Black Pean Information #4-6
Apr. 28th, 2018 05:44 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
tronellaMANY SPOILERS FOR EPISODE ONE.
Medical commentary on episode 1 (1)
Dr Yamagishi has provided medical commentary on the surgical scenes and so on in episode 1.
The brilliance of the Saeki method
Broadly speaking, there are three kinds of heart surgery in adult patients.
The Saeki method is surgery to repair a valve (a gate inside the heart). Although it is just repairing a gate, there is a lot of blood filling the inside of the heart, so it isn’t possible to just cut the heart open and repair the gate. Surgery is usually performed using a heart-lung machine (a machine that replaces the functions of the heart and lungs) and injecting cardioplegia solution (a fluid that stops and protects the heart) into the coronary artery. The Saeki method uses a heart-lung machine (on pump), but the mitral valve is repaired without stopping the heart, while it is still moving (beating-heart).
Think about fixing a normal gate. Wouldn’t it be difficult to fix a gate while crowds of people are going through it, opening and closing it? Usually you would stop people from passing through it and fix it like that.
The Saeki method is like fixing a gate while it is moving, with crowds of people going through it. The valves and muscles of the heart are extremely delicate, so repairing them while they are moving (e.g. by suturing them) is extremely difficult. If the needle misses by even a little, the tissue can tear and become impossible to repair. The genius Professor Saeki can complete this without missing by even 0.01 mm. He really is superhuman.
I think there are two main advantages to the Saeki method.
Stopping the heart (safely, using cardioplegia solution) causes some damage to the heart muscle, but the Saeki method does not stop the heart, so it can prevent damage to the heart muscle. Also, the heart is repaired while still moving, with blood passing through the valve, which means it can be repaired while seeing how the valve really moves. So after the gate is repaired, it won’t break again when lots of people actually go through it.
* Currently, in mitral valve surgeries under normal conditions, the heart is safely stopped. Cardioplegia technology is very advanced, so stopping the heart does not lead to cardiac muscle damage, so don’t worry.
Yokoyama’s failure (acute aortic dissection surgery) and Tokai’s brilliance
Mr Miyazaki from the private room, who was scheduled for surgery by the Saeki method, has an acute aortic dissection. Acute aortic dissection is a disease where a tear (fissure; entry) suddenly appears in the wall of the aorta. The wall tears and blood steadily flows inside the wall. The wall becomes thinner and, in the worst cases, the aorta can rupture, releasing a lot of blood and causing the patient’s death. It’s said that half of all patients who show symptoms die from this terrifying disease. It is reported at a frequency of about 5 in every 100,000 people per year. Although it is an uncommon disease, it became a topic of discussion for a while after some famous people had it.
The aorta comes out of the heart and carries blood to the rest of the body, and the part immediately after it leaves the heart is called the base of the aorta. The part above that is called the ascending aorta. A tear in the wall of the ascending aorta is called a type A dissection, and this often requires emergency surgery. A CT scan is performed to diagnose it. Mr Miyazaki is diagnosed with a rupture in the ascending aorta by CT scan and receives emergency surgery.
Dissection surgery involves replacing the part with the tear (fissure; entry) inside the wall with a prosthetic vessel. This is because, if the tear is left alone, blood will steadily flow into the blood vessel. In a type A dissection, if there is a tear (entry) inside the ascending aorta, the ascending aorta must be replaced with a prosthetic vessel, and if there is a tear in the aortic arch above that, total aortic arch replacement is required (replacing everything from the ascending aorta to the aortic arch with a prosthetic vessel). If there is a tear in the base, the base must be replaced (aortic root replacement or reconstruction of the aortic base).
In summary, you have to look for any tears inside the aorta and replace them with a prosthetic vessel. In Mr Miyazaki’s case, Professor Saeki looked at the monitor and said “there’s a tear in (inside) the ascending aorta. Yokoyama, repair the ascending aorta". That was an appropriate instruction, as an operation to replace the ascending aorta with a prosthetic vessel must be performed if there is a tear (entry) in the ascending aorta.
