L&P Medical Lab Researcher,
Fujiyoushi Keisuke-sensei.
Fujiyoushi-sensei! Having the super medical special zone been approved,
and pull in Fujiyoushi brilliantly as the exchange of myocardial sheet treatment there, right?
Fujiyoushi-sensei in L&P?
What is he thinking this time? Noguchi.
To prepare the suitable stage for the superstars to shine,
that's my job.
Why is Noguchi-sensei in L&P?
He has an exaggerated title besides the adviser.
Advancing Japan's Medical Care to the world?
Does it mean that Fujiyoushi-sensei's myocardial sheet,
is used for the global expansion?
Perhaps he is still aiming for another...
The one that we are facing is not Noguchi.
It's the patients.
Patients are waiting...
Is it the sample of the patient earlier?
Please turn the DNA to the Laboratory for me.
Don't forget the footprint as well. Ok. I got it.
How is the clean bench?
Bench are prepared already. Ok.
Fujiyoushi-sensei. Ah!
The research is going well? Thanks for the hard works.
Really glad that Tomita Kana-chan is saved, isn't it?
Her heart function is recovering well with the effect of myocardial sheet.
Thanks to the super medical special zone.
Yes. Ah! Actually, I have a proposal.
Yes...
Would you like go to America and continue the research there?
To America? Yes.
By having the successful medical treatment this time,
It seems that the approval of myocardial sheet in FDA is also close.
If the right being held down by the American company,
we must pay for an excessive price.
If so, then the myocardial sheet can be used only for limited patients.
Would you like to go to America,
in order to save many patients alone?
10th World Energy Summit which is inviting Minister Ahmad, Minister of Oil from Garang United Emirates,
will be held today.
As soon as the summit end,
I will take Minister Ahmad to L&P,
so I'll entrust the perfect preparation to you sincerely.
It's bad. Minister Ahmad is passed out.
Call the ambulance. Hey! Somebody, Ambulance!
Ambulance! The ambulance hasn't come yet?
I'm a doctor. Mr. Noguchi.
Minister, what happened?
It's possibly an appendicitis. An acute appendicitis.
Caecum? It's an appendicitis.
What? A caecum? It's ok, a caecum.
NO!
People who laugh at appendicitis, will cry with appendicitis.
Please rest assured. There was a plan for Minister to visit us anyway,
We will take you to L&P Hospital.
Asada.
I'm grateful to you for inviting me here.
Been engrossed to the development competition of the artificial heart in Meishin,
I couldn't face the patients properly.
Examining a patient is the starting point of a doctor. Yes.
Here, we can face the patient well one by one.
Though it's tight for the management.
Medical care is not a tool for making money.
You haven't changed, have you? From the first time we met.
Thanks for the hard work. Thank you.
Yes.
Lunch has come.
Hey, what happened?
Are you alright? Stay still.
An acute appendicitis.
I'm fine. I have works to do.
It's not a time to say such things.
We'll operate you now immediately... Operation?
I have neither money nor time. It's alright now, really alri...ght...
If you leave it like this, it will be dangerous for your life.
Hold him.
Minister Ahmad is very interested in Japan's medical care.
Please be really careful.
Although the visit couldn't be done anymore,
Let's have the Minister experienced the level of Japan's medical standards with his own body.
It's positive. The Minister is having an acute appendicitis.
I'll do an operation immediately.
I guess an unfortunate thing has occurred.
The Minister was planned to attend an international conference in Europe five days later.
Could he make it on time for that?
Five days later.
We definitely must grant patient's demand, right?
It means that he's the patient whom we must welcome for you guys, right?
We'll do a robotic operation.
The best of QOL in King of VIP.
Quality of Life.
No matter what problem it is in the examination data?
It seems that he'll be a patient whom we must welcome more than we've expected.
It will be fine.
Looks like that he must bring the money that he has earned in Japan to his family in Africa.
That's why he rejected the operation.
I guess long-term hospitalization is not possible.
Arase. I'll manage to do the anesthesia in spinal anesthesia,
with a low volume so that he can walk home in 3 hours later.
We'll do the shortest operation with the smallest incision.
From now, we'll do a removal of an acute appendicitis.
