to take samples from the surgical bed,
85
211000
3000
Moramo uzeti uzorak tkiva sa operacije,
03:49
what's left behind in the patient,
86
214000
2000
uzorak koji je u pacijentu,
03:51
and then send those bits to the pathology lab.
87
216000
4000
i moramo to poslati patolozima na analizu.
03:55
In the meanwhile, the patient's on the operating room table.
88
220000
2000
Pacijent je u međuvremenu na operacionom stolu.
03:57
The nurses, anesthesiologist, the surgeon,
89
222000
2000
Medicinske sestre, anesteziolog, hirurg,
03:59
all the assistants are waiting around.
90
224000
2000
pomoćno osoblje - svi čekaju.
04:01
And we wait.
91
226000
2000
I mi čekamo.
04:03
The pathologist takes that sample,
92
228000
2000
Patolog dobije uzorak,
04:05
freezes it, cuts it, looks in the microscope one by one
93
230000
3000
zamrzne ga, iseče, pogleda pod mikroskopom jedan po jedan slajd
04:08
and then calls back into the room.
94
233000
2000
i pozove operacionu salu.
04:10
And that may be 20 minutes later per piece.
95
235000
2000
Potrebno je oko 20 minuta po uzorku.
04:12
So if you've sent three specimens,
96
237000
2000
Ukoliko ste poslali tri uzorka,
04:14
it's an hour later.
97
239000
2000
čekate sat vremena.
04:16
And very often they say,
98
241000
2000
Veoma često kažu,
04:18
"You know what, points A and B are okay,
99
243000
3000
"Znate šta, tačke A i B su u redu,
04:21
but point C, you still have some residual cancer there.
100
246000
2000
ali na tački C i dalje imate ostatke tkiva raka.
04:23
Please go cut that piece out."
101
248000
3000
Molim vas uklonito to."
04:26
So we go back and we do that again, and again.
102
251000
3000
Tako da mi to uradimo ponovo, i onda još jednom.
04:29
And this whole process:
103
254000
2000
Ceo taj proces:
04:31
"Okay you're done.
104
256000
2000
"U redu, završili smo.
04:33
We think the entire tumor is out."
105
258000
2000
Mislimo da smo izvadili ceo tumor."
04:35
But very often several days later,
106
260000
3000
Veoma često nekoliko dana
04:38
the patient's gone home,
107
263000
2000
nakon što pacijent ode kući,
04:40
we get a phone call:
108
265000
2000
dobijemo telefonski poziv:
04:42
"I'm sorry,
109
267000
2000
"Izvinite,
04:44
once we looked at the final pathology,
110
269000
2000
kada smo pogledali krajnje patološke analize,
04:46
once we looked at the final specimen,
111
271000
2000
kada smo pogledali poslednji uzorak,
04:48
we actually found that there's a couple other spots
112
273000
3000
pronašli smo da je ostalo još nekoliko tačaka
04:51
where the margins are positive.
113
276000
3000
gde su obrisi pozitivni.
04:54
There's still cancer in your patient."
114
279000
3000
I dalje ima ćelija raka u pacijentu."
04:57
So now you're faced with telling your patient, first of all,
115
282000
3000
Tako da se sada suočavate sa tim da pre svega
05:00
that they may need another surgery,
116
285000
2000
treba da kažete pacijentu da mu je možda potrebna još jedna operacija,
05:02
or that they need additional therapy
117
287000
2000
ili da im je neophodna dodatna terapija
05:04
such as radiation or chemotherapy.
118
289000
4000
u vidu radio - ili hemo-terapije.
05:08
So wouldn't it be better
119
293000
2000
Zar ne bi bilo bolje
05:10
if we could really tell,
120
295000
2000
ako bismo zaista mogli da procenimo,
05:12
if the surgeon could really tell,
121
297000
3000
ako bi hirurg zaista mogao da tvrdi
05:15
whether or not there's still cancer on the surgical field?
122
300000
3000
da li je ili nije prisutno tkivo raka u operacionom polju?
05:18
I mean, in many ways, the way that we're doing it,
123
303000
3000
Iz mnogo uglova, način na koji mi to radimo je takav
05:21
we're still operating in the dark.
124
306000
4000
da mi i dalje operišemo u tami.
05:25
So in 2004, during my surgical residency,
125
310000
3000
Dok sam bila na hirurškom usavršavanju 2004.
