Batista operation was invented to treat DCM(Dilated Cardiomyopathy), other than requiring an unparalled medical technology, there still lies an assortment of difficulties but steady improvements have been established, and success rate is increasing
we will begin Batista operation
Batista team is performing an emergency operation
Batista.. emergency operation!!
he did it again
Batista operation is starting
the operation will be stopped soon
because of the patient's unstable condition, they couldn't perform enough examination pre-operation
there is another fatal disease on that kid
this is..
coronary artery aneurysm?
if we continue with the operation
he will die of acute myocardial infraction..this child
we will terminate the operation
move, move, back to your departments
you underlings, all of you get out
no
we will continue the operation
if parts of the aneurysm break and block the blood vessel
I will make a new route for blood flow
that means...
you're performing a bypass surgery?
yeah
bypass surgery?
he's planning to stitch a baby's vein that is thinner than a string?
is he serious?
it's a vein that is less than 1mm we're talking about..
they should close the heart and redo the operation at a later time
- surgical loupe won't do it.. - just relying on surgical loupe..
a human eye needs at least a microscope
a kid with situs inversus and single coronary artery
it's not an operation to be treated lightly
- are you serious? - even if we stop operation
this patient won't have enough physical strength to redo the operation
dying in an operation, or
dying on a bed beside his parents
these are 2 opposite scenarios
this patient is trying hard to live
in his small body, fighting desperately
as long as the patient hasn't given up
we will fight with them
operation
continue
we will begin to retrieve a graft from LITA* *(left internal thoracic artery)
it's going to be fun..
Iryu Team Medical Dragon LAST karte
- ultracision scalpel - yes
- tweezer - yes
- scalpel - yes
- isn't this a performance? - performance?
because...
at the professor's conference, voting rights for all the medical staffs was approved right?
yeah, it is
seeing the Batista team working hard performing this operation
it will greatly benefit Kato-sensei
her win in the professor election is determined by this
- forceps - yes
ultracision scalpel
- excuse me.. - what?
in general, can we retrieve the graft from internal thoracic artery rather than from LITA?
for a 9 months old kid, the internal thoracic artery has not fully developed yet
so there is a possibility that we can't get the required graft length
in the case of LITA, we can be sure to obtain sufficient length
also, it is directly visible so there won't be a situation of hurting surrounding veins accidentally
good decision
considering the patient's condition, LITA is the best choice
done exfoliating
- Arase, hand over heparin - ok
start cutting
small scissors
done retrieving graft
- prepare heart-lung machine for children - yes
good, ACT is over 300
inserting blood tubes of heart-lung machine
- 3-0 - yes
aorta of a child is very fragile, it's difficult to remodel
- tweezer - yes
- scalpel - yes
Kiene
blood insertion tube
clamp
done inserting blood inflow tube
next, inserting blood outflow tube
- 3-0 - yes
how amazing.. Asada
right on target
soon... bypass surgery almost done
- COMP ON - yes
connection to heart-lung machine done
now, we will perform bypass surgery at the right coronary artery
yes
clipper
- attaching clipper - yes
Asada-sensei
after this bypass surgery, we will be performing Batista operation
yeah
the diseased region.. to distinguish between the diseased and normal region
on this small heart.. can you really do it?
I will examine using my sense of touch
I understand that the senses of your fingertips are sensitive,
but.. on this small heart, diseased region is very small as well
and your senses is the only way for us to determine the diseased region
if you couldn't figure it out...
we will have to terminate the Batista operation
if I couldn't figure out the diseased region,
I will use my last trump card
last trump card?
if that succeeds, all the Batista thesis done up to now
will become obsolete
last trump card... what exactly is it?
madchuckles & his gf indokid
timing: tianj raw: chiisana_tantei
KEEP THIS A FREE FANSUB d-addicts.com
commencing stitching
- 8-0 - yes
starting to stitch the vein..
- tweezer - yes
he's stitching a vein that is less than 1mm
usually, to stitch up a vein that is less than 1mm, a microscope is required
even with Asada's proficiency
he won't be able to see everything just with a surgical loupe
trying to stitch with intuition will lead to many misses
- that will damage the vein too much - possibility of failure is high..
one tiny blink could
make him lose the tip of the needle
incredible concentration ability
he's not even blinking
unbelievable..
without any additional tool, he's stitching the vein with 0.3mm in between each stitch with no mistakes
you can't do this with intuition alone..
if so, stitching should look more sloppy
not even mending any stitches..
