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CatherineMohr_2009-_手术的过去，现在和手术机器人化的未来_
A talk about surgical robots is also a talk about surgery . 谈论手术机器人 也就是谈论手术。
surgical:adj.外科的;外科手术的; surgery:n.外科;外科手术;手术室;诊疗室;
And while I've tried to make my images not too graphic , keep in mind that surgeons have a different relationship with blood than normal people do, because, after all, what a surgeon does to a patient , if it were done without consent , would be a felony . 我尽量使我的想象不是太生动的同时, 一直记着外科医生对血液的感觉 与一般人不同。 因为毕竟,外科医生对病人做的 如果没有得到患者同意 将是严重违法的。
images:n.印象;声誉;形象;画像;雕像;(image的第三人称单数和复数) graphic:adj.形象的;图表的;绘画似的; keep in mind:记住; surgeons:n.外科医生;(surgeon的复数) patient:adj.有耐心的,能容忍的;n.病人;患者; consent:vi.同意;赞成;答应;n.同意;(意见等的)一致;赞成; felony:n.重罪;
Surgeons are the tailors, the plumbers , the carpenters -- some would say the butchers -- of the medical world: cutting, reshaping , reforming , bypassing , fixing. 外科医生是裁缝,是管工 是木匠,也有人说是 医疗界的屠夫。 切开,整形,重塑, 搭建旁路,固定。
plumbers:n.水管工(plumber的复数);v.弄糟(plumber的单数第三人称); carpenters:n.木匠(carpenter的复数);v.做木工活(carpenter的单三形式); butchers:n.屠宰者(butcher的复数形式); reshaping:v.矫形;使…再成形;[建]重新修整(reshape的ing形式); reforming:v.改革;改进;改良;(使)悔改;(reform的现在分词) bypassing:v.绕过;避开;不顾(规章制度);不请示;(bypass的现在分词)
But you need to talk about surgical instruments and the evolution of surgical technology together. 但是谈论手术器械需要与 手术技术的进展一起来讨论。
instruments:n.器械;仪器;器具;手段(instrument的复数) evolution:n.演变;进化;发展;渐进; technology:n.技术;工艺;术语;
So in order to give you some kind of a perspective of where we are right now with surgical robots, and where we're going to be going in the future, 为了给大家一些全景的感觉 对于我们目前 手术机器人的水平 以及将来我们会向哪些方向发展,
perspective:n.观点;远景;透视图;adj.透视的;
I want to give you a little bit of perspective of how we got to this point, how we even came to believe that surgery was OK, that this was something that was possible to do, that this kind of cutting and reforming was OK. 我想给大家简要介绍一下 我们是如何达到这一步的。 我们是如何相信 手术是可行的, 是可以做到的事情, 这种切开与整形是可行的。
So, a little bit of perspective -- about 10,000 years of perspective. 即是一点点介绍 关于手术一万年来的发展。
This is a trephinated skull . 这是一个做过环钻术的头颅骨,
skull:n.头盖骨,脑壳;
And trephination is simply just cutting a hole in the skull. 环钻术简单说就是在头上凿个洞。
And many, many hundreds of skulls like this have been found in archaeological sites all over the world, dating back five to 10 thousand years. 而且有成百上千个像这样的头骨 在考古时被发现, 在全世界, 时间退回五千至一万年。
skulls:n.头骨(skull的复数);v.击中…的头颅(skull的第三人称单数); archaeological:adj.[古]考古学的;[古]考古学上的; sites:n.网站(site的复数);遗址,举办地点;v.使...位于(site的单三形式);
Five to 10 thousand years! Now imagine this. 时间退回五千至一万年！想象一下。
You are a healer in a Stone Age village. 你是石器时代村落里的一个治疗师,
healer:n.医治者(尤指用宗教迷信方式给人治病的人);治疗物;治病术士; Stone Age:n.石器时代;
And you have some guy that you're not quite sure what's wrong with him -- 有一些家伙,你不能十分确定他得了什么病,
Oliver Sacks is going to be born way in the future. （Oliver Sacks(著名神经科医生)将在未来诞生）。
Sacks:n.麻布袋; v.解雇; (sack的第三人称单数和复数)
He's got some seizure disorder . And you don't understand this. 患者有些癫痫表现,你并不了解这种病,
seizure:n.没收;夺取;捕获;(疾病的)突然发作; disorder:n.混乱;骚乱;vt.使失调;扰乱;
But you think to yourself, "I'm not quite sure what's wrong with this guy. 但是你自己想: 我不是很确定这家伙得了什么病,
But maybe if I cut a hole in his head I can fix it." 但是如果在他的头上切个洞,我可能就能治好它”。
(Laughter) (观众笑)
Now that is surgical thinking. 现在看那就是手术想法。
Now we've got the dawn of interventional surgery here. 现在 我们看到了介入性手术的曙光。
