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Nikolai Begg: A tool to fix one of the most dangerous moments in surgery
一个工具，可以解决手术中最危险的一个环节。
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Readability: 4
1,373,990 views
手术是每天都会发生的事情，但在其真正就开始前必须刺破人的皮肤，并且伴随着损坏其它部位的风险。在这个吸引人的演讲中，去找寻机械工程师尼古拉·贝格是如何利用物理升级一个叫做套管针的医疗工具并解除手术中最危险的一个环节的。
Nikolai Begg - Mechanical engineer
Nikolai Begg is a PhD candidate in mechanical engineering whose passion is rethinking medical devices. Full bio
Nikolai Begg is a PhD candidate in mechanical engineering whose passion is rethinking medical devices. Full bio
Double-click the English transcript below to play the video.
当我第一次站在手术室，
00:12
The first time I stood
in the operating room
in the operating room
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00:14
and watched a real surgery,
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看到一个真正的手术的时候，
00:16
I had no idea what to expect.
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我不知道自己该期待着什么。
00:19
I was a college student in engineering.
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我当时是一个工科大学生。
00:21
I thought it was going to be like on TV.
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我以为会像在电视上看到的。
00:23
Ominous music playing in the background,
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在背景中播放着不详的音乐,
00:25
beads of sweat pouring down the surgeon's face.
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汗珠从外科医生的脸冲下。
但其实一点也不一样。
00:28
But it wasn't like that at all.
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这一天有着音乐在播放，
00:30
There was music playing on this day,
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00:32
I think it was Madonna's greatest hits. (Laughter)
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我想是麦当娜的最有名的歌
00:34
And there was plenty of conversation,
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也有很多的会话,
00:36
not just about the patient's heart rate,
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讲的不仅是病人的心脏率，
00:38
but about sports and weekend plans.
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也有的话题是关于运动和周末计划。
00:41
And since then, the more surgeries I watched,
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从此，我看的手术越多，
00:43
the more I realized this is how it is.
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就越发现就是这样的。
00:45
In some weird way, it's just
another day at the office.
another day at the office.
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在某种奇怪的角度上看，做手术和在办公室工作一样。
但是每隔一段时间，
00:48
But every so often
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00:50
the music gets turned down,
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音乐会被调低，
00:52
everyone stops talking,
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每个人都会停止说话，
00:53
and stares at exactly the same thing.
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然后盯着一样的东西。
00:56
And that's when you know
that something absolutely critical
that something absolutely critical
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那时候，你就知道十分关键
00:58
and dangerous is happening.
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而且危险的事情要发生了.
01:01
The first time I saw that
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我第一次见到这个发生的时候，
01:02
I was watching a type of surgery
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我是在看一种外科手术
01:03
called laparoscopic surgery
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叫腹腔镜手术.
01:05
And for those of you who are unfamiliar,
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对于不熟悉的人，
它并非你已常见的
01:08
laparoscopic surgery, instead of the large
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大切口手术，
01:10
open incision you might
be used to with surgery,
be used to with surgery,
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01:13
a laparoscopic surgery
is where the surgeon creates
is where the surgeon creates
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在腹腔镜手术中外科医生
01:15
these three or more small
incisions in the patient.
incisions in the patient.
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会在病人身上切出这样的三个或者更小的口。
01:18
And then inserts these long, thin instruments
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然后将这些长并且细的仪器
01:21
and a camera,
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和摄像头一齐塞入，
01:22
and actually does the procedure inside the patient.
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事实上在病人的体内进行手术。
这是非常好的，因为感染风险更小
01:26
This is great because there's
much less risk of infection,
much less risk of infection,
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01:28
much less pain, shorter recovery time.
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更少的痛苦，更短的修复时间。
但是同时这个仪器也带来了一些不好的，
01:32
But there is a trade-off,
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因为切口是由一个
01:34
because these incisions are created
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01:36
with a long, pointed device
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长并且尖的
01:38
called a trocar.
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叫做套管针的仪器切出来的。
01:40
And the way the surgeon uses this device
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外科医生使用该一起的方法是
他拿着它，
01:42
is that he takes it
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01:44
and he presses it into the abdomen
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并将其在腹部刺压
01:46
until it punctures through.
