Meishin... will change.
- New President? - It's Kito-sensei?
Actively do more difficult surgeries that we can show off to the world.
That's why I called both of you back.
Is this for your own glory?
That team changed me.
Weren't you the same?
Stop making me so worry. 75 kg.
Health care is also an industry.
You will no longer need them.
Goodbye, Team Dragon.
Arase collapsed.
No other doctors, can anyone come over!?
One hour! Try to buy time!
Where's Arase-sensei?
He's saved! How?
The souvenir I brought from U.S, it's unlike others.
The world's best catheter specialist, Kuroki Keijiro.
That was dangerously close, Arase-sensei.
Myocardial infarction from coronary artery stenosis.
I'm terrifed. Scary. Scary.
Rest well, I've placed a stent.
- You can be discharged in 4 days - 4 days?
If surgery, needs at least 2 weeks. It's amazing!
That is, catheter.
Catheter?
Compared to surgery, the damage to body is much lesser.
With this, no one wants surgery.
You can return to the team immediately.
Could it be Godhand? Unbelievable!
You are?
World's best catheter interventionist, Kuroki Keijiro.
You are too flattering, Noguchi-Sensei.
Inserting a catheter into the narrow left main coronary artery.
He's ridiculously good!
I didn't realize he is that good.
You know him?
In the U.S medical world, everyone knows him.
Former professor of cardiology at the University of Texas, member of ACC and AHA,
and of all FESC personnels, he is the only Japanese member.
To treat a 99% stenosis of left main coronary artery,
inserting a wire from the groin to the affected area.
Using a guiding catheter to deliver a balloon, and inflating it there.
Then fixing bare-metal stents, to retain the vascular expansion state,
restoring healthy blood flow.
Asada needs 4 hours for the operation, he only needs 45 minutes.
That is, Kuroki Keijiro's catheter.
By bringing him in, what are you planning to do?
On that, let's discuss slowly in this room.
- President. - Kato-chan.
I was about to present to the President
my reform plan for Meishin.
Why don't you join in?
Even though I have nothing to present to you.
This is a big problem!
It's too risky to use a catheter in that situation
We should lodge a complaint to the committee.
But if we did nothing, Arase-sensei would have died.
Yeah.. even if it is..
Surgery or catheter, it doesn't matter as long he's saved.
Or are you prejudiced against catheter procedure?
Stupid! What are you saying!
First step, by using catheter treatment,
to greatly reduce the patient's body stress medical treatment reformation
As you know, catheter leaves a smaller incision wounds.
Naturally, the stress on the patient's body is lesser, so can be discharged faster.
The hospital will have more empty beds, thus increasing profitability.
It's like tables turnover rate of a restaurant.
Patient count is doubled. And because operation time is shorter, a doctor can do more treatments in a day.
- And then? - Led by Kuroki-sensei,
strengthening the cardiology catheter department, as one of the main pillars of the reform.
And to be awarded an IMA certification.
IMA? International Medical Care Assessment?
The world's hospital review body.
You're well-informed. Not bad, Kato-chan.
That's right, the "Michelin Guide" of medical world.
Our goal is three stars!
In Japan, no hospital has ever been awarded an IMA.
If we receive the honors, patients from all over the world will come.
At the same time, lobbying at foreign and health ministries,
to relax the medical visa requirements for foreigners.
Wealthily foreigners, after seeking catheter treatments here
can be discharged in 3 days, the remaining 4 days for sight-seeing.
This is the real medical tourism.
Miss Kito. Excuse me, President Kito.
This is the outline of the reform, please consider.
Is this the 15th floor? As expected, the view is very scenic.
It's really not good.
Yeah..
After this, catheter treatment will gradually be the mainstream right?
Huh?
At that time, surgery will lose its grounds?
Don't say such sensational statements.
- Kihara! - Huh?
Is ward 3A Suzuki-san's inspection report done?
- I'm sorry! - Quickly write it!
Wow! Scary... but beautiful!
Do your work! Don't let me get scolded again.
