TEDxNatick
Peter Weinstock: Lifelike simulations that make real-life surgery safer
彼得·维恩斯特: 逼真的模拟，使现实生活中的手术更安全
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重症监护医生彼得·维恩斯特向我们展示了外科手术团队如何将好莱坞特效和3D打印技术相融合，为真正的患者创造出无比逼真的复制品，从而提前练习高风险手术。 想想看：“操作两次，实切一次”。 在这个前瞻性的演讲中，我们可以瞥见手术的未来。
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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如果我告诉你有一种新技术，
一旦医生和护士掌握了它，
00:16
that, when placed in the hands
of doctors and nurses,
of doctors and nurses,
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就能改善儿童和成人，
所有年龄段患者的治疗效果，
所有年龄段患者的治疗效果，
00:21
improved outcomes for children
and adults, patients of all ages;
and adults, patients of all ages;
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00:27
reduced pain and suffering,
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能减少疼痛和折磨，
缩短手术时间，
00:30
reduced time in the operating rooms,
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缩短麻醉时间，
00:33
reduced anesthetic times,
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拥有最终极的剂量-效果曲线，
00:36
had the ultimate dose-response curve
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你用的越多
00:38
that the more you did it,
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就对患者越有益，你信不信？
00:39
the better it benefitted patients?
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00:43
Here's a kicker: it has no side effects,
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关键是：它没有副作用，
并且可以在任何治疗中使用。
00:45
and it's available no matter
where care is delivered.
where care is delivered.
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00:49
I can tell you as an ICU doctor
at Boston Children's Hospital,
at Boston Children's Hospital,
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我是波士顿儿童医院的
加护病房医生，
加护病房医生，
这对我而言是划时代的技术。
00:52
this would be a game changer for me.
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这项技术叫做生命模拟演练。
00:55
That technology is lifelike rehearsal.
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01:00
This lifelike rehearsal is being delivered
through medical simulation.
through medical simulation.
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这种生命模拟演练
是通过医疗模拟实现的。
是通过医疗模拟实现的。
01:05
I thought I would start with a case,
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我会通过一个病例来开始讲述，
真实描述一下面临的挑战，
01:09
just to really describe
the challenge ahead,
the challenge ahead,
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以及为什么这项技术
不仅会改进医疗，
不仅会改进医疗，
01:12
and why this technology is not just
going to improve health care
going to improve health care
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而且对医疗至关重要。
01:16
but why it's critical to health care.
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01:19
This is a child that's born, young girl.
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这是一个刚出生的小女孩。
我们称为“生命首日”，
01:22
"Day of life zero," we call it,
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她刚刚来到这个世界，
经历生命的第一天。
经历生命的第一天。
01:24
the first day of life,
just born into the world.
just born into the world.
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刚一出生，
01:26
And just as she's being born,
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我们就发现她的状况在迅速恶化。
01:27
we notice very quickly
that she is deteriorating.
that she is deteriorating.
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心率不断上升，血压不断下降，
01:30
Her heart rate is going up,
her blood pressure is going down,
her blood pressure is going down,
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呼吸非常急促。
01:33
she's breathing very, very fast.
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病因就显示在这张X光片上。
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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我们叫它婴儿透视，
01:41
That's called a babygram,
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是婴儿全身的X光片。
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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这张图靠上的部分，
01:45
As you look on the top side of this,
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是心脏和肺所处的位置。
01:47
that's where the heart and lungs
are supposed to be.
are supposed to be.
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靠下的部分是腹部，
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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是肠子所处的位置。
01:53
and that's where the intestines
are supposed to be.
are supposed to be.
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你们能看到这里有些半透明的区域，
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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向上移动到了孩子的右胸腔内。
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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那些是错位的肠子。
02:01
And those are the intestines --
in the wrong place.
in the wrong place.
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结果就是它们压迫肺部，
02:05
As a result, they're pushing on the lungs
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使这个可怜的孩子难以呼吸。
02:07
and making it very difficult
for this poor baby to breathe.
for this poor baby to breathe.
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解决办法就是
02:11
The fix for this problem
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马上送她进手术室，
02:12
is to take this child immediately
to the operating room,
to the operating room,
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把肠子移回腹部，
02:15
bring those intestines
back into the abdomen,
back into the abdomen,
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让肺扩张，
02:17
let the lungs expand
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让孩子恢复呼吸。
02:19
and allow this child to breathe again.
