According to the theories of human social development, we're now living through the fourth great epoch of technological advancement, the Information Age. Connectivity through digital technology is a modern miracle. We can say it has broken down barriers of time and space which separate people, and it's created a condition for an age where information, ideas can be shared freely.
De acordo coas teorías sobre o desenvolvemento social humano, estamos vivindo na cuarta grande época do avance tecnolóxico, a Era da Información. A conectividade mediante tecnoloxía dixital é un milagre moderno. Pódese dicir que rompeu os límites do espazo e do tempo que separan a xente, e que posibilitou unha era na que as ideas se poden compartir libremente. [Presenza de imaxes médicas sensibles]
But are these great accomplishments in digital technology really the endgame in terms of what can be achieved? I don't think so, and today I'd like to share with you how I believe digital technology can take us to even greater heights. I'm a surgeon by profession, and as I stand here today talking to all of you, five billion people around the world lack access to safe surgical care. Five billion people. That's 70 percent of the world's population, who according to the WHO's Lancet Commission can't even access simple surgical procedures as and when they need them.
Pero son estes grandes avances en tecnoloxía dixital o verdadeiro punto e final de ata onde podemos chegar? Non o creo, e hoxe quero compartir con vós como creo que a tecnoloxía nos pode permitir chegar máis alá. Traballo como cirurxiá, e mentres estou aquí, falándovos a todos vós, cinco mil millóns de persoas carecen de coidados cirúrxicos seguros. Cinco mil millóns de persoas. Iso vén sendo o 70 por cento da poboación mundial, que, segundo a Comisión Lancet da OMS, non pode acceder nin a tratamentos cirúrxicos sinxelos onde e cando o necesite.
Let's zoom in on Sierra Leone, a country of six million people, where a recent study showed that there are only 10 qualified surgeons. That's one surgeon for every 600,000 people. The numbers are staggering, and we don't even need to look that far. If we look around us here in the US, a recent study reported that we need an extra 100,000 surgeons by 2030 to just keep up with the demand for routine surgical procedures. At the rate that we're going, we won't be meeting those numbers.
Ímonos fixar en Serra Leoa, un país con seis millóns de habitantes, onde un estudo recente demostrou que só hai 10 cirurxiáns cualificados. Iso é un cirurxián por cada 600 000 habitantes. As cifras son inquietantes, e nin necesitamos mirar tan lonxe. Se miramos aquí mesmo, nos Estados Unidos, un estudo afirmou que necesitaremos 100 000 cirurxiáns máis de aquí a 2030 só para atender a demanda de procedementos cirúrxicos rutineiros. Ao ritmo actual, non imos chegar.
As a surgeon, this is a global issue that bothers me. It bothers me a lot, because I've seen firsthand how lack of access to safe and affordable healthcare can blight the lives of ordinary people. If you're a patient that needs an operation and there isn't a surgeon available, you're left with some really difficult choices: to wait, to travel, or not to have an operation at all.
Como cirurxiá, este é un problema mundial que me preocupa. Preocúpame moitísimo, porque teño comprobado de primeira man como non contar cun servizo sanitario seguro e accesible pode arruinar a vida da xente. Se es un paciente que necesita operarse e non hai un cirurxián dispoñible, tes que afrontar unha decisión moi difícil: esperar, viaxar, ou directamente non operarte.
So what's the answer? Well, part of you are carrying some of that solution with you today: a smartphone, a tablet, a computer. Because for me, digital communications technology has the power to do so much more than just to allow us to shop online, to connect through social media platforms and to stay up to date. It has the power to help us solve some of the key issues that we face, like lack of access to vital surgical services. And today I'd like to share with you an example of how I think we can make that possible.
Así que, cal é a resposta? Algúns de vós tedes parte da solución aquí mesmo: un móbil, unha tableta ou un ordenador. Porque para min, a tecnoloxía da comunicación dixital ten o poder de facer máis que simplemente permitirnos comprar en liña ou estar ao día do que pasa nas nosas redes sociais. Ten o poder de axudarnos a solucionar algúns problemas críticos, como a inaccesibilidade a servizos cirúrxicos vitais. E hoxe quero compartir con vós un exemplo de como creo que podemos facelo realidade.
