TEDxNatick
Peter Weinstock: Lifelike simulations that make real-life surgery safer
ピーター・ワインストック: 手術の安全性を高める本物のようなシミュレーター
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Readability: 4.1
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緊急ケア医師ピーター・ワインストックが、危険な手術を事前に練習するために手術チームがハリウッドの特殊エフェクトや３Dプリンティング技術を使って、まるで本物のような患者の複製を作る様子を紹介します。「２度（模擬）手術を行い、切るのは１度だけ。」このトークで手術の未来を垣間見ましょう。
（模型ですが刺激的な映像の部分があります）
Peter Weinstock - Pediatric ICU doctor
Dr. Peter Weinstock is an Intensive Care Unit physician and Director of the Pediatric Simulator Program at Boston Children's Hospital/Harvard Medical School. Peter and his team fuse medicine with state of the art special effects, puppeteering and 3D printing technologies to create lifelike simulations of complex surgeries. Full bio
Dr. Peter Weinstock is an Intensive Care Unit physician and Director of the Pediatric Simulator Program at Boston Children's Hospital/Harvard Medical School. Peter and his team fuse medicine with state of the art special effects, puppeteering and 3D printing technologies to create lifelike simulations of complex surgeries. Full bio
Double-click the English transcript below to play the video.
00:12
What if I told you
there was a new technology
there was a new technology
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新たな治療技術があり
00:16
that, when placed in the hands
of doctors and nurses,
of doctors and nurses,
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それが医師や看護師の手に渡れば
00:21
improved outcomes for children
and adults, patients of all ages;
and adults, patients of all ages;
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子ども、大人、あらゆる年齢の
患者たちの治療アウトカムを改善し
患者たちの治療アウトカムを改善し
00:27
reduced pain and suffering,
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疼痛や苦しみ
00:30
reduced time in the operating rooms,
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手術室で過ごす時間
00:33
reduced anesthetic times,
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そして麻酔時間を減らし
00:36
had the ultimate dose-response curve
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治療は最高の効果を生み
00:38
that the more you did it,
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治療をすれば
00:39
the better it benefitted patients?
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その分だけ患者は良くなる
00:43
Here's a kicker: it has no side effects,
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それに加えて副作用がなく
00:45
and it's available no matter
where care is delivered.
where care is delivered.
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あらゆる場所で処置できる—
そんなものがあったらどうでしょう
そんなものがあったらどうでしょう
00:49
I can tell you as an ICU doctor
at Boston Children's Hospital,
at Boston Children's Hospital,
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ボストン小児病院の
ICUで働く救急医にすると
ICUで働く救急医にすると
00:52
this would be a game changer for me.
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これはゲームチェンジャーです
00:55
That technology is lifelike rehearsal.
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その技術とは
まるで本番のような手術のリハーサルです
まるで本番のような手術のリハーサルです
01:00
This lifelike rehearsal is being delivered
through medical simulation.
through medical simulation.
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本番のようなリハーサルが
治療シミュレーションを通じて行われます
治療シミュレーションを通じて行われます
01:05
I thought I would start with a case,
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症例を通して
01:09
just to really describe
the challenge ahead,
the challenge ahead,
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この奮闘の様子をご紹介し
01:12
and why this technology is not just
going to improve health care
going to improve health care
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この技術が医療の質を高めるだけでなく
01:16
but why it's critical to health care.
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医療にとって必須だという理由を
ご説明しましょう
ご説明しましょう
01:19
This is a child that's born, young girl.
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これは生まれたての女の子です
01:22
"Day of life zero," we call it,
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私たちは
01:24
the first day of life,
just born into the world.
just born into the world.
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生まれて最初の日を
「生後０日目」と言いますが
「生後０日目」と言いますが
01:26
And just as she's being born,
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この子が生まれるとすぐ
01:27
we notice very quickly
that she is deteriorating.
that she is deteriorating.
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全身状態が悪化しているのに
気づきました
気づきました
01:30
Her heart rate is going up,
her blood pressure is going down,
her blood pressure is going down,
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心拍が早まり血圧が下がり
01:33
she's breathing very, very fast.
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赤ちゃんの呼吸はとても速く
01:36
And the reason for this
is displayed in this chest X-ray.
is displayed in this chest X-ray.
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その理由は胸部レントゲンに表れていました
01:41
That's called a babygram,
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これはベビーグラムと言う
01:42
a full X-ray of a child's body,
a little infant's body.
a little infant's body.
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新生児の全身のレントゲン撮影です
01:45
As you look on the top side of this,
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上方は
01:47
that's where the heart and lungs
are supposed to be.
are supposed to be.
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心臓と肺があるべきところです
01:50
As you look at the bottom end,
that's where the abdomen is,
that's where the abdomen is,
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下方には腹部が見えますが
01:53
and that's where the intestines
are supposed to be.
are supposed to be.