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直至其穿过。
01:49
And now the reason why
everyone in the operating room
everyone in the operating room
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那一天所有手术室中的人
01:52
was staring at that device on that day
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都盯着那个仪器是因为
他必须非常小心
01:54
was because he had to be absolutely careful
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以避免伤害到
01:58
not to plunge it through
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01:59
and puncture it into the organs
and blood vessels below.
and blood vessels below.
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以下的器官以及血管。
这个问题你们一定不陌生
02:03
But this problem should seem
pretty familiar to all of you
pretty familiar to all of you
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02:05
because I'm pretty sure
you've seen it somewhere else.
you've seen it somewhere else.
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我很确定你们以前见过。
02:08
(Laughter)
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（笑声）
02:10
Remember this?
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记得这个嘛？
02:11
(Applause)
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（掌声）
你知道那根吸管
02:15
You knew that at any second
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不知道什么时候就会穿过
02:17
that straw was going to plunge through,
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02:19
and you didn't know if it was
going to go out the other side
going to go out the other side
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你不知道它是否会刺穿另一侧
02:21
and straight into your hand,
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或是直接刺到你的手上，
02:22
or if you were going to
get juice everywhere,
get juice everywhere,
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或是把果汁弄得到处都是，
但是你们都被吓到了，对不对？
02:24
but you were terrified. Right?
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每一次你们做这个的时候，
02:27
Every single time you did this,
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你们经历了相同的基本物理原理
02:29
you experienced the same
fundamental physics
fundamental physics
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就像我那天在手术里所看到的那样。
02:32
that I was watching in the operating room that day.
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结果证明这的确是一个问题。
02:35
And it turns out it really is a problem.
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02:37
In 2003, the FDA actually came out and said
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在 2003 年，(美国)食品药物管理局出面说
02:40
that trocar incisions might
be the most dangerous step
be the most dangerous step
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套管针切口可能是小创伤手术中
最危险的一步。
02:43
in minimally invasive surgery.
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再一次，在 2009 年，我们在报纸上看到
02:45
Again in 2009, we see a paper that says
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半数以上产生并发症的腹腔镜手术
02:48
that trocars account for over half
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02:50
of all major complications in laparoscopic surgery.
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由套管针产生。
哦，顺便说一句
02:54
And, oh by the way,
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02:55
this hasn't changed for 25 years.
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这在 25 年里都没变过。
当我读研究生时，
02:58
So when I got to graduate school,
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03:00
this is what I wanted to work on.
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这就是我想工作的领域。
我当时试着想我一个朋友解释
03:02
I was trying to explain to a friend of mine
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03:04
what exactly I was spending my time doing,
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我花时间在做什么，
03:06
and I said,
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我说，
这就像你在墙上打个孔
03:08
"It's like when you're drilling through a wall
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然后在你的公寓里挂些东西。
当钻子刺穿墙的那一瞬间
03:10
to hang something in your apartment.
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03:13
There's that moment when the drill
first punctures through the wall
first punctures through the wall
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03:17
and there's this plunge. Right?
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钻子会扎进去对不对？
他看着我然后说，
你是说就像是钻入大脑一样么？
03:23
And he looked at me and he said,
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然后我说 你说什么！？
03:25
"You mean like when they drill
into people's brains?"
into people's brains?"
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然后我调查了一下，医生确实会在脑袋上打孔。
03:28
And I said, "Excuse me?" (Laughter)
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03:31
And then I looked it up and they
do drill into people's brains.
do drill into people's brains.
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03:34
A lot of neurosurgical procedures
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很多神经外科手术
事实上都是从在头骨上钻个洞开始的。
03:36
actually start with a drill
incision through the skull.
incision through the skull.
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如果外科医生不够小心，
03:40
And if the surgeon isn't careful,
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03:41
he can plunge directly into the brain.
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他会直接钻入大脑。
这就是我开始思考的时候，
03:45
So this is the moment when I started thinking,
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03:47
okay, cranial drilling, laparoscopic surgery,
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颅骨钻孔，腹腔镜手术，
为什么不能是医学的其他领域呢？
03:50
why not other areas of medicine?
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03:52
Because think about it, when was
the last time you went to the doctor
the last time you went to the doctor
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因为，请想一想，你能想出哪次去看病
03:54
and you didn't get stuck with something? Right?