Scalpel. Ok.
Electric scalpel. Ok.
From now, we'll do a robotic operation of an acute appendicitis.
Right arm, DeBakey Set.
Left Arm, Scissors set.
Third arm, 3D Camera set.
Master controller, Command OK.
Inserting the entire arms into the ports.
Port set complete.
Next, the deployment of the appendix.
Weight liner. Ok.
Hook. Ok.
Pean. Ok.
Pean: a surgical tool used in many surgical procedures to control bleeding.
Kelly. Ok.
Kelly forceps: a type of hemostat usually made of stainless steel. They resemble a pair of scissors with the blade replaced by a blunted grip.
Flowing the antibiotic. Ok.
Tying up. 3-0. Ok.
Tying up. 3-0.
Rotating the camera port clockwise.
Tying up complete. Removing the appendix.
Scissors. Ok.
Scalpel. Ok.
Appendix removal complete. Disinfecting.
Changing the right arm to scissors.
Appendix removal done.
Oh! As expected, a robot.
A small incision. Appendectomy in only 15 minutes.
As expected, Team Dragon.
Japan's medical care is trully amazing.
He really doesn't feel like he has undergone a surgery.
He said that if there's something happen, He would want to be examined in Japan.
Thank you very much.
Really glad that you are fine.
I'm relieved to hear that you can participate the international conference in Europe as planned.
We are thankful to have Minister Yoshida, the Minister of Foreign Affairs come here.
Actually, in the preoperative examination of appendicitis,
We have found an observation to be worry about.
It's a coronary stenosis.
Coronary stenosis means that the blood vessels which called coronary arteries has become thinner,
It's a condition where there are enough bloods that can't be supplied to the heart.
Minister Ahmad's stenosis rate is 90%.
We woudn't know when it will become a myocardial infarction.
An immediate surgery is necessary.
But then, the conference in Europe...
This time the robotic that you've experienced....
It will be on time if we do a robotic operation.
Please leave it to us.
If it's me, the chairman of the International Medical Promotion Committee,
We can arrange it immediately.
I guess you might also be called to Dubai as an international doctor, huh?
International Doctor... Dubai. Hahaha...
Actually, my heart is also bad.
If it's wonderful like that, Definitely the robotic...
A robotic operation.
Ah, I want you to do it for me.
Of course. Doctor Kihara will be in charged.
Please leave it to me.
It will be alright to go out from the hospital after 4 days.
Thank you, sensei.
Is it an important thing?
It's a good-luck charm that I will give to a special person.
I received it from my family when I came to Japan.
Oh! Cute children, huh?
They are my treasures.
However, this Jenga, my youngest sister, Her heart is bad although she's only 3 years old.
Her heart?
They say that she might need a transplantation.
That's why I want to come back home soon, and with the money I've earned,
I will take her at least to a good hospital.
If only there is Katou-sensei's artificial heart for children, right?
Eh?
I've given it up now. Why?
Rector, do you believe such articles?
There's no other choice but to but to kick you out from the development team.
As a dean, I will continue the development.
We don't need your prototype anymore. It's merely a trash.
A magical heart. Huh?
It's a magical heart.
Please have it completed soon then bring it to my country too.
And then Jenga will be saved.
Excuse me.
Katou-sensei, a phone call for you. Ok.
Sorry to keep you waiting.
My name is Okamura from L&P Hospital...
L&P? Yes.
I would like to meet Katou-sensei, there's something that I want to talk about...
What happened? Your teeth seem to be in hurt for quite a while.
It's alright, just sometimes.. Tooth decay?
There's not even one...
Is there any other sense of discomfort in your body? My chest a little...
Do you feel a tightness?
No. It's occasionally. It's alright. Occasionally.
My disease has been cured right?
It's Kabir's examination result.
Kazue lesions of coronary artery stenosis of the left anterior descending branch.
It's exactly the same case, isn't it?
With Minister Ahmad of the Garang royal family who has been carried to L&P.
The news said that they have done a robotic operation.
Stenosis rate seems to be 90%.
Kabir is 99%. It's more serious.
If the stenosis rate is 99%,
It means that he is having a large bomb in his heart.