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但她进手术室之前，
02:21
But before she can go
to the operating room,
to the operating room,
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必须先来重症监护室
——我工作的地方。
——我工作的地方。
02:23
she must get whisked away
to the ICU, where I work.
to the ICU, where I work.
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我与手术团队合作，
02:26
I work with surgical teams.
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进行会诊，
02:28
We gather around her,
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我们采用心肺体外循环的方法。
02:30
and we place this child
on heart-lung bypass.
on heart-lung bypass.
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02:35
We put her to sleep,
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我们将孩子麻醉，
在她脖子上开个小小的切口，
02:37
we make a tiny
little incision in the neck,
little incision in the neck,
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把导管放入脖子的主血管内，
02:39
we place catheters into the major
vessels of the neck --
vessels of the neck --
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这些血管的尺寸也就钢笔——
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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钢笔尖那么粗，
02:46
the tip of a pen --
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我们把血液抽出来，
02:48
and then we have blood
drawn from the body,
drawn from the body,
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导入一个机器，充氧，
02:50
we bring it through a machine,
it gets oxygenated,
it gets oxygenated,
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再导回体内。
02:53
and it goes back into the body.
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我们保住了她的性命，
02:55
We save her life,
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把她安全送到了手术室。
02:56
and get her safely to the operating room.
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03:01
Here's the problem:
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问题在于：
03:03
these disorders --
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这种疾病，
我们称之为“先天性横膈疝气”——
03:05
what is known is congenital
diaphragmatic hernia --
diaphragmatic hernia --
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也就是隔膜上有一个洞，
使得肠子能向上移位——
使得肠子能向上移位——
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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这种疾病很罕见。
03:12
these disorders are rare.
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即使是世上最优秀医生，
03:15
Even in the best hands in the world,
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临床经验也不足，
03:19
there is still a challenge
to get the volume --
to get the volume --
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因为患者的数量太少，
03:22
the natural volume of these patients --
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使得我们的技能曲线
很难达到百分之百。
很难达到百分之百。
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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因为这种病例就是很难遇到。
03:30
So how do you make the rare common?
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你怎样才能让罕见变得常见呢？
03:36
Here's the other problem:
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还有一个问题：
我在医疗系统中
接受训练超过20年，
接受训练超过20年，
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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现有的训练模式叫做学徒模式，
03:42
what currently exists,
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03:44
the model of training is called
the apprenticeship model.
the apprenticeship model.
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它已经存在几百年了。
03:47
It's been around for centuries.
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它的基本概念是，你观摩手术，
03:49
It's based on this idea that you see
a surgery maybe once,
a surgery maybe once,
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也许一次，也许多次，
03:53
maybe several times,
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然后你亲自去做那个手术，
03:54
you then go do that surgery,
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最后你再把这个手术传给下一代。
03:57
and then ultimately you teach
that surgery to the next generation.
that surgery to the next generation.
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其实说白了，
04:02
And implicit in this model --
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相信大家也能想得到，
04:05
I don't need to tell you this --
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我们是在用患者进行练习。
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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04:14
That's a problem.
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这是个大问题。
04:19
I think there's a better approach.
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我认为有更好的方法。
医疗很可能是实操之前不进行训练的
04:21
Medicine may very well be the last
high-stakes industry
high-stakes industry
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最后一个高风险行业了。
04:25
that does not practice prior to game time.
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04:30
I want to describe to you a better
approach through medical simulation.
approach through medical simulation.
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这个更好的方法就是医疗模拟。
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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我们首先去参观了
其他高风险行业，
其他高风险行业，
它们用这种方法已经几十年了。
04:39
that had been using this type
of methodology for decades.
of methodology for decades.
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这是核电厂。
04:42
This is nuclear power.
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核电厂会定期举行演习，
04:44
Nuclear power runs scenarios
on a regular basis
on a regular basis
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为他们希望永不发生的事情做好准备
04:48
in order to practice
what they hope will never occur.
what they hope will never occur.
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以及我们都很熟悉的航空业——
04:52
And as we're all very familiar,
the airline industry --
the airline industry --
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现在大家坐飞机都很放松，
04:55
we all get on planes now,
comforted by the idea
comforted by the idea
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是因为我们知道，飞行员和机组人员
在模拟器上进行了训练
在模拟器上进行了训练
04:59
that pilots and crews have trained
on simulators much like these,
on simulators much like these,
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为应对我们希望永不发生的情况，
05:05
training on scenarios
that we hope will never occur,
that we hope will never occur,
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而且我们知道，一旦发生，
05:07
but we know if they did,
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他们也有能力应对。
05:09
they would be prepared for the worst.