- She seems to be very anxious. - Anxious?
Because patients will soon be taken away by catheterization.
As a department head, it's an important matter of survival.
Ah! Why return it to me?
The elevator is so slow.
Don't worry so much, it's bad for the heart.
- Hey! - Are you OK?
- Ehh?
- Bring stretcher here! - OK!
- Raising the bed. - Putting on oxygen.
- Bring her to emergency operation room! - Yes.
- Please make way! - Saturation?
86
BP 130!
Negishi Sakou, 29 years old. Test results
revealed severe Atrial Septal Defect, or ASD.
leading to heart failure.
Injected vasodilators, now in stable condition
Her dad is in our gastrointestinal ward,
she came to visit but fainted instead.
ASD refers to the condition where there's a hole in the wall between the left and right atria of the heart.
Why is it up to such a critical condition,
- no operation was done? - I don't know.
She has been buying medications from a hospital near her home.
ASD can lead to heart failure or arrhythmia.
- It will be dangerous if not operated on immediately. - Yeah.
- Book the operating room immediately. - Me?
- The operation.. - I'll...
Asada, you're in.
OK.
- Go. - Yes.
Due to atrial septum defect, ASD repair surgery is required.
Operation duration is around 3 hours. The surgical repair
will close the defect with a synthetic fibre patch.
Is there any questions?
Hospital discharge?
Of course, it depends on your postoperative recovery.
If there's no problem, it will be 2 weeks.
I see.
The surgeon will be the cardiothoracic surgery specialist,
Asada-sensei.
Um..
Is immediate surgery absolutely required?
You mean?
Actually, we are to get married in 10 days time.
Eh?
Negishi-san, your heart has severe ASD,
which can lead to heart failure any time.
It's a risky condition. I understand your feelings,
- but it cannot be delayed. - I see.
- Um... - Yes?
How big is the post-operative scars?
For a midline incision, the incision starts from the center of chest.
From this area, extending down around 15 cm long scar.
Pulmonary blood flow ratio 5.0, shunt rate 88%.
Pulmonary artery pressure 55mmHg.
It seems a really urgent surgery.
Yeah.
- Need immediate surgery! - Sensei!
- Her dad? - Yes.
End-stage stomach cancer.
And only a month to live.
When she was a child, her mother died in an accident.
Father and daughter have gone through so much,
therefore, we want to have this wedding as soon as possible.
So that's why she hadn't had an operation till now?
I understand your feelings.
But, with her current condition, we can't delay any more.
That's right. I know that also, but..
Daughter's wedding?
I want it to happen..
Good evening.
Translator & QC: indokid, serene012
HD re-timing by: @ChrHd
Catheter?
Yes. In this case
from the thigh vein
inserting this catheter,
guiding the catheter tip to location of atrial defect,
fixing an Amplatzer to patch the defect.
then, removing the Amplatzer,
and pulling out the catheter. That's it.
Operation takes about 2 hours. You can be discharged 3 days after.
- 3 days!? - Yes. Of course.
There won't be any chest scars.
I've never heard of such treatment.
Perhaps it's the vices of surgeons,
they are constraint to their "territory" to treat patients.
This is my thoughts.
Of course, surgery or catheter, which one to choose
is your freedom.
She declined surgery for Kuroki's catheter treatment?
She doesn't want any scarring.
He secretly coaxed Negishi-san.
That Kuroki..!
ASD catheter treatment is still premature.
Long-terms effects are unclear.
Larger uncertainties in prognosis, the Amplatzer has to match the defect hole exactly.
A crack will extend the risk of the defect.
Currently, catheter
carries a high risk.
Let's just go with surgery.
But, catheter treatment..
This is a cardiac operation.
What if anything happens?
Your health is not yours alone.
Here!
Negishi-san has decided to accept Asada's surgery.
Recommending unsuitable catheter treatments to patients..
Kuroki, you've changed.
So, the outcome is surgery?
Of course, this is a matter of life and death.
