TEDMED 2011
Yoav Medan: Ultrasound surgery -- healing without cuts
Yoav Medan: 超音波手術 -- 不用開刀的治療
Filmed:
Readability: 4.5
842,915 views
想像一下進行一場不用刀子的手術。在 TEDMED 中，Yoav Medan 分享了一項技術，使用磁振造影(MRI)找尋問題位置，然後使用聚焦超音波來治療例如腦部的病變、子宮肌瘤以及各種癌細胞的生成等問題。
Yoav Medan - Medical inventor
With his team, Yoav Medan is developing a tool for incision-less surgery via focused ultrasound. Full bio
With his team, Yoav Medan is developing a tool for incision-less surgery via focused ultrasound. Full bio
Double-click the English transcript below to play the video.
00:15
Over the last 13 years --
0
0
2000
過去 13 年中 --
00:17
one, three, 13 years --
1
2000
2000
1,3,13 年 --
00:19
I've been part of an exceptional team at InSightec in Israel
2
4000
3000
我曾是以色列 InSightec 公司和其來自世界各地的伙伴
00:22
and partners around the world
3
7000
2000
的一個優秀小組的成員，
00:24
for taking this idea, this concept,
4
9000
3000
我們把非侵入式的手術
00:27
noninvasive surgery,
5
12000
2000
這個想法、這個概念，
00:29
from the research lab to routine clinical use.
6
14000
3000
從研究實驗室中推行到例行性的臨床使用上。
00:32
And this is what I'll tell you about.
7
17000
2000
而這就是我將要告訴大家的東西。
00:34
13 years --
8
19000
2000
13 年 --
00:36
for some of you, you can empathize with that number.
9
21000
3000
對你們一些人而言，也許會有種同情的感覺。
00:39
For me, today, on this date,
10
24000
2000
對我而言，今天這個日子，
00:41
it's like a second bar mitzvah experience.
11
26000
2000
就像是第二次的成年禮一樣。
00:43
(Laughter)
12
28000
3000
(笑聲)
00:46
So this dream
13
31000
3000
而這個夢想
00:49
is really enabled
14
34000
2000
已經藉由
00:51
by the convergence
15
36000
2000
兩項技術的結合
00:53
of two known technologies.
16
38000
2000
而成真了。
00:55
One is the focused ultrasound,
17
40000
2000
其中一項是聚焦超音波，
00:57
and the other one is the
18
42000
3000
另一項則是
01:00
vision-enabled magnetic resonance imaging.
19
45000
3000
視覺化的磁振造影技術。
01:03
So let's first talk about focused ultrasound.
20
48000
4000
讓我們先談談聚焦超音波。
01:07
And I hold in my hand
21
52000
2000
我手中所拿著的是
01:09
a tissue-mimicking phantom.
22
54000
2000
一個組織模型。
01:11
It is made out of silicon.
23
56000
2000
它是用矽做成的。
01:13
It is transparent, made just for you.
24
58000
3000
它是透明的, 特別為大家製造的。
01:16
So you see, it's all intact,
25
61000
3000
如你所見，它是完好無缺，
01:19
completely transparent.
26
64000
2000
完全透明的。
01:21
I'll take you now to the acoustic lab.
27
66000
3000
我現在帶你來到聲效實驗室。
01:24
You see the phantom within the aquarium.
28
69000
2000
你可以看見模型被放在玻璃缸裡。
01:26
This is a setup I put in a physics lab.
29
71000
2000
這是我放在物理實驗室的一套設備。
01:28
On the right-hand side,
30
73000
2000
在右手邊，
01:30
you see an ultrasonic transducer.
31
75000
2000
你可以看見一台超音波轉換器。
01:32
So the ultrasonic transducer
32
77000
3000
當這個超音波轉換器
01:35
emits basically an ultrasonic beam
33
80000
2000
對著模型聚焦
01:37
that focuses inside the phantom.
34
82000
3000
發射出超音波束。
01:40
Okay, when you hear the click,
35
85000
4000
好,當你聽見「啪」一聲，
01:44
this is when the energy starts to emit
36
89000
2000
這表示能量開始被傳送出來，
01:46
and you see a little lesion form
37
91000
3000
然後你可以看見在模型裡面
01:49
inside the phantom.
38
94000
3000
出現小小的損傷。
01:52
Okay, so everything around it
39
97000
2000
而它周圍的其他位置
01:54
is whole and intact.