The history of surgery is filled with breakthroughs in how science and technology was able to help the surgeons of the day face their greatest challenges. If we go back several hundred years, an understanding of microbiology led to the development of antiseptic techniques, which played a big role in making sure patients were able to stay alive postsurgery. Fast-forward a few hundred years and we developed keyhole or arthroscopic surgery, which combines video technology and precision instruments to make surgery less invasive. And more recently, a lot of you will be aware of robotic surgery, and what robotics brings to surgery is much like modern automated machinery, ultraprecision, the ability to carry out procedures at the tiniest scales with a degree of accuracy that even surpasses the human hand. But robotic surgery also introduced something else to surgery: the idea that a surgeon doesn't actually have to be standing at the patient's bedside to deliver care, that he could be looking at a screen and instructing a robot through a computer. We call this remote surgery.
A historia da cirurxía está chea de fitos en que a ciencia e a tecnoloxía axudaron aos cirurxiáns do momento a superar calquera reto. Se retrocedemos no tempo uns centos de anos, entender a microbioloxía provocou o desenvolvemento de técnicas antisépticas, o que tivo un gran papel na supervivencia dos pacientes despois dunha operación. Avanzamos uns centos de anos e conseguimos desenvolver a cirurxía artroscópica, a cal combina tecnoloxía de vídeo e instrumentos de precisión para facer a cirurxía menos invasiva. Algo máis actual e coñecido é a cirurxía robótica, e como esta aporta á cirurxía as calidades das máquinas modernas: ultraprecisión, a capacidade de realizar intervencións en escalas diminutas cun nivel de precisión que incluso supera a do ser humano. Pero, a cirurxía robótica engadiu algo máis á cirurxía: a idea de que un cirurxián non ten que estar ao lado do paciente para atendelo, senón que podería estar mirando unha pantalla e controlando un robot por ordenador. Chamámoslle a isto cirurxía remota.
It is incumbent on us to find solutions that solve these answers in a cost-effective and scalable way, so that everyone, no matter where they are in the world, can have these problems addressed.
É da nosa incumbencia encontrar solucións que respondan dun xeito rendible e escalable, para que todo o mundo, tanto ten onde se atope, supere estes problemas.
So what if I told you that you didn't really need a million-dollar robot to provide remote surgery? That all you needed was a phone, a tablet, or a computer, an internet connection, a confident colleague on the ground and one magic ingredient: an augmented reality collaboration software. Using this augmented reality collaboration software, an expert surgeon can now virtually transport himself into any clinical setting simply by using his phone or tablet or computer, and he can visually and practically interact in an operation from start to finish, guiding and mentoring a local doctor through the procedure step by step.
Que pasa se vos digo que non se necesita un robot dun millón de dólares para realizar cirurxía remota? Que todo o que necesitas é un teléfono, unha tableta ou un ordenador, conexión a Internet, un colega de confianza in situ e o ingrediente máxico: un programa de colaboración en realidade aumentada. Usando este programa un cirurxián experto pode transportarse virtualmente a calquera contorno clínico só con usar o seu teléfono, tableta ou ordenador, e pode interactuar na operación visual e practicamente de principio a fin, guiando e controlando un médico local a través do procedemento paso a paso.
Well, enough of me telling you about it. I'd now like to show you. We're now going to go live to Dr. Marc Tompkins, an orthopedic surgeon at the University of Minnesota. He's going to perform an arthroscopic surgery for us, a keyhole surgery of the knee, and I'd like to disclose that this patient has consented to having their operation streamed. I'd also like to point out that in the interest of time, we're just going to go through the first steps, marking up the patient and just identifying a few key anatomical landmarks. Hello, Dr. Tompkins, can you hear me? Dr. Mark Tompkins: Good morning, Nadine.
Ben, chega de charla. Agora gustaríame ensinárvolo. Ímonos unir en directo ao Dr. Marc Tompkins, cirurxián ortopédico da Universidade de Minnesota. Vai realizar unha cirurxía artroscópica, unha cirurxía laparoscópica do xeonllo, e gustaríame aclarar que este paciente consentiu a retransmisión da súa operación. Tamén me gustaría comentar que por limitacións de tempo, soamente imos ver os primeiros pasos: marcar o paciente e identificar algúns puntos anatómicos clave. Ola, Dr. Tompkins, pode oírme? Dr. Mark Tompkins: Bos días, Nadine.
Nadine Hachach-Haram: Everyone from TED says hello.
Nadine Hachach-Haram: Saúdos de parte da audiencia de TED.
Audience: Hi.
Audiencia: Ola!
NHH: Alright, Dr. Tompkins, let's get started. So let's start with our incisions and where we're going to make these, on either side of the patellar tendon. So if you can make your incisions there and there, that should hopefully get us into the knee.