dawn:n.黎明;开端;vt.破晓;出现;被领悟; interventional:介入性;
What is astonishing about this is, even though we don't know really how much of this was intended to be religious , or how much of it was intended to be therapeutic , what we can tell is that these patients lived! 令人惊奇之处是 尽管我们不知道这其中有多少 是出于宗教目的, 有多少是出于治疗目的, 但我们在这里可以说的是 这些病人存活了！
astonishing:adj.令人十分惊讶的;v.使十分惊讶;使吃惊;(astonish的现在分词) intended:adj.预定的;计划的;v.打算;计划;想要;(intend的过去分词和过去式) religious:adj.宗教的;虔诚的;严谨的;修道的;n.修道士;尼姑; therapeutic:adj.治疗的;治疗学的;有益于健康的;n.治疗剂;治疗学家; patients:n.接受治疗者,病人;(patient的复数)
Judging by the healing on the borders of these holes, they lived days, months, years following trephination. 根据这些孔边缘的愈合情况判断 他们在钻孔术后活了几天,几个月,甚至很多年。
healing:n.康复; adj.痊愈中的; v.(使)康复,复原; (heal的现在分词)
And so what we are seeing is evidence of a refined technique that was being handed down over thousands and thousands of years, all over the world. 因此,我们这里看到的是 精湛技术的证据, (该技术)已经传承了成千上万年 遍布全世界。
evidence:n.证据,证明;迹象;明显;v.证明; refined:adj.精制的; v.精炼; technique:n.技巧,技术;手法;
This arose independently at sites everywhere that had no communication to one another. 在很多地方都有这个手术, 互相之间没有联系,
arose:vi.出现(arise的过去式);引发; independently:adv.独立地;自立地;
We really are seeing the dawn of interventional surgery. 我们的确看到了介入性手术的曙光。
Now we can fast forward many thousands of years into the Bronze Age and beyond. 现在,我们快速推进几千年 进入到青铜时代,
Bronze Age:n.青铜时代;青铜器时代;
And we see new refined tools coming out. 我们看到精良的手术器械出现了。
But surgeons in these eras are a little bit more conservative than their bold , trephinating ancestors. 但是这个时代的手术者 比他们大胆的祖先变得保守了些。
eras:n.[天]纪元,时代;年代(era的复数形式); conservative:adj.保守的;n.保守派,守旧者; bold:adj.大胆的,英勇的;黑体的;厚颜无耻的;险峻的;
These guys confined their surgery to fairly superficial injuries . 这些人将手术限制在 相当表浅的创伤。
confined:adj.狭窄的; v.限制(confine的过去式和过去分词); fairly:adv.相当地;公平地;简直; superficial:adj.表面的;肤浅的;表面文章的;外表的;(人)浅薄的; injuries:n.伤害,损伤;挫伤;(injury的复数)
And surgeons were tradesmen , rather than physicians . 而且手术者更像个商人, 而不象医生。
tradesmen:商人; physicians:n.[内科]内科医生(physician的复数);
This persisted all the way into and through the Renaissance . 这种情况一直延续到文艺复兴时期。
persisted:v.持续(persist的过去分词);坚持不懈; Renaissance:n.文艺复兴(欧洲14至17世纪);
That may have saved the writers, but it didn't really save the surgeons terribly much. 文艺复兴可能拯救了作家, 但并没有太多地拯救外科医生。
They were still a mistrusted lot. 他们仍受到很多怀疑。
mistrusted:vt.不信任;怀疑;vi.不信任;怀疑;n.不信任;怀疑;
Surgeons still had a bit of a PR problem, because the landscape was dominated by the itinerant barber surgeon. 外科医生仍有很多公共关系问题。 因为当时主要是 流动理发医生控制着局面。
landscape:n.景观;乡村风景画;(文件的)横向打印格式;v.对…做景观美化;美化…的环境; dominated:v.支配;控制;左右;影响;(dominate的过去式和过去分词) itinerant:adj.巡回的;流动的;n.巡回者;行商; barber:vt.为…理发;修整;n.理发师;vi.当理发师;
These were folks that traveled from village to village, town to town, doing surgery sort of as a form of performance art . 这些人穿行于村镇之间, 做手术有点像艺术表演。
performance art:n.行为艺术;
Because we were in the age before anesthesia , the agony of the patient is really as much of the public spectacle as the surgery itself. 因为我们这时还没发明麻醉技术, 病人的痛苦 象手术本身 一样公开。
anesthesia:n.麻醉;麻木(等于anaesthesia); agony:n.苦恼;极大的痛苦;临死的挣扎; spectacle:n.景象;场面;奇观;壮观;公开展示;表相,假相n.(复)眼镜;
One of the most famous of these guys, Frere Jacques, shown here doing a lithotomy -- which is the removal of the bladder stone, one of the most invasive surgeries they did at the time -- had to take less than two minutes. 其中最著名的一位名叫Frere Jacques, 这里展示的是他在做结石取出术, 取出膀胱里的结石 这是当时最具创伤的手术之一, 需要在两分钟内结束。