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事实上，航空业已经发展到
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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直接造一个机身进行模拟，
05:17
of simulation environments,
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这样可以使整个团队一同训练。
05:18
because of the importance
of the team coming together.
of the team coming together.
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这是疏散训练模拟器。
05:22
This is an evacuation drill simulator.
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那么再次说明
一旦发生这种非常罕见的事故
一旦发生这种非常罕见的事故
05:25
So again, if that ever were to happen,
these rare, rare events,
these rare, rare events,
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他们能够瞬间作出反应
05:29
they're ready to act
on the drop of a dime.
on the drop of a dime.
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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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我想最吸引我的是体育行业了——
有争议的高风险
05:40
arguably high stakes.
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你想想棒球队：棒球手训练。
05:42
You think about a baseball team:
baseball players practice.
baseball players practice.
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我认为那是渐进训练的完美示例。
05:45
I think it's a beautiful example
of progressive training.
of progressive training.
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首先他们要做的是春季训练。
05:48
The first thing they do
is go out to spring training.
is go out to spring training.
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他们去春季训练营，
05:51
They go to a spring training camp,
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也许用棒球模拟器。
05:53
perhaps a simulator in baseball.
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他们不在真实赛场，
但在模拟赛场上，
但在模拟赛场上，
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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他们在赛前季节打球。
05:59
and they're playing in the pregame season.
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然后在赛季比赛中进入赛场。
06:01
Then they make their way to the field
during the season games,
during the season games,
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开始比赛前他们做什么？
06:05
and what's the first thing they do
before they start the game?
before they start the game?
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是去击球练习区做数小时的击打练习，
06:08
They go into the batting cage
and do batting practice for hours,
and do batting practice for hours,
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球以各种投掷方式投向他们，
06:12
having different types of pitches
being thrown at them,
being thrown at them,
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一次接一次地击球，练习肌肉，
06:16
hitting ball after ball
as they limber their muscles,
as they limber their muscles,
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为真正的比赛做准备。
06:20
getting ready for the game itself.
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这是最令人震惊的部分，
06:22
And here's the most
phenomenal part of this,
phenomenal part of this,
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所有观看任何体育比赛的人，
06:26
and for all of you who watch
any sport event,
any sport event,
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06:29
you will see this phenomenon happen.
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都会看到这种现象。
击球手进入击球位，
06:31
The batter gets into the batter's box,
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投球手准备投掷。
06:34
the pitcher gets ready to pitch.
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就在马上投球之前，
06:36
Right before the pitch is thrown,
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击球手做了什么？
06:39
what does that batter do?
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击球手退出击球位，
06:41
The batter steps out of the box
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06:44
and takes a practice swing.
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练习一次挥臂动作。
他一定会这样做。
06:46
He wouldn't do it any other way.
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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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我想告诉你的是，
我们在医疗行业是
如何像他们这样做击球练习的。
如何像他们这样做击球练习的。
06:52
in medicine.
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我们在波士顿儿童医院，
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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为我们的患者做一个击球练习区。
06:58
at Boston Children's.
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我想利用一下，
这个最近做好的病例。
这个最近做好的病例。
06:59
I want to use this case
that we recently built.
that we recently built.
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这是四岁儿童头部逐渐扩大的病例，
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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作为结果，
07:06
and as a result,
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这种病症会导致发育缺失，重要的神经功能缺失，
07:08
had loss of developmental milestones,
neurologic milestones,
neurologic milestones,
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这个问题的原因在这里——
07:11
and the reason for this problem is here --
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它叫做脑积水。
07:14
it's called hydrocephalus.
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那么，简短解释下脑外科知识。
07:16
So, a quick study in neurosurgery.
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这是脑部。
07:19
There's the brain,
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你能看到包围大脑的颅骨。
07:20
and you can see the cranium
surrounding the brain.
surrounding the brain.
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在大脑和颅骨之间，围绕大脑的
07:23
What surrounds the brain,
between the brain and cranium,
between the brain and cranium,
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是脑脊液，
07:27
is something called
cerebrospinal fluid or fluid,
cerebrospinal fluid or fluid,
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它的作用是减震。
07:30
which acts as a shock absorber.
