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  • The first time I stood in the operating room and watched a real surgery, I had no idea what to expect.

    翻訳: Akiko Hicks 校正: Eriko T

  • I was a college student in engineering.

    手術室に初めて入って

  • I thought it was going to be like on TV,

    実際に手術を見学するまで

  • ominous music playing in the background, beads of sweat pouring down the surgeon’s face.

    どんなものなのか イメージも浮かびませんでした

  • But it wasn’t like that at all.

    当時 大学の工学部の学生で

  • There was music playing on this day. I think it was Madonna’s greatest hits.

    テレビで見たようなものを 想像していました

  • And there was plenty of conversation, not just about the patient’s heart rate,

    不吉な音楽が流れる中で

  • but about sports and weekend plans.

    外科医の額からは汗が噴き出している

  • And since then, the more surgeries I watched, the more I realized this is how it is.

    でも 実際は全く違いました

  • In some weird ways, it’s just another day at the office.

    そこで流れていた音楽は

  • But every so often, the music gets turned down,

    マドンナのベストヒットだったと思います (笑)

  • everyone stops talking, and stares at exactly the same thing.

    手術スタッフ同士で よく会話もしています

  • And that’s when you know that something absolutely critical and dangerous is happening.

    患者の心拍数などだけではなく

  • The first time I saw that I was watching a type of surgery called laparoscopic surgery.

    スポーツの話とか 週末に何をするかとか

  • And for those who are unfamiliar, laparoscopic surgery, instead of the large open incision you might be used to with surgery,

    それ以後 手術というものを見学する度に

  • a laparoscopic surgery is where the surgeon creates these three or more small incisions in the patient.

    このようなものだと分かってきました

  • And then inserts these long, thin instruments and a camera,

    いつも通りの日常的な風景があるだけです

  • and actually does the procedure inside the patient.

    でも たまに

  • This is great because this is much less risk of infections, much less pain, shorter recovery time.

    音楽が止み

  • But there is a trade-off,

    突然皆が静かになって

  • because these incisions are created with a long, pointed device, called the trocar.

    全員が何かに注目することあります

  • And the way the surgeon uses this device is that he takes it

    これは 何か重大で 注意を要する危険なことが

  • and he presses it into the abdomen until it punctures through.

    起こっているサインです

  • And now the reason why everyone in the operating room was staring at that device on that day

    最初にそれを目撃したのは

  • was because he had to be absolutely careful not to plunge it through and puncture it into the organs and blood vessels below.

    腹腔鏡手術と呼ばれる

  • But this problem should seem pretty familiar to all of you,

    手術の最中でした

  • because I’m pretty sure youve seen it somewhere else.

    ご存知ない方のために 簡単に説明すると

  • Remember this?

    腹腔鏡手術では一般の手術のように

  • You knew that at any second, that straw was going to plunge through.

    大きく開腹する代わりに

  • And you didn’t know if it was going to go out the other side and straight into your hand,

    外科医は このような

  • or if you were going to get juice everywhere,

    小さな穴を 3箇所以上開け

  • but you were terrified. Right?

    そこに この様な長くて細い器具と

  • Every single time you did this, you experienced the same fundamental physics

    カメラも挿入して

  • that I was watching in the operating room that day.

    患者の体内の空間で 手術を行うものです

  • And it turns out it really is a problem.

    この手術の利点は 細菌感染のリスクや

  • In 2003, the FDA actually came out and said

    痛みが大幅に減り 回復も早いことです

  • that trocar incisions might be the most dangerous step in minimally invasive surgery.

    でも欠点もあります

  • Again in 2009, we see a paper that says that

    腹壁に小さな穴を開けるのに

  • trocars account for over half of all major complications in laparoscopic surgery.

    先の尖った細長い

  • And, oh by the way, this hasn’t changed for 25 years.

    「トロッカー」という器具を使いますが

  • So when I got to graduate school, this is what I wanted to work on.

    これを外科医が どのように使うかというと

  • I was trying to explain to a friend of mine what exactly I was spending my time doing,

    患者のお腹にあて

  • and I said,

    腹壁に穴が開くまで

  • It’s like when youre drilling through a wall to hang something in your apartment.

    押すわけです

  • There’s that moment when the drill first punctures through the wall

    手術室のスタッフ全員が

  • and there’s this, plunge. Right?”

    この器具に注目していたのは

  • And he looked at me and he said,

    この過程で細心の注意を払い

  • You mean like when they drill into people’s brains?”

    器具が腹壁を突き破ったときに

  • And I said, “Excuse me?”