Frere:n.兄弟;团友;修道士; removal:n.去除;消除;清除;除去; bladder:n.膀胱;皮囊,气囊(如球胆); invasive:adj.侵略性的;攻击性的; surgeries:n.外科手术(surgery复数);
You had to have quite a flair for the dramatic , and be really, really quick. 你会因这种戏剧性而感到惊奇, 的确是非常迅速。
flair:n.天资;天分;资质;鉴别力; dramatic:adj.突然的;巨大的;令人吃惊的;激动人心的;
And so here you see him doing a lithotomy. 在这里你们看到他在做结石取出术了。
And he is credited with doing over 4,000 of these public surgeries, wandering around in Europe, which is an astonishing number, when you think that surgery must have been a last resort . 他的纪录是做了超过4000例这样的公开手术, 遍布欧洲。 这是一个令人吃惊的数字, 尤其是当你认为手术是最后一招。
resort:n.度假胜地;诉诸;采取;旅游胜地;v.去;凭藉;
I mean who would put themselves through that? 我的意思是谁愿意经受那种手术？
Until anesthesia, the absence of sensation . 直到出现了麻醉,使意识丧失。
absence:n.没有;缺乏;缺席;不注意; sensation:n.感觉;轰动;感动;
With the demonstration of the Morton Ether Inhaler at the Mass . General in 1847, a whole new era of surgery was ushered in. 随着莫顿醚吸入的演示 在马萨诸塞州,大约在1847年 开创了外科手术的新时代。
demonstration:n.示范;演示;论证;证明; Ether:n.乙醚;[有化]以太;苍天;天空醚; Inhaler:n.[临床]吸入器;空气过滤器;吸入者; Mass:n.块,团; adj.群众的,民众的; v.聚集起来,聚集; ushered:n.引座员,带位员; vt.引导,招待; vi.作招待员;
Anesthesia gave surgeons the freedom to operate. 麻醉使得外科医生可以自由操作,
Anesthesia gave them the freedom to experiment, to start to delve deeper into the body. 麻醉使他们可以自由尝试, 开始深入到人体内。
delve:vi.钻研;探究;挖;vt.钻研;探究;挖;n.穴;洞;
This was truly a revolution in surgery. 这的确是手术的一场革命。
revolution:n.革命;旋转;运行;循环;
But there was a pretty big problem with this. 但还是有个非常大的问题。
After these very long, painstaking operations, attempting to cure things they'd never been able to touch before, the patients died. 医生经过长时间辛勤的手术, 企图去治愈他们过去从未接触到的病症, 但最后病人死了,
painstaking:adj.艰苦的;勤勉的;小心的;n.辛苦;勤勉; attempting:v.努力;尝试;试图;(attempt的现在分词)
They died of massive infection . 他们死于严重感染。
massive:adj.大量的;巨大的,厚重的;魁伟的; infection:n.感染;传染;(身体某部位的)感染;传染病;
Surgery didn't hurt anymore, but it killed you pretty quickly. 手术没有加重创伤, 但是它能非常快地将你杀掉。
And infection would continue to claim a majority of surgical patients until the next big revolution in surgery, which was aseptic technique. 而且感染还会继续发生在许多手术病人身上, 直到外科手术的下一次革命。 那就是无菌技术。
claim:v.要求;声称;需要;认领;n.要求;声称;索赔;断言;值得; majority:n.大部分:大多数:多数票:成年人: aseptic:adj.无菌的;防腐性的;n.[助剂]防腐剂;
Joseph Lister was aepsis's, or sterility's, biggest advocate , to a very very skeptical bunch of surgeons. Joseph Lister是无菌 或灭菌的最大拥护者, 他努力说服一群持非常怀疑态度的医生,
Joseph:n.连帽大氅; Lister:n.制表人;双耕犁; advocate:v.拥护;支持;提倡;n.支持者;提倡者;辩护律师;出庭辩护人; skeptical:adj.怀疑的;怀疑论的,不可知论的; bunch:n.群;串;突出物;vi.隆起;打褶;形成一串;vt.使成一串;使打褶;
But eventually they did come around. 但是最终,他们接受了。
eventually:adv.最后,终于;
The Mayo brothers came out to visit Lister in Europe. Mayo兄弟去欧洲拜访了Lister。
And they came back to their American clinic and they said they had learned it was as important to wash your hands before doing surgery as it was to wash up afterwards. (Laughter) 他们回到美国的诊所后,说 他们学到 术前清洁双手 与术后洗手同样重要,
clinic:n.诊所;临床实习;(医院的)门诊部;门诊时间;
Something so simple. 就是如此简单。
And yet, operative mortality dropped profoundly . 然而,手术死亡率却极大地降低了。
operative:adj.有效的;运转着的;从事生产劳动的;n.侦探;技工; mortality:n.死亡数,死亡率;必死性,必死的命运; profoundly:adv.深刻地;深深地;极度地;
These surgeries were actually now being effective . 这些手术现今也很有效,
effective:adj.有效的,起作用的;实际的,实在的;给人深刻印象;
With the patient insensitive to pain, and a sterile operating field all bets were off, the sky was the limit. 由于病人对疼痛不敏感了, 无菌手术领域 不再有限制,天空才是极限。
