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Surgeons: Life in Their Hands - Season 2 Episode 3
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01:29And, after Valmer's marathon surgery...
01:35I had to look at who you were after the operation
01:37because I don't want that to affect me.
01:39Dr Keo shares a special moment with a special patient.
01:43I've had some amazing things happen to me in my life,
01:46but I think this one tops the lot.
01:49Can you give us a hug here?
01:50Yeah.
01:51Okay.
01:56It needs a clone, doesn't it?
01:58It's filthy.
01:59We'll have to wash it.
02:00Yeah, I know you will.
02:02Make sure I gave him properly.
02:0350-year-old Peter is in the fight of his life with lymphatic cancer.
02:09All right, guys, let's go.
02:10You get on with it, do it with it.
02:13And that's how I've managed to keep myself, I think,
02:16mentally pretty strong,
02:18considering exactly all the other crap that's going on with it.
02:22Excuse the language.
02:23The dad of three has a stomach tumour,
02:25a diagnosis that's been tough on him and his family.
02:30Yeah, it's been really hard seeing dad, like, so sick
02:34and going through something so horrible.
02:36It's very unpredictable, like, one time we'd sit here
02:39and he'd be fine, next minute he'd have to go to hospital
02:41and it's very upsetting, but we know he's strong
02:43and he'll get through it.
02:44So, is there any questions you guys want to ask me about tomorrow?
02:48Um, do you just do three days?
02:50Yeah, three days, a couple hours each day, apparently.
02:53Also with him every step of the way
02:55are parents Rob and Rainia.
02:58When you first get told,
02:59your mind's going at 1,000 miles an hour.
03:01Yeah.
03:02You have...
03:03..you have all of the visions that everybody has, you know...
03:09It comes with the C word.
03:10It comes with the word.
03:11The tumour is inoperable.
03:14Doctors tried chemo,
03:16but the impact on Peter was devastating.
03:18I lost just on 50 kilo on body weight.
03:23Um, and it got...
03:24So I got down to as low as 68 kilos at one stage.
03:27Worse, the chemo didn't work.
03:30And neither did radiotherapy.
03:32The radiotherapy, though, just...
03:34The nausea from it was horrendous.
03:36So it actually put me in hospital a couple of times
03:38just with nausea,
03:39just to get that under control.
03:41Um, so they did 20 treatments of that, 20 hits,
03:45which is quite a lot.
03:46Peter was running out of options.
03:48There's so much uncertainty with it.
03:50You can't obtain anything
03:51because you have no idea whether, you know,
03:54as much as I don't want to say it,
03:55you're going to be here in a couple of years' time.
03:57Well, you're not.
03:57You don't know.
03:58I don't know.
03:59Now he's been thrown a lifeline by Professor Joy Ho.
04:05Nice to see you again.
04:07RPA's principal investigator
04:09of a revolutionary cancer treatment
04:11called CAR T cell therapy.
04:13It stands for Chimeric Antigen Receptor T cells,
04:17which is a bit of a mouthful.
04:18But what it means is that we take the immune T cells
04:24from your bloodstream
04:26and those cells are then sent overseas to a laboratory
04:32whereby, uh, using genetic engineering,
04:35a receptor is inserted into the T cells
04:39so that it directs the T cells
04:43to the lymphoma cells to fight a tumour.
04:46What drives me in particular is,
04:50um, and I hope this doesn't sound holier than thou,
04:52but is the opportunity to do good.
04:55And it's a very exciting time to be in haematology
04:58because we are deriving more and more exciting therapies
05:04which can help patients,
05:06which previously there were no options.
05:09The treatment costs several hundred thousand dollars per patient.
05:13He has a significant amount of residual tumour in his abdomen,
05:17which, uh, if not treated, will lead to his passing.
05:21He knows that, you know, we don't know what comes after this
05:25if this doesn't work.
05:27So, there's, um, yeah, it's got to work, so.
05:31While we are hoping, of course, to achieve a good result,
05:35that is to destroy the tumour
05:37and hopefully get you into remission,
05:39there are some side effects
05:41and as your doctor,
05:43I have to make sure you understand them very clearly.
05:46Yep.
05:46The first is that your blood cells can go very low,
05:50which can be associated with the risk
05:53of, um, infection and bleeding.
05:56I will also mention for completeness
05:59that there is neurotoxicity or brain toxicity.
06:03At the more severe end of the spectrum,
06:05um, people can even have weakness of muscles
06:09and even coma.
06:11Okay.
06:11So, it's very important to understand that
06:13because, uh, with coma,
06:16patients have to go into intensive care again.
06:18The side effects sound fairly dramatic, um...
06:23Yeah, so...
06:24Just...
06:26Of course...
06:26You're talking about brain toxicity
06:29and, you know, all of that sort of stuff.