Asada has a 3D image of completed stitches in his mind
that's how he can stitch with the best shape
How?... in that microscopic world.. he is able to use such method to stitch the vein
even with a slight blur in sight
by visualising a 3D image in his mind
he's able to make his sight sharper
amazing, he's the one who was able to treat patients in the midst of gun shots and bombs
am I dreaming?
that is a baby's vein right?
stitching completed
amazing
he did it with just a loupe
what's wrong?
I'm going out for a while
we will continue with the detachment
- tweezer - yes
- electronic scalpel - yes
Excuse me
they succeeded on the bypass operation
and are now starting detachment stage
is that so?
the operation is about to succeed?
no, the rest is still uncertain
the real operation starts now
but, they might be able to do it
genius surgeon at the centre
a nurse who transfers equipment with great timing
first assistant, who's providing an accurate support
second assistant who is vigilantly assisting the head surgeon
genius anesthetist who can adjust to speed of head surgeon and superbly control patient's condition
all of them trust one another, and helping one another as if they're one
I think it's a great team
if with that team...
team, huh?
what can it do for you?
what?
human beings are alone after all
born alone and die alone
however, I don't get why people try to get together and forming team
when a person get involved with another
when a person get involved with another, that's when you feel solitude
I was always alone
that's why I never felt solitude
umm...
I will go watch the operation
I will come to report again
Kihara-kun
yes
why are you helping me?
ever since I came to this hospital, the person who can remember my full name
you're the first one, sensei
excuse me
even if you achieve higher positions
I will never look up to you
in this life, you will never surpass Asada-sensei
there's one thing
that I would not lose to you
I have
my comrades..
comrades who I could rely on wholeheartedly
I...
loved you
Following this..
we will perform PTCA on the enlarged left ventricle, which is causing pulmonic stenoinsufficiency
- scalpel - yes
I understand
Kihara, emergency patient
Nakata-sensei said to come quickly
understood
fallen from high ground, broken ribs
no pulse, no sign of life
- starting CPR - yes
- going - yes
1, 2, 3
pulling out stretcher
- prepare transfusion blood - yes
preparing equipment
- check it - yes
- attaching patches - get the line off
-getting CV line - yes
prepare the valume
tweezer
30 year old male, fallen off high ground
heart stopped beating, cardiogenic shock
falling accident, that sounds bad
- saturation is 94% - get the dose
- quick, we will put the sheets - yes
what's wrong?
Kirishima-sensei
Kihara, we have no time
- continue with treatment - yes
- cutting injured region, scalpel - yes
- tweezer - yes
gauze
- electronic scalpel - yes
this is cardiorrhexis caused by cardiac tamponade
cardiorrhexis.. cardiac tamponade?
he won't last
blood pressure decreased to 41 pulse is 31
pulse not recovering
will you work for me?
thank you for your guidance
I want to make an ordinary person like you to have a place in the medical department
ordinary?
Batista team is.. a gathering of people with special skills
the majority of staffs, who are merely commoners, won't be allowed to join it
humans with shallow existance, that no one bothers to care
but I won't be like them
I'm also just a commoner
that's why this can't go on
I plan to create a new medical department with you people
from now on, I will be relying on you
Kihara Takehiko
opening up chest
- scalpel - yes
- saw - yes
- Kihara, bring the rib spreader - yes
- rib spreader - yes
- electronic scalpel - yes
cardiorrhexis
chest overflowing with blood
can't see anything
- clear out the blood - yes
- sucker - yes
- hurry the blood transfusion, bring more people - yes
veins have shrunk.. solution won't enter
- just force it in! - yes
even before connecting to heart-lung machine
this patient won't even last until the blood arrives
Professor Touhou
what?
Kirishima had a falling accident?
Professor Noguchi
can you please be quiet
this one is more important
tweezer
what's going on?
Kirishima-sensei was involved in an accident
he's unconscious, and in critical condition
Asada
do you remember?
it's the same case as when you first arrived to the hospital
we thought it's just cardiac tamponade, but
it was cardiorrhexis
you're the only one who could save him
what the hell is he doing?
we're in middle of an operation
won't happen right now, he can't leave
you shouldn't go
don't..