We wouldn't know when the myocardial infarction will occur.
But Kabir wants to cure his disease as soon as possible,
then go home to his family.
What will you do, Asada?
Haha... Dubai is calling me...
The one that they want is this surgical robot, isn't it?
This robot is already a part of my body .
Look! The smooth motion that has been sent out from the arms with six flexibility degree.
It's undoubtedly a god hand.
Oh?! It fell down...
If it's like this, I might be carried to Dubai, isn't it?
We hope so... Ahaha...
Hayakawa-sensei, Can I have a word with you?
Ok.
I'll introduce to you. He's Hayakawa-kun, an intern who came from L&P Hospital.
I'm definitely belong to L&P.
I'm here as the replacement of Fujiyoushi-sensei who is going to America to focus on the research.
Don't act as you are Fujiyoushi's replacement. Two blocks.
There are a lot of things that you can learn when you are in this team.
Let's start the conference.
Intern, what treatment will you do if it's you?
In order to have him discharged at the fastest,
We have to take a method which gives no burden to the body.
Speaking of the guidelines in our country right now,
I guess the 1st choice will be catheter treatment.
There's no catheter room in here. None?
This is general hospital that also treated heart, right?
What an annoying guy, huh!
Then I'll contact L&P.
Ask them to lend us the equipment... We won't do catheter.
Eh?!
It's MIDCAB.
MIDCAB: Minimally Invasive Direct Coronary Artery Bypass
I've thought the same thing too.
Hmm I see... MIDCAB is it?
If I remember correctly, MIDCAB is an operation which do a thoracotomy with a small incision from the lower part of the breast, right?
Isn't that a surgical technique which has been obsoleted for a long time?
It's the best treatment for Kabir.
The surgical wound will be small, also the recovery, he'll be able to return to the society as early as possible.
But, the visual field will be narrow, the difficulty level will increase much more.
To the common doctors, ok? However....
It's possible if it's us.
Kabir-san has the same disease with Minister Ahmad in L&P.
They do a robotic operation over there, right?
I suppose the treatment cost must be enormous...
Lightly, it will be more than three million. Uwa...
Kabir, wait! I won't undergo the surgery.
I have to go home soon. Jenga is suffering from a disease.
Kabir, it's not a condition to say such thing.
But, hospitals in my country is only a few.
Also it's far from my home. It will take a day.
That's not the reason to let you go home at this state.
But I don't have money. Tightly for the previous surgery.
If I use more than that, Jenga won't be able to go to the hospital.
Three million is impossible! Three million?
I heard a conversation..
They said it will take three millions for the Minister who has the same disease at the big hospital. I don't have three millions.
Treatment methods are not only one. Don't worry.
We have our own way.
If the treatment cost is still terrible,
You can do the payment at the time when you can pay it.
You can go home as planned. You don't have to worry about the money too.
Is there any other reasons to say no?
Thank you. Really thank you.
Training in Sakurai Hospital?
Please report all of things that are happening around them.
It's a training plan which is expecting Hayakawa-sensei, the excellent human resource.
Ah, In other words, you want me to be a spy?
As I expected, seems like there was no mistake in selecting the personnel, huh?
I'm sorry for calling you here.
What is the discussion you said?
You will like the California wine here.
I suppose Katou-sensei will like it because you've been in America, right?
No, thank you. I have to go back to the hospital.
I found an article like this yesterday.
Looks like it will still need time to be in a practical use at Meishin.
It's not a relevant thing to me anymore.
Yes.
Do you want to try to continue the artificial heart's research in L&P?
We'll prepare any required environments, from the financial support to the development facilities.
I will refuse.
I will only give all my best to save patients.
And for that reason, I've come to Sakurai Hospital.
I have no intention to be used in your business.
Is it a bad thing to make use of a business?
There are many patients that can be saved with the power of business.
You have seen a lot of children who couldn't receive transplantations and lost their lives.
That's why, you worked on the development of the permanent pediatric artificial heart, right?
There's nothing like rights and honor that can replace a research that is used for saving patients in L&P.
I will guarantee.
Katou-sensei.
Can't sleep? I'm fine.
Just worry about Jenga.
The magical heart.
I hope to have you completed it then cure Jenga someday.