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现在你的头部里面，
07:32
In your heads right now,
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有脑脊液正在浸泡着你的脑部，
07:33
there is cerebrospinal fluid
just bathing your brains
just bathing your brains
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并围绕着脑部。
07:37
and making its way around.
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它在一个区域产生，流动，
07:39
It's produced in one area
and flows through,
and flows through,
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然后再循环。
07:41
and then is re-exchanged.
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我们每个人都有这种美丽的流动通道。
07:43
And this beautiful flow pattern
occurs for all of us.
occurs for all of us.
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但不幸的是，有些孩子，
07:46
But unfortunately in some children,
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这种流通通道受到阻碍，
07:48
there's a blockage of this flow pattern,
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就像堵车。
07:51
much like a traffic jam.
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结果是，脑脊液积聚，
07:53
As a result, the fluid accumulates,
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脑部被推到一边。
07:55
and the brain is pushed aside.
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难以生长。
07:59
It has difficulty growing.
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结果，孩子失去神经系统的重要功能。
08:01
As a result, the child loses
neurologic milestones.
neurologic milestones.
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这是对于儿童的毁灭性疾病。
08:05
This is a devastating disease in children.
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它的治疗方法是手术。
08:08
The cure for this is surgery.
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传统手术是取下一点颅骨，
08:12
The traditional surgery is to take
a bit of the cranium off,
a bit of the cranium off,
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头骨的一小部分，
08:15
a bit of the skull,
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排出液体，在适当位置安装排放管，
08:16
drain this fluid out,
stick a drain in place,
stick a drain in place,
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然后最终把这排放管引到身体内部。
08:19
and then eventually bring
this drain internal to the body.
this drain internal to the body.
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大手术。
08:21
Big operation.
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但好消息是，神经外科医疗的进步
08:24
But some great news is that advances
in neurosurgical care
in neurosurgical care
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让我们为这手术开发出
08:28
have allowed us to develop
minimally invasive approaches
minimally invasive approaches
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微创方法。
08:32
to this surgery.
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通过小针孔，可插入相机，
08:33
Through a small pinhole,
a camera can be inserted,
a camera can be inserted,
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引导相机进入深层脑结构，
08:38
led into the deep brain structure,
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并在膜上开个小孔，让液体排出，
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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就像在水槽里排水一样。
08:45
much like it would in a sink.
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转眼间，脑部不再受压，
08:47
All of a sudden, the brain
is no longer under pressure,
is no longer under pressure,
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能再扩大，
08:50
can re-expand
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我们通过单孔切口治好了这孩子。
08:52
and we cure the child
through a single-hole incision.
through a single-hole incision.
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08:56
But here's the problem:
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但问题是：
脑积水比较少见。
08:58
hydrocephalus is relatively rare.
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并且没有好的训练方法
09:00
And there are no good training methods
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能让我们在把镜头
放入正确位置时相当熟练。
放入正确位置时相当熟练。
09:03
to get really good at getting
this scope to the right place.
this scope to the right place.
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但外科医生对此特别有创造力，
甚至我们自己的医生也是。
甚至我们自己的医生也是。
09:06
But surgeons have been quite creative
about this, even our own.
about this, even our own.
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他们发明了训练模型。
09:11
And they've come up with training models.
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这是目前的训练模型。
09:13
Here's the current training model.
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09:15
(Laughter)
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1958
（笑声）
我可没开玩笑。
09:17
I kid you not.
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这是红辣椒，不是好莱坞做的；
09:18
This is a red pepper,
not made in Hollywood;
not made in Hollywood;
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是真正的红辣椒。
09:21
it's real red pepper.
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外科医生把镜头伸到辣椒里面，
09:23
And what surgeons do is they stick
a scope into the pepper,
a scope into the pepper,
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他们把这叫做“辣椒籽切除术”。
09:25
and they do what is called a "seedectomy."
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09:29
(Laughter)
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（笑声）
他们利用这个镜头，
用小镊子摘除辣椒籽。
用小镊子摘除辣椒籽。
09:30
They use this scope to remove seeds
using a little tweezer.
using a little tweezer.
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那是一种方式，能够学会
09:37
And that is a way to get under their belts
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做这个手术的基本操作。
09:40
the rudimentary components
of doing this surgery.
of doing this surgery.