05:28
I had the great fortune
126
313000
2000
imala sam veliku sreću
05:30
to meet Dr. Roger Tsien,
127
315000
3000
da upoznam dr Rodžera Čena,
05:33
who went on to win the Nobel Prize for chemistry
128
318000
3000
koji je kasnije dobio Nobelovu nagradu
05:36
in 2008.
129
321000
2000
za hemiju 2008.
05:38
Roger and his team
130
323000
2000
Rodžer i njegov tim
05:40
were working on a way to detect cancer,
131
325000
3000
su istraživali načine detekcije raka,
05:43
and they had a very clever molecule
132
328000
2000
i pronašli su
05:45
that they had come up with.
133
330000
2000
veoma pametan molekul.
05:47
The molecule they had developed
134
332000
2000
Molekul do kojeg su došli
05:49
had three parts.
135
334000
2000
je imao tri dela.
05:51
The main part of it is the blue part, polycation,
136
336000
3000
Njegov glavni deo je u plavoj boji, to je polikatjon,
05:54
and it's basically very sticky
137
339000
2000
i lako se lepi za
05:56
to every tissue in your body.
138
341000
2000
bilo koje tkivo u telu.
05:58
So imagine that you make a solution
139
343000
2000
Zamislite da napravite rastvor koji je
06:00
full of this sticky material
140
345000
2000
zasićen ovim lepljivim materijalom
06:02
and inject it into the veins of someone who has cancer,
141
347000
2000
i da to ubrizgate u vene osobe koja boluje od raka,
06:04
everything's going to get lit up.
142
349000
2000
sve će biti osvetljeno.
06:06
Nothing will be specific.
143
351000
2000
Ništa nije specifično.
06:08
There's no specificity there.
144
353000
2000
Tu ne postoji specifičnost.
06:10
So they added two additional components.
145
355000
2000
Ubacili su još dva dodatna dela.
06:12
The first one is a polyanionic segment,
146
357000
3000
Prvi deo je polianjonski dodatak,
06:15
which basically acts as a non-stick backing
147
360000
2000
koji prosto deluje kao zaštitni papir
06:17
like the back of a sticker.
148
362000
2000
na poleđini nalepnice.
06:19
So when those two are together, the molecule is neutral
149
364000
3000
Kada su ovi delovi zajedno, molekul je neutralan
06:22
and nothing gets stuck down.
150
367000
2000
i ništa se za to ne vezuje.
06:24
And the two pieces are then linked
151
369000
3000
Ova dva dela su povezana nečim
06:27
by something that can only be cut
152
372000
3000
što može biti odsečeno
06:30
if you have the right molecular scissors --
153
375000
2000
ukoliko imate ispravne molekularne makaze -
06:32
for example, the kind of protease enzymes
154
377000
2000
na primer, tip proteaze-enzima
06:34
that tumors make.
155
379000
2000
koji proizvode tumori.
06:36
So here in this situation,
156
381000
2000
U ovom rastvoru,
06:38
if you make a solution full of this three-part molecule
157
383000
4000
ukoliko napravite rastvor zasićen ovim trodelnim molekulima
06:42
along with the dye, which is shown in green,
158
387000
2000
zajedno sa bojom, koja je prikazana u zelenom,
06:44
and you inject it into the vein
159
389000
3000
i to ubrizgate u venu
06:47
of someone who has cancer,
160
392000
2000
nekoga ko boluje od raka
06:49
normal tissue can't cut it.
161
394000
2000
zdravo tkivo to ne može da procesuje.
06:51
The molecule passes through and gets excreted.
162
396000
3000
Molekul prođe kroz sistem i telo ga izbaci.
06:54
However, in the presence of the tumor,
163
399000
2000
Međutim, ako se tu nalazi tumor
06:56
now there are molecular scissors
164
401000
2000
tada su tu i molekularne makaze
06:58
that can break this molecule apart
165
403000
2000
koje mogu da rastave ovaj molekul
07:00
right there at the cleavable site.
166
405000
2000
baš tu gde se molekul može preseći.
07:02
And now, boom,
167
407000
2000
Sada, tras,
07:04
the tumor labels itself
168
409000
2000
tumor sam sebe obeleži
07:06
and it gets fluorescent.
169
411000
2000
i postaje fluorescentan.