Takashi is our patient right now
please leave, Kihara-sensei
please
save him
brief me his condition in details
it's cardiorrhexis
bleeding won't stop, flowing like water
could you be...
thinking of leaving here?
I won't allow that
Asada!
this is an order
go away, Kihara
take him out
Asada
you're the only one..
Asada!
there are too many places to stitch
and the wound is enlarging
I can't hold it with my hands anymore
try harder..
Asada is coming soon
Kato
what?
you have done many cases of children's valve distancing right?
Ijyuuin
could you serve as first assistant in this operation?
- what are you saying? - answer me!
I can't
then, we will continue the Batista operation
tell Kihara that I won't make it, by internal phone
Ijyuuin
I know how much you have been researching for this Batista operation
therefore, I trust your decision
I've studied valve distancing video so many times
I have a sharp image of an infant's heart
can I really not do it?
no medical cases are exactly the same as textbook
that's why surgeons can only improve by performing actual operations
listen trainee
a patient whose life does not matter.. does not exist
not saving a life that could be saved.. that is also a crime!
I can do it
while Kato-sensei is performing the operation on the valve
I have confidence to serve as first assistant
Kato
how many minutes do you need to finish this task?
you are going afterall?
just relying on Ijyuuin's personal judgement, making this big decision
- I cannot allow it - that's not it
I evaluate Ijyuuin the same way, that's why
and also
you could serve as my replacement
even if I'm gone, as long as you are here, this team is fine
right?
yeah
15 minutes
I won't wait, not even for a second after
understood
- hurry - alright
- we don't have much time - yes
- we're starting - yes
it's cardiac arrest..
you really came...
how many minutes after cardiac arrest?
30 seconds
there are 7 positions with cardiorrhexis
I couldn't stitch them up, since they were broken so close to each other
keep the heart arrested
we have 4 minutes 30 seconds until brain dead
we won't recover the heart function until the last minute
stitching will speed up on an arrested heart
I will bet on this 4 minutes 30 seconds
- nurse, keep track of the time - yes
Nakata-sensei, could you please assist me
there is a better assistant here
the best assistant in the world
ER is in charge of emergency patients
let's start this
Asada-sensei
4-0, stitching tool
is the ice ready yet?
keep the brain as cold as possible, to slow brain death
yes
- gauze - yes
4 more minutes
what could he do with 4 minutes?
he's already stitching
what is this speed?
it's so different from his previous stitchings
roughly stitching them all together
done stitching
is he the same human being?
done putting the ice
even if I add, only 10 more
- put them all together and push them - yes
Kihara, pumping
done stitching second wound
why did you come here?
I thought you would send Kato-sensei
I thought the faster surgeon is needed for this operation
- Is Batista operation fine? - it's fine
when it comes to infant valve operations, Kato serves the best
Also, Ijyuuin
Miki
Arase
Fujiyoshi
I wouldn't be able to come here if it wasn't with them
done stitching third position
- how many minutes passed? - 3 minutes 30 seconds after arrest
- continue counting - yes
- in 30 seconds - brain cells will start deteriorating
but it will take more than one minute to stitch the rest of the wounds
even if his life is saved, there is risk of brain damage
- how is the heart-lung machine? - 5 more minutes
10 more seconds
9..8
9..8..7
done stitching 4th position
starting heart massage heparin 3.5ml
- stitching is not completed - don't care!
he already knew that he wouldn't able to make all the stitches
there were more wounds than he could hold
he prioritized the stitching to all the wounds he couldn't reach with his hands
don't die
Kirishima
resuscitated
- 4-0 - yes
- scissors - yes
- how's the heart-lung machine? - it's prepared
connect it
- we will start treating the rest - yes
is Asada done yet?