06:31But it's pretty frightening for me and Raina.
06:35I don't know about Pete, you know.
06:36They are...
06:37She did explain all the side effects
06:38and I accepted that.
06:40It's part of it.
06:42Same with anything, I guess,
06:43and I wasn't going to knock it back based on that.
06:53On average,
06:54ten patients a day
06:56find themselves in ED after a fall
06:58and a high proportion of those
07:01have fallen off a ladder.
07:02This is Nicky,
07:0544-year-old male.
07:08He's been involved in a workplace accident
07:10where he's fallen headfirst onto the ground
07:13and he's complaining of significant pain
07:16to his right shoulder.
07:18We have struggled to get his pain under control.
07:22I was up on a ladder
07:22trying to put a...
07:23..a light fixture up
07:26and, um...
07:26Yeah, I just wanted to go up a little bit higher
07:28to line the screws up
07:29and I'll come up for that.
07:30I think the way it's shifted
07:32and the ladder's just toppled over
07:33and I've...
07:34Yeah, it'll come down
07:35for crashing down.
07:37You're happy to get him across?
07:38Taking the lead
07:39is Dr Ian Lee,
07:41an emergency veteran.
07:44I think responsibility is a privilege
07:46and...
07:48I think then the responsibility
07:50is to make sure
07:50that you are
07:51doing the best you can
07:53with all that's at your disposal
07:56and ultimately the patient
07:58is at the centre of this.
08:01OK, on three.
08:02One, two, three.
08:07Hello, how are you doing?
08:09Yeah, so my name's Ian,
08:10one of the ED consultants.
08:11You've had better days, haven't you?
08:13So how bad's your pain
08:14on a scale of one to ten?
08:16I don't know, I'll say about...
08:17Ten's been in here.
08:18Eight.
08:18OK, all right, we'll give you
08:19something for that as well.
08:21Nicky's excruciating shoulder pain
08:23is obvious
08:23but Dr Lee's more worried
08:25about what he can't see.
08:27All right, and you're right
08:29or left-handed?
08:29I'm right-handed.
08:30OK.
08:31We knew that he had
08:31a scalp or head lacerations
08:34so that could signify
08:35something much more significant
08:36in terms of
08:37like an intracranial haemorrhage
08:39or some cervical spinal injury
08:41plus any other allied injuries
08:43to the torso, pelvis, etc.
08:46We will do a chest and pelvis
08:48x-ray very quickly.
08:49We'll run you through the scanner
08:50and check your head and neck
08:52and obviously we'll look
08:52at your shoulder
08:53but from our perspective
08:54the shoulder would have
08:55a slightly secondary injury.
08:56Yeah, yeah.
08:56Compared to everything else
08:57we'll just make sure you're fine.
08:58Do you have any questions at all?
08:59Um, no.
09:00The main concerns for him
09:01primarily would be thinking
09:03a head injury
09:04so if he has a complication
09:06we will need to intubate him
09:08and scan him
09:08and get the neurosurgical team involved.
09:11Nicky's wife, Rochelle,
09:12came to the ED immediately
09:14after hearing of his nasty fall.
09:16Amy, are you okay?
09:18It feels like I've got this
09:19cape on my shoulder.
09:22It's okay.
09:23It's okay.
09:25Oh, that's not what I was expecting
09:27this morning.
09:28No, that was not what I was like.
09:31Oh.
09:33I knew this day was going to come.
09:35It's a bit emotional
09:37seeing him like this.
09:38He's normally the strong one.
09:40He's strong.
09:41He's my strong man.
09:43He's, you know,
09:44passionate about his family
09:46and his daughter.
09:48I've got a little four-year-old.
09:49They have a beautiful relationship.
09:51Love playing.
09:53Do you want to rest your arm?
09:54Oh, I'll try it.
09:55X-ray.
09:57Can you breathe in?
09:59Hold your breath.
10:01Breathe, mommy.
10:04That looks grossly dislocated.
10:07It looks like a scene from a sci-fi movie.
10:16But this time,
10:18being expertly directed by robotic surgeon
10:20Dr. Chris Kayo,
10:21the robots are on our side.
10:24I've been a consultant here
10:25for more than five years now.
10:27Stop there.
10:28The special area of interest,
10:30I suppose, for me,
10:31has been minimally invasive robotic surgery.
10:34The robot hasn't got too much
10:36artificial intelligence being involved.
10:39So everything that a robot does
10:40is a direct reflection
10:42or a mimicry of the movements I make.
10:45And so the surgeon obviously has direct input
10:48as to what the robot does.
10:49However, you know,
10:50one day it's quite possible
10:52that the robot will learn
10:53how to perform procedures along its own.
10:56Then I guess I can retire and play footy.
11:02So, Velma, just this way, please.