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ここには腸があるべき場所です
01:55
And you can see how
there's sort of that translucent area
there's sort of that translucent area
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透明な部分が
01:58
that made its way up into the right side
of this child's chest.
of this child's chest.
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赤ちゃんの胸部 向かって右側へ
侵入しているのが見えると思いますが
侵入しているのが見えると思いますが
02:01
And those are the intestines --
in the wrong place.
in the wrong place.
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これらは間違った場所にある腸です
02:05
As a result, they're pushing on the lungs
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それが肺を圧迫し
02:07
and making it very difficult
for this poor baby to breathe.
for this poor baby to breathe.
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この哀れな赤ちゃんの
呼吸を困難にしていました
呼吸を困難にしていました
02:11
The fix for this problem
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これを解決するためには
02:12
is to take this child immediately
to the operating room,
to the operating room,
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この子をすぐに手術室へ運び
02:15
bring those intestines
back into the abdomen,
back into the abdomen,
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腹部に腸を戻し
02:17
let the lungs expand
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肺の圧迫を解決し
02:19
and allow this child to breathe again.
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再び呼吸できるようにすることが必要です
02:21
But before she can go
to the operating room,
to the operating room,
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でも彼女が手術室へ入る前に
02:23
she must get whisked away
to the ICU, where I work.
to the ICU, where I work.
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一旦私たちのICUへ連れてこられます
02:26
I work with surgical teams.
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私は外科手術チームと働いています
02:28
We gather around her,
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その子を取り囲み
02:30
and we place this child
on heart-lung bypass.
on heart-lung bypass.
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人工心肺装置につなぎ
02:35
We put her to sleep,
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そしてまず麻酔をかけ
02:37
we make a tiny
little incision in the neck,
little incision in the neck,
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首にごく小さな切開を加え
02:39
we place catheters into the major
vessels of the neck --
vessels of the neck --
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そこから大血管へカテーテルを通し
02:43
and I can tell you that these vessels
are about the size of a pen,
are about the size of a pen,
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この大血管はボールペンの
02:46
the tip of a pen --
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芯ほどの太さです
02:48
and then we have blood
drawn from the body,
drawn from the body,
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そして血液を体内からとり出し
02:50
we bring it through a machine,
it gets oxygenated,
it gets oxygenated,
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機械を通して血液に酸素が加えられ
02:53
and it goes back into the body.
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それが体内に戻されます
02:55
We save her life,
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この子の命を救い
02:56
and get her safely to the operating room.
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手術室へ安全に運びます
03:01
Here's the problem:
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でも問題があります
03:03
these disorders --
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こうした疾患—
03:05
what is known is congenital
diaphragmatic hernia --
diaphragmatic hernia --
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先天性横隔膜ヘルニアというのは
03:08
this hole in the diaphragm that has
allowed these intestines to sneak up --
allowed these intestines to sneak up --
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横隔膜に空いた穴から
内臓が胸腔内に脱出するのですが—
内臓が胸腔内に脱出するのですが—
03:12
these disorders are rare.
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稀だということです
03:15
Even in the best hands in the world,
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世界で最高の技術を持つ外科医でも
03:19
there is still a challenge
to get the volume --
to get the volume --
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完全に手技が熟練するために必要な数の
手術の機会に恵まれるのは困難です
手術の機会に恵まれるのは困難です
03:22
the natural volume of these patients --
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03:24
in order to get our expertise
curve at 100 percent.
curve at 100 percent.
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03:27
They just don't present that often.
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この症例は稀なのです
03:30
So how do you make the rare common?
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稀少な症例をどうやって
ありふれたものにできるでしょう？
ありふれたものにできるでしょう？
03:36
Here's the other problem:
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もうひとつの問題は
03:38
in the health care system
that I trained for over 20 years,
that I trained for over 20 years,
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現行の医療制度で臨床訓練を
03:42
what currently exists,
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20年やってきましたが
03:44
the model of training is called
the apprenticeship model.
the apprenticeship model.
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現行のトレーニングモデルは
徒弟（技術見習い）制度といい
徒弟（技術見習い）制度といい
03:47
It's been around for centuries.
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数世紀の間使われてきたものですが
03:49
It's based on this idea that you see
a surgery maybe once,
a surgery maybe once,
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手術を一度だか
03:53
maybe several times,
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数回見学した後
03:54
you then go do that surgery,
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その手術を実地で行います
03:57
and then ultimately you teach
that surgery to the next generation.
that surgery to the next generation.
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次には次世代の医師に
教えるというものです
教えるというものです
04:02
And implicit in this model --
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このモデルでは
04:05
I don't need to tell you this --
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言うまでもなく
04:07
is that we practice on the very patients
that we are delivering care to.
that we are delivering care to.
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私たちは治療すべき患者を
練習台にしています
練習台にしています
04:14
That's a problem.