40
99000
2000
則都完好無缺。
01:56
It's just a lesion formed inside.
41
101000
2000
損傷只在內部形成。
01:58
So think about, this is in your brain.
42
103000
3000
想像一下，這東西在你的大腦內。
02:01
We need to reach a target inside the brain.
43
106000
2000
我們需要觸及大腦中的這個目標物。
02:03
We can do it without harming any tissue.
44
108000
3000
我們可以在不傷及任何組織的前提下做到。
02:06
So this is, I think,
45
111000
2000
所以，我想，
02:08
the first kosher Hippocratic surgical system.
46
113000
3000
這是第一個符合猶太戒律的希波克拉提斯手術系統。
02:11
(Laughter)
47
116000
2000
(笑聲)
02:13
Okay, so let's talk a little bit about ultrasound,
48
118000
2000
接著我們來談談超音波，
02:15
the force of ultrasound.
49
120000
2000
超音波的力量。
02:17
You know all about imaging, right, ultrasound imaging.
50
122000
3000
大家都聽過造影,對,超音波的造影。
02:20
And you know also about lithotripsy --
51
125000
3000
也聽過震波碎石 --
02:23
breaking kidney stones.
52
128000
3000
震碎腎臟結石。
02:26
But ultrasound can be shaped
53
131000
3000
但超音波可以被塑造成
02:29
to be anything in between,
54
134000
3000
介於這兩者之間的東西，
02:32
because it's a mechanical force.
55
137000
3000
因為它是一種機械式的力量。
02:35
Basically, it's a force acting on a tissue
56
140000
2000
基本上，它的一種作用在
02:37
that it transverses.
57
142000
2000
它所橫越過的組織上的力量。
02:39
So you can change the intensity, the frequency,
58
144000
3000
所以你可以改變超音波的強度、頻率、
02:42
the duration, the pulse shape of the ultrasound
59
147000
3000
週期、波形等
02:45
to create anything
60
150000
2000
來創造出
02:47
from an airbrush to a hammer.
61
152000
3000
像噴鎗以至鎚頭的任何東西。
02:50
And I am going to show you
62
155000
2000
接下來我將會給你演示
02:52
multiple applications in the medical field
63
157000
2000
藉由聚焦，
02:54
that can be enabled
64
159000
2000
完全的聚焦，
02:56
just by focusing,
65
161000
2000
在醫療領域中
02:58
physically focusing.
66
163000
3000
所能做到的各種應用。
03:01
So this idea
67
166000
2000
使用控制聚焦超音波
03:03
of harnessing focused ultrasound to treat lesions in the brain
68
168000
3000
來治療大腦裡的患處
03:06
is not new at all.
69
171000
2000
並不是全新的想法。
03:08
When I was born, this idea was already conceived
70
173000
3000
這個想法在我出生時
03:11
by pioneers such as the Fry brothers
71
176000
3000
就已經被一些前輩提出，例如 Fry 兄弟們，
03:14
and Lars Leksell,
72
179000
2000
以及 Lars Leksell，
03:16
who is know actually
73
181000
2000
他實際上正是
03:18
as the inventor of the gammaknife.
74
183000
2000
加馬刀(利用放射線聚焦)的發明人。
03:20
But you may not know
75
185000
2000
不過你可能不知道
03:22
that he tried to perform lobotomies in the brain,
76
187000
2000
他曾經在1950年代，
03:24
noninvasively,
77
189000
2000
嘗試利用聚焦超音波
03:26
with focused ultrasound in the '50s.
78
191000
3000
進行非侵入式的前腦葉白質切除術。
03:29
He failed,
79
194000
2000
他失敗了，
03:31
so he then invented the gammaknife.
80
196000
2000
之後他就發明了加馬刀。
03:33
And it makes you ponder
81
198000
3000
這會讓你疑惑
03:36
why those pioneers failed.
82
201000
4000
為什麼這些前輩們會失敗。
03:40
And there was something fundamental
83
205000
2000
他們缺少了一些
03:42
that they were missing.
84
207000
2000
很基本的東西。
03:44
They were missing the vision.