    その下にある臓器や血管まで傷つけないように する必要があったからです

  • And then I looked it up and they do drill into people’s brains.

    日常よくある問題と同じですね

  • A lot of neurosurgical procedures actually start with a drill incision through the skull.

    日常よくある問題と同じですね

  • And if the surgeon isn’t careful, he can plunge directly into the brain.

    (笑)

  • So this is the moment when I started thinking, okay,

    皆さんも経験ありますね?

  • cranial drilling, laparoscopic surgery, why not other areas of medicine?

    (拍手)

  • Because think about it, when was the last time you went to the doctor and you didn’t get stuck with something? Right?

    ストローがもう少しで

  • So the truth is, in medicine puncture is everywhere.

    突き刺さるというとき

  • And here are just a couple of the procedures that I’ve found that involve some tissue puncture step.

    反対側まで突き破って パックを持つ手に

  • And if we take just three of them,

    突き刺さってしまうとか

  • laparoscopic surgery, epidurals and cranial drillings,

    ジュースが ドバッと噴出するかとか

  • these procedures account for over 30,000 complications every year in this country alone.

    不安な気分になりましたよね?

  • I call that a problem worth solving.

    皆さんもストローを手に 毎回

  • So let’s take a look at some of the devices that are used in these types of procedures.

    私が手術室で見たものと 物理的には同じ事を

  • I’ve mentioned epidurals.

    やっていたわけです

  • This is an epidural needle.

    実はこれが本当に問題であることが分かりました

  • It’s used to puncture through the ligaments in the spine and deliver anesthesia during childbirth.

    2003年にFDAが

  • Here’s a set of bone marrow biopsy tools.

    トロッカーの刺入が低侵襲手術の

  • These are actually used to burrow into the bone and collect bone marrow or sample bone lesions.

    最も危険な作業であると発表し

  • Here’s a bayonet from the Civil War.

    再び2009年にはトロッカーが

  • If I had told you it was a medical puncture device, you probably would have believed me.

    腹腔鏡手術に伴う重大な問題の

  • Right? Because what’s the difference?

    過半数以上に関係するという論文も発表されました

  • So the more I did this research, the more I thought there has to be a better way to do this.

    にもかかわらず

  • And for me, the key to this problem is that all these different puncture devices share a common set of fundamental physics.

    この器具は過去25年 同じものが使われているのです

  • So what are those physics? Let’s go back to drilling through a wall.

    そこで 大学院では

  • So youre applying a force on the drill toward the wall. Right?

    これをテーマに研究することにしました

  • And Newton says, the wall is going to apply force back, equal and opposite.

    何に取り組んでいるかを

  • So as you drill through the wall, those forces balance.

    友達に解ってもらおうとして

  • But then there’s that moment when the drill first punctures through the other side of the wall,

    「アパートの壁に何かを掛けるために

  • and right at that moment, the wall can’t push back anymore.

    ドリルで穴を開けていて

  • But your brain hasn’t reacted to that change in force.

    ドリルが内壁を突き破った瞬間

  • So for that millisecond, or however long it takes you to react, youre still pushing.

    刃が突然 突き抜けてしまった 経験があるだろう?」と言うと

  • and that unbalanced force causes an acceleration,

    刃が突然 突き抜けてしまった 経験があるだろう?」と言うと

  • and that is the plunge.

    彼は私の方を見て こう言いました

  • But what ifwhat if right at the moment of puncture,

    「頭蓋骨にドリルで穴を開けるときと同じだね?」

  • you could pull that tip back, actually oppose the forward acceleration?

    これにはビックリしました(笑)

  • That’s what I set out to do.

    実際調べてみると 頭の手術にはドリルを使うんです

  • So imagine you have a device and it’s got some kind of sharp tip to cut through tissue.

    脳神経科の手術の多くは

  • What’s the simplest way you could pull that tip back?

    頭蓋骨にドリルで穴を開けることから 始まります

  • I chose a spring.

    外科医が気をつけないと

  • So when you extend that spring, you extend that tip out so it’s ready to puncture tissue.

    ドリルの刃が脳内に突き進んでしまいます

  • The spring wants to pull the tip back.

    これを知り 考え始めました

  • So how do you keep the tip in place until the moment of puncture?

    頭蓋骨に穴を開けたり 腹腔鏡手術

  • I used this mechanism.

    他にも何かあるんじゃないか?

  • When the tip of the device is pressed against tissue,

    だって 医者に行けば 何かで必ず

  • the mechanism expands outward and wedges in place against the wall.