Who would bother about the wound size?
I think each person's values are different.
- What? - There are people who value non-scarring highly.
Sensei, you seemed to be blinded by surgery.
Ah! It's time! See you!
This is your lab.
You'll do your research work here.
University of Aachen in Germany has developed an
anti-carcinogen cultivated from iPS cells. The race has started.
- I want to ask you something. - Yes?
What plans do you have for Professor Noguchi?
I'm putting him as a member of Meishin Reform Commission.
What! Why?
The reform plan he proposed is in line with Meishin's fundamentals.
- That's it. - But he..
Reformation is costly.
Of course, including raising your research funds.
Management philosophy is thus required.
That's why you bring in Noguchi?
Black rat or white rat.
As long it can bring in money, it's a good rat.
Chew~
Excuse me, adjusting infusion amount.
I'm sorry, sensei. It's confusing.
It's normal to have many doubts.
I think you've heard, my dad's days are numbered.
My mom passed away when I was 3, it's been only both of us ever since.
My dad works as a taxi driver,
while single-handedly raising me up.
Nevertheless..
he's suffering from stomach cancer.
What is he living his life for?
I wonder.
His wife died not long after marriage.
To bring me up, he worked tirelessly.
At the end, being told his time is running out.
Maybe, my dad's happiest moment would be
when I am wearing my mom's wedding dress at my wedding.
Therefore, if non-scarring catheter treatment is possible..
Ah.. you're still here?
Ijyuuin, call Kato here.
Minimally Invasive Cardiac Surgery?
Yeah, MICS.
At the middle of right ribs, opening a 5 cm incision in order to reach the heart.
Then performing the defect repair.
In this way, the wound is smaller, and you can be discharged in 5 days.
The operative field is much smaller,
hence is extremely difficult technically.
However, you can have non-visible scars at your wedding.
This is done out of consideration of Negishi-san's QoL (Quality of Life).
We will do our best, to provide you with such an option.
- Yes. - Although the risk is increased,
but it shouldn't be a problem for Asada-sensei, don't worry.
In this way, you can wear that wedding dress.
- Thank you. - Thank you.
Sigh..
No matter what, a midline incision is still safest.
You cannot fail, Asada!
Ijyuuin, this is not a simple operation.
- Yes. - We start rehersal today.
With such small incision, we can only guarantee operative field of the surgeon, Asada.
The rest of us can observe via this monitor.
It looks good.
But, if you cannot match the monitor recording to a 3d image of heart in your mind,
- this operation cannot be done. - Yes.
- Let's start. - Yes.
- I'm sorry for troubling you. - It's OK.
I'll take care of all the wedding matters.
Thank you.
- Hold it. - Yes.
- Ijyuuin-kun, thread is loose. - Sorry.
Maintain a constant tension for thread.
Yes.
Continue.
Ijyuuin, let's start from the beginning.
Yes.
- Excuse me. - Yes?
Where is Kato-sensei?
Kato-sensei is right over there.
Thank you very much.
Tweezer. Needle holder.
- Ijyuuin, follow the thread. - Yes.
- You have to constantly think ahead, of what is needed next. - Yes.
- Let's try again. - Yes.
In the end it's surgery? You guys are reckless.
Everything has to cut.
Weren't you also a cardiac surgeon before?
A person can change, Kato-chan.
Just like President Kito.
She is deeply interested in catheter treatment.
It's a no-brainer, after all
if you can treat more patients, profit increases.
Miss Kito is no longer a doctor,
but an outstanding businesswoman.
("Team Dragon" as the core of rebirth of surgical team)
(I. Meishin University Hospital current status. II. Strengthening the surgical department status. III. The so-called "Team Dragon". IV. Implementation of pediatric heart transplant. V. Other scheduled difficult surgeries. VI. Expected results of reformation.)
See you tomorrow, have a good rest tonight.
Good night.
Good evening.
This is bad!
It'll be OK.
It will end quickly.
- Don't worry. - Yes.
Why today? Who convinced her?