85
209000
2000
他們缺少了視覺影像。
03:46
It wasn't until the invention of the MR
86
211000
3000
直到磁振造影被發明出來，
03:49
and really the integration of MR
87
214000
2000
並且真正將磁振造影
03:51
with focused ultrasound
88
216000
2000
結合聚焦超音波
03:53
that we could get the feedback --
89
218000
3000
使我們得到
03:56
both the anatomical and the physiological
90
221000
3000
解剖學和生理學上的回饋
03:59
in order to have a completely noninvasive, closed-loop
91
224000
4000
藉以達到完全非侵入式，封閉循環的
04:03
surgical procedure.
92
228000
3000
手術程序。
04:06
So this is how it looks, you know,
93
231000
2000
這就是在今天,我們所看到
04:08
the operating room of the future today.
94
233000
3000
未來的手術室的樣子。
04:11
This is an MR suite with a focused ultrasound system.
95
236000
3000
這是搭配了聚焦超音波系統的磁振造影設備。
04:14
And I will give you several examples.
96
239000
2000
我將會給大家看一些範例。
04:16
So the first one is in the brain.
97
241000
2000
第一個例子是在大腦之中。
04:18
One of the neurological conditions
98
243000
3000
一種神經系統的疾病
04:21
that can be treated with focused ultrasound
99
246000
2000
是可以用聚焦超音波來治療的
04:23
are movement disorders,
100
248000
2000
是運動障礙症,
04:25
like Parkinson's or essential tremor.
101
250000
3000
像帕金森氏症或是原發性顫抖症等。
04:28
What is typical to those conditions,
102
253000
3000
這些問題的典型症狀是，
04:31
to essential tremor for example,
103
256000
3000
以原發性顫抖症為例，
04:34
is inability
104
259000
3000
在喝湯或吃麥片時
04:37
to drink or eat cereal or soup
105
262000
4000
無法做到
04:41
without spilling everything all over you,
106
266000
3000
不把東西灑得到處都是，
04:44
or write legibly so people can understand it,
107
269000
3000
或是無法端正寫字讓大家看懂，
04:47
and be really independent in your life
108
272000
3000
以及無法不靠別人的幫助
04:50
without the help of others.
109
275000
2000
只靠自己過生活。
04:52
So I'd like you to meet John.
110
277000
3000
我想讓大家看看 John。
04:55
John is a retired professor of history
111
280000
2000
John 是退休的歷史教授，
04:57
from Virginia.
112
282000
2000
住在維吉尼亞。
04:59
So he suffered from essential tremor for many years.
113
284000
3000
他罹患原發性顫抖症許多年了。
05:02
And medication didn't help him anymore.
114
287000
4000
藥物治療無法再給他任何幫助。
05:06
And many of those patients refused to undergo surgery
115
291000
3000
許多患這種病的人拒絕接受
05:09
to have people cut into their brain.
116
294000
2000
讓人切割大腦的手術。
05:11
And about four or five months ago,
117
296000
3000
在 4~5 個月前，
05:14
he underwent an experimental procedure.
118
299000
5000
他接受了一次實驗性的療程。
05:19
It is approved under an FDAIDE
119
304000
3000
這獲得美國食品藥品管理局(FDA)的臨床試驗醫療器材豁免(IDE)批准，
05:22
at the University of Virginia
120
307000
2000
在夏洛特斯維爾的
05:24
in Charlottesville
121
309000
2000
維吉尼亞大學裡面進行，
05:26
using focused ultrasound
122
311000
2000
使用聚焦超音波
05:28
to ablate a point in his thalamus.
123
313000
3000
消融他視丘葉片中的一點。
05:33
And this is his handwriting.
124
318000
3000
這是他的筆跡。
05:36
"On June 20th," if you can read it,
125
321000
3000
「在 6 月 20 號」 如果你有看見的話，
05:39
"2011."
126
324000
3000
「2011年」
05:42
This is his handwriting
127
327000
2000
這是他在治療當天早上
05:44
on the morning of the treatment
128
329000
2000
進行磁振造影之前
05:46
before going into the MR
129
331000
2000
所留下的筆跡。
05:48
So now I'll take you through
130
333000
2000
接下來我要讓大家了解
05:50
[what] a typical procedure like that looks like,
131
335000
3000
像這種手術的典型流程是怎樣的，
05:53
[what] noninvasive surgery looks like.
132
338000
3000
無侵入式的手術是怎樣的。
05:56
So we put the patient on the MR table.