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不是被体内什么东西卡住的呢？
事实是
03:57
So the truth is
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在医疗中，打孔是非常普遍的。
03:58
in medicine puncture is everywhere.
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这里只是一部分我所发现的
04:01
And here are just a couple
of the procedures that I've found
of the procedures that I've found
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涉及到组织刺穿的步骤。
04:03
that involve some tissue puncture step.
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如果我们只算上其中的三种--
04:07
And if we take just three of them —
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腹腔镜手术，硬脑膜外麻醉和颅钻--
04:09
laparoscopic surgery,
epidurals, and cranial drilling —
epidurals, and cranial drilling —
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这些过程导单单在这个国家
04:13
these procedures account
for over 30,000 complications
for over 30,000 complications
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04:17
every year in this country alone.
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每年就造成了超过 30,000 起并发症。
我认为那个问题是值得解决的。
04:20
I call that a problem worth solving.
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让我们来看看
04:22
So let's take a look at some of the devices
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在这些手术中使用到的设备。
04:25
that are used in these types of procedures.
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我提及到硬膜外麻醉。这是一个硬膜外针头。
04:27
I mentioned epidurals. This is an epidural needle.
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它是用来刺穿脊椎韧带
04:30
It's used to puncture through
the ligaments in the spine
the ligaments in the spine
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04:33
and deliver anesthesia during childbirth.
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和分娩期间注射麻醉药。
这是一组骨髓穿刺检查工具。
04:35
Here's a set of bone marrow biopsy tools.
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这些实际用于钻入骨头
04:38
These are actually used
to burrow into the bone
to burrow into the bone
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04:40
and collect bone marrow
or sample bone lesions.
or sample bone lesions.
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和收集骨髓或病变骨头的样本。
下面是来自南北战争中的刺刀。
04:43
Here's a bayonette from the Civil War.
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（笑声）
04:45
(Laughter)
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04:48
If I had told you it was a
medical puncture device
medical puncture device
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如果我告诉你这是医疗穿孔工具
你也许会信我。
04:51
you probably would have believed me.
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有什么区别呢？
04:53
Because what's the difference?
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我越进行这项调研
04:55
So, the more I did this research
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就越觉得
04:57
the more I thought there has to be
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04:59
a better way to do this.
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得有更好的办法
我认为，解决这个问题的关键在于
05:01
And for me the key to this problem
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这些医疗设备都有一个
05:03
is that all these different puncture devices
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05:06
share a common set of fundamental physics.
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共通的物理原理。
那些物理原理是什么呢？
05:09
So what are those physics?
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让我们再回到在墙上钻孔这个话题。
你对墙上的一个钻子施加压力。
05:11
Let's go back to drilling through a wall.
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按照牛顿力学 墙会给出一个相对作用力，
05:12
So you're applying a force
on a drill towards the wall.
on a drill towards the wall.
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05:16
And Newton says the wall
is going to apply force back,
is going to apply force back,
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05:19
equal and opposite.
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大小相同 方向相反
05:21
So, as you drill through the wall,
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钻墙的过程中，
力量是平衡的。
05:23
those forces balance.
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但是有一个时刻
05:25
But then there's that moment
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当钻子刚刚穿过墙的那一瞬间
05:26
when the drill first punctures
through the other side of the wall,
through the other side of the wall,
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05:28
and right at that moment
the wall can't push back anymore.
the wall can't push back anymore.
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在那个时刻，墙便不能再施加力。
但是你的大脑在那一瞬间来不及反应。
05:31
But your brain hasn't reacted
to that change in force.
to that change in force.
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因此在你的大脑做出反应的一毫秒或其他时间内
05:35
So for that millisecond,
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05:36
or however long it takes you
to react, you're still pushing,
to react, you're still pushing,
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你仍在推钻子，
然后那个不平衡的力造成了加速度，
05:38
and that unbalanced force
causes an acceleration,
causes an acceleration,
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05:41
and that is the plunge.
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这就是刺入的过程。
但是如果你可以在那一瞬间
05:44
But what if right at the moment of puncture
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05:48
you could pull that tip back,
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将针尖拉回来
05:49
actually oppose the forward acceleration?
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并抵消向前的加速度呢？
那是我决定去做的
05:52
That's what I set out to do.