Arase!?
5ml Propofol.
Why, Arase-sensei?
1 2 3
4 5 6
7. She's down.
We already promised MICS to her. And yet..?
She changed her mind.
Does not want her chest to be cut opened for 4-5 hours.
You know very well it does not take that long!
Asada has operated on you before.
Yeah, that's why my body has not been good since then.
I heard the patient herself wished for a catheter treatment.
We need to respect the patient's request.
Team Asada can standby and prepare just in case.
- Helper, monitor. - Yes.
- Syringe. - Yes.
- Fast! How? - Not looking at his hand or monitor.
Just using fingertip feelings?
- Sheath. - Yes.
Wire is out.
Beautiful! Flowing perfectly like water into the body!
Here.
30 seconds to reach right atrium.
Fast..
Sensei, saturation is falling!
- Not so loud. Shut it. - Sorry.
Raising O2 to 5 litres.
OK.
- Went through the hole of ASD. - What's he doing?
Shouldn't he be patching the defect hole?
That catheter..?
What on earth is Kuroki doing?
Patient has symptoms of cardiac arrhythmia, AF(Atrial Fibrillation) condition.
Making use of ASD to cure AF, all at once.
How..? I've always thought that irregular heartbeat is caused by heart failure..
So, he has been planning from start to cure the AF.
Even so, making use of the hole from ASD to treat AF, how..?
Now commencing catheter ablation for AF.
- Lasso 2. - Yes.
I see.. to treat AF with ablation,
the passage of catheter from right to left atrium,
requires puncturing a hole in atrial septum.
However, since there's already a hole from ASD, it's not necessary.
It's a great idea.
Curing AF all at once.
No need for any arrhythmic drugs next time.
Arrhythmia too?
Surgery can only cure ASD.
But with my catheter, both can be cured.
Don't worry.
I will explain to Asada-sensei.
OK. Start with extensive ablation at pulmonary vein.
- 30W. - Yes.
It's show time!
Catheter ablation.
With 30W RF power to induce AF, then burning the source of all abnormal electrical signals.
To completely ablate all abnormal signals,
is extremely difficult, if you over-burn,
will burn a hole in heart, if incomplete burning,
arrhythmia will not not cured.
Amazing!
That line is perfectly isolating sources of AF.
AF!
Atrial fibrillation occurred.
This is bad! Ablation is not yet completed, you cannot clearly find the remaining..
AF continuing!
Found it!
He smiled!
Asada-sensei!?
It's here!
It's gone! AF has disappeared!
AF has disappeared.
Wonderful!
Not yet. We're not done yet.
Unbelievable, recovering from intraoperative AF...
No, that was intentionally induced.
- Eh? - Taking advantage of AF,
to determine the location of abnormal signals.
What a guy!
Curing ASD and AF all at once!
Perfect catheter!
Great.
So, President, I have something to discuss.
Ah, Kato-chan, you're still here?
Now you can wear that wedding dress.
Thank you so much, Kuroki-sensei.
Let's go.
This man, Kuroki Keijiro,
and that, is world-class medical technique.
There will be more catheter treatment cases.
And this man will show to the world
a new catheter technique.
In the future, with the development of medical devices,
Godhand surgery will be a legacy of the past.
How much is their salary?
If you were to assign all their operations to Kuroki alone,
how much expenses would be saved?
What are you saying?
From admiration of Kuroki's skills, worldwide catheter specialists will gather here.
Soon, Team Kuroki will be formed.
The present Meishin, is Team Dragon really necessary?
I've seen Negishi-san's post-operative CT.
You want to say that surgery is a better treatment?
AF is completely cured.
Considering the QoL of patient, it is the best treatment.
Dad, all these years. Thank you.
That catheter was spectacular.
It's nothing too uncommon for me.
15 years has passed, the you at that time...
Old story, stop it. I'm not the person you once knew.
You still hate surgery?
- Helper. - Yes.
- Deliver this paper to the health ministry. - Yes.
hope you enjoy!