TEDxBeaconStreet
Nikolai Begg: A tool to fix one of the most dangerous moments in surgery
尼古拉．貝格: 讓手術關鍵時刻更安全的工具
Filmed:
Readability: 4
1,373,990 views
每一天，外科醫生都得在手術前，對病患體表進行穿刺──每次穿刺，都潛在損傷體內組織器官的風險。在這引人入勝的演講中，我們將看到機械工程師尼古拉利用物理原理，改良一種重要的手術器械──穿刺套針，以改善許多常見手術中危險性極高的穿刺步驟。
Nikolai Begg - Mechanical engineer
Nikolai Begg is a PhD candidate in mechanical engineering whose passion is rethinking medical devices. Full bio
Nikolai Begg is a PhD candidate in mechanical engineering whose passion is rethinking medical devices. Full bio
Double-click the English transcript below to play the video.
00:12
The first time I stood
in the operating room
in the operating room
0
879
1976
我第一次進手術室
00:14
and watched a real surgery,
1
2855
1872
觀摩實際手術時，
00:16
I had no idea what to expect.
2
4727
2575
沒預料會看到什麼。
00:19
I was a college student in engineering.
3
7302
1975
我當時是工科大學生。
00:21
I thought it was going to be like on TV.
4
9277
2200
我以為會像電視上演的一樣，
00:23
Ominous music playing in the background,
5
11477
1905
播著緊張的背景音樂，
00:25
beads of sweat pouring down the surgeon's face.
6
13382
2999
豆大的汗珠由外科醫生臉上滑落。
00:28
But it wasn't like that at all.
7
16381
2160
但根本不是那樣。
00:30
There was music playing on this day,
8
18541
1599
當天的確有播音樂，
00:32
I think it was Madonna's greatest hits. (Laughter)
9
20140
2722
我想是瑪丹娜的金曲選輯。
（笑聲）
（笑聲）
00:34
And there was plenty of conversation,
10
22862
2127
當時還有許多交談，
00:36
not just about the patient's heart rate,
11
24989
2000
話題除了病人心率外，
00:38
but about sports and weekend plans.
12
26989
2773
還有運動跟週末計劃。
00:41
And since then, the more surgeries I watched,
13
29762
1936
我手術看得越多，
00:43
the more I realized this is how it is.
14
31698
1827
就越懂那是怎麼回事。
00:45
In some weird way, it's just
another day at the office.
another day at the office.
15
33525
2753
從某個古怪角度來看，
這跟在辦公室沒兩樣。
這跟在辦公室沒兩樣。
00:48
But every so often
16
36278
1905
但有時，
00:50
the music gets turned down,
17
38183
2098
音樂聲會被轉小，
00:52
everyone stops talking,
18
40281
1430
所有人停止說話，
00:53
and stares at exactly the same thing.
19
41711
2984
眼睛盯著同樣的東西。
00:56
And that's when you know
that something absolutely critical
that something absolutely critical
20
44695
2160
那時你就知道，有很重要、
00:58
and dangerous is happening.
21
46855
2440
很危險的事情正在進行。
01:01
The first time I saw that
22
49295
1016
首次遇到那狀況時，
01:02
I was watching a type of surgery
23
50311
1232
我正在觀摩腹腔鏡手術。
01:03
called laparoscopic surgery
24
51543
2289
01:05
And for those of you who are unfamiliar,
25
53832
2558
為不熟悉的人說明一下，
01:08
laparoscopic surgery, instead of the large
26
56390
2393
腹腔鏡手術不像
01:10
open incision you might
be used to with surgery,
be used to with surgery,
27
58783
2494
傳統大切口的手術，
01:13
a laparoscopic surgery
is where the surgeon creates
is where the surgeon creates
28
61277
2208
腹腔鏡手術中，外科醫生
01:15
these three or more small
incisions in the patient.
incisions in the patient.
29
63485
3017
在病人身上開三個以上的切口。
01:18
And then inserts these long, thin instruments
30
66502
2866
接著插入這些細長、
附攝影機的器材，
01:21
and a camera,
31
69368
1114
01:22
and actually does the procedure inside the patient.
32
70482
3851
並透過它在病患體內進行手術。
01:26
This is great because there's
much less risk of infection,
much less risk of infection,
33
74333
2592
這很不錯，因為感染風險低、
01:28
much less pain, shorter recovery time.