insensitive:adj.感觉迟钝的,对…没有感觉的; sterile:adj.不育的;无菌的;贫瘠的;不毛的;枯燥乏味的; bets:v.下赌注(于);用…打赌;敢说;八成儿(bet的第三人称单数)
You could now start doing surgery everywhere, on the gut , on the liver , on the heart, on the brain. 现在身体各部位都可以实施手术, 肠道、肝脏、 心脏,在大脑。
gut:n.勇气;肠道;内脏;v.损毁内部;取出…的内脏;adj.非理性的;本能的 liver:n.肝;(动物供食用的)肝;
Transplantation : you could take an organ out of one person, you could put it in another person, and it would work. 移植:器官从一个人身上取出 可以装到另一个人身上,仍然可以工作。
Transplantation:n.移植;迁移;移民; organ:n.[生物]器官;机构;风琴;管风琴;嗓音;
Surgeons didn't have a problem with respectability anymore; they had become gods. 外科医生不再有名声问题, 他们变成了神。
respectability:n.体面;可尊敬;有社会地位;
The era of the "big surgeon, big incision " had arrived, but at quite a cost, because they are saving lives, but not necessarily quality of life, because healthy people don't usually need surgery, and unhealthy people have a very hard time recovering from a cut like that. “大外科医生,大切口”的时代来临了。 但是有很大的成本。 因为医生虽然挽救生命, 但没有特别关注病人的生活质量。 因为健康人通常不需要手术, 而不健康的人要从术后恢复有一段非常痛苦的时间。
incision:n.切口;雕刻,切割;切开; necessarily:adv.必要地;必定地,必然地; unhealthy:不健康的
The question had to be asked, "Well, can we do these same surgeries but through little incisions ?" 所以必须问这样一个问题: “我们能否用小的切口 做同样的手术？
incisions:n.切口;雕刻,切割;切开;
Laparoscopy is doing this kind of surgery: surgery with long instruments through small incisions. 腹腔镜就是用于这类手术。 手术用长器械,小切口,
Laparoscopy:n.腹腔镜检查,内视镜检查;
And it really changed the landscape of surgery. 它真正改变了手术的景观。
Some of the tools for this had been around for a hundred years, but it had only been used as a diagnostic technique until the 1980s, when there was changes in camera technologies and things like that, that allowed this to be done for real operations. 有些器械大约都有100年了, 但直到80年代 才被用于诊断技术, 当时照相这类技术有所改进, 使它可以真正用于手术。
diagnostic:adj.诊断的;特征的;n.诊断法;诊断结论; technologies:n.技术;科技(technology的复数);
So what you see -- this is now the first surgical image -- as we're coming down the tube, this is a new entry into the body. 所以你看到的——这是第一个手术影象—— 我们放入这个管子,这是进入身体的一个新入口。
It looks very different from what you're expecting surgery to look like. 它与你所想象的外科手术非常不同。
We bring instruments in, from two separate cuts in the side, and then you can start manipulating tissue . 我们从旁边两个分别的切口 把仪器放进去, 然后你可以开始操作了。
manipulating:v.(暗中)控制,操纵,影响;正骨;治疗脱臼;(manipulate的现在分词) tissue:n.纸巾,手巾纸;(人、动植物细胞的)组织;
Within 10 years of the first gallbladder surgeries being done laparoscopically , a majority of gallbladder surgeries were being done laparoscopically -- truly a pretty big revolution. 在第一例腹腔镜胆囊手术后的 10年里, 又做了大量的 腹腔镜胆囊手术。 这是一场真正的巨大革命。
gallbladder:n.[解剖]胆囊; laparoscopically:腹腔镜的;
But there were casualties of this revolution. 但是这场革命是有代价的。
casualties:n.伤亡;人员伤亡(casualty的复数);
These techniques were a lot harder to learn than people had anticipated . 这些技术 比人们预料的更难掌握。
techniques:n.技巧;技艺;工艺;技术;(technique的复数) anticipated:adj.预期的; v.预期; (anticipate的过去式和过去分词)
The learning curve was very long. 学习曲线很长,
learning curve:n.经验学习曲线;
And during that learning curve the complications went quite a bit higher. 在这期间并发症上升相当高。
Surgeons had to give up their 3D vision . 外科医生不得不放弃他们的3维视觉,
vision:n.视力;美景;幻象;想象力;v.想象;显现;梦见;
They had to give up their wrists . 不得不放弃他们的手腕,
wrists:n.手腕(wrist的复数);
They had to give up intuitive motion in the instruments. 不得不放弃对器械的直觉运动。