07:08
So here's an example of a nerve
170
413000
3000
Ovo je primer nerva oko kojeg
07:11
that has tumor surrounding it.
171
416000
2000
se nalazi tkivo tumora.
07:13
Can you tell where the tumor is?
172
418000
2000
Da li možete da vidite gde je tumor?
07:15
I couldn't when I was working on this.
173
420000
3000
Ja nisam mogla kada sam radila na ovome.
07:18
But here it is. It's fluorescent.
174
423000
2000
Ali ovde je. Fluorescentan je.
07:20
Now it's green.
175
425000
2000
Sada je zelen.
07:22
See, so every single one in the audience
176
427000
3000
Vidite, sada svako u publici može
07:25
now can tell where the cancer is.
177
430000
3000
da kaže gde se rak nalazi.
07:28
We can tell in the operating room, in the field,
178
433000
3000
Možemo na licu mesta, u operacionoj sali,
07:31
at a molecular level,
179
436000
2000
na molekularnom nivou,
07:33
where is the cancer and what the surgeon needs to do
180
438000
2000
uočiti gde je locirano tkivo raka i hirurg zna šta treba da uradi
07:35
and how much more work they need to do
181
440000
2000
i koliko ima posla oko
07:37
to cut that out.
182
442000
3000
odstranjivanja tumora.
07:40
And the cool thing about fluorescence
183
445000
2000
Dobra osobina fluorescencije je da,
07:42
is that it's not only bright,
184
447000
3000
ne samo da je svetla,
07:45
it actually can shine through tissue.
185
450000
3000
već svetli i kroz tkivo.
07:48
The light that the fluorescence emits
186
453000
3000
Svetlost koju fluorescencija emituje
07:51
can go through tissue.
187
456000
2000
prolazi kroz tkivo.
07:53
So even if the tumor is not right on the surface,
188
458000
3000
Tako da čak ako tumor nije na samoj površini
07:56
you'll still be able to see it.
189
461000
3000
i dalje ćete moći da ga uočite.
07:59
In this movie, you can see
190
464000
2000
U ovom filmu možete videti
08:01
that the tumor is green.
191
466000
3000
da je tumor zelene boje.
08:04
There's actually normal muscle on top of it. See that?
192
469000
3000
Preko njega se nalazi normalan mišić. Vidite li to?
08:07
And I'm peeling that muscle away.
193
472000
2000
Ja odstranjujem mišić.
08:09
But even before I peel that muscle away,
194
474000
2000
Ali čak i pre nego što uklonim taj mišić,
08:11
you saw that there was a tumor underneath.
195
476000
3000
videli ste tkivo tumora ispod njega.
08:14
So that's the beauty of having a tumor
196
479000
3000
U tome se nalazi lepota toga što je tumor
08:17
that's labeled with fluorescent molecules.
197
482000
3000
obeležen fluorescentnim molekulima.
08:20
That you can, not only see the margins
198
485000
2000
U tom slučaju možete ne samo da vidite
08:22
right there on a molecular level,
199
487000
2000
ivice na molekularnom nivou,
08:24
but you can see it even if it's not right on the top --
200
489000
3000
već ga možete uočiti iako nije na samom vrhu -
08:27
even if it's beyond your field of view.
201
492000
3000
iako je izvan vašeg vidnog polja.
08:30
And this works for metastatic lymph nodes also.
202
495000
3000
Ovo se može primeniti i u slučaju metastaza limfnih čvorova.
08:33
Sentinel lymph node dissection
203
498000
2000
Operacija senzornih limfnih čvorova je
08:35
has really changed the way that we manage breast cancer, melanoma.
204
500000
4000
ne tako davno promenila način lečenja raka dojke, melanoma.
08:39
Women used to get
205
504000
2000
Žene su bile podvrgavane
08:41
really debilitating surgeries
206
506000
2000
operacijama koje su ih onesposobljavale
08:43
to excise all of the axillary lymph nodes.
207
508000
3000
i putem kojih su im izvađeni svi pazušni limfni čvorovi.
08:46
But when sentinel lymph node
208
511000
3000
Kada su senzorni limfni čvorovi
08:49
came into our treatment protocol,
209
514000
3000
uvedeni u procedure lečenja,
08:52
the surgeon basically looks for the single node
210
517000
3000
hirurg u principu traži tačno određeni čvor
08:55
that is the first draining lymph node of the cancer.