However, there is something the operator (operating surgeon) must do in every case. They must check that there is no tear (entry) inside or going into the base. If a tear is left in the base, blood will gradually build up in the walls of the vessels in the base, causing ruptures in the worst-case scenario. This is naturally expected of a heart surgeon, and Yokoyama was negligent in accepting the professor’s instructions without question.
I have personally never experienced large amounts of blood coming out of the base after a real aortic reconstruction, but it is a very possible situation. In that case, you really would panic like Yokoyama did. If the base ruptures, the blood flow into the coronary artery (a blood vessel that supplies the heart itself with oxygen and nutrients), which comes out of the base, will be drastically reduced, causing convulsions of the heart (ventricular fibrillation). If the blood flow into the coronary artery is reduced, blood cannot reach the heart muscle properly, so the heart muscle will steadily weaken.
When Takashina in the monitor room says “They're running out of time”, he means “the blood flow into the coronary artery has been reduced and blood can’t reach the heart muscle, so the heart muscle will become more and more damaged and it will soon be impossible to repair it”. In that kind of situation, you have to block off the aorta again (meaning the prosthetic vessel, this time), use cardioplegia solution to stop (and protect) the heart and reconstruct the base (base reconstruction or aortic root replacement).
Tokai calmly says “Okay, I'll reconstruct the base. Clamp forceps.” and briskly reconstructs the base (base reconstruction is a fairly difficult operation). The two assistants are also overwhelmed by the speed of his actions and don’t help at all. Usually during surgery, the operator, first assistant and second assistant are all there and cooperate to perform the operation, but Tokai does it all himself. He is so skilled that he doesn’t need an assistant. It also proves that he doesn’t rely on other surgeons at all and is confident that no one can match his skill in his field. He shows that he thinks that “if you can’t do it, don’t do it badly”. Some surgeons blame their own failures on other people. Either their assistant was bad, or the anaesthetist was bad, or the nurse was bad… “The problem is the surgeon who accepted his orders without question and continued the operation without checking the base.” Everything is the surgeon’s responsibility. Through his own actions, Tokai represents something that is very natural for surgeons.
---
Next time, I will talk about “Tokai’s judgement”.
Please look forward to it.
Medical commentary on episode 1 (2)
Medical commentary by Dr Yamagishi on episode 1. This time, he discusses “Tokai’s judgement” and “autologous aortic valvuloplasty”.
Tokai’s judgement
A first-rate surgeon is not only good at surgical technique, but also has excellent judgement. They calculate the shortest route to save the patient in front of them in an instant and take the appropriate steps to achieve that. To treat Mr Miyazaki, who still had mitral regurgitation after his surgery for acute aortic dissection, should he stop the heart, operate without stopping the heart or monitor him and treat the mitral regurgitation another day? Looking at the condition of the heart and the patient’s overall condition as a whole, he makes an instant judgement and decides to treat him with the heart still beating (Saeki method). He is confident that he himself can succeed in the Saeki method even though he’s never used it before, and he succeeds wonderfully. He is truly first-rate.
Autologous aortic valvuloplasty
In the large meeting room, Kakitani and Sera watch Sekikawa and Tokai perform surgery. Typically, heart surgery is started by cutting the chest open vertically in the middle (midline incision), with the surgeon standing on the patient’s right side and the first assistant on the left. Generally, surgery is performed by the person standing on the right (Sekikawa), but Sekikawa does hardly anything, and Tokai on the left continues the operation. Tokai decides the course of the surgery, giving instructions like “I'm taking this pericardial patch.” “I don't need a prosthetic valve.” This kind of autologous aortic valvuloplasty was developed by Professor Ozaki at Tokyo University Oohashi Hospital’s cardiac surgery department, and only a few people in the world are able to perform it as yet. For Tokai to be able to think of it and casually perform it shows that he is no ordinary person, after all, not to mention that he was acting as the assistant. Just from watching this short scene, heart surgeons around the world would look at him with envy. Tokai’s line, “We can treat this patient with his own tissues, but you want to shove in some foreign body like a prosthetic valve?”, is a very wise saying.