133
341000
3000
我們讓病人躺在磁振造影的檯子上。
05:59
We attach a transducer, in this case, to the brain,
134
344000
2000
在這個案例裡,我們把轉換器接到大腦上，
06:01
but if it will be a different organ,
135
346000
2000
如果是不同的器官，
06:03
it will be a different transducer attached to the patient.
136
348000
4000
就會把不同的轉換器接到病人身上。
06:07
And the physician
137
352000
2000
接著主治醫師
06:09
will then take a regular MR scan.
138
354000
3000
會進行常規的磁振造影掃描。
06:12
And the objective of that?
139
357000
2000
目的是什麼呢?
06:14
I don't have a pointer here,
140
359000
2000
我手邊沒有投影筆，
06:16
but you see the green, sort of rectangle or trapezoid?
141
361000
5000
不過你可以看見這綠色、類似矩形或梯形的部份?
06:21
This is the sort of general area of the treatment.
142
366000
2000
這是進行治療的大概區域。
06:23
It's a safety boundary
143
368000
2000
這是目標物周圍的
06:25
around the target.
144
370000
2000
安全範圍。
06:27
It's a target in the thalamus.
145
372000
2000
它是在視丘內的一個目標。
06:29
So once those pictures are acquired
146
374000
2000
一旦取得了這些照片後，
06:31
and the physician has drawn
147
376000
3000
主治醫師畫出了
06:34
all the necessary safety limits and so on,
148
379000
3000
所有必要的安全限制範圍等等，
06:37
he selects basically a point --
149
382000
2000
他基本上選取一點 --
06:39
you see the round point in the middle where the cursor is --
150
384000
3000
你看到在游標的位置,中間的一個圓點 --
06:42
and he presses this blue button called "sonicate."
151
387000
3000
然後他按下這個叫做「超音波降解」的藍色按鈕。
06:45
We call this instance of injecting the energy,
152
390000
3000
我們稱這注入能量的步驟，
06:48
we call it sonication.
153
393000
2000
我們稱它為超音波降解。
06:50
The only handwork the physician does here
154
395000
3000
主治醫師唯一需要動手的
06:53
is moving a mouse.
155
398000
2000
是移動這隻滑鼠。
06:55
This is the only device he needs in this treatment.
156
400000
3000
這是他在這項治療中唯一用到的器具。
06:58
So he presses "sonicate," and this is what happens.
157
403000
3000
他按下超音波降解，跟著就會出現以下的情況。
07:01
You see the transducer, the light blue.
158
406000
2000
你看看那個轉換器，淺藍色的地方。
07:03
There's water in between the skull and the transducer.
159
408000
3000
在頭顱和轉換器之間注有水。
07:06
And it does this burst of energy.
160
411000
2000
然後它放出巨大能量。
07:08
It elevates the temperature.
161
413000
2000
它提升溫度。
07:10
We first need to verify
162
415000
2000
首先我們必須確認
07:12
that we are on target.
163
417000
2000
我們命中了目標。
07:14
So the first sonication
164
419000
2000
所以第一次超音波降解
07:16
is at lower energy.
165
421000
2000
是使用較低的能量。
07:18
It doesn't do any damage,
166
423000
2000
這不會造成任何傷害，
07:20
but it elevates the temperature
167
425000
2000
它只是讓溫度上升
07:22
by a few degrees.
168
427000
2000
幾度而已。
07:24
And one of the unique capabilities
169
429000
2000
使用磁振造影
07:26
that we leverage with the MR
170
431000
2000
其中一項獨特的能力就是
07:28
is the ability to measure temperature noninvasively.
171
433000
4000
可以進行非侵入式溫度量測。
07:32
This is really a unique capability of the MR.
172
437000
3000
這確實是磁振造影的獨特之處。
07:35
It is not being used
173
440000
2000
它並不是被用作
07:37
in regular diagnostic imaging.
174
442000
2000
常規的造影診斷。
07:39
But here we can get
175
444000
2000
但這裡我們可以取得
07:41
both the anatomical imaging and the temperature maps in real time.
176
446000
3000
實時的解剖造影和溫度分佈圖。
07:44
And you can see the points there on the graph.
177
449000
3000
你可以看見圖中的這些點。
07:47
The temperature was raised
178
452000
2000
溫度暫時地
07:49
to 43 degrees C temporarily.
179
454000
2000
上升到攝氏 43 度。
07:51
This doesn't cause any damage.