I can entrust at east if it's you, Katou-sensei.
So eager, huh?
Doing such an operation like a MIDCAB for this case,
The others wouldn't consider this. It's so Asada, huh?
I'm glad that I've come here. Are you really glad?
You haven't been able to say anything yet to your girlfriend, right?
I always miss the timing to say it.
She thinks that I'm still in Meishin.
Here. Oh!
Is it ok if I just cut it out?
Arase-sensei?
It's impossible for you to get married. Give it up.
If Arase-sensei can do it,
then it shouldn't be a problem for me too, right?
Don't worry. You'll go back to your family soon.
1... 2... 3...
Why I must observe this no matter what?
Director Sakurai said that you have to keep watching it properly.
There's no meaning to watch such thing like a MIDCAB.
6... 7...
Ok, passed out.
You're such a noisy, two-block.
Please. Let's go Dubai.
Seems like today the are doing an arterial stenosis operation too in Sakurai Hospital.
Apparently a MIDCAB.
MIDCAB? Old-fashioned, huh?
It's 2014 now.
Oh! Minister, Thank you for coming all the way here.
Well then, over here please. Ok.
From now, we'll do a MIDCAB for the left anterior descending coronary artery stenosis.
Scalpel. Ok.
Tweezers. Gauze. Ok.
Sucker. Ok.
From now, we'll do a robotic operation for the left anterior descending coronary artery stenosis.
Auto set complete. Installment OK.
Mid-access. Ok.
Cell saver. Ok.
Wire. Ok.
Positioner. Ok.
OK.
1st term done. Moving to 2nd term.
DeBakey set completed.
Motion scaling into 3.
Changing 2nd slave into coagulator.
Ok.
Coagulator change OK.
Detaching LITA.
LITA: Left Internal Thoracic Artery
Detaching LITA. Ok.
Papaverine. Hemogrip.
Starting the ?-blocker.
Harmonic. Ok.
Set the coagulator output in 40.
Upped to 40.
Motion scalling to 5.
Left ventricular function is good.
LITA detachment is done. Next, the detachment of the coronary artery.
Detachment of the coronary artery is done.
Next, opening the 1st diagonal artery. Snare. Ok.
Mosquito. Ok.
Blower. Ok.
Rate control.
Diamond scalpel. Ok.
Snare up.
Potts scissors. Ok.
Shunt tube. Ok.
Coronary tweezers.
Stitching LITA-LAD.
LAD: Left Anterior Descending
I'll do a trip. Ok.
Releasing the snare after one more stitch.
3rd term is done.
Ok. After this, closing the pericardium then finish.
I guess the robotic operation is success.
Wonderful! Next, Ministier also...
Minister?
Thrombosis that are made in coronary artery aneurysm gone, causing a myocardial infarction.
Then, by the catheter?
No, on the shape of Minister Yoshida's coronary artery aneurysm,
the expansion and constriction are sequential, it can't be approached by catheter.
We'll do a bypass with median sternotomy.
I'll prepare it immediately. No, you can't do that.
Minister Yoshida has infectious atheroma on top of his sternum.
When you put a scalpel to the infectious atheroma,
Bacterias will invade the surgical field. And if the bacterias invade the surgical field,
It will cause a mediastinitis, and be a fatal wound.
We can't do the midline incision.
Then, how to do it?
It's bad. What should we do?
There's only one way.
It's impossible. We're also in the midst of a surgery right now.
Isn't there anything you can do with L&P's facilities?
In this case, even though we use any advanced facilities,
The coronary artery aneurysm can't be cured. Other than Asada.
If it goes on like this, The patient will die. Asada!
Our patient is Kabir-san.
Asada, Go.
I will do the surgery in here. But...
Ijyuuin. Yes.
We, Doctors don't abandon any patients.
Katou. I entrusted it all to you.
Kitou. I'll go now. Ijyuuin.
Take the first position. I'll serve as second assistant.
Ok.
Going there although you can't do a mid line incision. It's useless.
Two-blocks.
You still don't understand the guy who is called Asada even for one mm, huh?
Eh? Even if you stay here too, it will be useless.
Go there together and properly watch Asada's operation.