211
520000
3000
koji je prvi drenažni limfni čvor tkiva raka.
08:58
And then if that node has cancer,
212
523000
3000
Ukoliko ima ćelija raka u čvoru,
09:01
the woman would go on to get
213
526000
2000
žena bi bila podrvgnuta
09:03
the axillary lymph node dissection.
214
528000
2000
operaciji pazušnih limfnih čvorova.
09:05
So what that means
215
530000
2000
To prosto znači da žene
09:07
is if the lymph node did not have cancer,
216
532000
3000
ne bi prolazile kroz nepotrebne operacije
09:10
the woman would be saved
217
535000
2000
ukoliko se rak nije proširio
09:12
from having unnecessary surgery.
218
537000
2000
na limfne čvorove.
09:14
But sentinel lymph node, the way that we do it today,
219
539000
3000
Senzorni limfni čvorovi i način na koji to radimo danas
09:17
is kind of like having a road map
220
542000
2000
su bukvalno nešto kao mapa puta
09:19
just to know where to go.
221
544000
2000
kako biste znali gde da idete.
09:21
So if you're driving on the freeway
222
546000
2000
Ukoliko se vozite auto-putem
09:23
and you want to know where's the next gas station,
223
548000
2000
i želite da znate lokaciju sledeće benzinske pumpe,
09:25
you have a map to tell you that that gas station is down the road.
224
550000
3000
vi imate mapu koja vam kaže gde se ta pumpa nalazi.
09:28
It doesn't tell you whether or not
225
553000
2000
Ne govori vam ništa o tome
09:30
the gas station has gas.
226
555000
2000
da li ima ili nema benzina.
09:32
You have to cut it out, bring it back home,
227
557000
3000
Morate da je isečete, donesete kući,
09:35
cut it up, look inside
228
560000
2000
secirate, analizirate,
09:37
and say, "Oh yes, it does have gas."
229
562000
2000
i zaključite: "Da, ima goriva."
09:39
So that takes more time.
230
564000
2000
To traži više vremena.
09:41
Patients are still on the operating room table.
231
566000
2000
Pacijenti su i dalje na operacionom stolu.
09:43
Anesthesiologists, surgeons are waiting around.
232
568000
2000
Anesteziolozi i hirurzi prosto čekaju.
09:45
That takes time.
233
570000
2000
Za to je potrebno vreme.
09:47
So with our technology, we can tell right away.
234
572000
3000
Uz pomoć naše tehnologije, mi to odmah možemo da saznamo.
09:50
You see a lot of little, roundish bumps there.
235
575000
3000
Vidite ovde mnogo malih, okruglastih izbočina.
09:53
Some of these are swollen lymph nodes
236
578000
3000
Neke od njih su natečeni limfni čvorovi
09:56
that look a little larger than others.
237
581000
2000
koji deluju veće od drugih.
09:58
Who amongst us hasn't had swollen lymph nodes with a cold?
238
583000
3000
Ko od nas nema natečene limfne čvorove kada se prehladi?
10:01
That doesn't mean that there's cancer inside.
239
586000
2000
To ne znači da su unutar njih ćelije raka.
10:03
Well with our technology,
240
588000
2000
Uz pomoć naše tehnologije,
10:05
the surgeon is able to tell immediately
241
590000
3000
hirurzi odmah mogu proceniti
10:08
which nodes have cancer.
242
593000
2000
u kojim čvorovima ima ćelija raka.
10:10
I won't go into this very much,
243
595000
2000
Ne bih previše dataljisala o ovome,
10:12
but our technology, besides being able
244
597000
2000
ali pored toga što je naša tehnologija u stanju
10:14
to tag tumor and metastatic lymph nodes with fluorescence,
245
599000
4000
da obeleži tumor i limfni čvor sa metastazama fluorescencijom,
10:18
we can also use the same smart three-part molecule
246
603000
4000
ona nam omogućava i da koristimo isti onaj pametan trodelni molekul
10:22
to tag gadolinium onto the system
247
607000
3000
kako bismo dodali gadolinijum u sistem
10:25
so you can do this noninvasively.
248
610000
2000
i radili sve to neinvazivnim postupkom.
10:27
The patient has cancer,
249
612000
2000
Pacijent boluje od raka,
10:29
you want to know if the lymph nodes have cancer
250
614000
2000
vi želite da znate da li su limfni čvorovi zaraženi
10:31
even before you go in.