    ブチッと刺されますからね? (笑)

  • And the friction that’s generated locks it in place and prevents the spring from retracting the tip.

    実際 医療の現場では

  • But right at the moment of puncture, the tissue can’t push back on the tip anymore.

    刺す行為は日常的にあります

  • So the mechanism unlocks and the spring retracts the tip.

    体の様々な組織を刺す医療行為を

  • Let me show you that happening in slow motion. This is about 2,000 frames a second,

    いくつか調べてみました

  • and I’d like you to notice the tip that’s right there at the bottom, about to puncture through tissue.

    ここでは3つだけ 見てみましょう

  • And youll see that right at the moment of puncture,

    腹腔鏡手術 硬膜外麻酔 開頭手術ですが

  • right there, the mechanism unlocks and retracts that tip back.

    これらの手術だけで アメリカでは年間

  • I want to show it to you again, a little closer up.

    3万件もの問題が 報告されています

  • So youre going to see the sharp bladed tip,

    これは 何とかした方が良いと 思ったわけです

  • and right when it punctures that rubber membrane, it’s going to disappear into this white blunt sheath.

    これらの処置に使用される

  • Right there.

    器具をいくつかお見せしましょう

  • That happens within four 100th of a second after puncture.

    硬膜外麻酔に 使われる針がこれです

  • And because this device is designed to address the physics of puncture

    これで背骨の間から靱帯を穿刺して

  • and not the specifics of cranial drilling or laparoscopic surgery or another procedure,

    出産時などの麻酔薬を注入します

  • it’s applicable across these different medical disciplines and across different length scales.

    これは 骨髄生検に使われる器具です

  • But it didn’t always look like this.

    骨の中に突き刺して

  • This was my first prototype.

    骨髄や骨病変のサンプルを採取します

  • Yes, those are popsicle sticks and there’s a rubber band at the top.

    こちらは 南北戦争時代の銃剣です

  • It took about 30 minutes to do this, but it worked.

    (笑)

  • And it proved to me that my idea worked and justified the next couple years of work on this project.

    これが 医療器具だと紹介しても

  • I worked on this because this problem really fascinated me. It kept me up at night.

    きっと誰も疑わないでしょうね

  • But I think it should fascinate you too,

    似たようなものですから

  • because I said puncture is everywhere,

    調べれば調べるほど

  • that means at some point, it’s going to be your problem too.

    さらに良い方法があるべきだと

  • That first day in the operating room I never expected to find myself on the other end of a trocar.

    思うようになりました

  • But last year, I got appendicitis when I was visiting Greece.

    これらの人体に穴を開ける器具に

  • So I was in the hospital in Athens, and the surgeon was telling me he was going to perform a laparoscopic surgery.

    共通の問題も見えてきました

  • He was going to remove my appendix through these tiny incisions.

    物理的な問題です

  • And he was talking about what I could expect for the recovery and what was going to happen.

    物理的に何が起こっているのでしょう?

  • He said, “Do you have any questions?”

    再び壁に穴を開けるのを見てみましょう

  • And I said, “Just one doc. What kind of trocar do you use?”

    ドリルで壁に対して力をかけていますね?

  • So my favourite quote about laparoscopic surgery comes from a doctor H. C. Jacobaeus.

    ニュートンの法則によれば この時 壁が押し返す力は

  • It is puncture itself that causes risk.”

    同じ強さで逆向きです

  • And that’s my favorite quote because H. C. Jacobaeus was the first person to ever perform laparoscopic surgery on humans,

    穴を開ける過程では

  • and he wrote that in 1912.

    この2つの力は釣り合っています

  • So this is a problem that’s been injuring and even killing people for over 100 years.

    でも ドリルの刃が

  • So it’s easy to think that for every major problem out there, there’s some team of experts working around the clock to solve it.

    壁を貫通した瞬間

  • The truth is that’s not always the case.

    壁はもう押し返す力が無くなります

  • We have to be better at finding those problems and finding ways to solve them.

    でも その変化に人間が反応できないため

  • So if you come across a problem that grabs you,

    ほんのミリ秒間

  • let it keep you up at night.

    反応が起こるまで ドリルを押し続けることになり

  • Allow yourself to be fascinated,

    その一方的な力によって

  • because there are so many lives to save.

    刃が突っ込んでしまうわけです

  • Thank you.

    でも もし貫通の瞬間に

The first time I stood in the operating room and watched a real surgery, I had no idea what to expect.

翻訳: Akiko Hicks 校正: Eriko T

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