WEBVTT

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The first time I stood
in the operating room

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and watched a real surgery

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I had no idea what to expect.

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I was a college student in engineering.

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I thought it was going to be like on TV.

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Ominous music playing in the background,

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beads of sweat 
pouring down a surgeon's face.

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But it wasn't like that at all.

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There was music playing on this day,

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I think it was Madonna's Greatest Hits.
(Laughter)

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And there was plenty of conversation.

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Not just about the patient's heart rate,

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but about sports and weekend plans.

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And since then 
the more surgeries I watched,

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the more I realized this is how it is.

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In some weird way, 
it's just another day at the office.

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But every so often

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the music gets turned down,

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everyone stops talking,

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and stares at exactly the same thing.

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And that's when you know
that something absolutely critical

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and dangerous is happening.

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The first time I saw that

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I was watching a type of surgery

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called "laparoscopic surgery"

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And for those of you who are unfamiliar

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laparoscopic surgery instead of the large

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open incision you might be used to 
with surgery,

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a laparoscopic surgery
is where the surgeon creates

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these three or more 
small incisions in the patient.

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And then inserts these long, 
thin instruments

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and a camera,

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and actually does the procedure
inside the patient.

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This is great because 
there's much less risk of infection,

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much less pain, shorter recovery time.

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But there is a trade off.

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Because these incisions are created

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with a long pointed device

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called a "trocar".

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And the way the surgeon uses this device

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is that he takes it 
and he presses it into the abdomen

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until it punctures through.

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And now the reason why 
everyone in the operating room

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was staring at that device on that day

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was because he had to be 
absolutely careful

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not to plunge it through

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and puncture it into the organs 
and blood vessels below.

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But this problem should seem 
pretty familiar to all of you

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because I'm pretty sure 
you've seen it somewhere else.

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(Laughter)

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Remember this?

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(Applause)

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You knew that at any second

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that straw was going to plunge through,

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and you didn't know 
if it was going to go out the other side

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and straight into your hand,

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or if you were going to get 
juice everywhere,

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but you were terrified. Right?

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Every single time you did this,

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you experienced 
the same fundamental physics

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that I was watching
in the operating room that day.

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And it turns out it really is a problem.

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In 2003, the FDA actually came out 
and said

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that trocar incisions 
might be the most dangerous step

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in minimally invasive surgery.

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Again in 2009, we see a paper that says

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that trocars account for 
over half of all major complications

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in laproscopic surgery.

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And, by the way, 
this hasn't changed for 25 years.

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So when I got to graduate school

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this is what I wanted to work on.

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I was trying to explain to a friend of mine

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what exactly I was spending my time doing
and I said,

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"It's like when you're drilling through a wall

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to hang something in your apartment.

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There's that moment when the drill
first punctures through the wall

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and there's this plunge. Right?

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And he looked at me and he said,

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"You mean like when they drill 
into people's brains?"

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And I said, "Excuse me?"

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(Laughter)

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

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A lot of neurosurgical procedures

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actually start with a drill incision
through the skull.

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And if the surgeon isn't careful,

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he can plunge directly into the brain.

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This is the moment when I started thinking,

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OK, cranial drilling, laproscopic surgery,

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why not other areas of medicine?

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Because think about it, when was
the last time you went to the doctor

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and you didn't get stuck with something?
(Laughter)

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So the truth is

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in medicine puncture is everywhere.

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And here are just a couple
of the procedures that I've found

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that involve some tissue puncture step.

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And if we take just three of them

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Laparoscopic Surgery, 
Epidurals and Cranial Drilling,

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these procedures account 
for over 30,000 complications

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every year in this country alone.

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I call that a problem worth solving.

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Let's take a look at some of the devices

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that are used in these types of procedures.

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I mentioned Epidurals, 
this is an epidural needle.

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It's used to puncture through 
the ligaments in the spine

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and deliver anesthesia during childbirth.

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Here's a set of bone marrow biopsy tools.