---
Next time, I’ll write about “the importance of preparation”.
Please look forward to it.
Medical commentary on episode 1 (3)
This is the last part of Dr Yamagishi’s medical commentary on episode 1.
The importance of preparation (imminent rupture of a splenic artery aneurysm)
Although this is also true for the first half of episode 1, in the second half Tokai makes even more wise and medically educational statements that we should take to heart.
He tells Takashina, who wants to continue the SNIPE operation, “I'm not talking about the future, I'm talking about now!”
Doctors exist to save the patients in front of us, and you’d expect that people aim to become doctors because they simply want to save patients. That sounds obvious, but forgets about things like position, influence, human relationships, honour and so on.
Tokai sounds the alarm on Takashina. After Professor Saeki orders them to continue the operation with the SNIPE, Tokai’s expression shows his sincere desire to save the patient in front of him.
After that, he shows Mrs Minagawa’s CT scan to a shocked Sera, saying “An amateur like you probably can't tell, but Takashina set this up.”
What does Tokai mean by this? As well as looking at all of the patient’s preoperative scans and deciding on the course of the surgery, on heading into this surgery, he’s thinking of all the effort he has put in as preparation since he became a doctor – no, since he was born. At least in my view, that’s how prepared Tokai is. If not, he wouldn’t be so confident in the operating room.
Takashina says “Why is she haemorrhaging? The surgery should have gone perfectly.” And Tokai replies “For her heart, yes. You didn't look at anything else, though.”
“If you've killed this woman, you should die.” He steadily corners Takashina.
Takashina is probably fairly skilled, and he even went abroad and brought back the latest SNIPE technology to Japan. Tokai constantly attacks Takashina, as if denying his entire career as a doctor. No matter how great his work history looks or if he uses the latest technology, if he causes the patient in front of him to die, that career and technology are meaningless, nothing more than a dangerous weapon. Saying that going abroad and bringing the latest SNIPE technology back to Japan is what’s killing Mrs Minagawa is no exaggeration. Not only does he overlook the splenic artery aneurysm, but his hands shake in the surgery and he can’t operate. Even with the latest foreign technology in his hands, when it looks like the patient in front of him will lose her life, his hands shake and he can’t do anything. Some people might be thinking “is that even possible?” … Actually, there are probably quite a few surgeons who graduated from a top university, did a placement at a top university, published many papers and seem to have a bright, brilliant career, but when they actually operate, their hands shake and they can’t meet your eyes.
Splenic artery aneurism is a disease where an aneurysm develops in the artery going from the stomach to the spleen. It is not a common disease – I have seen about 5 cases in 10 years. Maybe doctors from gastrointestinal surgery or radiology departments have more experience with it. “If you just put a new valve in and instantly improve her circulation, you ought to know that would cause damage elsewhere” means that when you put in a new valve in a case of mitral valve insufficiency and control the mitral regurgitation, the blood flow around the body (forward flow, output) increases, blood pressure increases and this causes arterial aneurysms to rupture. To support this possibility, Tokai also says “There was a fatal case (in the SNIPE paper) similar to this one”, further attacking his lack of preparation.
In reality, in a case with a splenic artery aneurysm of that size together with severe mitral valve insufficiency, the decision about which of these should be surgically treated first would be based on the patient’s kidney function, and I think it would be fairly difficult to decide.
Splenic artery aneurysms are treated by surgical ablation (+ bypass surgery), coil embolisation by catheter or various other methods, but if they rupture, it would probably be appropriate to treat the rupture by laparoscopy (cutting the stomach open). This depends on the hospital’s power balance, or whether laparoscopy (by the radiology department, etc.) or catheter treatment can be prepared faster. Mrs Minagawa is in shock and her blood pressure is dropping rapidly, and the anaesthesiologist seems quite panicked as he administers anaesthesia too: the tube holder is the wrong way around.
The CT scan shows quite a deep location, so surgery of the rupture would be quite difficult. Depending on the situation, they could decide to remove the spleen, but the splenic artery is at the base of the spleen so a simple splenectomy would probably not resolve this. They block the vessels leading into and out of the splenic artery, but Takashina can’t identify the site of the bleeding and panics; his hands shake as he sees that the patient is dying, and he can’t even hold the needle holder (a tool for holding needles). That’s when Tokai appears.