- we will perform salivation, 2-0 - yes
hemoglobin level is back, bring the blood
he's late
15 minutes will pass soon
come back
please
done connecting to heart-lung machine
- COMP ON - yes
valve distancing completed
we have nothing to do now
- scissors - yes
done stitching seventh position
I can handle it from here
go back to Batista operation
they don't have much time too.. hurry
keep checking until conciousness is recovered
yes
- checking the leaving blood - yes
Asada
that child... please save him too
leave it to me
- let's finish it - yes
starting to identify diseased region
can you determine the diseased region?
he can't figure it out?
we will
now begin the new Batista operation
new Batista?
what is he talking about?
he couldn't identify the fatal region by sense of touch
so he's going to test a new technique
a new technique?
that kind of procedure won't work
what is going to happen?
what are you planning to do?
- scalpel - yes
whats going on?
you're going to excise randomly, without identifying the diseased region?
I'm not excising, just cutting
proceeding
he inserted scalpel into the heart
without first determining the diseased region
does he have a winning plan?
if he's doing this without thinking, it is intolerable
- scissors - yes
cutting completed
he's really just cutting..
in all the previous Batista operations, diseased region had to be identified
and then cutting along border to excise the diseased part
this time, he merely cut along the coronary arteries muscleline
sandwiching his finger between heart muscle to check the heart condition
is this the last trump card you were referring to?
that's it.. we will stitch back the heart
what is this?
the new Batista?
- it seems like he failed - what a shame
failure after randomly cutting parts what a mess
- 3-0 - yes
Kato
hold this part
tweezer
what.. is this?
what's wrong? is there something wrong?
what's wrong?
the heart..
is shrinking
this is the
new Batista
really?
heart is shrinking
what did you do.. Asada!
time is running out
- finishing up altogether - yes
never knew this kind of technique existed
making the heart small not by excising the fatal region, but
by piling the heart muscle layers
what is this?
this idea
Asada surely is a genius
Kitou-sensei
Kirishima-sensei was saved without any problem
what in the world is going on?
cutting the heart muscle along the coronary artery, piling them and then stiching
by overlapping
changing the size of heart back to normal
with this technique, you won't have to identify the diseased region
unlike the former Batista technique, you won't have to excise the heart muscle therefore
won't hurt any veins
there will be less risk during operation
let's give it a name..
overwrapping technique
this team will be announcing the new technique
done stitching left ventricle
now, closing up
operation.. finished
it's finished..
operation is a success
Takashi
Takashi-kun
held up well
sensei..
thank you so much
you guys are truly real doctors
I will be..
right here
I will be here
during that operation
Kato-sensei was the one who wanted to get there as soon as possible
you too
Kato became the new professor after getting the majority of votes, right?
because of your actions to become head professor, the university is in chaos
it's difficult to let you take my place
head professor
I have a good report for you
yes
I succeeded on the new Batista thesis
really?
if you report this, Meishin will have a great reputation
- what a great story - yes
but that thesis is done by Professor Kato
what?
you like Tom Yum Goong, right?
there is one hospital in Thailand which needs a superintendent
Thailand is great..
it's hot for the entire year though
how do you feel?
congratulation on your promotion to professor
thanks
you too.. recover fast
when I'm out, I will go to U.S.
what?
I want to be away for a while
I want to make a team now
like the one you made
the best team
alright
- hey.. Harry - yes
did you tell them about me?
what..?
the case of putting me inside Team Dragon
oh
- Professor Kato said you could join to handle general affairs - general affairs?
isn't general affairs....
isn't it total budget and stuff?
it has nothing to do with Batista!
Asada is going away after all?
yes
don't be sad
let's go drink again, 55kg
what?
you're too relaxed since Batista was done
you gained 2kg
going back to MSAP?
yeah
sorry
that I couldn't join ER
I never thought you would join to begin with
your ability is beyond what this hospital deserves
the next area you're going to is very dangerous
many doctors have died going there
I want to try one more time, in a challenging place
is that so?
when you're done with that, come to U.S.
this time, I will use you as an assistant
I will think about it
you're the best surgeon
you figured out late
it took time but..
bye
yeah
Asada
don't die
you're not going to go with Asada?
yes
this time, I will do this alone
is that so?
so, we say good bye here then
yeah
you sure we don't have to send you to the airport?
yeah
the team is to gather quickly as when needed
then, again?
hey 76kg
take it
good luck charm
take care
take care of your body well
yeah
it's all thanks to you
what?
you wanted me
after I returned to Japan and when I had...
no direction
that's why
I was able to become stronger
thanks
no good byes
we will meet again, right?
yeah
we will meet soon
see you