180
456000
2000
這並不會造成任何傷害。
07:53
But the point is we are right on target.
181
458000
2000
但重點是，我們準確的命中目標。
07:55
So once the physician verifies
182
460000
3000
一旦主治醫師確認了
07:58
that the focus spot is on the target he has chosen,
183
463000
3000
聚焦點是在他所選取的目標上，
08:01
then we move to perform
184
466000
3000
接著就會進行
08:04
a full-energy ablation
185
469000
2000
一次最高能量的消融治療，
08:06
like you see here.
186
471000
2000
就像你在這裡看到的一樣。
08:08
And you see the temperature rises
187
473000
3000
你看見溫度上升
08:11
to like 55 to 60 degrees C.
188
476000
2000
到達約攝氏 55 至 60 度。
08:13
If you do it for more than a second,
189
478000
2000
如果持續超過 1 秒鐘，
08:15
it's enough to basically destroy
190
480000
3000
基本上足以
08:18
the proteins of the cells.
191
483000
3000
消滅細胞中的蛋白質了。
08:22
This is the outcome from a patient perspective --
192
487000
2000
這是從病人角度看到的結果 --
08:24
same day after the treatment.
193
489000
3000
就在治療完成當天。
08:27
This is an immediate relief.
194
492000
2000
問題立刻就被解決了。
08:29
(Applause)
195
494000
5000
(掌聲)
08:34
Thank you.
196
499000
2000
謝謝大家。
08:36
John is one of [about] a dozen
197
501000
3000
John 是許多有膽量、
08:39
very heroic, courageous people
198
504000
4000
有勇氣自願接受這個研究的
08:43
who volunteered for the study.
199
508000
2000
約12個參加者中之一。
08:45
And you have to understand
200
510000
2000
你必須了解，
08:47
what is in people's mind
201
512000
2000
當這些人願意接受這個風險時，
08:49
when they are willing to take the risk.
202
514000
3000
他們的心裡在想些什麼。
08:52
And this is a quote from John after he wrote it.
203
517000
3000
這裡引用了 John 所寫下的內容。
08:55
He said, "Miraculous."
204
520000
2000
他說「太神奇了」。
08:57
And his wife said, "This is the happiest moment of my life."
205
522000
4000
他的妻子說「這是我這一生中最開心的時刻」。
09:01
And you wonder why.
206
526000
2000
你也許感到疑惑。
09:03
I mean, one of the messages I like to carry over
207
528000
3000
我想傳達給大家其中一個訊息是，
09:06
is, what about defending quality of life?
208
531000
3000
有沒有想過維護生活質素?
09:09
I mean, those people lose their independence.
209
534000
2000
我是說，這些人失去了獨立性。
09:11
They are dependent on others.
210
536000
2000
他們必須依靠其他人。
09:13
And John today is fully independent.
211
538000
3000
然而現在，John 完全不需要依靠別人了。
09:16
He returned to a normal life routine.
212
541000
3000
他回復到一個正常生活了。
09:19
And he also plays golf,
213
544000
2000
他也打打高爾夫球，
09:21
like you do in Virginia
214
546000
2000
就像你們在維吉尼亞
09:23
when you are retired.
215
548000
4000
退休後所做的一樣。
09:28
Okay, so you can see here the spot.
216
553000
4000
你可以看到這邊的班點處。
09:32
It's like three millimeters in the middle of the brain.
217
557000
2000
在大腦中約 3 mm 的東西。
09:34
There's no damage outside.
218
559000
2000
在外面並沒有任何的損傷。
09:36
He suffers from no neurodeficit.
219
561000
3000
他沒有受到任何神經損傷。
09:39
There's no recovery needed, no nothing.
220
564000
3000
不需要復健，什麼都不需要。
09:42
He's back to his normal life.
221
567000
2000
他已恢復正常生活。
09:44
Let's move now
222
569000
2000
接著我們繼續
09:46
to a more painful subject.
223
571000
2000
談談一個更痛苦的題目。
09:48
Pain is something
224
573000
2000
疼痛是一種
09:50
that can make your life miserable.
225
575000
2000
讓你的生命很不舒服的東西。
09:52
And people are suffering from all kinds of pain
226
577000
2000
而人們正承受著種種的疼痛，
09:54
like neuropathic pain, lower-back pain
227
579000
4000
例如神經痛、下背痛、
09:58
and cancer pain from bone metastases,
228
583000
3000
以及癌症骨擴散的疼痛，
10:01
when the metastases get to your bones,
229
586000
3000
當癌細胞擴散到你的骨頭時，
10:04
sometimes they are very painful.