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これは問題です
04:19
I think there's a better approach.
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もっとましなアプローチがあるはずです
04:21
Medicine may very well be the last
high-stakes industry
high-stakes industry
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医学の世界は高い危険を伴うのに
04:25
that does not practice prior to game time.
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本番に備え練習をしない
最後の業界と言えるかもしれません
最後の業界と言えるかもしれません
04:30
I want to describe to you a better
approach through medical simulation.
approach through medical simulation.
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治療シミュレーションを使ったより良い方法を
ご紹介したいと思います
ご紹介したいと思います
04:36
Well, the first thing we did is we went
to other high-stakes industries
to other high-stakes industries
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まず 私たちはこのような方法を
何十年も使ってきた
何十年も使ってきた
04:39
that had been using this type
of methodology for decades.
of methodology for decades.
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危険を伴う業務を行う
他の業界を訪ねました
他の業界を訪ねました
04:42
This is nuclear power.
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原子力発電所です
04:44
Nuclear power runs scenarios
on a regular basis
on a regular basis
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ここでは想定外の事態が起こった際の訓練を
04:48
in order to practice
what they hope will never occur.
what they hope will never occur.
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シナリオに基づいて 定期的に行います
04:52
And as we're all very familiar,
the airline industry --
the airline industry --
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私たちに身近な 航空業界では
04:55
we all get on planes now,
comforted by the idea
comforted by the idea
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私たちは安心して飛行機に乗れますが
04:59
that pilots and crews have trained
on simulators much like these,
on simulators much like these,
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それもパイロットやクルーが
このようなシミュレーターで訓練を積み
このようなシミュレーターで訓練を積み
05:05
training on scenarios
that we hope will never occur,
that we hope will never occur,
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緊急事態のシナリオで経験を重ね
05:07
but we know if they did,
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万が一そんなことが起こったとしても
05:09
they would be prepared for the worst.
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最悪の事態に備えているという
安心感があるからです
安心感があるからです
05:12
In fact, the airline industry has gone
as far as to create fuselages
as far as to create fuselages
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実際 航空業界は飛行機の
胴体丸ごとをシミュレーション環境に
胴体丸ごとをシミュレーション環境に
05:17
of simulation environments,
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してしまいました
05:18
because of the importance
of the team coming together.
of the team coming together.
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チームの息が合うことが
重要だったからです
重要だったからです
05:22
This is an evacuation drill simulator.
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これは脱出ドリルシミュレーターで
05:25
So again, if that ever were to happen,
these rare, rare events,
these rare, rare events,
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もしその「極めて稀な事態」が
起こるようなことがあっても
起こるようなことがあっても
05:29
they're ready to act
on the drop of a dime.
on the drop of a dime.
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彼らは即座に対応する
準備ができています
準備ができています
05:34
I guess the most compelling for me
in some ways is the sports industry --
in some ways is the sports industry --
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そして いろいろな面で衝撃的だったのが
文字通り大きなお金が関わる
文字通り大きなお金が関わる
05:40
arguably high stakes.
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スポーツ業界です
05:42
You think about a baseball team:
baseball players practice.
baseball players practice.
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野球チームの選手たちの
練習風景を想像してください
練習風景を想像してください
05:45
I think it's a beautiful example
of progressive training.
of progressive training.
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これは素晴らしく
進んだトレーニングモデルだと思います
進んだトレーニングモデルだと思います
05:48
The first thing they do
is go out to spring training.
is go out to spring training.
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彼らはまず春季キャンプへ出かけます
05:51
They go to a spring training camp,
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春季キャンプへ行き
05:53
perhaps a simulator in baseball.
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野球におけるシミュレーター
のようなものです
のようなものです
05:56
They're not on the real field,
but they're on a simulated field,
but they're on a simulated field,
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実際の球場ではなく
シミュレーションで
シミュレーションで
05:59
and they're playing in the pregame season.
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プレシーズンマッチの練習をします
06:01
Then they make their way to the field
during the season games,
during the season games,
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シーズン中にフィールドで
06:05
and what's the first thing they do
before they start the game?
before they start the game?
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ゲーム開始の前にまず何をすると思いますか？
06:08
They go into the batting cage
and do batting practice for hours,
and do batting practice for hours,
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バッティングケージで
何時間もバッティング練習をして
何時間もバッティング練習をして
06:12
having different types of pitches
being thrown at them,
being thrown at them,
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様々なボールを打ち
06:16
hitting ball after ball
as they limber their muscles,
as they limber their muscles,
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筋肉がほぐれるまで
十分に練習して
十分に練習して
06:20
getting ready for the game itself.
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本番に備えます
06:22
And here's the most
phenomenal part of this,
phenomenal part of this,
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ここからが最も興味深い部分です
06:26
and for all of you who watch
any sport event,
any sport event,
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スポーツ観戦をする方なら
06:29
you will see this phenomenon happen.