“Then do it yourself!”
He passionately says of Sera’s patient.
“Bring a large needle!” “I can't tell where the blood is coming from!”
Tokai using Metzenbaum scissors to separate the tissue surrounding the spleen and pulling it out by hand, Sera’s expression as he holds the spleen, Tokai quickly stopping the bleeding, Nekota quickly dealing with the instruments. It’s a very realistic surgery scene.
[Then the section on “autologous aortic valvuloplasty” from vol. 5 is accidentally repeated here again.]
Medical commentary on episode 1 (1)
Dr Yamagishi has provided medical commentary on the surgical scenes and so on in episode 1.
The brilliance of the Saeki method
Broadly speaking, there are three kinds of heart surgery in adult patients.
- Coronary artery bypass, surgery to make an alternative route (bypass) for the blood vessels around the heart (1-2 mm).
- Heart valve surgery: surgery to repair (reconstruct) or replace the gates (valves) inside the heart.
- Aortic surgery: surgery to replace an aorta that has an aneurysm or a tear (rupture) in its wall with a prosthetic vessel.
The Saeki method is surgery to repair a valve (a gate inside the heart). Although it is just repairing a gate, there is a lot of blood filling the inside of the heart, so it isn’t possible to just cut the heart open and repair the gate. Surgery is usually performed using a heart-lung machine (a machine that replaces the functions of the heart and lungs) and injecting cardioplegia solution (a fluid that stops and protects the heart) into the coronary artery. The Saeki method uses a heart-lung machine (on pump), but the mitral valve is repaired without stopping the heart, while it is still moving (beating-heart).
Think about fixing a normal gate. Wouldn’t it be difficult to fix a gate while crowds of people are going through it, opening and closing it? Usually you would stop people from passing through it and fix it like that.
The Saeki method is like fixing a gate while it is moving, with crowds of people going through it. The valves and muscles of the heart are extremely delicate, so repairing them while they are moving (e.g. by suturing them) is extremely difficult. If the needle misses by even a little, the tissue can tear and become impossible to repair. The genius Professor Saeki can complete this without missing by even 0.01 mm. He really is superhuman.
I think there are two main advantages to the Saeki method.
Stopping the heart (safely, using cardioplegia solution) causes some damage to the heart muscle, but the Saeki method does not stop the heart, so it can prevent damage to the heart muscle. Also, the heart is repaired while still moving, with blood passing through the valve, which means it can be repaired while seeing how the valve really moves. So after the gate is repaired, it won’t break again when lots of people actually go through it.
* Currently, in mitral valve surgeries under normal conditions, the heart is safely stopped. Cardioplegia technology is very advanced, so stopping the heart does not lead to cardiac muscle damage, so don’t worry.
Yokoyama’s failure (acute aortic dissection surgery) and Tokai’s brilliance
Mr Miyazaki from the private room, who was scheduled for surgery by the Saeki method, has an acute aortic dissection. Acute aortic dissection is a disease where a tear (fissure; entry) suddenly appears in the wall of the aorta. The wall tears and blood steadily flows inside the wall. The wall becomes thinner and, in the worst cases, the aorta can rupture, releasing a lot of blood and causing the patient’s death. It’s said that half of all patients who show symptoms die from this terrifying disease. It is reported at a frequency of about 5 in every 100,000 people per year. Although it is an uncommon disease, it became a topic of discussion for a while after some famous people had it.
The aorta comes out of the heart and carries blood to the rest of the body, and the part immediately after it leaves the heart is called the base of the aorta. The part above that is called the ascending aorta. A tear in the wall of the ascending aorta is called a type A dissection, and this often requires emergency surgery. A CT scan is performed to diagnose it. Mr Miyazaki is diagnosed with a rupture in the ascending aorta by CT scan and receives emergency surgery.