11:04Yes, thank you.
11:06His patient is 86-year-old Velma.
11:10She has lung cancer.
11:11And for patients such as yourself
11:13with early-stage lung cancer,
11:15the best treatment today
11:16would be to cut it out,
11:17the surgical resection.
11:18Using robotic keyhole surgery
11:20means less trauma,
11:22less pain,
11:23faster recovery
11:24and a smaller risk of infection,
11:27important in an elderly patient.
11:29This way of doing the operation
11:30using the robot
11:31is much better
11:32in terms of recovery
11:34than spreading your ribs apart
11:36and getting my hands in your chest,
11:38which is unfortunately
11:38the traditional way of doing things.
11:40Yes.
11:41That's very different.
11:43That's what I thought it would be.
11:45To perform a minimally invasive operation,
11:47to make those patients
11:49who were previously
11:49not surgical candidates
11:51into patients
11:52who had successful operations,
11:54it's a very fulfilling experience.
11:56You've just got to fight for me
11:57for the first three days
11:58after the surgery.
11:59I will.
12:00I know you're a bit sore.
12:01This is a fighter, yeah.
12:01I know you are.
12:02That's why I'm taking you on, right?
12:03You know, I know you're up for it.
12:06Very good.
12:06Well, Mum's an ex-ballet dancer,
12:08so it's a different kind of human being.
12:10Oh, and I can sense that.
12:13Velma spent her life
12:14in the world of dance.
12:16Ballet taught her stamina
12:17and endurance,
12:19and she'll need both
12:20to recover from this operation.
12:23As a ballet dancer,
12:24we're trained
12:25and we have great discipline
12:27and we know pain,
12:29we know our bodies very well.
12:31So I'll do my job tomorrow
12:33and I hope you can do your job.
12:34I'll do it.
12:35First three days,
12:36get out of the bed whenever you can,
12:37do the physiotherapy,
12:38deep breathing exercises,
12:39and that'll get you home safely
12:42and quicker.
12:43I'm very confident about tomorrow.
12:46I'm in such good hands
12:48and I know I'll be looked after.
12:50Yes.
12:50Yes.
12:51Yes.
12:51Yes.
12:51Yes.
12:51Yes.
12:51Yes.
12:51Yes.
12:51Yes.
12:51Yes.
12:51Yes.
12:51Yes.
12:5544-year-old electrician Nicky
13:00is in the ED
13:01after crash-landing heavily
13:03from the top of a ladder.
13:04One, two, three.
13:06Smashing his shoulder
13:07and his head.
13:08That looks grossly dislocated.
13:11So he's pulled his humerus forward.
13:14He's dislocated anteriorly.
13:16So he's certainly going to have
13:17torn some ligaments,
13:18pulled some rotated calf muscles.
13:20Doesn't look like there's any bone there,
13:22but hopefully we can just give him
13:24some decent sedation
13:25and pull it back in.
13:26But before doctors tackle the shoulder,
13:29they need to exclude
13:30any potentially life-threatening brain
13:32or other internal injuries
13:34with a CT scan.
13:36Waiting for full results
13:38is a stressful test of endurance
13:40for Nicky's wife, Rochelle.
13:42If you can follow my fingers here.
13:48Good.
13:49And then you can feel me
13:50touching everywhere here.
13:52Yep.
13:53And do you know where
13:54this sort of blood has dripped off?
13:55Is that your eyebrow?
13:59So there's quite a bit of bleeding here.
14:02It's a significant gash,
14:04but what it means for Nicky's brain
14:06can only be revealed by a CT scan.
14:09Valma and daughter Roseanne
14:18are first cab off the rank this morning.
14:21I'm very happy the day is here,
14:23and I'll soon be having coffee again.
14:25Yeah.
14:26The 86-year-old is a mother of four,
14:29grandmother of 12,
14:30and soon-to-be great-grandma
14:32for the seventh time.
14:33She's at RPA for robotic surgery
14:36to remove cancer
14:38from the top left lobe of her lung.
14:41Surgeon Chris Kayo
14:42is already doing his homework.
14:44What I'm doing now
14:45is having a look at the pre-operative imaging
14:47that we've obtained for Valma
14:49so that I have in my mind
14:50a better idea about
14:51whether anatomy
14:53or her pulmonary artery branches
14:54are in relation to the lung cancer.
14:56Many surgeons would be hesitant
14:58to offer a surgical resection
15:02for Valma, who's 86 years old,
15:05particularly if they may require
15:07the removal of half of her lung.
15:10But I had the experience
15:11and confidence in our team
15:13because we've achieved
15:14these successful operations in the past.
15:18This 3D model of part of her lung
15:20has been generated from Valma CT scans.
15:24So that's the cancer on the CT imaging,
15:26and that's the cancer
15:26built into the 3D model.