230
589000
3000
有時候是會非常痛楚的。
10:07
All those I've indicated
231
592000
2000
我所指出的這些全部狀況
10:09
have already been shown
232
594000
2000
都已經被證實
10:11
to be successfully treated
233
596000
2000
可用聚焦超音波
10:13
by focused ultrasound
234
598000
3000
成功治療
10:16
relieving the pain, again, very fast.
235
601000
3000
很快速的解除疼痛。
10:19
And I would like to tell you
236
604000
2000
接著我想告訴大家
10:21
about PJ.
237
606000
4000
關於 PJ 的故事。
10:25
He's a 78 year-old farmer
238
610000
4000
他是一位 78 歲的農夫，
10:29
who suffered from -- how should I say it? --
239
614000
3000
患上 -- 該怎麼說呢? --
10:32
it's called pain in the butt.
240
617000
2000
那被稱為臀部疼痛的病症。
10:34
He had metastases in his right buttock,
241
619000
3000
他的癌細胞擴散到了右臀，
10:37
and he couldn't sit
242
622000
2000
即使靠著藥物治療
10:39
even with medication.
243
624000
2000
他仍然沒辦法坐下來。
10:41
He had to forgo all the farm activities.
244
626000
4000
他必須放棄所有農田的工作。
10:48
He was treated with radiation therapy,
245
633000
2000
他接受了放射線治療，
10:50
state-of-the-art radiation therapy,
246
635000
2000
最先進的放射線治療，
10:52
but it didn't help.
247
637000
2000
不過沒用。
10:54
Many patients like that favor radiation therapy.
248
639000
3000
許多像他一樣的病人偏向使用放射線治療。
10:57
And again, he volunteered
249
642000
2000
不過，他自願參與
10:59
to a pivotal study
250
644000
2000
我們在世界各地進行的
11:01
that we ran worldwide,
251
646000
3000
也在美國進行的
11:04
also in the U.S.
252
649000
3000
一個關鍵性的研究，
11:08
And his wife actually took him.
253
653000
3000
事實上是由他妻子帶他來的。
11:11
They drove like three hours
254
656000
2000
他們從農場
11:13
from their farm to the hospital.
255
658000
3000
開了 3 個小時的車到醫院。
11:16
He had to sit on a cushion,
256
661000
3000
他必須坐在一個軟墊上，
11:19
stand still, not move,
257
664000
2000
完全不能移動，
11:21
because it was very painful.
258
666000
3000
因為動的話會很痛。
11:24
He took the treatment,
259
669000
2000
他接受了治療，
11:26
and on the way back,
260
671000
3000
在回家的時候，
11:29
he drove the truck by himself.
261
674000
4000
是由他自己開著卡車。
11:33
So again, this is an immediate relief.
262
678000
3000
再一次，問題立刻就被解決了。
11:36
And you have to understand
263
681000
2000
你必須明白
11:38
what those people feel
264
683000
2000
當事情發生時，
11:40
and what their family experiences
265
685000
3000
這些人的感覺
11:43
when it happens.
266
688000
2000
以及他們家人的感受。
11:45
He returned again
267
690000
2000
他再次回到
11:47
to his daily routine on the farm.
268
692000
2000
農場進行日常工作。
11:49
He rides his tractor.
269
694000
2000
他駕駛他的拖拉機。
11:51
He rides his horse to their mountain cabin regularly.
270
696000
4000
經常騎馬到山上小屋。
11:55
And he has been very happy.
271
700000
3000
他變得很開心。
11:58
But now, you ask me,
272
703000
3000
但你可能會問我，
12:01
but what about war, the war on cancer?
273
706000
2000
那對抗癌症的戰爭又怎樣呢?
12:03
Show us some primary cancer.
274
708000
3000
讓我們看看主要的癌症。
12:06
What can be done there?
275
711000
2000
又有甚麼可以做的呢?
12:08
So I have good news and bad news.
276
713000
2000
我有好消息，也有壞消息。
12:10
The good news: there's a lot that can be done.
277
715000
3000
好消息是：我們有許多事情可以做。
12:13
And it has been shown actually outside of the U.S.