251
616000
2000
pre nego što otvorite pacijenta.
10:33
Well you can see this on an MRI.
252
618000
3000
To možete uraditi uz pomoć MRI tehnologije.
10:36
So in surgery,
253
621000
2000
Važno je znati u toku operacije
10:38
it's important to know what to cut out.
254
623000
3000
šta treba odstraniti.
10:41
But equally important
255
626000
2000
Isto toliko je važno
10:43
is to preserve things
256
628000
3000
sačuvati strukture
10:46
that are important for function.
257
631000
3000
koje su značajne za funkcionisanje.
10:49
So it's very important to avoid inadvertent injury.
258
634000
3000
Tako da je veoma važno izbegavati povrede nastale iz nepažnje.
10:52
And what I'm talking about
259
637000
2000
Sada govorim
10:54
are nerves.
260
639000
2000
o nervima.
10:56
Nerves, if they are injured,
261
641000
2000
Ukoliko povredimo nerve
10:58
can cause paralysis,
262
643000
2000
može doći do paralize,
11:00
can cause pain.
263
645000
3000
uzrokuju bol.
11:03
In the setting of prostate cancer,
264
648000
2000
U slučaju raka prostate,
11:05
up to 60 percent of men
265
650000
2000
čak i do 60 odsto muškaraca
11:07
after prostate cancer surgery
266
652000
2000
nakon operacije prostate
11:09
may have urinary incontinence
267
654000
2000
gubi kontrolu nad bešikom
11:11
and erectile disfunction.
268
656000
2000
i doživljava probleme sa erekcijom.
11:13
That's a lot of people to have a lot of problems --
269
658000
3000
To je mnogo ljudi koji imaju puno problema,
11:16
and this is even in
270
661000
2000
a ovo je čak
11:18
so-called nerve-sparing surgery,
271
663000
2000
nešto što zovemo zahvat koji štiti nerve,
11:20
which means that the surgeon is aware of the problem,
272
665000
4000
što znači da su hirurzi svesni problema
11:24
and they are trying to avoid the nerves.
273
669000
2000
i pokušavaju da zaobiđu nerve.
11:26
But you know what, these little nerves are so small,
274
671000
3000
Znate li da su ovi mali nervi u okviru prostate
11:29
in the context of prostate cancer,
275
674000
3000
toliko mali
11:32
that they are actually never seen.
276
677000
2000
da nikada nisu uočeni.
11:34
They are traced
277
679000
2000
Pratimo ih samo
11:36
just by their known anatomical path
278
681000
2000
uz pomoć poznate anatomske putanje
11:38
along vasculature.
279
683000
2000
uz krvne sudove.
11:40
And they're known because somebody has decided to study them,
280
685000
4000
Za njh znamo jer je neko odlučio da ih izučava,
11:44
which means that we're still learning
281
689000
2000
što znači da mi i dalje učimo
11:46
about where they are.
282
691000
2000
gde se oni nalaze.
11:48
Crazy to think that we're having surgery,
283
693000
3000
Ludo je pomisliti da radimo operaciju,
11:51
we're trying to excise cancer, we don't know where the cancer is.
284
696000
3000
pokušavamo da otklonimo rak, a ne znamo gde se nalazi.
11:54
We're trying to preserve nerves; we can't see where they are.
285
699000
3000
Pokušavamo da sačuvamo nerve, a ne možemo da uočimo gde su.
11:57
So I said, wouldn't it be great
286
702000
2000
Zapitala sam, se zar ne bi bilo sjajno
11:59
if we could find a way
287
704000
2000
kada bih pronašla način
12:01
to see nerves with fluorescence?
288
706000
3000
da vidim nerve uz pomoć fluorescencije?
12:04
And at first this didn't get a lot of support.
289
709000
4000
U početku nismo naišli na mnogo podrške.
12:08
People said, "We've been doing it this way for all these years.
290
713000
2000
Ljudi bi rekli: "Radili smo to na ovaj način godinama.
12:10
What's the problem?
291
715000
2000
U čemu je problem?
12:12
We haven't had that many complications."
292
717000
3000
Nismo imali toliko komplikacija."
12:15
But I went ahead anyway.
293
720000
2000
Ali sam ja bez obzira na to nastavila.