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想象你有一个仪器,
05:55
So imagine you have a device
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05:56
and it's got some kind of sharp tip
to cut through tissue.
to cut through tissue.
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有着锋利的尖端可以切过软组织。
把尖头拉回来的最简单的方式是什么呢？
05:59
What's the simplest way
you could pull that tip back?
you could pull that tip back?
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我选择使用弹簧。
06:02
I chose a spring.
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当你拉伸弹簧时，针头会伸出
06:04
So when you extend that spring,
you extend that tip out
you extend that tip out
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06:07
so it's ready to puncture tissue,
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在正要刺穿组织时
弹簧会往回收。
06:09
the spring wants to pull the tip back.
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06:10
How do you keep the tip in place
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你怎样才能保持针头的位置
直到刺穿的那一时刻呢？
06:12
until the moment of puncture?
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我用这种机制。
06:15
I used this mechanism.
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当仪器的尖端压着组织时，
06:17
When the tip of the device
is pressed against tissue,
is pressed against tissue,
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这个机械向外扩张并顶住墙壁。
06:20
the mechanism expands outwards
and wedges in place against the wall.
and wedges in place against the wall.
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所产生的摩擦力
06:23
And the friction that's generated
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06:25
locks it in place and prevents
the spring from retracting the tip.
the spring from retracting the tip.
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使仪器被固定住，并防止弹簧收回针尖。
但是在刺穿得那一瞬间，
06:28
But right at the moment of puncture,
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组织不能再将针尖向回推。
06:30
the tissue can't push back
on the tip anymore.
on the tip anymore.
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因此这个机械解锁，弹簧便收回针尖。
06:32
So the mechanism unlocks
and the spring retracts the tip.
and the spring retracts the tip.
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让我展示给你们它的慢镜头。
06:35
Let me show you that
happening in slow motion.
happening in slow motion.
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06:37
This is about 2,000 frames a second,
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这大概有每秒 2,000 帧，
06:39
and I'd like you to notice the tip
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我想让你们注意一下针尖部位
就在那的底部位置，正要刺穿软组织。
06:41
that's right there on the bottom,
about to puncture through tissue.
about to puncture through tissue.
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06:43
And you'll see that
right at the moment of puncture,
right at the moment of puncture,
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你会看见在刺穿得瞬间，
就在那里，机械装置解锁并收回针尖。
06:48
right there, the mechanism unlocks
and retracts that tip back.
and retracts that tip back.
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我要给你们再看一遍，这一次近一些。
06:51
I want to show it to you again, a little closer up.
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06:54
You're going to see the sharp bladed tip,
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你会看到那锋利的刀尖，
06:56
and right when it punctures
that rubber membrane
that rubber membrane
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就在它刺穿橡胶薄膜的瞬间
06:58
it's going to disappear
into this white blunt sheath.
into this white blunt sheath.
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它便会消失在白色的保护套中。
就在那里。
07:02
Right there.
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07:04
That happens within four 100ths
of a second after puncture.
of a second after puncture.
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那发生在刺穿后的百分之一秒。
因为这个仪器不是为了纯物理刺穿而设计的
07:09
And because this device is designed
to address the physics of puncture
to address the physics of puncture
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也不是专门为颅骨钻孔
07:12
and not the specifics of cranial drilling
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07:14
or laparoscopic surgery,
or another procedure,
or another procedure,
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或腹腔镜手术或其它医疗步骤而设计，
07:16
it's applicable across these
different medical disciplines
different medical disciplines
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这在不同的医学领域
和不同的长度范围都可被应用。
07:19
and across different length scales.
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但其中还会有变数。
07:22
But it didn't always look like this.
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这是我的第一个原型。
07:24
This was my first prototype.
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是的那些是冰棒棍，
07:26
Yes, those are popsicle sticks,
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在顶端是橡皮筋。
07:29
and there's a rubber band at the top.
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这只花了我大概30分钟，但是成功了。
07:31
It took about 30 minutes to do this, but it worked.
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这证明了我的想法是正确的，
07:34
And it proved to me that my idea worked
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07:36
and it justified the next couple
years of work on this project.
years of work on this project.