34
76925
3160
較少疼痛，恢復時間也更短。
01:32
But there is a trade-off,
35
80085
2592
但這其中有著取捨，
01:34
because these incisions are created
36
82677
1784
因為開這些切口
01:36
with a long, pointed device
37
84461
2498
用的是個尖長的器械，
01:38
called a trocar.
38
86959
1464
叫做穿刺套針。
01:40
And the way the surgeon uses this device
39
88423
2194
而外科醫生用這器械的方法
01:42
is that he takes it
40
90617
1416
是他抓著這東西，
01:44
and he presses it into the abdomen
41
92033
1967
然後壓在你的腹部，
01:46
until it punctures through.
42
94000
3255
直到它穿進去。
01:49
And now the reason why
everyone in the operating room
everyone in the operating room
43
97255
3072
這就是為何在手術室的所有人
01:52
was staring at that device on that day
44
100327
2647
在當時都盯著那東西看，
01:54
was because he had to be absolutely careful
45
102974
3231
因為他必須非常小心
01:58
not to plunge it through
46
106205
1467
不要穿太過，
01:59
and puncture it into the organs
and blood vessels below.
and blood vessels below.
47
107672
3941
以免刺穿下面的臟器和血管。
02:03
But this problem should seem
pretty familiar to all of you
pretty familiar to all of you
48
111613
1839
但這問題大家都很熟，
02:05
because I'm pretty sure
you've seen it somewhere else.
you've seen it somewhere else.
49
113452
2921
因為你們八成在其他地方看過了。
02:08
(Laughter)
50
116373
1792
（笑聲）
02:10
Remember this?
51
118165
1656
記得這個吧？
02:11
(Applause)
52
119821
4116
（掌聲）
02:15
You knew that at any second
53
123937
1876
你很清楚在某個時間點，
02:17
that straw was going to plunge through,
54
125813
1880
吸管會刺穿，
02:19
and you didn't know if it was
going to go out the other side
going to go out the other side
55
127693
1585
而你不知是否會穿透，
02:21
and straight into your hand,
56
129278
1303
戳到你的手，
02:22
or if you were going to
get juice everywhere,
get juice everywhere,
57
130581
1696
或把果汁噴得到處是。
02:24
but you were terrified. Right?
58
132277
3303
你怕死了。對吧？
02:27
Every single time you did this,
59
135580
1976
每次你做這件事，
02:29
you experienced the same
fundamental physics
fundamental physics
60
137556
2556
所體驗到的物理原理，
02:32
that I was watching in the operating room that day.
61
140112
3080
都和我那天在手術室經歷的一樣。
02:35
And it turns out it really is a problem.
62
143192
2546
這顯然是個大問題。
02:37
In 2003, the FDA actually came out and said
63
145738
2792
2003 年，FDA 甚至出面表示：
02:40
that trocar incisions might
be the most dangerous step
be the most dangerous step
64
148530
3377
套針穿刺或許是在微創手術中
02:43
in minimally invasive surgery.
65
151907
2016
最危險的步驟。
02:45
Again in 2009, we see a paper that says
66
153923
2440
2009 年，我們又看到一篇論文說：
02:48
that trocars account for over half
67
156363
2184
腹腔鏡手術的主要併發症
02:50
of all major complications in laparoscopic surgery.
68
158547
3687
有半數以上和穿刺套針有關。
02:54
And, oh by the way,
69
162234
1142
噢！除此之外，
02:55
this hasn't changed for 25 years.
70
163376
3594
這件事已經 25 年沒變了。
02:58
So when I got to graduate school,
71
166970
1530
所以我上研究所時，
03:00
this is what I wanted to work on.
72
168500
1868
就想做這東西。
03:02
I was trying to explain to a friend of mine
73
170368
1808
我試著跟朋友解釋
03:04
what exactly I was spending my time doing,
74
172176
2115
我到底在忙什麼，
03:06
and I said,
75
174291
1816
我說：
03:08
"It's like when you're drilling through a wall
76
176107
2176
「這就像你為了掛東西
03:10
to hang something in your apartment.