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見たことがあるでしょう
06:31
The batter gets into the batter's box,
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打者がバッターボックスに入り
06:34
the pitcher gets ready to pitch.
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ピッチャーも投球準備ができました
06:36
Right before the pitch is thrown,
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投球の直前には
06:39
what does that batter do?
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打者は何をするでしょう？
06:41
The batter steps out of the box
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ボックスから踏み出し
06:44
and takes a practice swing.
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まずスイングします
06:46
He wouldn't do it any other way.
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必ずその順番です
06:49
I want to talk to you about how
we're building practice swings like this
we're building practice swings like this
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私たちがどのようにこんな訓練の場を
医学の世界で作っているのかを
医学の世界で作っているのかを
06:52
in medicine.
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お話しします
06:54
We are building batting cages
for the patients that we care about
for the patients that we care about
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ボストン小児病院で私たちは
患者を治療する前のバッティングケージを
患者を治療する前のバッティングケージを
06:58
at Boston Children's.
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作っています
06:59
I want to use this case
that we recently built.
that we recently built.
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最近の例でお話しすると
07:02
It's the case of a four-year-old
who had a progressively enlarging head,
who had a progressively enlarging head,
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頭部が大きくなり続ける
４歳児の症例ですが
４歳児の症例ですが
07:06
and as a result,
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その結果
07:08
had loss of developmental milestones,
neurologic milestones,
neurologic milestones,
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神経系などの発達に遅れが起こります
07:11
and the reason for this problem is here --
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これを引き起こしていたのは—
07:14
it's called hydrocephalus.
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水頭症と呼ばれる疾患です
07:16
So, a quick study in neurosurgery.
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神経外科学を簡単に説明すると
07:19
There's the brain,
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まず脳があり
07:20
and you can see the cranium
surrounding the brain.
surrounding the brain.
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それを包む頭蓋骨があります
07:23
What surrounds the brain,
between the brain and cranium,
between the brain and cranium,
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脳と頭蓋骨の間にあるのは
07:27
is something called
cerebrospinal fluid or fluid,
cerebrospinal fluid or fluid,
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脳脊髄液あるいは髄液と呼ばれ
07:30
which acts as a shock absorber.
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衝撃を吸収します
07:32
In your heads right now,
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あなたの頭の中では
07:33
there is cerebrospinal fluid
just bathing your brains
just bathing your brains
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脳脊髄液が脳を包み
07:37
and making its way around.
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脳と頭蓋の間を満たしています
07:39
It's produced in one area
and flows through,
and flows through,
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脳のある部位で生産され
それが回流し
それが回流し
07:41
and then is re-exchanged.
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それが再吸収されます
07:43
And this beautiful flow pattern
occurs for all of us.
occurs for all of us.
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この見事な流れは私たち皆に起こります
07:46
But unfortunately in some children,
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しかし不幸にも
07:48
there's a blockage of this flow pattern,
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交通渋滞のようにこの流れが
07:51
much like a traffic jam.
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滞ってしまう子どもがいて
07:53
As a result, the fluid accumulates,
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滞留した髄液が
07:55
and the brain is pushed aside.
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脳を圧迫し
07:59
It has difficulty growing.
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脳の成長を阻害します
08:01
As a result, the child loses
neurologic milestones.
neurologic milestones.
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その結果 子どもは
神経系発達指標に後れを生じます
神経系発達指標に後れを生じます
08:05
This is a devastating disease in children.
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これは非常に厄介な小児の疾患で
08:08
The cure for this is surgery.
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手術で治療します
08:12
The traditional surgery is to take
a bit of the cranium off,
a bit of the cranium off,
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従来の手術法は
頭蓋骨の１部を
頭蓋骨の１部を
08:15
a bit of the skull,
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切り取り
08:16
drain this fluid out,
stick a drain in place,
stick a drain in place,
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この液体を排出し
そこに排出管を取り付けて
そこに排出管を取り付けて
08:19
and then eventually bring
this drain internal to the body.
this drain internal to the body.
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さらに排出された髄液が体内に
戻るようにします
戻るようにします
08:21
Big operation.
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大手術ですが
08:24
But some great news is that advances
in neurosurgical care
in neurosurgical care
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良いニュースは
神経外科技術の向上で
神経外科技術の向上で
08:28
have allowed us to develop
minimally invasive approaches
minimally invasive approaches
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この手術では
侵襲の低いアプローチが
侵襲の低いアプローチが
08:32
to this surgery.
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可能になっています
08:33
Through a small pinhole,
a camera can be inserted,
a camera can be inserted,
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小さなピンホールを作って
カメラを挿入し
カメラを挿入し
08:38
led into the deep brain structure,
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脳の深層部まで導いて
08:41
and cause a little hole in a membrane
that allows all that fluid to drain,
that allows all that fluid to drain,
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小さな穴を被膜に開け
髄液を排出します
髄液を排出します
08:45
much like it would in a sink.