intuitive:adj.直觉的;凭直觉获知的; motion:n.动作;移动;手势;请求;意向;议案;v.运动;打手势;
This surgeon has over 3,000 hours of laparoscopic experience. 这个医生有3000多小时的腹腔镜经验。
Now this is a particularly frustrating placement of the needle . 现在特别令人沮丧的是针的安置,
particularly:adv.特别地,独特地;详细地,具体地;明确地,细致地; frustrating:adj.令人沮丧的;v.使沮丧;(frustrate的现在分词) needle:n.针;针头;指针;缝针;v.穿过;刺激;拿针缝;拿针穿;
But this is hard. 这是很难的。
And one of the reasons why it is so hard is because the external ergonomics are terrible. 为什么这个很难呢,其中一个原因是 外部工效太糟糕了。
external:n.外部;外观;形式;外部情况;adj.外部的;外面的;外界的;外来的; ergonomics:n.工效学;人类工程学;
You've got these long instruments, and you're working off your centerline . 你拿着这些长器械,你的操作会偏离中央线。
centerline:n.中心线;
And the instruments are essentially working backwards. 这个器械基本上是逆向工作的。
essentially:adv.本质上;本来;
So what you need to do, to take the capability of your hand, and put it on the other side of that small incision, is you need to put a wrist on that instrument. 所以你要做的,是利用你手的技能, 把它放在小切口的另一边, 你要把你的一个腕子放在那个器械上。
capability:n.才能,能力;性能,容量; on the other side:另一面;在另一边;
And so -- I get to talk about robots -- the da Vinci robot put just that wrist on the other side of that incision. 然后——我开始谈论机器人—— 达芬奇机器人 把你的腕子放在小切口的另一边。
And so here you're seeing the operation of this wrist. 在这里你可以看到这个腕子在操作。
And now, in contrast to the laparoscopy, you can precisely place the needle in your instruments, and you can pass it all the way through and follow it in a trajectory . 现在与腹腔镜相比, 你可以准确地把针放到你的器械上, 你可以一直穿过它, 跟随它的轨迹。
contrast:n.对比;对照;反差;明显的差异;v.对比;对照;形成对比; trajectory:n.[物]轨道,轨线;[航][军]弹道;
And the reason why this becomes so much easier is -- you can see on the bottom -- the hands are making the motions, and the instruments are following those motions exactly. 它变得如此简单 是因为你可以在下面看到, 手在做这些动作, 器械准确地跟随那些动作。
Now, what you put between those instruments and those hands, is a large, fairly complicated robot. 现在你放在器械和手之间的 是一个大的,相当复杂的机器人。
complicated:adj.复杂的;难懂的;v.使复杂化;(complicate的过去分词和过去式)
The surgeon is sitting at a console , and controlling the robot with these controllers . 医生坐在一个控制台边, 用这些控制器控制机器人。
console:v.安慰;抚慰;慰藉;n.控制台,操纵台,仪表板; controllers:n.[自]控制器(controller的复数形式);管理者;控制部件;
And the robot is moving these instruments around, and powering them, down inside the body. 机器人在挪动这些器械, 推动它们,向下进入身体。
You have a 3D camera, so you get a 3D view. 你有3维相机,你就能得到3维视图。
And since this was introduced in 1999, a lot of these robots have been out and being used for surgical procedures like a prostatectomy , which is a prostate deep in the pelvis , and it requires fine dissection and delicate manipulation to be able to get a good surgical outcome . 从1999年推出这个机器人后, 许多机器人问世了, 并被用于外科手术,象前列腺切除术。 前列腺在骨盆深处, 它需要精细的解剖 精确的操作 才能得到良好的结果。
procedures:n.程序;规程(procedure的复数); prostatectomy:n.[泌尿]前列腺切除术; pelvis:n.骨盆; dissection:n.解剖,切开;解剖体;详细查究; delicate:adj.精致的,微妙的,脆弱的,熟练的,柔和的; manipulation:n.操作;管理措施;处理;操纵证券市场;变换; outcome:n.结果,结局;成果;
You can also sew bypass vessels directly onto a beating heart without cracking the chest. 你也可以给一个跳动的心脏做搭桥 而无需打开心脏。
sew:v.缝;缝制;缝补;做针线活; vessels:n.血管(vessel的复数);船舶;容器; directly:adv.直接地;立即;马上;正好地;坦率地;conj.一…就; cracking:n.破裂;开裂;adj.裂解的;分裂的;
This is all done in between the ribs . 这都是在肋骨间做的。
ribs:n.[解剖]肋骨;排骨(rib的复数);
And you can go inside the heart itself and repair the valves from the inside. 你可以进入心脏里, 从内部修补瓣膜。
repair:v.修理;修补;修缮;补救;n.修理;修补;修缮; valves:n.[机]阀门; v.装阀于…;