NHH: De acordo, Dr. Tompkins, imos empezar. Comecemos coas incisións; ímolas facer a ámbolos lados do tendón rotuliano. Así que se pode facer as incisións aí, e aí, deberiamos poder acceder ó xeonllo se todo vai ben.
MT: All right, I'm going in.
MT: De acordo, vou proceder.
NHH: Great. So we're just getting inside the joint now. So why don't we go around and have a quick look at the meniscus.
NHH: Xenial. Estamos entrando na articulación agora mesmo. Que tal se lle botamos unha ollada ao menisco dende o outro lado?
MT: Perfect.
MT: Perfecto.
NHH: Great, so we can see there's a small tear there on the meniscus, but otherwise it looks alright. And if you turn and head to this direction, follow my finger, let's have a quick look at the ACL and the PCL. That's your ACL there, that looks quite healthy, no problems there. So we've just identified that small meniscus tear there, but otherwise the fluid around the joint looks OK as well. All right, thank you very much, Dr. Tompkins. Thank you for your time. I'll let you continue. Have a good day. Bye.
NHH: Xenial, podemos ver que hai unha pequena rotura no menisco, pero o demais parece que está ben. Se xira e se dirixe aquí, siga o meu dedo, imos mirar un momento o LCA e o LCP. Ese é o LCA, que parece bastante san, sen problemas por aí. É certo que encontramos esa pequena rotura no menisco, pero o líquido que cobre a articulación parece que tamén está ben. De acordo, moitas grazas, Dr. Tompkins. Grazas polo seu tempo. Déixoo continuar. Teña un bo día. Adeus.
(Applause)
(Aplausos)
So I hope through this simple demonstration I was able to illustrate to you just how powerful this technology can be. And I'd like to point out that I wasn't using any special equipment, just my laptop and a really simple webcam. We're so used to using digital technology to communicate through voice and text and video, but augmented reality can do something so much deeper. It allows two people to virtually interact in a way that mimics how they would collaborate in person. Being able to show someone what you want to do, to illustrate and demonstrate and gesture, is so much more powerful than just telling them. And it can make for such a great learning tool, because we learn better through direct experience.
Espero que mediante esta simple demostración fora capaz de transmitirvos como de potente pode ser esta tecnoloxía. E gustaríame aclarar que non estaba usando ningún equipamento especial, só o meu portátil e unha cámara moi sinxela. Estamos moi acostumados a usar a tecnoloxía dixital para comunicarnos mediante voz, texto e vídeo, pero a realidade aumentada pode lograr algo máis profundo. Permite que dúas persoas interactúen virtualmente dun xeito que se parece a como o farían presencialmente. Ser capaz de mostrarlle a alguén que queres facer, ilustrar, demostrar, xesticular, é moito máis eficaz que só dicirllo. E pode ser unha gran ferramenta didáctica, porque aprendemos mellor con experiencias directas.
So how is this making a difference around the world? Well, back in my teaching hospital, we've been using this to support local district general hospitals and providing skin cancer surgery and trauma treatment. Now, patients can access care at a local level. This reduces their travel time, improves their access, and saves money. We've even started seeing its use in wound care management with nurses and in outpatient management. Most recently, and quite exciting, it was used in supporting a surgeon through a cancer removal of a kidney. And I'd like to just share with you a very quick video here. I apologize for some of the gruesome views.
Así que, como pode marcar a diferenza no mundo? No hospital onde traballo, estámolo usando para apoiar hospitais xerais locais, realizando cirurxías de cancro de pel e en traumatoloxía. Agora, os pacientes poden acceder a coidados médicos a un nivel local. Isto reduce o tempo que gastan viaxando, mellora a súa accesibilidade e afórralles cartos. Incluso empezamos a ver enfermeiros usalo para realizar curas e atender pacientes ambulatorios. Hai pouco, e bastante emocionante, usouse para axudar a un cirurxián a extirpar un cancro dun ril. Gustaríame ensinarvos un vídeo moi curto. Perdoádeme polas imaxes espantosas.
(Video) Doctor 1: OK. Show me again.
(Vídeo) Doutor 1: Vale. Ensínamo de novo.
Doctor 2: If you see here, that's the upper part, the most outer part of your tumor.
Doutor 2: Se te fixas aquí, é a parte superior, a parte máis externa do tumor.
Doctor 1: Yes.
Doutor 1: Si.
Doctor 2: So it's three centimeters deep, so this should be three centimeters.