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まるでシンクが排水するように
08:47
All of a sudden, the brain
is no longer under pressure,
is no longer under pressure,
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突然 脳は圧力から解放され
08:50
can re-expand
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本来の大きさに戻ります
08:52
and we cure the child
through a single-hole incision.
through a single-hole incision.
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私たちはその子を穴１つで
治療した訳です
治療した訳です
08:56
But here's the problem:
174
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しかし問題があります
08:58
hydrocephalus is relatively rare.
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水頭症は比較的珍しい疾患で
09:00
And there are no good training methods
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この内視鏡を正しい場所に持っていく
09:03
to get really good at getting
this scope to the right place.
this scope to the right place.
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トレーニングはありませんでした
09:06
But surgeons have been quite creative
about this, even our own.
about this, even our own.
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でも外科医たちは創造性を駆使し
09:11
And they've come up with training models.
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彼らはトレーニングモデルを選びました
09:13
Here's the current training model.
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これが今のトレーニングモデルです
09:15
(Laughter)
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（笑）
09:17
I kid you not.
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本当ですよ
09:18
This is a red pepper,
not made in Hollywood;
not made in Hollywood;
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この赤ピーマンは
ハリウッドの特殊効果ではなく
ハリウッドの特殊効果ではなく
09:21
it's real red pepper.
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本物の赤ピーマンです
09:23
And what surgeons do is they stick
a scope into the pepper,
a scope into the pepper,
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医師はこの中に内視鏡を差し込み
09:25
and they do what is called a "seedectomy."
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「種除去手術」をするのです
09:29
(Laughter)
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（笑）
09:30
They use this scope to remove seeds
using a little tweezer.
using a little tweezer.
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この内視鏡と小さなピンセットを使い
種を取り出します
種を取り出します
09:37
And that is a way to get under their belts
189
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原始的な方法ですが
09:40
the rudimentary components
of doing this surgery.
of doing this surgery.
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これが手術の技を身につけるための方法です
09:44
Then they head right into
the apprenticeship model,
the apprenticeship model,
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それから医師たちは徒弟制度に戻り
09:46
seeing many of them
as they present themselves,
as they present themselves,
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多くの手術例を見て学び
09:49
then doing it, and then teaching it --
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手術し、それをまた教え—
09:51
waiting for these patients to arrive.
194
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患者と出会うチャンスを
待つだけです
待つだけです
09:54
We can do a lot better.
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しかしもっと良い方法があります
09:56
We are manufacturing
reproductions of children
reproductions of children
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私たちは子どもをモデルに
複製を作り
複製を作り
10:00
in order for surgeons and surgical
teams to rehearse
teams to rehearse
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外科医や手術チームが
あらゆる重要な場面の
あらゆる重要な場面の
10:04
in the most relevant possible ways.
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リハーサルをできるようにしました
10:07
Let me show you this.
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これをご覧ください
10:09
Here's my team
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私のチーム—
10:10
in what's called the SIM Engineering
Division of the Simulator Program.
Division of the Simulator Program.
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シミュレーター・プログラム
SIMエンジニアリング部門で
SIMエンジニアリング部門で
10:15
This is an amazing team of individuals.
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素晴らしいスタッフで構成されています
10:18
They are mechanical engineers;
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彼らは機械工学技術者
10:20
you're seeing here, illustrators.
204
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イラストレーターたち
10:22
They take primary data
from CT scans and MRIs,
from CT scans and MRIs,
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CTスキャンやMRIから得た１次データを
10:27
translate it into digital information,
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デジタル情報化し
10:30
animate it,
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アニメーションにして
10:32
put it together into the components
of the child itself,
of the child itself,
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子供の臓器の通りの配置に組み立て
10:37
surface-scan elements of the child
that have been casted as needed,
that have been casted as needed,
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手術の必要に応じて
体表のスキャンが行われ
体表のスキャンが行われ
10:40
depending on the surgery itself,
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重ねられます
10:43
and then take this digital data
and be able to output it
and be able to output it
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そのデジタルデータを取り
10:47
on state-of-the-art,
three-dimensional printing devices
three-dimensional printing devices
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この最先端の３D印刷デバイスで
アウトプットし
アウトプットし
10:51
that allow us to print the components
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子どもの臓器を
10:53
exactly to the micron detail of what
the child's anatomy will look like.
the child's anatomy will look like.
214
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ミクロンレベルまで本物そっくりに
印刷することができます
印刷することができます
10:59
You can see here,
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1304
このように
11:00
the skull of this child being printed
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この子の頭蓋は
11:02
in the hours before
we performed this surgery.
we performed this surgery.
