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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.

  • I was a college student in engineering.

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

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

  • But it wasn’t like that at all.

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

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

  • but about sports and weekend plans.

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

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

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

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

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

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

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

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

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

  • and actually does the procedure inside the patient.

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

  • But there is a trade-off,

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

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

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

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

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

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

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

  • Remember this?

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

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

  • or if you were going to get juice everywhere,

  • but you were terrified. Right?

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

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

  • And it turns out it really is a problem.

  • In 2003, the FDA actually came out and said

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

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

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

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

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

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

  • and I said,

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

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

  • and there’s this, plunge. Right?”

  • And he looked at me and he said,

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

  • And I said, “Excuse me?”

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

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

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

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

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

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

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

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

  • And if we take just three of them,

  • laparoscopic surgery, epidurals and cranial drillings,

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

  • I call that a problem worth solving.

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

  • I’ve mentioned epidurals.

  • This is an epidural needle.

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

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

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

  • Here’s a bayonet from the Civil War.

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

  • Right? Because what’s the difference?

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

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

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

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

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

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

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

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

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

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

  • and that unbalanced force causes an acceleration,

  • and that is the plunge.

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

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

  • That’s what I set out to do.

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

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

  • I chose a spring.

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

  • The spring wants to pull the tip back.

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

  • I used this mechanism.

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

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

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

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

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

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

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

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

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

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

  • So youre going to see the sharp bladed tip,

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

  • Right there.

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

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

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

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

  • But it didn’t always look like this.

  • This was my first prototype.

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

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

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

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

  • But I think it should fascinate you too,

  • because I said puncture is everywhere,

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

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

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

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

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

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

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

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

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

  • It is puncture itself that causes risk.”

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

  • and he wrote that in 1912.

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

  • 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.

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

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

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

  • let it keep you up at night.

  • Allow yourself to be fascinated,

  • because there are so many lives to save.

  • Thank you.

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

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B1 US TED puncture surgery drill tissue device

【TED】Nikolai Begg: A tool to fix one of the most dangerous moments in surgery (Nikolai Begg: A tool to fix one of the most dangerous moments in surgery)

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    Go Tutor posted on 2014/10/21
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