77
178283
3200
鑽牆壁那樣。
03:13
There's that moment when the drill
first punctures through the wall
first punctures through the wall
78
181483
3912
鑽子在鑽穿牆壁那個瞬間
03:17
and there's this plunge. Right?
79
185395
3652
會爆衝一下。對吧？」
03:23
And he looked at me and he said,
80
191389
2041
然後他看著我說：
03:25
"You mean like when they drill
into people's brains?"
into people's brains?"
81
193430
3471
「你是說，
像他們鑽人腦袋那樣？」
像他們鑽人腦袋那樣？」
03:28
And I said, "Excuse me?" (Laughter)
82
196901
2332
然後我說：「啥？！」
（笑聲）
（笑聲）
03:31
And then I looked it up and they
do drill into people's brains.
do drill into people's brains.
83
199233
3048
我後來查了一下，
發現他們真會這麼做。
發現他們真會這麼做。
03:34
A lot of neurosurgical procedures
84
202281
2064
很多的神經外科手術
03:36
actually start with a drill
incision through the skull.
incision through the skull.
85
204345
3782
第一步就是在你顱骨上鑽個洞。
03:40
And if the surgeon isn't careful,
86
208127
1785
如果外科醫生不謹慎，
03:41
he can plunge directly into the brain.
87
209912
3584
他有可能會直接戳到腦部。
03:45
So this is the moment when I started thinking,
88
213496
2166
從那時候我開始思考，
03:47
okay, cranial drilling, laparoscopic surgery,
89
215662
3308
好，顱骨鑽孔、腹腔鏡手術，
03:50
why not other areas of medicine?
90
218970
1664
那其他醫學領域呢？
03:52
Because think about it, when was
the last time you went to the doctor
the last time you went to the doctor
91
220634
1944
你想想，哪次你去看醫生
03:54
and you didn't get stuck with something? Right?
92
222578
2747
沒被塞點什麼，是吧？
03:57
So the truth is
93
225325
1317
事實就是，
03:58
in medicine puncture is everywhere.
94
226642
2552
在醫學上，穿刺無所不在。
04:01
And here are just a couple
of the procedures that I've found
of the procedures that I've found
95
229194
2792
而這只是我查到的幾種手術，
04:03
that involve some tissue puncture step.
96
231986
3209
其中有組織穿刺的步驟。
04:07
And if we take just three of them —
97
235195
2079
如果我們只看其中三種──
04:09
laparoscopic surgery,
epidurals, and cranial drilling —
epidurals, and cranial drilling —
98
237274
4096
腹腔鏡手術、硬膜外麻醉、
顱骨鑽孔──
顱骨鑽孔──
04:13
these procedures account
for over 30,000 complications
for over 30,000 complications
99
241370
3979
而這些手術引發了
超過三萬起的併發症，
超過三萬起的併發症，
04:17
every year in this country alone.
100
245349
2851
而這只是這個國家一年的數字。
04:20
I call that a problem worth solving.
101
248200
2715
我認為這是個值得解決的問題。
04:22
So let's take a look at some of the devices
102
250915
2325
讓我們來看一些
04:25
that are used in these types of procedures.
103
253240
2504
用在這類手術的器械。
04:27
I mentioned epidurals. This is an epidural needle.
104
255744
3225
我提過硬膜外麻醉。
這是硬膜外套針。
這是硬膜外套針。
04:30
It's used to puncture through
the ligaments in the spine
the ligaments in the spine
105
258969
2317
他用來穿刺脊椎韌帶，
04:33
and deliver anesthesia during childbirth.
106
261286
2439
在分娩時注射麻醉藥。
04:35
Here's a set of bone marrow biopsy tools.
107
263725
2553
這是組骨髓切片取樣工具，
04:38
These are actually used
to burrow into the bone
to burrow into the bone
108
266278
1936
用來做骨骼穿孔，
04:40
and collect bone marrow
or sample bone lesions.
or sample bone lesions.
109
268214
3500
並收集骨髓，
或做骨骼病變的取樣。
或做骨骼病變的取樣。
04:43
Here's a bayonette from the Civil War.
110
271714
1910
這是南北戰爭的刺刀。
04:45
(Laughter)
111
273624
3016
（笑聲）
04:48
If I had told you it was a
medical puncture device
medical puncture device
112
276640
2593
若我告訴你這是醫學穿刺器材，
04:51
you probably would have believed me.