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手術の数時間前に印刷されます
11:06
But we could not do this work
218
654618
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これを実現する手助けをしてくれたのは
11:09
without our dear friends on the West Coast
in Hollywood, California.
in Hollywood, California.
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4387
西海岸はカリフォルニア州
ハリウッドの友人たち
ハリウッドの友人たち
11:14
These are individuals
that are incredibly talented
that are incredibly talented
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彼らは現実を再現する技術に長けている
11:18
at being able to recreate reality.
221
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技術者たちです
11:20
It was not a long leap for us.
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私たちにとって
大きな跳躍ではありませんでした
大きな跳躍ではありませんでした
11:24
The more we got into this field,
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この分野に踏み込んでいくと
11:26
the more it became clear to us
that we are doing cinematography.
that we are doing cinematography.
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自分たちは映画製作と同じことを
やっているのだとわかりました
やっているのだとわかりました
11:30
We're doing filmmaking,
225
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映画を作っているんです
11:32
it's just that the actors are not actors.
226
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2224
ちょっと違うのは 俳優たちではなく
11:35
They're real doctors and nurses.
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本物の医者や看護師が出演することです
11:39
So these are some photos
of our dear friends at Fractured FX
of our dear friends at Fractured FX
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3379
これらはカリフォルニア州ハリウッドの
Fractured FX社の
Fractured FX社の
11:42
in Hollywood California,
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友人たちによる画像です
11:44
an Emmy-Award-winning
special effects firm.
special effects firm.
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3574
エミー賞を受賞した特殊効果技術の会社
11:47
This is Justin Raleigh and his group --
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ジャスティン・ラレイとチームで
11:50
this is not one of our patients --
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これは患者ではありませんよ—
11:52
(Laughter)
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（笑）
11:53
but kind of the exquisite work
that these individuals do.
that these individuals do.
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彼らの優れた仕事を見て
11:57
We have now collaborated
and fused our experience,
and fused our experience,
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彼らと協力し互いの専門を融合させるため
12:00
bringing their group
to Boston Children's Hospital,
to Boston Children's Hospital,
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2406
彼らをボストン小児病院へ招いたり
12:03
sending our group
out to Hollywood, California
out to Hollywood, California
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我々がハリウッドへ赴いたりして
12:05
and exchanging around this
238
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シミュレーター開発のため
12:07
to be able to develop
these type of simulators.
these type of simulators.
239
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3003
意見を交換しました
12:10
What I'm about to show you
is a reproduction of this child.
is a reproduction of this child.
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これからお見せするのは
この子の複製です
この子の複製です
12:19
You'll notice here that every hair
on the child's head is reproduced.
on the child's head is reproduced.
241
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髪の一本一本まで再現されています
12:24
And in fact, this is also
that reproduced child --
that reproduced child --
242
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3703
これも同じ子の複製です
12:28
and I apologize for any queasy stomachs,
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気分悪くなられたら申し訳ありませんが
12:31
but that is a reproduction and simulation
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2860
これは手術をする予定の
12:34
of the child they're about to operate on.
245
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2094
子供を再現しシミュレートしたものです
12:38
Here's that membrane we had talked about,
246
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2438
これが先ほどの被膜で
12:40
the inside of this child's brain.
247
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この子の脳の中にあります
12:43
What you're going to be seeing here
is, on one side, the actual patient,
is, on one side, the actual patient,
248
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4968
今からお見せするのは
本物の患者と
本物の患者と
12:48
and on the other side, the simulator.
249
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シミュレーションです
12:50
As I mentioned, a scope, a little camera,
needs to make its way down,
needs to make its way down,
250
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小さな内視鏡カメラが
入っていくのが
入っていくのが
12:55
and you're seeing that here.
251
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ここに見えますね
12:56
It needs to make a small hole
in this membrane
in this membrane
252
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2324
この被膜に小さな穴を開け
12:58
and allow this fluid to seep out.
253
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2709
液体が出るようにします
13:03
I won't do a quiz show to see
who thinks which side is which,
who thinks which side is which,
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4641
ここでどちらが本物でしょう？
なんていうクイズを出すつもりはありません
なんていうクイズを出すつもりはありません
13:08
but on the right is the simulator.
255
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2304
右がシミュレーターです
13:12
So surgeons can now produce
training opportunities,
training opportunities,
256
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3798
外科医たちはトレーニング環境を用意し
13:16
do these surgeries
as many times as they want,
as many times as they want,
257
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3053
こうした手術を何度でも練習できます
13:19
to their heart's content,
until they feel comfortable.
until they feel comfortable.
258
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慣れて安心できるまで
13:22
And then, and only then,
bring the child into the operating room.
bring the child into the operating room.
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3565
そうした練習を経た後でのみ
子どもを手術室へ運びます
子どもを手術室へ運びます
13:26
But we don't stop here.