278
718000
3000
在美國以外的國家實際上已經被證實了。
12:16
And doing that in the U.S.
279
721000
4000
但在美國進行這件事
12:20
is very painful.
280
725000
2000
是很痛苦的。
12:22
I don't see, without this nation
281
727000
4000
我想，除非這個國家
12:26
taking it as some collective will
282
731000
4000
將它視為某種集體意願
12:30
or something that is a national goal to make that happen,
283
735000
3000
或是某種必須達成的國家目標，
12:33
it will not happen.
284
738000
2000
否則它不會發生。
12:35
And it's not just because of regulation;
285
740000
2000
它不單是監管上的問題；
12:37
it's because of the amount of money needed
286
742000
3000
而因為在現行的實證醫學體系下，
12:40
under the current evidence-based medicine
287
745000
4000
以及測試規模等問題下，
12:44
and the size of trials and so on
288
749000
2000
想要達成它
12:46
to make it happen.
289
751000
2000
必須花費很大量的金錢。
12:48
So the first two applications
290
753000
2000
最初的兩項應用
12:50
are breast cancer and prostate cancer.
291
755000
3000
是乳癌和前列腺癌。
12:53
They were the first to be treated by focused ultrasound.
292
758000
3000
這是最早使用聚焦超音波來治療的癌症。
12:56
And we have better-than-surgery results in breasts.
293
761000
5000
對於乳癌，效果比開刀還好。
13:01
But I have a message for the men here.
294
766000
2000
不過我要告訴在場的男士們一個消息。
13:03
We heard here yesterday Quyen
295
768000
3000
我們昨天在這裡
13:06
talking about the adverse event trait
296
771000
3000
聽到 Quyen 談論治療前列腺癌
13:09
in prostate cancer.
297
774000
2000
不好的後遺症。
13:11
There is a unique opportunity now
298
776000
2000
而使用磁振造影引導進行聚焦超音波治療
13:13
with focused ultrasound guided by MR,
299
778000
3000
有著獨一無二的契機，
13:16
because we can actually think about
300
781000
3000
因為我們可以改良原有的
13:19
prostate lumpectomy --
301
784000
2000
前列腺腫瘤切除術 --
13:21
treating just the focal lesion
302
786000
2000
只針對聚焦點進行治療，
13:23
and not removing the whole gland,
303
788000
2000
而不是將整個腺體移除，
13:25
and by that, avoiding all the issues
304
790000
3000
藉此，避開所有
13:28
with potency and incontinence.
305
793000
3000
性能力或尿失禁的問題。
13:32
Well, there are other cancer tumors in the abdomen --
306
797000
6000
此外,腹腔內還有其他的癌症腫瘤 --
13:38
quite lethal, very lethal actually --
307
803000
2000
很小的，事實上非常細小的 --
13:40
pancreas, liver, kidney.
308
805000
3000
在胰臟、肝臟和腎臟裡。
13:43
The challenge there
309
808000
2000
這裡的挑戰是，
13:45
with a breathing and awake patient --
310
810000
3000
對於有意識而且清醒的病人 --
13:48
and in all our treatments,
311
813000
2000
在我們所有的治療中，
13:50
the patient is awake and conscious
312
815000
2000
病人都是清醒的，有意識的，
13:52
and speaks with the physician --
313
817000
4000
並且和主治醫師交談的 --
13:56
is you have to teach the MR some tricks
314
821000
3000
你必須教導磁振造影一些訣竅，
13:59
how to do it in real time.
315
824000
3000
如何實進行。
14:02
And this will take time.
316
827000
2000
這要花一些時間。
14:04
This will take two years.
317
829000
2000
這要花兩年的時間。
14:06
But I have now a message to the ladies.
318
831000
3000
現在我要給現場的女士一個消息。
14:09
And this is, in 2004,
319
834000
3000
那就是，在 2004 年，
14:12
the FDA has approved MR-guided focused ultrasounds
320
837000
3000
美國食品藥品管理局(FDA)已批准了磁振造影引導聚焦超音波
14:15
for the treatment of symptomatic uterine fibroids.
321
840000
5000
用來治療子宮肌瘤。
14:20
Women suffer from that disease.
322
845000
4000
女人常被這個病所苦。
14:24
All those tumors
323
849000
2000
那些腫瘤會導致
14:26
have heavy bleeding during periods,
324
851000
2000
經期大量出血、
14:28
abdominal pressure, back pain,
325
853000
2000
腹部漲痛、背痛、
14:30
frequent urination.