Dissection surgery involves replacing the part with the tear (fissure; entry) inside the wall with a prosthetic vessel. This is because, if the tear is left alone, blood will steadily flow into the blood vessel. In a type A dissection, if there is a tear (entry) inside the ascending aorta, the ascending aorta must be replaced with a prosthetic vessel, and if there is a tear in the aortic arch above that, total aortic arch replacement is required (replacing everything from the ascending aorta to the aortic arch with a prosthetic vessel). If there is a tear in the base, the base must be replaced (aortic root replacement or reconstruction of the aortic base).
In summary, you have to look for any tears inside the aorta and replace them with a prosthetic vessel. In Mr Miyazaki’s case, Professor Saeki looked at the monitor and said “there’s a tear in (inside) the ascending aorta. Yokoyama, repair the ascending aorta". That was an appropriate instruction, as an operation to replace the ascending aorta with a prosthetic vessel must be performed if there is a tear (entry) in the ascending aorta.
However, there is something the operator (operating surgeon) must do in every case. They must check that there is no tear (entry) inside or going into the base. If a tear is left in the base, blood will gradually build up in the walls of the vessels in the base, causing ruptures in the worst-case scenario. This is naturally expected of a heart surgeon, and Yokoyama was negligent in accepting the professor’s instructions without question.
I have personally never experienced large amounts of blood coming out of the base after a real aortic reconstruction, but it is a very possible situation. In that case, you really would panic like Yokoyama did. If the base ruptures, the blood flow into the coronary artery (a blood vessel that supplies the heart itself with oxygen and nutrients), which comes out of the base, will be drastically reduced, causing convulsions of the heart (ventricular fibrillation). If the blood flow into the coronary artery is reduced, blood cannot reach the heart muscle properly, so the heart muscle will steadily weaken.
When Takashina in the monitor room says “They're running out of time”, he means “the blood flow into the coronary artery has been reduced and blood can’t reach the heart muscle, so the heart muscle will become more and more damaged and it will soon be impossible to repair it”. In that kind of situation, you have to block off the aorta again (meaning the prosthetic vessel, this time), use cardioplegia solution to stop (and protect) the heart and reconstruct the base (base reconstruction or aortic root replacement).
Tokai calmly says “Okay, I'll reconstruct the base. Clamp forceps.” and briskly reconstructs the base (base reconstruction is a fairly difficult operation). The two assistants are also overwhelmed by the speed of his actions and don’t help at all. Usually during surgery, the operator, first assistant and second assistant are all there and cooperate to perform the operation, but Tokai does it all himself. He is so skilled that he doesn’t need an assistant. It also proves that he doesn’t rely on other surgeons at all and is confident that no one can match his skill in his field. He shows that he thinks that “if you can’t do it, don’t do it badly”. Some surgeons blame their own failures on other people. Either their assistant was bad, or the anaesthetist was bad, or the nurse was bad… “The problem is the surgeon who accepted his orders without question and continued the operation without checking the base.” Everything is the surgeon’s responsibility. Through his own actions, Tokai represents something that is very natural for surgeons.
---
Next time, I will talk about “Tokai’s judgement”.
Please look forward to it.
Medical commentary on episode 1 (2)
Medical commentary by Dr Yamagishi on episode 1. This time, he discusses “Tokai’s judgement” and “autologous aortic valvuloplasty”.
Tokai’s judgement
A first-rate surgeon is not only good at surgical technique, but also has excellent judgement. They calculate the shortest route to save the patient in front of them in an instant and take the appropriate steps to achieve that. To treat Mr Miyazaki, who still had mitral regurgitation after his surgery for acute aortic dissection, should he stop the heart, operate without stopping the heart or monitor him and treat the mitral regurgitation another day? Looking at the condition of the heart and the patient’s overall condition as a whole, he makes an instant judgement and decides to treat him with the heart still beating (Saeki method). He is confident that he himself can succeed in the Saeki method even though he’s never used it before, and he succeeds wonderfully. He is truly first-rate.