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然后，他们直接进入学徒模式，
09:44
Then they head right into
the apprenticeship model,
the apprenticeship model,
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现场观摩很多手术，
09:46
seeing many of them
as they present themselves,
as they present themselves,
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然后亲自做，然后传授——
09:49
then doing it, and then teaching it --
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等待着新患者的到来。
09:51
waiting for these patients to arrive.
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2017
我们可以做得更好。
09:54
We can do a lot better.
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我们现在生产儿童的复制品
09:56
We are manufacturing
reproductions of children
reproductions of children
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用于给外科医生和手术团队
10:00
in order for surgeons and surgical
teams to rehearse
teams to rehearse
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用最接近的方式演练。
10:04
in the most relevant possible ways.
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我来展示一下这个。
10:07
Let me show you this.
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这是我的团队，
10:09
Here's my team
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它是模拟器项目的SIM工程部。
10:10
in what's called the SIM Engineering
Division of the Simulator Program.
Division of the Simulator Program.
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这是多人组成的一个神奇团队。
10:15
This is an amazing team of individuals.
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2843
他们是机械工程师；
10:18
They are mechanical engineers;
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这里看到的是演示器。
10:20
you're seeing here, illustrators.
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他们拿到CT扫描和MRI的原始数据，
10:22
They take primary data
from CT scans and MRIs,
from CT scans and MRIs,
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翻译成数字信息，
10:27
translate it into digital information,
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3330
使其动态化，
10:30
animate it,
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整合成儿童自己的身体器官，
10:32
put it together into the components
of the child itself,
of the child itself,
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根据手术本身，
10:37
surface-scan elements of the child
that have been casted as needed,
that have been casted as needed,
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3794
已经按需要投射儿童的体表扫描元素，
10:40
depending on the surgery itself,
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然后将这个数字数据输出到
10:43
and then take this digital data
and be able to output it
and be able to output it
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3891
最新技术的三维打印设备，
10:47
on state-of-the-art,
three-dimensional printing devices
three-dimensional printing devices
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该设备使我们能打印出
10:51
that allow us to print the components
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与儿童解剖结构的细微细节
完全一样的器官。
完全一样的器官。
10:53
exactly to the micron detail of what
the child's anatomy will look like.
the child's anatomy will look like.
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在这里可以看到，
10:59
You can see here,
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1304
在实施手术的数小时前，
11:00
the skull of this child being printed
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2434
打印出儿童的头骨。
11:02
in the hours before
we performed this surgery.
we performed this surgery.
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但是如果没有加州好莱坞的西海岸朋友们，
11:06
But we could not do this work
218
654618
2576
11:09
without our dear friends on the West Coast
in Hollywood, California.
in Hollywood, California.
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4387
我们做不到这样。
这是一些特别擅长
11:14
These are individuals
that are incredibly talented
that are incredibly talented
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再造现实的人。
11:18
at being able to recreate reality.
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2424
而这对我们来说并不是大步飞跃。
11:20
It was not a long leap for us.
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4424
我们在这个领域了解越多，
11:24
The more we got into this field,
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就越清楚，我们在做的是摄影。
11:26
the more it became clear to us
that we are doing cinematography.
that we are doing cinematography.
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我们在拍电影，
11:30
We're doing filmmaking,
225
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1877
只是演员并非演员，
11:32
it's just that the actors are not actors.
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2224
而是真正的医生和护士。
11:35
They're real doctors and nurses.
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683909
2496
这些照片来自
获得艾美奖的特效公司，
获得艾美奖的特效公司，
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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687190
3379
加州好莱坞的Fractured FX的朋友们，
11:42
in Hollywood California,
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11:44
an Emmy-Award-winning
special effects firm.
special effects firm.
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这是贾斯汀·罗利和他的小组——
11:47
This is Justin Raleigh and his group --
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这个可不是我们的病人——
11:50
this is not one of our patients --
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1648
（笑声）
11:52
(Laughter)
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1358
而是这些人做的精湛的工作。
11:53
but kind of the exquisite work
that these individuals do.
that these individuals do.
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我们现在已经合作并融合了我们的经验，
11:57
We have now collaborated
and fused our experience,
and fused our experience,
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请他们的团队到波士顿儿童医院，
12:00
bringing their group
to Boston Children's Hospital,
to Boston Children's Hospital,
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将我们的团队送到加州的好莱坞，
12:03
sending our group
out to Hollywood, California
out to Hollywood, California
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做各种交换
12:05
and exchanging around this
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以便能够开发这些类型的模拟器。
12:07
to be able to develop
these type of simulators.
these type of simulators.