12:17
And Roger helped me.
294
722000
2000
Rodžer mi je pomogao.
12:19
And he brought his whole team with him.
295
724000
3000
Poveo je svoj ceo tim.
12:22
So there's that teamwork thing again.
296
727000
4000
Tako da je opet u pitanju timski rad.
12:26
And we eventually discovered molecules
297
731000
3000
Na kraju smo otkrili molekule
12:29
that were specifically labeling nerves.
298
734000
2000
koji specifično obeležavaju nerve.
12:31
And when we made a solution of this,
299
736000
2000
Kada smo napravili rastvor tog molekula
12:33
tagged with the fluorescence
300
738000
2000
i obeležili ga fluorescencijom,
12:35
and injected in the body of a mouse,
301
740000
3000
a potom to ubrizgali u telo miša,
12:38
their nerves literally glowed.
302
743000
2000
njihovi nervi su prosto blistali.
12:40
You can see where they are.
303
745000
2000
Možete videti gde su.
12:42
Here you're looking at a sciatic nerve of a mouse,
304
747000
4000
Ovde možete uočiti išijadični nerv miša,
12:46
and you can see that that big, fat portion you can see very easily.
305
751000
3000
i vidite da ovaj veliki, masni deo možete lako uočiti.
12:49
But in fact, at the tip of that where I'm dissecting now,
306
754000
3000
Ali, u suštini, na vrhu mesta gde vršim disekciju sada
12:52
there's actually very fine arborizations
307
757000
3000
se nalazi mesto gde dolazi do finog grananja nerva
12:55
that can't really be seen.
308
760000
2000
koje baš i nije lako uočiti.
12:57
You see what looks like little Medusa heads coming out.
309
762000
4000
Možete uočiti nešto nalik na glavu male Meduze koja se probija.
13:01
We have been able to see nerves
310
766000
2000
Uspeli smo da vidimo nerve koji kontrolišu
13:03
for facial expression, for facial movement, for breathing --
311
768000
3000
facijalnu ekspresiju, pokrete lica, disanje -
13:06
every single nerve --
312
771000
2000
svaki pojedinačni nerv -
13:08
nerves for urinary function around the prostate.
313
773000
3000
nerve koji kontrolišu urinarnu funkciju oko prostate.
13:11
We've been able to see every single nerve.
314
776000
3000
Mogli smo da uočimo svaki pojedinačni nerv.
13:14
When we put these two probes together ...
315
779000
4000
Pomešali smo ove dve probe i ...
13:18
So here's a tumor.
316
783000
2000
Ovo je tumor.
13:20
Do you guys know where the margins of this tumor is?
317
785000
3000
Da li znate gde su granice tumora?
13:23
Now you do.
318
788000
3000
Sada znate.
13:26
What about the nerve that's going into this tumor?
319
791000
3000
Šta je sa nervom koji ulazi u tumor?
13:29
That white portion there is easy to see.
320
794000
2000
Beličasti deo je lako uočiti.
13:31
But what about the part that goes into the tumor?
321
796000
2000
Šta se dešava sa delom koji ulazi u tumor?
13:33
Do you know where it's going?
322
798000
2000
Da li znate gde se pruža?
13:35
Now you do.
323
800000
2000
Sada znate.
13:37
Basically, we've come up with a way
324
802000
2000
U suštini pronašli smo način
13:39
to stain tissue
325
804000
2000
da obojimo tkivo
13:41
and color-code the surgical field.
326
806000
2000
i bojama obeležimo operativno polje.
13:43
This was a bit of a breakthrough.
327
808000
3000
To je podsećalo na otkirće.
13:46
I think that it'll change the way that we do surgery.
328
811000
4000
Mislim da će to promeniti hirurgiju.
13:50
We published our results
329
815000
2000
Objavili smo naše rezultate u
13:52
in the proceedings of the National Academy of Sciences
330
817000
2000
"Proceedings of the National Academy of Sciences" (PNAS)
13:54
and in Nature Biotechnology.
331
819000
2000
i u "Nature Biotechnology" žurnal.
13:56
We received commentary in Discover magazine,
332
821000
3000
To je propraćeno u časopisu "Otkriće",
13:59
in The Economist.
333
824000
2000
i u "Ekonomistu".
14:01
And we showed it to a lot of my surgical colleagues.
334
826000
3000
Pokazali smo to mojim kolegama hirurzima.