Autologous aortic valvuloplasty
In the large meeting room, Kakitani and Sera watch Sekikawa and Tokai perform surgery. Typically, heart surgery is started by cutting the chest open vertically in the middle (midline incision), with the surgeon standing on the patient’s right side and the first assistant on the left. Generally, surgery is performed by the person standing on the right (Sekikawa), but Sekikawa does hardly anything, and Tokai on the left continues the operation. Tokai decides the course of the surgery, giving instructions like “I'm taking this pericardial patch.” “I don't need a prosthetic valve.” This kind of autologous aortic valvuloplasty was developed by Professor Ozaki at Tokyo University Oohashi Hospital’s cardiac surgery department, and only a few people in the world are able to perform it as yet. For Tokai to be able to think of it and casually perform it shows that he is no ordinary person, after all, not to mention that he was acting as the assistant. Just from watching this short scene, heart surgeons around the world would look at him with envy. Tokai’s line, “We can treat this patient with his own tissues, but you want to shove in some foreign body like a prosthetic valve?”, is a very wise saying.
---
Next time, I’ll write about “the importance of preparation”.
Please look forward to it.
Medical commentary on episode 1 (3)
This is the last part of Dr Yamagishi’s medical commentary on episode 1.
The importance of preparation (imminent rupture of a splenic artery aneurysm)
Although this is also true for the first half of episode 1, in the second half Tokai makes even more wise and medically educational statements that we should take to heart.
He tells Takashina, who wants to continue the SNIPE operation, “I'm not talking about the future, I'm talking about now!”
Doctors exist to save the patients in front of us, and you’d expect that people aim to become doctors because they simply want to save patients. That sounds obvious, but forgets about things like position, influence, human relationships, honour and so on.
Tokai sounds the alarm on Takashina. After Professor Saeki orders them to continue the operation with the SNIPE, Tokai’s expression shows his sincere desire to save the patient in front of him.
After that, he shows Mrs Minagawa’s CT scan to a shocked Sera, saying “An amateur like you probably can't tell, but Takashina set this up.”
What does Tokai mean by this? As well as looking at all of the patient’s preoperative scans and deciding on the course of the surgery, on heading into this surgery, he’s thinking of all the effort he has put in as preparation since he became a doctor – no, since he was born. At least in my view, that’s how prepared Tokai is. If not, he wouldn’t be so confident in the operating room.
Takashina says “Why is she haemorrhaging? The surgery should have gone perfectly.” And Tokai replies “For her heart, yes. You didn't look at anything else, though.”
“If you've killed this woman, you should die.” He steadily corners Takashina.
Takashina is probably fairly skilled, and he even went abroad and brought back the latest SNIPE technology to Japan. Tokai constantly attacks Takashina, as if denying his entire career as a doctor. No matter how great his work history looks or if he uses the latest technology, if he causes the patient in front of him to die, that career and technology are meaningless, nothing more than a dangerous weapon. Saying that going abroad and bringing the latest SNIPE technology back to Japan is what’s killing Mrs Minagawa is no exaggeration. Not only does he overlook the splenic artery aneurysm, but his hands shake in the surgery and he can’t operate. Even with the latest foreign technology in his hands, when it looks like the patient in front of him will lose her life, his hands shake and he can’t do anything. Some people might be thinking “is that even possible?” … Actually, there are probably quite a few surgeons who graduated from a top university, did a placement at a top university, published many papers and seem to have a bright, brilliant career, but when they actually operate, their hands shake and they can’t meet your eyes.
Splenic artery aneurism is a disease where an aneurysm develops in the artery going from the stomach to the spleen. It is not a common disease – I have seen about 5 cases in 10 years. Maybe doctors from gastrointestinal surgery or radiology departments have more experience with it. “If you just put a new valve in and instantly improve her circulation, you ought to know that would cause damage elsewhere” means that when you put in a new valve in a case of mitral valve insufficiency and control the mitral regurgitation, the blood flow around the body (forward flow, output) increases, blood pressure increases and this causes arterial aneurysms to rupture. To support this possibility, Tokai also says “There was a fatal case (in the SNIPE paper) similar to this one”, further attacking his lack of preparation.