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下面要展示的是这个孩子的复制品。
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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你会注意到，孩子头上的
每一根头发都被复制了。
每一根头发都被复制了。
12:19
You'll notice here that every hair
on the child's head is reproduced.
on the child's head is reproduced.
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事实上，这也是那个复制的孩子——
12:24
And in fact, this is also
that reproduced child --
that reproduced child --
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我为造成的任何不舒服道歉，
12:28
and I apologize for any queasy stomachs,
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但那是为他们要实施手术的孩子
12:31
but that is a reproduction and simulation
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所做的复制和模拟。
12:34
of the child they're about to operate on.
245
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2094
12:38
Here's that membrane we had talked about,
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这是我们前面说过的膜，
这孩子的脑部里面。
12:40
the inside of this child's brain.
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你将看到的是
一侧是真实的患者，
一侧是真实的患者，
12:43
What you're going to be seeing here
is, on one side, the actual patient,
is, on one side, the actual patient,
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另一侧是模拟器。
12:48
and on the other side, the simulator.
249
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2279
如我所说，镜头、小相机需要想办法下去，
12:50
As I mentioned, a scope, a little camera,
needs to make its way down,
needs to make its way down,
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你在这里能看到它。
12:55
and you're seeing that here.
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需要在这个膜上开个小孔
12:56
It needs to make a small hole
in this membrane
in this membrane
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2324
让液体渗出。
12:58
and allow this fluid to seep out.
253
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2709
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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我不会考你们哪一侧的真假，
13:08
but on the right is the simulator.
255
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2304
右侧是模拟器。
13:12
So surgeons can now produce
training opportunities,
training opportunities,
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3798
因此医生现在可以创造训练机会，
把这些手术做无数遍，
13:16
do these surgeries
as many times as they want,
as many times as they want,
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3053
直到他们满意，直到有信心。
13:19
to their heart's content,
until they feel comfortable.
until they feel comfortable.
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2842
然后，并且只有在那之后，
再把孩子送进手术室。
再把孩子送进手术室。
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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但这不是终点。
13:26
But we don't stop here.
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我们知道，关键步骤不只是技巧本身，
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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而是将技巧与实施手术的团队相结合。
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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现在我们看看一级方程式。
13:36
Now we turn to Formula One.
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2342
这是技术人员安装轮胎的例子，
13:39
And here is an example
of a technician putting on a tire
of a technician putting on a tire
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3250
一次又一次地在这个车上重复。
13:42
and doing that time and time
again on this car.
again on this car.
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3209
但这很快就结合到
13:45
But that is very quickly
going to be incorporated
going to be incorporated
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2985
团队训练之中，
13:48
within team-training experiences,
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1931
现在作为整个团队来协调换轮胎，
13:50
now as a full team orchestrating
the exchange of tires
the exchange of tires
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4209
把车送回赛道。
13:54
and getting this car back on the speedway.
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2998
那么我们在医疗领域也这么做了
13:58
We've done that step in health care,
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现在你要看的是模拟手术，
14:01
so now what you're about to see
is a simulated operation.
is a simulated operation.
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把我刚才描述的模拟器，
14:06
We've taken the simulator
I just described to you,
I just described to you,
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2387
带到波士顿儿童医院的手术室，
14:09
we've brought it into the operating room
at Boston Children's Hospital,
at Boston Children's Hospital,
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这些人——本地团队，手术团队——
14:12
and these individuals --
these native teams, operative teams --
these native teams, operative teams --
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在真正的手术之前
已经在做这个手术了。
已经在做这个手术了。
14:16
are doing the surgery before the surgery.
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3523
操作两次；实切一次。
14:19
Operate twice;
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1737
14:21
cut once.
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1206
请看。
14:23
Let me show that to you.
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1396
（视频）手术队员1：
你想让头部降低还是升高？
你想让头部降低还是升高？
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
手术队员2：能降到10吗？
14:28
STM 2: Can you lower it down to 10?
280
856554
1704
手术队员3：整个台降低一点？
14:30
STM 3: And then lower
the whole table down a little bit?
the whole table down a little bit?
281
858282
2649
手术队员4：手术台正在下降
14:32
STM 4: Table coming down.
282
860955
1254
14:36
STM 3: All right, this
is behaving like a vessel.
is behaving like a vessel.
283
864856
2705
手术队员3：好的，这里有类血管表现
请把剪子拿回来好吗？
14:39
Could we have the scissors back, please?