113
279233
2216
你說不定真會相信我。
04:53
Because what's the difference?
114
281449
2193
因為這沒什麼不同嘛！
04:55
So, the more I did this research
115
283642
1935
我越深入研究，
04:57
the more I thought there has to be
116
285577
1584
越是覺得
一定有更好的做法。
04:59
a better way to do this.
117
287161
2029
05:01
And for me the key to this problem
118
289190
2419
對我來說，問題的關鍵在於
05:03
is that all these different puncture devices
119
291609
2411
所有的這些穿刺器材
05:06
share a common set of fundamental physics.
120
294020
3802
都遵循同一套物理原理。
05:09
So what are those physics?
121
297822
1552
什麼原理呢？
05:11
Let's go back to drilling through a wall.
122
299374
1592
讓我們回到鑽牆壁。
05:12
So you're applying a force
on a drill towards the wall.
on a drill towards the wall.
123
300966
3632
你透過鑽子對牆施加壓力，
05:16
And Newton says the wall
is going to apply force back,
is going to apply force back,
124
304598
3344
牛頓告訴我們，
牆壁會給我們反作用力，
牆壁會給我們反作用力，
05:19
equal and opposite.
125
307942
1265
等量且反向。
05:21
So, as you drill through the wall,
126
309207
1963
當你正在鑽的時候，
05:23
those forces balance.
127
311170
1930
兩力平衡。
05:25
But then there's that moment
128
313100
1541
但在某個瞬間，
05:26
when the drill first punctures
through the other side of the wall,
through the other side of the wall,
129
314641
2136
牆壁會被鑽穿，
05:28
and right at that moment
the wall can't push back anymore.
the wall can't push back anymore.
130
316777
2856
牆壁將無法再提供反作用力。
05:31
But your brain hasn't reacted
to that change in force.
to that change in force.
131
319633
3467
但你的大腦還來不及
對變化作出反應，
對變化作出反應，
05:35
So for that millisecond,
132
323100
1061
有幾毫秒時間
05:36
or however long it takes you
to react, you're still pushing,
to react, you're still pushing,
133
324161
2632
──依你的反應速度而定，
你還在施加壓力。
你還在施加壓力。
05:38
and that unbalanced force
causes an acceleration,
causes an acceleration,
134
326793
2544
而不平衡的力造成加速度，
05:41
and that is the plunge.
135
329337
3112
導致爆衝。
05:44
But what if right at the moment of puncture
136
332449
3904
但如果在刺穿瞬間，
05:48
you could pull that tip back,
137
336353
1624
你能夠將針尖
05:49
actually oppose the forward acceleration?
138
337977
3013
往加速的反方向縮回呢？
05:52
That's what I set out to do.
139
340990
2137
那就是我要做的。
05:55
So imagine you have a device
140
343127
1320
想像你有種器材，
05:56
and it's got some kind of sharp tip
to cut through tissue.
to cut through tissue.
141
344447
3200
它有用來刺穿組織的針尖。
05:59
What's the simplest way
you could pull that tip back?
you could pull that tip back?
142
347647
3213
把針尖縮回的最簡單方法是什麼？
06:02
I chose a spring.
143
350860
1811
我選擇了彈簧。
06:04
So when you extend that spring,
you extend that tip out
you extend that tip out
144
352671
2584
當彈簧拉伸，針尖便伸出，
06:07
so it's ready to puncture tissue,
145
355255
2215
就能穿刺組織。
06:09
the spring wants to pull the tip back.
146
357470
1440
彈簧會想拉回針尖。
06:10
How do you keep the tip in place
147
358910
1753
你如何在穿透前，
06:12
until the moment of puncture?
148
360663
2464
固定住針尖呢？
06:15
I used this mechanism.
149
363127
2423
我採用這機械結構。
06:17
When the tip of the device
is pressed against tissue,
is pressed against tissue,
150
365550
2561
當針尖受到組織的反作用力，
06:20
the mechanism expands outwards
and wedges in place against the wall.
and wedges in place against the wall.
151
368111
3840
這機構會向外撐向內壁。
06:23
And the friction that's generated
152
371951
1704
而其產生的摩擦力
06:25
locks it in place and prevents
the spring from retracting the tip.
the spring from retracting the tip.