In reality, in a case with a splenic artery aneurysm of that size together with severe mitral valve insufficiency, the decision about which of these should be surgically treated first would be based on the patient’s kidney function, and I think it would be fairly difficult to decide.
Splenic artery aneurysms are treated by surgical ablation (+ bypass surgery), coil embolisation by catheter or various other methods, but if they rupture, it would probably be appropriate to treat the rupture by laparoscopy (cutting the stomach open). This depends on the hospital’s power balance, or whether laparoscopy (by the radiology department, etc.) or catheter treatment can be prepared faster. Mrs Minagawa is in shock and her blood pressure is dropping rapidly, and the anaesthesiologist seems quite panicked as he administers anaesthesia too: the tube holder is the wrong way around.
The CT scan shows quite a deep location, so surgery of the rupture would be quite difficult. Depending on the situation, they could decide to remove the spleen, but the splenic artery is at the base of the spleen so a simple splenectomy would probably not resolve this. They block the vessels leading into and out of the splenic artery, but Takashina can’t identify the site of the bleeding and panics; his hands shake as he sees that the patient is dying, and he can’t even hold the needle holder (a tool for holding needles). That’s when Tokai appears.
“Then do it yourself!”
He passionately says of Sera’s patient.
“Bring a large needle!” “I can't tell where the blood is coming from!”
Tokai using Metzenbaum scissors to separate the tissue surrounding the spleen and pulling it out by hand, Sera’s expression as he holds the spleen, Tokai quickly stopping the bleeding, Nekota quickly dealing with the instruments. It’s a very realistic surgery scene.
[Then the section on “autologous aortic valvuloplasty” from vol. 5 is accidentally repeated here again.]
![[identity profile]](https://www.dreamwidth.org/img/silk/identity/openid.png){kind=small}
(no subject)
Date: 2018-04-28 06:08 pm (UTC)Thanks for all this tidbit info!! No medical dorama without all the blood loss and lots of talking in the operating room lol
It is interesting which theory that only exist in dorama and what not
(no subject)
Date: 2018-04-28 10:53 pm (UTC)(no subject)
Date: 2018-04-28 10:54 pm (UTC)(no subject)
Date: 2018-04-29 03:32 am (UTC)Waw... it kind an amazing explanation. And it make me like that freaking damn skilled tokai sensei even more.. thanks! I'll be waiting the continuation!
(no subject)
Date: 2018-04-29 07:00 pm (UTC)(no subject)
Date: 2018-04-29 03:51 am (UTC)Looking forward to the next episode ^_^
(no subject)
Date: 2018-04-29 04:09 am (UTC)(no subject)
Date: 2018-04-29 09:14 am (UTC)I'm not a doctor, but I am a medical translator. (Although I don't translate Japanese at work.)
(no subject)
Date: 2018-04-29 08:18 am (UTC)(no subject)
Date: 2018-04-29 12:47 pm (UTC)(no subject)
Date: 2018-04-29 02:58 pm (UTC)but I kinda confuse from the third part - “An amateur like you probably can't tell, but Takashina set this up.”
does it means Takashina already knew the patient's condition or he missed the details of the CT scan?
(no subject)
Date: 2018-04-29 03:05 pm (UTC)(no subject)
Date: 2018-04-29 03:36 pm (UTC)I enjoy the operation scenes with your translation ^_^
(no subject)
Date: 2018-04-29 03:41 pm (UTC)(no subject)
Date: 2018-04-29 03:29 pm (UTC)(no subject)
Date: 2018-04-29 04:27 pm (UTC)(all in caps)
I'm soooooo bad at this kind of stuff (was in art and languages program in high school) that I have to (happily) watch the EP twice, with your sub, of course. I don't watch medical stuff at all. And honestly I still don't fully understand everything.
I wouldn't say i understand everything you said but I do understand stuff better.
with all the knowledge you gave us, sensei, i'm heading off for my third time of watching this.
(no subject)
Date: 2018-04-29 07:02 pm (UTC)(no subject)
Date: 2018-04-30 06:26 am (UTC)(no subject)
Date: 2018-04-30 01:28 pm (UTC)