ST continues to rise.
Extrasystole also occur frequently.
Asada!
I'll do the operation. It's impossible.
There are some infectious atheroma on top of his sternum, so we can't do the mid line incision.
I won't do the mid line incision. Then how will you do it?
MIDCAB. Huh?
I will do a coronary angioplasty with MIDCAB according to onlay patch.
Onlay: a graft applied or laid on the surface of an organ or structure
Doing a coronary angioplasty with MIDCAB? Moreover, with the onlay patch?
For the coronary artery aneurysm that continues to expand and constrict,
The aneurysm will be cut off, and cover it with the internal mammary artery.
Remodel it as the patchwork.
The onlay patch method that Asada has chosen.
This procedure can only be done by a top-notch practitioner.
Moreover, in order to avoid the chest that has the infectious atheroma, rather than the mid line incision,
He will do it with a high difficulty MIDCAB.
Such thing... It's possible, if it's Asada.
MIDCAB is old-fashioned.
It's not. It just that there's no surgeon who can do MIDCAB.
I will do the onlay patch. Potts reverse.
Ok.
Potts. Ok.
7-0. Ok.
7-0 backhands. Ok.
Blower. Lavage.
After one stich has been applied, Unplug the shunt tube.
Ok The rate is increased.
7-0 Backhand.
Systemic pressure. Ok.
ST has recovered.
Amazing. As expected, Asada Ryutarou.
Scissors. Ok.
Flow probe. Ok.
Scissors. Ok.
The operation is done.
Thank you. You really saved us.
It's not for you.
It's for the patient. for the patient.
You haven't changed, have you?
That's the Asada Ryuutarou who I know.
I will have you to save many patients from now on.
Oh yeah,
I guess I must introduce you to Minister Yoshida, huh? Since you're his life-saver.
It's enough by saying that Kihara is the one who handled it all.
See you in India.
How was it? You've learned from Asada's operation, right?
MIDCAB is certainly needed for Minister Yoshida.
Wonderful skill. However, Kabir is different.
It's enough by borrowing the catheter's lab at L&P.
And yet somehow you guys still bother to bring out the surgical procedure which has been obsoleted.
Isn't that the ego of the surgeon?
You don't understand why we did a MIDCAB not a catheter?
I guess I'm not. No matter how you think of it, catheter is enough.
Supposing that we did the catheter treatment to Kabir,
If we put the stent to his body, What would happen?
He will have to go to the hospital to check regularly.
Of course.
Kabir's country is Africa.
In order to cure his body without frequently need to go to the hospital,
Asada chose MIDCAB.
It's not about 'Old' and 'New'.
There's the best treatment for each patients.
This...
Although I just made 1 only because I had no time, It's for you guys.
Katou.
A lucky charm for your special person. You guys are my lifesaver.
This is the only thing I can do right now.
Thank you.
Katou-sensei.
I'm waiting... Eh?
The magical heart.
Glad that the patient is saved, right?
Have you thought about our previous discussion?
The road for the artificial heart to be in a practical use won't open even if you entrusted it to Meishin.
But there are many years of know-how over there.
They also team up with the medical manufacturers who know everything about artificial heart.
Do you mean that the development can't be done, because there's no medical manufacturer who became a partner?
Japan's winning leasing company,
L&P Lease has taken over a leading medical equipment manufacturer, General Medic, Inc. in America.
According to the authorized party, L&P Lease...
General Medic Inc.?
They have been developing a techonlogy,
to solve the durability problem of the artificial heart,
that had been an issue in Meishin. Eh?
And if we add Katou-sensei as the person in charge,
The development of the artificial heart will make a significant progress, right?
You said that you are only giving all your best in saving the patients.
and for that reason, you've come to Sakurai Hospital.
If we complete the permanent pediatric artificial heart,
How many children's lives will be able to be saved?
It's a magical heart...
I want to have you complete it then cure Jenga someday.
I'm waiting...
Children who have heart diseases all over the world are waiting.
Your magical heart.
Two years. I'll show that it can be delivered in two years.
To those children who can't take heart transplants.
Well...
I wonder who will come to my place next?
After I came here, body weight has been lost three kg.
It's not me. Your mentor.