14:04
They said, "Wow!
335
829000
2000
Rekoše: "Sjajno!"
14:06
I have patients
336
831000
2000
Moji pacijenti bi mogli
14:08
who would benefit from this.
337
833000
2000
da imaju koristi od ovoga.
14:10
I think that this will result in my surgeries
338
835000
2000
Mislim da će ovo rezultirati u
14:12
with a better outcome
339
837000
2000
boljim ishodima operacija
14:14
and fewer complications."
340
839000
3000
i manje komplikacija."
14:17
What needs to happen now
341
842000
2000
Sada je neophodno da dođe do
14:19
is further development of our technology
342
844000
3000
daljeg razvijanja naše tehnologije
14:22
along with development
343
847000
2000
koju bi pratio razvoj
14:24
of the instrumentation
344
849000
2000
neophodnih instrumenata
14:26
that allows us to see
345
851000
2000
koji bi nam omogućio da vidimo
14:28
this sort of fluorescence in the operating room.
346
853000
3000
ovaj tip fluorescencije u operacionoj sali.
14:31
The eventual goal
347
856000
2000
Krajni cilj jeste da
14:33
is that we'll get this into patients.
348
858000
3000
na ovaj način pomognemo pacijentima.
14:36
However, we've discovered
349
861000
3000
Međutim, otkrili smo da
14:39
that there's actually no straightforward mechanism
350
864000
2000
u principu ne postoji jednostavan mehanizam
14:41
to develop a molecule
351
866000
2000
kojim bismo sintetisali molekul
14:43
for one-time use.
352
868000
2000
za jednokratnu upotrebu.
14:45
Understandably, the majority of the medical industry
353
870000
3000
Razumljivo je da je veliki deo medicinske industrije
14:48
is focused on multiple-use drugs,
354
873000
4000
fokusiran na lekove za višestruku upotrebu,
14:52
such as long-term daily medications.
355
877000
3000
kao što su dnevni lekovi koji se dugo koriste.
14:55
We are focused on making this technology better.
356
880000
3000
Posvećeni smo tome da tu tehnologiju unapredimo.
14:58
We're focused on adding drugs,
357
883000
3000
Posvećeni smo dodavanju lekova,
15:01
adding growth factors,
358
886000
2000
dodavanju hormona rasta,
15:03
killing nerves that are causing problems
359
888000
2000
ubijanju nerava koji uzrokuju probleme
15:05
and not the surrounding tissue.
360
890000
3000
ali ne i okolnog tkiva.
15:08
We know that this can be done and we're committed to doing it.
361
893000
4000
Znamo da se ovo može uraditi i posvećeni smo tom radu.
15:12
I'd like to leave you with this final thought.
362
897000
4000
Želim da završim ovom mišlju.
15:16
Successful innovation
363
901000
2000
Uspešan izum nije
15:18
is not a single breakthrough.
364
903000
3000
jedno veliko otkriće.
15:21
It is not a sprint.
365
906000
3000
To nije sprint trka.
15:24
It is not an event for the solo runner.
366
909000
4000
To nije događaj za solo trkača.
15:28
Successful innovation
367
913000
2000
Uspešni pronalsci su rezultat
15:30
is a team sport, it's a relay race.
368
915000
3000
timskog sporta, štafete.
15:33
It requires one team for the breakthrough
369
918000
4000
Neophodan je jedan tim za otkriće
15:37
and another team
370
922000
2000
i drugi tim
15:39
to get the breakthrough accepted and adopted.
371
924000
2000
koji će otkriće učiniti prihvaćenim.
15:41
And this takes the long-term steady courage
372
926000
3000
Sve to zahteva dugotrajnu, nepokolebljivu hrabrost
15:44
of the day-in day-out struggle
373
929000
2000
za vođenje svakodnevne borbe
15:46
to educate, to persuade
374
931000
3000
da obrazujete, ubedite
15:49
and to win acceptance.
375
934000
3000
i konačno dođete do prihvatanja.
15:52
And that is the light that I want to shine
376
937000
2000
To je svetlost kojom želim
15:54
on health and medicine today.
377
939000
2000
da obasjam zdravstvo i medicinu današnjice.
15:56
Thank you very much.
378
941000
2000
Hvala vam mnogo.
15:58
(Applause)
379
943000
4000
(Aplauz)
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