326
855000
2000
頻尿等問題。
14:32
And sometimes, they cannot even conceive and become pregnant
327
857000
4000
有時候,子宮肌瘤甚至會造成
14:36
because of the fibroid.
328
861000
2000
無法受孕或無法懷孕等問題。
14:38
This is Frances.
329
863000
2000
這是Frances。
14:40
She was diagnosed with a grapefruit-sized fibroid.
330
865000
2000
她被診斷出有葡萄柚大小的子宮肌瘤。
14:42
This is a big fibroid.
331
867000
2000
這是一個很大的子宮肌瘤。
14:44
She was offered a hysterectomy,
332
869000
2000
醫生建議她進行子宮切除手術，
14:46
but this is an inconceivable proposition
333
871000
2000
但對於一位還想懷孕的女士而言
14:48
for someone who wants to keep her pregnancy option.
334
873000
3000
這是一個無法接受的建議。
14:51
So she elected to undergo a focused ultrasound procedure
335
876000
4000
所以在 2008 年，
14:55
in 2008.
336
880000
2000
她選擇了接受聚焦超音波的治療。
14:57
And in 2010, she became a first-time mother to a healthy baby.
337
882000
4000
而在 2010 年，她成為了一個健康寶寶的新手媽媽。
15:01
So new life was born.
338
886000
2000
就這樣，一個新生命誕生了。
15:03
(Applause)
339
888000
2000
(掌聲)
15:05
So in conclusion,
340
890000
3000
所以，在最後，
15:08
I'd like to leave you with actually four messages.
341
893000
3000
我要給大家四項消息。
15:11
One is, think about the amount
342
896000
2000
首先，請想想看
15:13
of suffering that is saved
343
898000
2000
病人接受無侵入式手術，
15:15
from patients undergoing noninvasive surgery,
344
900000
4000
可以免受多少的苦痛，
15:19
and also the economical and emotional burden
345
904000
4000
還有，可以讓他們的家人、居住的社區、
15:23
removed from their families and communities
346
908000
3000
以及社會都可以解除那巨大的
15:26
and the society at large --
347
911000
4000
經濟以及情感上的負擔，
15:30
and I think also from their physicians, by the way.
348
915000
6000
另外,我想也解除他的主治醫師的負擔。
15:36
And the other thing I would like you to think about
349
921000
3000
另一件我想大家思考的事情
15:39
is the new type of relationship
350
924000
3000
是主治醫師和病人之間
15:42
between physician and patients
351
927000
2000
所出現的全新型態的關係，
15:44
when you have a patient on the table
352
929000
3000
病人躺在手術台上時，
15:47
[who] is awake and can even monitor the treatment.
353
932000
3000
是清醒的,甚至還可監視著治療的進行。
15:50
In all our treatments,
354
935000
2000
在我們所有的治療中，
15:52
the patient holds a stop sonication button.
355
937000
2000
病患都握著一個停止超音波降解的按鈕。
15:54
He can stop the surgery at any moment.
356
939000
4000
他可隨時停止手術的進行。
15:58
And with that note,
357
943000
3000
以此按語
16:01
I would like to thank you for listening.
358
946000
3000
我想感謝大家的聆聽。
16:04
(Applause)
359
949000
3000
(掌聲)
ABOUT THE SPEAKER
Yoav Medan - Medical inventorWith his team, Yoav Medan is developing a tool for incision-less surgery via focused ultrasound.
Why you should listen
Yoav Medan is the Chief Systems Architect at InSightec Ltd. in Israel, where he works on MRI-guided guided focused ultrasound technology. Before this, he spent 17 years in research and management at the IBM Research Division and was elected to the IBM Academy of Technology. Medan has taught at the EE department at the Technion, Israel Institute of Technology, in addition to serving as a lecturer for Avionic Systems at the Aeronautical Engineering faculty, and mentors young enterpreneurs as part of the Technion Alumni "Technion for Life" program. He plans a 2012 sabbatical as an associate professor at the BioMedical Engineering department of the Technion and its Autonomous Systems Program.
Medan is also the inventor of the QR-code enabled tombstone. Read Adam Ostrow's Q&A with Yoav Medan at TEDGlobal >>
Yoav Medan | Speaker | TED.com