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それだけでなく
13:27
We know that a key step to this
is not just the skill itself,
is not just the skill itself,
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4310
ここでの重要なステップは
技術そのものだけでなく
技術そのものだけでなく
13:31
but combining that skill with a team
who's going to deliver that care.
who's going to deliver that care.
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その技術を担当チームとの
連携にうまく組み込むことです
連携にうまく組み込むことです
13:36
Now we turn to Formula One.
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2342
F1の例を見てみましょう
13:39
And here is an example
of a technician putting on a tire
of a technician putting on a tire
264
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3250
テクニシャンがタイヤを交換しています
13:42
and doing that time and time
again on this car.
again on this car.
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3209
この車で何度も繰り返し作業し
13:45
But that is very quickly
going to be incorporated
going to be incorporated
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2985
それは即座に
チーム・トレーニングに
チーム・トレーニングに
13:48
within team-training experiences,
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1931
採り入れられ
13:50
now as a full team orchestrating
the exchange of tires
the exchange of tires
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4209
チームが一丸となってタイヤ交換を行い
13:54
and getting this car back on the speedway.
269
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2998
車をレーストラックに送り出します
13:58
We've done that step in health care,
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私たちは医療にそれを取り入れました
14:01
so now what you're about to see
is a simulated operation.
is a simulated operation.
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4122
これは手術のシミュレーションです
14:06
We've taken the simulator
I just described to you,
I just described to you,
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2387
お話ししたシミュレーターを
14:09
we've brought it into the operating room
at Boston Children's Hospital,
at Boston Children's Hospital,
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3401
ボストン小児病院の手術室に持ち込み
14:12
and these individuals --
these native teams, operative teams --
these native teams, operative teams --
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3655
当院の手術チームが
14:16
are doing the surgery before the surgery.
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3523
本物の手術の前に
シミュレーション手術をしています
シミュレーション手術をしています
14:19
Operate twice;
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1737
２度の手術を行いますが—
14:21
cut once.
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1206
切るのは１度だけ
14:23
Let me show that to you.
278
851119
1396
このように
14:25
(Video) Surgical team member 1:
You want the head down or head up?
You want the head down or head up?
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3113
（ビデオ）手術チームスタッフ１：
頭は下へ それとも上？
頭は下へ それとも上？
14:28
STM 2: Can you lower it down to 10?
280
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1704
スタッフ２：10まで下げてくれる？
14:30
STM 3: And then lower
the whole table down a little bit?
the whole table down a little bit?
281
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2649
スタッフ３：それから手術台全体を
少し下げて
少し下げて
14:32
STM 4: Table coming down.
282
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1254
スタッフ４：手術台下げます
14:36
STM 3: All right, this
is behaving like a vessel.
is behaving like a vessel.
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2705
スタッフ３：船を操縦しているようだ
14:39
Could we have the scissors back, please?
284
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2087
ハサミをくれない？
14:41
STM 5: I'm taking my gloves,
8 to 8 1/2, all right? I'll be right in.
8 to 8 1/2, all right? I'll be right in.
285
869696
3301
スタッフ５：手袋をはめます
サイズ8か8 1/2ある？すぐに参加するよ
サイズ8か8 1/2ある？すぐに参加するよ
14:45
STM 6: Great! Thank you.
286
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2401
スタッフ６：よし！ありがとう
14:48
Peter Weinstock: It's really amazing.
287
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1833
ワインストック：本当に驚きです
14:50
The second step to this,
which is critical,
which is critical,
288
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2092
この次のステップが重要なのですが
14:52
is we take these teams out
immediately and debrief them.
immediately and debrief them.
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3099
チームは部屋から出るとすぐに
振り返りを行います
振り返りを行います
14:55
We use the same technologies
290
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1464
軍隊と同じ
14:56
that are used in Lean
and Six Sigma in the military,
and Six Sigma in the military,
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4688
リーンやシックスシグマと
同じテクニックを使い
同じテクニックを使い
15:01
and we bring them out
and talk about what went right,
and talk about what went right,
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彼らを集め 何がうまくいったか
15:04
but more importantly,
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そして もっと大切なことですが
15:06
we talk about what didn't go well,
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何がうまくいかなかったか
15:08
and how we're going to fix it.
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どうやってそれを修正するかを話します
15:10
Then we bring them right back in
and do it again.
and do it again.
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そして手術室に戻り
繰り返すのです
繰り返すのです
15:13
Deliberative batting practice
in the moments when it matters most.
in the moments when it matters most.
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最も必要な時に
バッティング練習ができるんです
バッティング練習ができるんです
15:20
Let's go back to this case now.
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さあこの症例に戻りましょう
15:23
Same child,
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同じ子ですが
15:24
but now let me describe
how we care for this child
how we care for this child
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ボストン小児病院で
この子がどんなケアを受けるかを
この子がどんなケアを受けるかを
15:26
at Boston Children's Hospital.