You've got these technologies -- thank you -- 你们已经有了这些技术——谢谢——
(Applause) （鼓掌）
And so you might say, "Wow this is really cool! 你可能会说,“喔,太酷了！
So, smartypants, why isn't all surgery being done this way?" 为什么不是所有的手术都这样做呢？”
And there are some reasons, some good reasons. 是有一些理由的,一些好的理由。
And cost is one of them. 费用是其中之一。
I talked about the large, complicated robot. 我谈论了大型的、复杂的机器人。
With all its bells and whistles , one of those robots will cost you about as much as a solid gold surgeon. 加上它所有的附属配件,一个机器人 与你付给金牌外科医生的费用一样。
bells and whistles:附加的修饰物;
More useful than a solid gold surgeon, but, still, it's a fairly big capital investment . 但它比金牌外科医生更有用, 它的确是一个相当大的投资。
investment:n.投资;投入;封锁;
But once you've got it, your procedure costs do come down. 但你一旦拥有它,你的费用就会下降。
But there are other barriers . 但还有一些其它障碍。
barriers:n.障碍;栅栏;篱笆墙(barrier的复数形式);
So something like a prostatectomy -- the prostate is small, and it's in one spot, and you can set your robot up very precisely to work in that one spot. 例如前列腺切除术, 前列腺很小,在一个位置。 你安装你的机器人非常精确地在 那一点工作。
And so it's perfect for something like that. 机器人用于这类手术非常好。
And in fact if you, or anyone you know, had their prostate taken out in the last couple of years, chances are it was done with one of these systems. 实际上如果你或是你认识的人 在过去几年里做了前列腺手术, 可能会有机会是这样做的。
But if you need to reach more places than just one, you need to move the robot. 但是如果你的手术不仅在一个位置上, 你就需要挪动机器人。
And you need to put some new incisions in there. 你需要有新的切口,
And you need to re-set it up. 你需要重新设置,
re-set:重排;
And then you need to add some more ports, and more. 你需要增加一些接口,更多的接口。
And the problem is it gets time-consuming , and cumbersome . 这时的问题就是费时费力。
time-consuming:adj.耗时的;旷日持久的; cumbersome:adj.笨重的;累赘的;难处理的;
And for that reason there are many surgeries that just aren't being done with the da Vinci. 因为这个原因,有许多手术 都不是用达芬奇做的。
So we had to ask the question, "Well how do we fix that?" 因此我们不得不问这样一个问题,“我们如何解决呢”？
What if we could change it so that we didn't have to re-set up each time we wanted to move somewhere different? 我们能做什么改进使我们不必在每次挪动之后 都要重新设置？
What if:如果…怎么办?
What if we could bring all the instruments in together in one place? 如果我们把所有的仪器 放在一个地方集中起来会怎样？
How would that change the capabilities of the surgeon? 它会如何改变外科医生的技能？
And how would that change the experience for the patient? 它会如何改变病人的经历？
Now, to do that, we need to be able to bring a camera and instruments in together through one small tube, like that tube you saw in the laparoscopy video. 现在要那样做的话, 我们需要能带一个摄像头 和一些器械,一起穿过小的管道, 就象你在电视腹腔镜手术看到的那个管子一样,
Or, not so coincidentally , like a tube like this. 或不完全一样,就象这个。
coincidentally:adv.巧合地;一致地;
So what's going to come out of that tube is the debut of this new technology, this new robot that is going to be able to reach anywhere. 从那个管子里会出来什么呢？ 它是这个新技术的首次亮相, 这个新机器人可以到达任何地方。
debut:n.初次登台;开张;vi.初次登台;
Ready? So here it comes. 准备好了吗？它来了。
This is the camera, and three instruments. 这是摄像头,还有三个器械。
And as you see it come out, in order to actually be able to do anything useful, it can't all stay clustered up like this. 你看见它出来了, 为了真正能够做任何有用的事, 它不可能老是以这种成簇的形式在一起。
clustered:adj.成群的;成簇的;v.群聚;聚集;(cluster的过去式和过去分词)
It has to be able to come off of the centerline and then be able to work back toward that centerline. 它必须从中央线分出来, 背对着中央线工作。
He's a cheeky little devil . 它是个冒失鬼。
cheeky:adj.无耻的;厚脸皮的; devil:n.魔鬼;撒旦;家伙;恶棍;淘气鬼;冒失鬼;v.虐待,折磨;扯碎;做助手;