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These are actually used
to burrow into the bone,

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and collect bone marrow, 
or sample boney lesions.

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And I already showed you 
a laproscopic surgery trocar,

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but here it is again.

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Here's a bayonette from the Civil War.

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(Laughter)

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If I had told you
it was a medical puncture device

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you probably would have believed me.

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Because what's the difference?

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So, the more I did this research

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the more I thought 
there has to be a better way to do this.

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And for me the key to this problem

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is that 
all these different puncture devices

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share a common set of fundamental physics.

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So what are those physics?

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Let's go back to drilling through a wall.

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So you're applying a force 
on a drill towards the wall. Right?

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And Newton says,
the wall is going to apply force back,

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equal and opposite.

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So, as you drill through the wall,

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those forces balance.

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But then there's that moment

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when the drill first punctures
through the other side of the wall,

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and right at that moment 
the wall can't push back anymore.

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

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So for that millisecond,

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or however long it takes you 
to react, you're still pushing,

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and that unbalanced force 
causes an acceleration,

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and that is the plunge.

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

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you could pull that tip back?

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Actually oppose the forward acceleration.

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That's what I set out to do.

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So imagine that you have a device

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and it's got some kind of sharp tip 
to cut through tissue.

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

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I chose a spring.

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So when you extend that spring, 
you extend that tip out

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so it's ready to puncture tissue,

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the spring wants to pull the tip back.

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How do you keep the tip in place

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until the moment of puncture?

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I use this mechanism.

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When the tip of the device
is pressed against tissue,

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the mechanism expands outwards 
and wedges in place against the wall.

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And the friction that's generated

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locks it in place and prevents the spring 
from retracting the tip.

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But right at the moment of puncture,

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the tissue can't push back
on the tip anymore.

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So the mechanism unlocks 
and the spring retracts the tip.

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Let me show you that 
happening in slow motion.

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This is about 2,000 frames a second,

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and I'd like you to notice the tip

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right there on the bottom, 
about to puncture through tissue.

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And you'll see that 
right at the moment of puncture,

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

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

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You're going to see the sharp bladed tip,

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and right when it punctures 
that rubber membrane

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it's going to disappear
into this white blunt sheath.

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Right there.

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That happens within 4 100ths 
of a second after puncture.

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

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and not the specifics of cranial drilling,

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or laproscopic surgery, 
or another procedure,

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it's applicable across
these different medical disciplines,

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and across different length scales.

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But it didn't always look like this.

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This was my first prototype.

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Yes, those are popsicle sticks 
(Laughter)

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and there's a rubber band at the top.

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

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And it proved to me that my idea worked

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and justified the next couple years 
of work on this project.

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I worked on this because

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this problem really fascinated me.

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I mean it kept me up at night.

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But I think it should fascinate you too.

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Because I said puncture is everywhere.

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That means at some point 
it's going to be your problem too.

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That first day in the operating room

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I never expected to find myself 
on the other end of a trocar.

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

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So I was in the hospital in Athens,

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and the surgeon was telling me

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he was going to perform 
a laproscopic surgery.

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

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He was talking about 
what I could expect for the recovery,

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and what was going to happen.

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He said "Do you have any questions?"

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"Just one, doc. 
What kind of trocar do you use?"

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So my favorite quote 
about laproscopic surgery

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comes from a doctor H. C. Jacobaeus.

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And he said,

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"It is puncture itself that causes risk."

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That's my favorite quote 
because H.C. Jacobaeus

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was the first person to ever perform 
laproscopic surgery on humans,

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and he wrote that in 1912.

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This is a problem that's been injuring,
even killing people for over 100 years.

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It's easy to think 
that for every problem out there

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there's some team of experts 
working around the clock to solve it.

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The truth is that's not always the case.

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We have to be better at finding 
those problems

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and finding ways to solve them.

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So if you come across a problem
that grabs you,

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let it keep you up at night.

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Allow yourself to be fascinated,

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because there are so many lives to save.

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(Applause)