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ご説明しましょう
15:28
This child was born
at three o'clock in the morning.
at three o'clock in the morning.
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この子は午前３時に生まれました
15:30
At two o'clock in the morning,
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午前２時には
15:32
we assembled the team,
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私たちチームは集まり
15:35
and took the reproduced anatomy
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スキャンや画像からデータを得た
臓器を複製し
臓器を複製し
15:36
that we would gain
out of scans and images,
out of scans and images,
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スキャンや画像からデータを得た
臓器を複製し
臓器を複製し
15:40
and brought that team
to the virtual bedside,
to the virtual bedside,
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いわゆるバーチャル・ベッドサイド環境を
作り出しました
作り出しました
15:43
to a simulated bedside --
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シミュレーテッド・ベッドサイドを
15:45
the same team that's going to operate
on this child in the hours ahead --
on this child in the hours ahead --
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数時間後にはこの子を
実際に手術するチームに
実際に手術するチームに
15:48
and we have them do the procedure.
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その手順を行ってもらいます
15:51
Let me show you a moment of this.
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ごらんください
15:54
This is not a real incision.
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複製にメスを入れているところです
15:57
And the baby has not yet been born.
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赤ちゃんはまだ生まれていません
16:01
Imagine this.
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どうですか
16:04
So now the conversations
that I have with families
that I have with families
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私がボストン小児病院のICUで家族に話す
16:08
in the intensive care unit
at Boston Children's Hospital
at Boston Children's Hospital
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説明の内容はすっかり変わりました
16:10
are totally different.
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説明の内容はすっかり変わりました
16:12
Imagine this conversation:
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こんな会話を想像してみてください
16:15
"Not only do we take care of this disorder
frequently in our ICU,
frequently in our ICU,
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「私たちはICUで頻繁に
この病気の症例を処置します
この病気の症例を処置します
16:20
and not only have we done surgeries
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お子さんに行うような手術を
16:22
like the surgery we're going
to do on your child,
to do on your child,
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数多くした それだけでなく
16:25
but we have done your child's surgery.
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『あなたのお子さんの手術』
に慣れているんです
に慣れているんです
16:29
And we did it two hours ago.
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２時間前に
16:32
And we did it 10 times.
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10回も手術したので
16:35
And now we're prepared to take them
back to the operating room."
back to the operating room."
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これからの本番にも
万全の準備ができていますよ」
万全の準備ができていますよ」
16:40
So a new technology in health care:
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この新しい医療技術とは
16:44
lifelike rehearsal.
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本番に備えて練習ができる
16:47
Practicing prior to game time.
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極めてリアルなリハーサルです
16:51
Thank you.
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ありがとうございました
16:52
(Applause)
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（拍手）
ABOUT THE SPEAKER
Peter Weinstock - Pediatric ICU doctorDr. Peter Weinstock is an Intensive Care Unit physician and Director of the Pediatric Simulator Program at Boston Children's Hospital/Harvard Medical School. Peter and his team fuse medicine with state of the art special effects, puppeteering and 3D printing technologies to create lifelike simulations of complex surgeries.
Why you should listen
Dr. Peter Weinstock has merged his lifelong interest in human nature, medicine, theater and puppetry to develop one of the most advanced rehearsal spaces in medicine. Weinstock is a practicing pediatric intensive care unit physician at Boston Children's Hospital, where he serves as Senior Associate in Critical Care Medicine, Associate Professor of Anesthesia at Harvard Medical School, Chair of Pediatric Simulation and Director of the Boston Children's Hospital Simulator Program (SIMPeds). Weinstock works with his team of educators, psychologists, engineers, animators, special effects designers and 3D printers to immerse doctors, nurses, patients and their families in Hollywood-style "life-like" experiences -- all to optimize performance, clinical outcomes, as well as the entire healthcare journey for children and their families.
Weinstock received his PhD from Rockefeller University in molecular and cell biology, followed by clinical training in plastic and general surgery at the University of Pittsburgh and general pediatrics and critical care medicine at the Boston Children’s Hospital. His passion is in developing methods that link highly realistic practice and preparedness training directly to the delivery of high quality, safe care to improve the lives of infants, children and their families. Due to its inherent emotionality, Weinstock's approach to simulation is keenly connected to emotionality and behavioral psychology as essential elements of relationships and decision-making to understand and optimize human-human and human-technology interactions. Weinstock has rapidly grown SIMPeds to thousands of simulations per year, and the SIMPeds method has been adopted among pediatric teaching centers around the globe.
Weinstock frequently lectures internationally on state of art simulation and experiential learning, and he has published sentinel articles in innovative application and approaches to simulation -- from human factors to engineering and testing of next generation of ultra-realistic training devices. He has chaired meetings worldwide and is Founding President of the International Pediatric Simulation Society.
Peter Weinstock | Speaker | TED.com