But what this lets you do is gives you that all-important traction , and counter-traction, so that you can dissect, so that you can sew, so that you can do all the things that you need to do, all the surgical tasks. 但让你做的 是给你所有必要的牵引, 反向牵引, 这样你能够解剖、能够缝合, 你可以做所有你需要做的事, 所有的手术工作。
all-important:adj.非常重要的;首要的; traction:n.牵引;[机][车辆]牵引力;
But it's all coming in through one incision. 但所有都从一个小切口进去。
It's not so simple. 它并不是这样简单。
But it's worth it for the freedom that this gives us as we're going around. 但值得这样去做,因为它使我们能够 自如地操作。
For the patient, however, it's transparent . This is all they're going to see. 但对于病人来说 它是透明的。这是他们想要看到的。
transparent:adj.透明的;显然的;坦率的;易懂的;
It's very exciting to think where we get to go with this. 想到我们要开始做的事情我们非常兴奋。
We get to write the script of the next revolution in surgery. 我们开始撰写关于外科手术的下一次革命。
script:n.剧本;电影剧本;笔迹;广播(或讲话等)稿;v.为电影(或戏剧等)写剧本;
As we take these capabilities, and we get to go to the next places, we get to decide what our new surgeries are going to be. 当我们使用这些技能的时候,我们又开始转向下一个地方, 我们开始考虑新的外科手术会是什么样子。
And I think to really get the rest of the way in that revolution, we need to not just take our hands in in new ways, we also need to take our eyes in in new ways. 我认为要走好这次手术革命 下面的路, 我们不仅手要采取新的方式, 我们的眼睛也要采取新的方式。
We need to see beyond the surface. 我们要透过表面去看。
We need to be able to guide what we're cutting in a much better way. 我们要能够用更好的方法 指导手术。
This is a cancer surgery. 这是个癌症手术。
cancer:n.癌症;恶性肿瘤;
One of the problems with this, even for surgeons who've been looking at this a lot, is you can't see the cancer, especially when it's hidden below the surface. 其中一个问题是, 即使对于外科医生,尽管他已经看过很多这样的病例, 你看不到这个肿瘤, 特别是当它隐藏在深处的时候。
especially:adv.尤其;特别;格外;十分;
And so what we're starting to do is we're starting to inject specially designed markers into the bloodstream that will target the cancer. 我们开始要做的 就是向血管中注射特殊设计的标记物 瞄准肿瘤。
inject:v.注入;注射; markers:n.(表示方位的)标记,记号;标识;表示;记号笔;(marker的复数) bloodstream:n.[生理]血流,血液的流动;
It will go, bind to the cancer. 它可以与肿瘤结合在一起。
bind:v.结合;装订;有约束力;过紧;n.捆绑;困境;讨厌的事情;植物的藤蔓;
And we can make those markers glow . 我们可以让那些标记物发光,
glow:n.喜悦; v.发热;
And we can take special cameras, and we can look at it. 然后我们用特殊的摄像头 可以看到它。
Now we know where we need to cut, even when it's below the surface. 现在我们知道我们需要切哪, 即使它不在表面。
We can take these markers and we can inject them in a tumor site. 我们可以用这些标记物,在肿瘤部位注射。
tumor:n.肿瘤;肿块;赘生物;
And we can follow where they flow out from that tumor site, so we can see the first places where that cancer might travel. 然后我们能够追溯它们从肿瘤的哪个部位流出来, 这样我们能够看到肿瘤最初可能转移的地方。
We can inject these dyes into the bloodstream, so that when we do a new vessel and we bypass a blockage on the heart, we can see if we actually made the connection, before we close that patient back up again -- something that we haven't been able to do without radiation before. 我们可以把这些染料注射到血流中, 这样我们可以为心脏堵塞的病人 搭建血管旁路。 在我们最后为病人缝合之前, 我们能够看到是否真正搭建了连接。 以前由于没有放射技术, 有些事我们还是做不到。
dyes:n.[染料]染料,染色(dye复数形式);v.给…染色;被着色(dye的第三人称单数); blockage:n.堵塞,堵塞;封锁;妨碍; radiation:n.辐射;放射线;放射疗法;
We can light up tumors like this kidney tumor, so that you can exactly see where the boundary is between the kidney tumor and the kidney you want to leave behind , or the liver tumor and the liver you want to leave behind. 现在我们能使肿瘤发光, 就象这个肾肿瘤, 你可以真实地看到肿瘤的边界, 这个肾你想留下。 或者肝脏肿瘤,这个肝脏你想留下。
tumors:n.肿瘤(tumor的复数); kidney:n.[解剖]肾脏;腰子;个性; boundary:n.边界;范围;分界线; leave behind:留下,丢下