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2087
手术队员5：我正戴手套，8到8 1/2，马上加入
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.
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3301
手术队员6：太好了！谢谢。
14:45
STM 6: Great! Thank you.
286
873021
2401
14:48
Peter Weinstock: It's really amazing.
287
876336
1833
真的很棒。
这里的第二步，非常关键，
14:50
The second step to this,
which is critical,
which is critical,
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2092
我们马上请这些团队出来，
听他们汇报。
听他们汇报。
14:52
is we take these teams out
immediately and debrief them.
immediately and debrief them.
289
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3099
我们使用的技术
14:55
We use the same technologies
290
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1464
与军方的精益和六西格玛
使用的技术相同，
使用的技术相同，
14:56
that are used in Lean
and Six Sigma in the military,
and Six Sigma in the military,
291
884920
4688
让他们出来
讨论哪里做的正确，
讨论哪里做的正确，
15:01
and we bring them out
and talk about what went right,
and talk about what went right,
292
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3085
更重要的是，
15:04
but more importantly,
293
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1645
讨论哪里做得不好，
15:06
we talk about what didn't go well,
294
894410
2467
以及如何改正。
15:08
and how we're going to fix it.
295
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1935
然后让他们马上回去，
再做一次。
再做一次。
15:10
Then we bring them right back in
and do it again.
and do it again.
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2754
在最重要的时刻，
做刻意的“击打”练习。
做刻意的“击打”练习。
15:13
Deliberative batting practice
in the moments when it matters most.
in the moments when it matters most.
297
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5191
15:20
Let's go back to this case now.
298
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2022
现在我们回到这个病例。
同一个孩子，
15:23
Same child,
299
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1377
但这次我要描述的是
15:24
but now let me describe
how we care for this child
how we care for this child
300
912484
2390
我们在波士顿儿童医院
如何护理这个孩子。
如何护理这个孩子。
15:26
at Boston Children's Hospital.
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914898
1463
这孩子在凌晨三点出生。
15:28
This child was born
at three o'clock in the morning.
at three o'clock in the morning.
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2486
在凌晨两点，
15:30
At two o'clock in the morning,
303
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2007
我们集合队伍，
15:32
we assembled the team,
304
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2126
拿到从扫描和图像做出的
15:35
and took the reproduced anatomy
305
923076
1801
复制的解剖结构，
15:36
that we would gain
out of scans and images,
out of scans and images,
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3705
把团队带到虚拟病床，
15:40
and brought that team
to the virtual bedside,
to the virtual bedside,
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模拟的病床——
15:43
to a simulated bedside --
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几小时后要为这孩子
做手术的同一个团队——
做手术的同一个团队——
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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让他们做一遍手术。
15:48
and we have them do the procedure.
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请看其中的片段。
15:51
Let me show you a moment of this.
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这不是真的切口。
15:54
This is not a real incision.
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婴儿还未出生。
15:57
And the baby has not yet been born.
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16:01
Imagine this.
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想象一下吧。
16:04
So now the conversations
that I have with families
that I have with families
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那么现在，在波士顿儿童医院
的重症监护室，
的重症监护室，
我与孩子家长的对话
16:08
in the intensive care unit
at Boston Children's Hospital
at Boston Children's Hospital
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就完全不同了。
16:10
are totally different.
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想象下这样的对话：
16:12
Imagine this conversation:
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16:15
"Not only do we take care of this disorder
frequently in our ICU,
frequently in our ICU,
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“我们在ICU不仅
经常治疗这种疾病，
经常治疗这种疾病，
以及不仅做过
您孩子要做的这种手术，
您孩子要做的这种手术，
16:20
and not only have we done surgeries
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16:22
like the surgery we're going
to do on your child,
to do on your child,
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而且，我们已经做过了
您的孩子的这台手术。
您的孩子的这台手术。
16:25
but we have done your child's surgery.
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我们两个小时前做的。
16:29
And we did it two hours ago.
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并且做了10次。
16:32
And we did it 10 times.
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现在，我们准备好真正的手术了。”
16:35
And now we're prepared to take them
back to the operating room."
back to the operating room."
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16:40
So a new technology in health care:
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因此，医疗新技术：
16:44
lifelike rehearsal.
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生命模拟演练。
比赛之前的练习。
16:47
Practicing prior to game time.
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16:51
Thank you.
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谢谢。
16:52
(Applause)
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（掌声）
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