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这也证实了剩下几年在这个项目上需要做的工作。
我研究这个是因为
07:39
I worked on this because
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07:41
this problem really fascinated me.
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这个问题真的使我着迷。
07:43
It kept me up at night.
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这个主意让我晚上睡不着。
但我认为它也应该让你着迷，
07:45
But I think it should fascinate you too,
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因为我说过穿孔在哪里都会发生。
07:48
because I said puncture is everywhere.
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这也就意味着在某个时刻它会成为你的问题。
07:50
That means at some point
it's going to be your problem too.
it's going to be your problem too.
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在手术室的第一天
07:54
That first day in the operating room
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我从来没有想过套针会被用在我身上。
07:56
I never expected to find myself
on the other end of a trocar.
on the other end of a trocar.
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但是去年，我在访问希腊的途中得了阑尾炎。
07:59
But last year, I got appendicitis
when I was visiting Greece.
when I was visiting Greece.
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我在雅典的医院里，
08:03
So I was in the hospital in Athens,
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08:04
and the surgeon was telling me
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医生告诉我，他要
做一个腹腔镜手术。
08:06
he was going to perform
a laparoscopic surgery.
a laparoscopic surgery.
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他准备从那些小的切口中移除我的阑尾，
08:08
He was going to remove my appendix
through these tiny incisions,
through these tiny incisions,
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他告诉我将来的康复情况
08:11
and he was talking about what
I could expect for the recovery,
I could expect for the recovery,
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以及可能发生的后果。
08:14
and what was going to happen.
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他说：“你还有别的问题么？”我说”只有一个。
08:15
He said, "Do you have any questions?"
And I said, "Just one, doc.
And I said, "Just one, doc.
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你用什么样的套针？”
08:17
What kind of trocar do you use?"
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关于腹腔镜手术我最喜欢的一句话是
08:21
So my favorite quote
about laparoscopic surgery
about laparoscopic surgery
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H.C.雅各布斯医生所说的：
08:24
comes from a Doctor H. C. Jacobaeus:
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“是刺穿自身导致危险。”
08:27
"It is puncture itself that causes risk."
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那是我最喜欢的一句话 因为
08:31
That's my favorite quote
because H.C. Jacobaeus
because H.C. Jacobaeus
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H.C.雅各布斯医生是第一位实行腹腔镜手术的人，
08:34
was the first person to ever perform
laparoscopic surgery on humans,
laparoscopic surgery on humans,
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08:38
and he wrote that in 1912.
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他在 1912 年写下了这句话。
在超过 100 年中，这是一个伤害甚至杀害人们的问题。
08:41
This is a problem that's been injuring and
even killing people for over 100 years.
even killing people for over 100 years.
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08:47
So it's easy to think that for
every major problem out there
every major problem out there
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所以这不难想象，对于每一个重要的问题
08:49
there's some team of experts
working around the clock to solve it.
working around the clock to solve it.
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会有某个队伍的专家不分昼夜地工作去解决它。
但事实并不是这样的。
08:53
The truth is that's not always the case.
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我们需要更善于发现问题
08:57
We have to be better at finding those problems
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并找到解决它们的方法。
08:59
and finding ways to solve them.
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所以如果你遇到一个吸引你的问题，
09:02
So if you come across a problem that grabs you,
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让自己在夜里反复思量它
09:05
let it keep you up at night.
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允许自己被它吸引，
09:07
Allow yourself to be fascinated,
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因为又很多生命等着你去拯救。
09:09
because there are so many lives to save.
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（掌声）
09:12
(Applause)
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ABOUT THE SPEAKER
Nikolai Begg - Mechanical engineerNikolai Begg is a PhD candidate in mechanical engineering whose passion is rethinking medical devices.
Why you should listen
Since Nikolai Begg first saw robotic surgery performed as a thirteen-year-old, he has been in love with building things to help others. Now as a PhD Candidate in mechanical engineering at MIT, Begg works on designs to improve any number of things in people's lives -- from salt and pepper shakers that always stay in the same position relative to one another to a non-invasive female urinary catheter. He's especially passionate about how he can apply physics and mechanical principles to medical devices. In 2013 he won the annual Lemelson-MIT Student Prize for Invention, for a product that makes more precise incisions during surgery.
More profile about the speakerNikolai Begg | Speaker | TED.com