And we don't even need to confine ourselves to this macro vision. 我们甚至不需要限于 宏观视野。
macro:adj.巨大的,大量的;n.宏,巨(计算机术语);
We have flexible microscopic probes that we can bring down into the body. 我们有很灵活的显微探头 可以直接下到身体里。
flexible:adj.灵活的;柔韧的;易弯曲的; microscopic:adj.微观的;用显微镜可见的; probes:n.探索; v.探查; bring down:降低;打倒,打死;击落;
And we can look at cells directly. 我们可以直接观看细胞。
I'm looking at nerves here. So these are nerves you see, down on the bottom, and the microscope probe that's being held by the robotic hand, up at the top. 我正在这看神经。你看到的就是神经,在下面, 这个显微探头由机械臂拿着,
nerves:n.神经;神经紧张;勇气;v.鼓足勇气;振作精神;(nerve的第三人称单数和复数) microscope:n.显微镜; robotic:adj.机器人的,像机器人的;自动的;n.机器人学;
So this is all very prototypey at this point. 实物就是这样。
But you care about nerves, if you are a surgical patient. 但如果你是个外科病人你就会关注神经,
Because they let you keep continence , bladder control, and sexual function after surgery, all of which is generally fairly important to the patient. 因为它使你在术后能保持节制、 排尿控制和性功能。 这些对病人来说都是非常重要的。
continence:n.自制,克制;节欲(尤指禁欲); sexual:adj.性的;性别的;有性的; generally:adv.通常;普遍地,一般地;
So, with the combination of these technologies we can reach it all, and we can see it all. 所以将这些技术结合起来 我们就能够做到这一切,看到这一切。
combination:n.结合;组合;联合;[化学]化合;
We can heal the disease . 我们可以治愈疾病。
disease:n.病,[医]疾病;弊病;vt.传染;使…有病;
And we can leave the patient whole and intact and functional afterwards. 我们能保持病人术后 各种功能完整无损。
intact:adj.完整的;原封不动的;未受损伤的; functional:adj.功能的;
Now, I've talked about the patient as if the patient is, somehow , someone abstract outside this room. 我一直在谈论病人, 好象病人是这个房间外面 某个抽象的人。
somehow:adv.以某种方法;莫名其妙地; abstract:n.摘要; adj.抽象的; vt.摘要; vi.做摘要;
And that is not the case. 并不是这样。
Many of you, all of you maybe, will at some point, or have already, faced a diagnosis of cancer, or heart disease, or some organ dysfunction that's going to buy you a date with a surgeon. 你们中的许多人,或者是全部, 将会有这个问题或已经面临癌症 或心脏病的诊断,或一些器官功能失调, 那就是你要花钱和医生约会了。
diagnosis:n.诊断; dysfunction:n.功能紊乱;机能障碍;官能不良;vi.功能失调;出现机能障碍;垮掉;
And when you get to that point -- 当你出现这些问题的时候——
I mean, these maladies don't care how many books you've written, how many companies you've started, that Nobel Prize you have yet to win, how much time you planned to spend with your children. 我是指,这些疾病可不管你 写了多少书, 你拥有多少家公司, 也不管你获得了诺贝尔奖, 你打算与你的孩子在一起度过多少时间。
maladies:n.弊病;疾病;腐败; Nobel Prize:n.诺贝尔奖;
These maladies come for us all. 这些疾病我们都会有。
And the prospect I'm offering you, of an easier surgery ... 我提供给你的简单手术的前景
prospect:n.展望;前景;希望;前途;v.勘探;探矿;
is that going to make that diagnosis any less terrifying ? 能使诊断少一些恐怖吗？
terrifying:adj.令人恐惧的;骇人的;极大的;v.使害怕,使恐怖;(terrify的现在分词)
I'm not sure I really even want it to. 我不能确定我是否真想让它这样。
Because facing your own mortality causes a re-evaluation of priorities , and a realignment of what your goals are in life, unlike anything else. 因为当你面临死亡的时候 你会重新评价你生活的重点, 重新排列你生活的目标,不象其它任何事情。
re-evaluation:再评价;重新评价; priorities:n.优先事项;优先权;重点;(priority的复数) realignment:n.重新排列;重新组合;改组;
And I would never want to deprive you of that epiphany . 我从来不想剥夺你的顿悟,
deprive:vt.使丧失,剥夺; epiphany:对事物真谛的顿悟;
What I want instead, is for you to be whole, intact, and functional enough to go out and save the world, after you've decided you need to do it. 相反我想要的是 你完整无损、 功能齐全的去拯救世界, 在你一旦决定去这样做的时候。
And that is my vision for your future. 那就是我对你们未来的想象。
Thank you. 谢谢
(Applause) （鼓掌）