153
373655
3192
會鎖定針尖，阻止彈簧將它縮回。
06:28
But right at the moment of puncture,
154
376847
1887
但在穿透瞬間，
06:30
the tissue can't push back
on the tip anymore.
on the tip anymore.
155
378734
2064
組織不再提供反作用力。
06:32
So the mechanism unlocks
and the spring retracts the tip.
and the spring retracts the tip.
156
380798
3182
所以機構解鎖，彈簧將針尖縮回。
06:35
Let me show you that
happening in slow motion.
happening in slow motion.
157
383980
1650
看一下慢動作。
06:37
This is about 2,000 frames a second,
158
385630
1648
這大約每秒 2,000 畫格。
06:39
and I'd like you to notice the tip
159
387278
1872
注意針尖的部分，
06:41
that's right there on the bottom,
about to puncture through tissue.
about to puncture through tissue.
160
389150
2628
在畫面下方，即將刺穿組織。
06:43
And you'll see that
right at the moment of puncture,
right at the moment of puncture,
161
391778
3061
你會發現在刺穿的瞬間，
在這，機構解鎖，針尖縮回。
06:48
right there, the mechanism unlocks
and retracts that tip back.
and retracts that tip back.
162
396590
3302
06:51
I want to show it to you again, a little closer up.
163
399892
2344
我們拉近點再看一次。
06:54
You're going to see the sharp bladed tip,
164
402236
2192
你會看到那尖銳的針尖，
06:56
and right when it punctures
that rubber membrane
that rubber membrane
165
404428
1992
在它刺穿橡膠膜的瞬間，
06:58
it's going to disappear
into this white blunt sheath.
into this white blunt sheath.
166
406420
4152
會縮進那個鈍邊白色套管。
07:02
Right there.
167
410572
1865
在這。
07:04
That happens within four 100ths
of a second after puncture.
of a second after puncture.
168
412437
4664
這一切都在百分之四秒內發生。
07:09
And because this device is designed
to address the physics of puncture
to address the physics of puncture
169
417101
3800
而且因為這項設計是
遵循穿刺的物理原理
遵循穿刺的物理原理
07:12
and not the specifics of cranial drilling
170
420901
1832
而非針對顱骨鑽孔、
07:14
or laparoscopic surgery,
or another procedure,
or another procedure,
171
422733
2207
腹腔鏡手術或其他手術，
07:16
it's applicable across these
different medical disciplines
different medical disciplines
172
424940
2657
其適用範圍涵蓋醫學各領域，
07:19
and across different length scales.
173
427597
3031
以及各種不同規模。
07:22
But it didn't always look like this.
174
430628
2113
但它不見得長這樣。
07:24
This was my first prototype.
175
432741
2185
這是我作品的原型。
07:26
Yes, those are popsicle sticks,
176
434926
2642
對，那是冰棒棍，
07:29
and there's a rubber band at the top.
177
437568
1902
頂部那是橡皮筋。
07:31
It took about 30 minutes to do this, but it worked.
178
439470
3400
做這只花 30 分鐘，但成品就有用了。
07:34
And it proved to me that my idea worked
179
442870
1696
它證明我的想法可行，
07:36
and it justified the next couple
years of work on this project.
years of work on this project.
180
444566
3392
並讓我接下來幾年的
付出有所憑據。
付出有所憑據。
07:39
I worked on this because
181
447958
1808
我投入其中，
因為這問題讓我著迷，
07:41
this problem really fascinated me.
182
449766
1663
07:43
It kept me up at night.
183
451429
2129
甚至使我夜不能眠。
07:45
But I think it should fascinate you too,
184
453558
2982
但我想這也該吸引你，
07:48
because I said puncture is everywhere.
185
456540
1902
因為穿刺無所不在。
07:50
That means at some point
it's going to be your problem too.
it's going to be your problem too.
186
458442
4264
意味著在某個時刻，
那也將成為你的問題。
那也將成為你的問題。
07:54
That first day in the operating room
187
462706
1560
進手術室第一天，
07:56
I never expected to find myself
on the other end of a trocar.
on the other end of a trocar.