Doutor 2: Ten tres centímetros de profundidade, así que debería medir tres centímetros.
Doctor 1: Yes, yes.
Doutor 1: Si, si.
Doctor 2: OK, so you need to get a 3.5 margin.
Doutor 2: Vale, entón necesitas unha marxe de 3,5 cm
Doctor 1: I'm going to show you anyway and tell me what you think about it.
Doutor 1: Voucho ensinar de todas formas e disme o que pensas.
NHH: We're also seeing the use of this technology at a global scale, and one of the most heartwarming stories I can recall is from the town of Trujillo in the north of Lima in Peru, where this technology was used to support the provision of cleft lip and palate surgery to children, children from poor backgrounds who didn't have access to health insurance. And in this town, there was a hospital with one surgeon working hard to provide this care, Dr. Soraya. Now, Dr. Soraya was struggling under the sheer demand of her local population, as well as the fact that she wasn't specifically trained in this procedure. And so, with the help of a charity, we were able to connect her with a cleft surgeon in California, and using this technology, he was able to guide her and her colleagues through the procedure step by step, guiding them, training them and teaching them. Within a few months, they were able to perform 30 percent more operations with less and less complications. And now Dr. Soraya and her team can perform these operations independently, competently and confidently. And I remember one quote from a mother who said, "This technology gave my daughter her smile."
NHH: Tamén vemos o uso desta tecnoloxía a nivel mundial, e unha das historias máis conmovedoras que recordo pasou en Trujillo, un pobo ao norte de Lima, no Perú, onde esta tecnoloxía se usou para axudar a corrixir o labio leporino e o padal fendido de nenos, nenos de contornas pobres que non tiñan seguro médico. E nesta vila había un hospital cunha cirurxiá traballando duro para dar este servizo, a Dra. Soraya. Á Dra. Soraya estábaselle facendo costa arriba atender a todos no seu pobo, á parte de que non estaba especializada neste procedemento. Así, coa axuda dunha ONG, conseguimos que se conectara cun cirurxián de padal en California, e usando esta tecnoloxía, foi capaz de guiala a ela e ós seus axudantes paso a paso neste procedemento, guiándoos, ensinándolles e dándolles consellos. En tan só uns meses, foron capaces de aumentar nun 30 por cento o número de operacións, cada vez con menos complicacións. E agora, a Dra. Soraya e o seu equipo poden realizar estas operacións sen axuda, de forma competente e segura. Acórdome dunha frase que me dixo unha nai: "Esta tecnoloxía deulle á miña filla o seu sorriso."
For me, this is the real power of this technology. The beauty is that it breaks boundaries. It transcends all technological difficulties. It connects people. It democratizes access. Wi-Fi and mobile technology are growing rapidly, and they should play a role in boosting surgical provision. We've even seen it used in conflict zones where there's considerable risk in getting specialist surgeons to certain locations. In a world where there are more mobile devices than there are human beings, it truly has a global reach. Of course, we've still got a long way before we can solve the problem of getting surgery to five billion people, and unfortunately, some people still don't have access to internet. But things are rapidly moving in the right direction. The potential for change is there. My team and I are growing our global footprint, and we're starting to see the potential of this technology.
Para min, este é o verdadeiro poder desta tecnoloxía. O bonito é que rompe barreiras. Transcende todas as dificultades da tecnoloxía. Conecta a xente. Fai que sexa accesible para todos. O wifi e a tecnoloxía móbil crecen moi rápido, e deberían ter un papel clave no aumento do acceso á cirurxía. Vimos o seu uso en zonas conflitivas, onde levar persoal cirúrxico a determinados lugares supón un risco considerable. Nun mundo onde hai máis dispositivos móbiles que seres humanos, esta ferramenta ten moito alcance. Por suposto, aínda queda moito antes de dar acceso a cirurxía a cinco mil millóns de persoas, e por desgraza, aínda hai persoas que non teñen acceso a Internet. Pero as cousas avanzan rapidamente na boa dirección. O potencial para o cambio está aí. Co meu equipo estamos aumentando a pegada que deixamos no mundo, e estamos empezando a ver o potencial desta tecnoloxía.
Through digital technology, through simple, everyday devices that we take for granted, through devices of the future, we can really do miraculous things.
Coa tecnoloxía dixital, usando dispositivos do día a día que todos damos por supostos, mediante os dispositivos do futuro, podemos chegar a facer verdadeiros milagres.
Thank you.
Grazas.
(Applause)
(Aplausos)