188
464266
2984
我沒料到有天
穿刺套針會用在我身上。
穿刺套針會用在我身上。
07:59
But last year, I got appendicitis
when I was visiting Greece.
when I was visiting Greece.
189
467250
3890
但去年，我在希臘時
患上闌尾炎。
患上闌尾炎。
08:03
So I was in the hospital in Athens,
190
471140
1830
我在雅典的醫院，
08:04
and the surgeon was telling me
191
472970
1488
外科醫生告知我
08:06
he was going to perform
a laparoscopic surgery.
a laparoscopic surgery.
192
474458
2136
他將進行腹腔鏡手術。
08:08
He was going to remove my appendix
through these tiny incisions,
through these tiny incisions,
193
476594
2752
他將透過那些小切口切除闌尾，
08:11
and he was talking about what
I could expect for the recovery,
I could expect for the recovery,
194
479346
2694
接著他告訴我預期的康復狀況、
08:14
and what was going to happen.
195
482040
1442
接下來會做什麼。
08:15
He said, "Do you have any questions?"
And I said, "Just one, doc.
And I said, "Just one, doc.
196
483482
2418
他說：「你有什麼問題嗎？」
我說：「只有一個。
我說：「只有一個。
08:17
What kind of trocar do you use?"
197
485900
3474
你們用的是哪種穿刺套針？」
08:21
So my favorite quote
about laparoscopic surgery
about laparoscopic surgery
198
489374
3505
關於腹腔鏡手術，我最愛的引語
08:24
comes from a Doctor H. C. Jacobaeus:
199
492879
2646
出自雅各貝烏斯醫師：
08:27
"It is puncture itself that causes risk."
200
495525
3664
「造成風險的，是穿刺本身。」
08:31
That's my favorite quote
because H.C. Jacobaeus
because H.C. Jacobaeus
201
499189
3136
這是我最愛的引語，
因為雅各貝烏斯
因為雅各貝烏斯
08:34
was the first person to ever perform
laparoscopic surgery on humans,
laparoscopic surgery on humans,
202
502325
4040
是在人體進行
腹腔鏡手術的第一人。
腹腔鏡手術的第一人。
08:38
and he wrote that in 1912.
203
506365
3432
而他在 1912 年寫下這句話。
08:41
This is a problem that's been injuring and
even killing people for over 100 years.
even killing people for over 100 years.
204
509797
5784
這問題傷害人們，
甚至致人於死已超過百年之久。
甚至致人於死已超過百年之久。
08:47
So it's easy to think that for
every major problem out there
every major problem out there
205
515581
2234
你可以安逸地想說，重要問題
08:49
there's some team of experts
working around the clock to solve it.
working around the clock to solve it.
206
517815
3936
已有一群專家不眠不休致力解決。
08:53
The truth is that's not always the case.
207
521751
3349
真相是，事情並非總如此。
08:57
We have to be better at finding those problems
208
525100
2445
我們得找到這樣的問題，
08:59
and finding ways to solve them.
209
527545
2768
並找方法解決。
09:02
So if you come across a problem that grabs you,
210
530313
3256
所以若你遇到那種
「刺眼」的問題，
「刺眼」的問題，
09:05
let it keep you up at night.
211
533569
1881
讓自己夜以繼日地投入吧！
09:07
Allow yourself to be fascinated,
212
535450
2143
讓自己為其著迷，
09:09
because there are so many lives to save.
213
537593
2912
因為有太多的生命，正待幫助。
09:12
(Applause)
214
540505
3399
（掌聲）
ABOUT THE SPEAKER
Nikolai Begg - Mechanical engineerNikolai Begg is a PhD candidate in mechanical engineering whose passion is rethinking medical devices.
Why you should listen
Since Nikolai Begg first saw robotic surgery performed as a thirteen-year-old, he has been in love with building things to help others. Now as a PhD Candidate in mechanical engineering at MIT, Begg works on designs to improve any number of things in people's lives -- from salt and pepper shakers that always stay in the same position relative to one another to a non-invasive female urinary catheter. He's especially passionate about how he can apply physics and mechanical principles to medical devices. In 2013 he won the annual Lemelson-MIT Student Prize for Invention, for a product that makes more precise incisions during surgery.
More profile about the speakerNikolai Begg | Speaker | TED.com