15:28But the difference is,
15:29in the 3D model,
15:30we can really have a better appreciation
15:32of the relationships
15:34to her pulmonary arteries.
15:36So it looks like spaghetti,
15:37but I have to know exactly
15:38where everything is
15:39in terms of making the operation safer.
15:41Operating in this area
15:43requires total precision.
15:45One tiny nick
15:46can trigger a massive
15:47and possibly fatal hemorrhage.
15:49The pulmonary artery
15:51is actually the most fragile artery
15:53in the body.
15:54It's because of the thinnest arteries.
15:55They're very small.
15:57You need to pay a lot of respect
15:59because if they bleed,
16:00they tend to bleed very quickly,
16:01very difficult to stop.
16:03How are you feeling, Mum?
16:04Yes, I'm feeling good, darling.
16:07She's 86 years old.
16:08You've got to show a lot of respect
16:10to all the structures
16:11because they're all going to be fragile.
16:13And 86-year-olds,
16:14you know, you need to make sure
16:16that you get everything right
16:17the first time
16:17because you may not get a second chance.
16:20This hat is slipping.
16:23Get hair and make up in here.
16:25I think one of the special moments
16:27was seeing Mum with a surgeon yesterday.
16:30Ah, that's good.
16:31The eye contact
16:32and the connection that was there
16:33was kind of like a really special moment.
16:36The robotics is, like, extraordinary.
16:40But it's the care factor,
16:43the human kind of connection
16:44that I think has been
16:46the most amazing, yeah.
16:54OK.
16:55My sweetheart, love you.
16:56Love you, too.
16:58Let's do this.
17:0550-year-old Peter
17:07has come to the end of the line
17:09after an 18-month battle
17:11with a stomach tumour.
17:12His last chance
17:15is a ground-breaking therapy.
17:18Hi, Jude.
17:21Peter's here.
17:22All ready for you.
17:24All right.
17:24It starts with Peter's T-cells,
17:26or white blood cells,
17:28being harvested
17:29in a six-hour procedure
17:30that is just like giving blood.
17:32I think the most important facet
17:35of leading a very diverse team
17:39is to not ever lose sight
17:41of the goal of what we are doing,
17:44and that is to benefit the patient
17:47and their families.
17:49So we put one cannula here.
17:51Yes.
17:51And then one cannula there.
17:53So we withdraw your blood.
17:56The blood will go to that machine.
17:57Yes.
17:58It will go to the centrifuge,
18:00and then it will separate
18:01your T-cell or your lymphocytes,
18:05and then the rest will go back to you
18:06through the return line.
18:08Yep.
18:08Yep.
18:08Not at all.
18:10Once the centrifuge machine
18:12has extracted Peter's T-cells,
18:14they will be shipped overnight
18:15to a lab in California
18:17to be genetically modified.
18:19To get Peter through the next six hours,
18:25Mum Rainier has arrived.
18:27Hi, mate.
18:27How are you going?
18:28How are you?
18:29How's it all going?
18:30Yeah, going all right.
18:30Yeah.
18:31Going all right.
18:32Yeah, too bad.
18:33Yeah.
18:34Just never been a bad kid,
18:35even younger days,
18:37go out and drinking and all that,
18:38you know.
18:39Nearly finished?
18:41About two o'clock.
18:42They say that, two o'clock.
18:43Yeah, about two o'clock.
18:44He's a very good dad.
18:46They'd be lost without him,
18:48so if that's not motive enough
18:51to get better,
18:52there's nothing easy, is it?
18:55This one's finished?
18:57Mm-hmm.
18:58It will take about three weeks
19:00to get Peter's modified cells back
19:02and when they're re-injected,
19:04the hope is they'll act like missiles
19:07seeking out and destroying his cancer cells.
19:11I don't know whether you've got to go through
19:13the hard times to get to the good times.
19:15but if you do, he's had enough.
19:20He needs the good times.
19:21Yeah.
19:21He deserves the good times.
19:23He deserves the good times.
19:24Yeah.
19:24For sure.
19:25That's the first step, mate, isn't it, eh?
19:27Yeah, sure.
19:28See what happens.
19:29We'll go from there and...
19:30Absolutely.
19:31It'll be that.
19:32Yep.
19:33All right.
19:34Back in the real world.
19:3586-year-old Velma has a tumour
19:43inside the top half or lobe of her left lung.
19:47Dr Keo is removing the entire top lobe
19:51via robotic surgery.
19:52The robotic approach is ideal
19:54because the alternative will be
19:56a conventional thoracotomy
19:58or a cut between the ribs
19:59and spreading her ribs apart.
20:01That's really going to cause her a lot more pain
20:04and patients of her age
20:06often don't have much reserve.
20:09First, a high-definition camera
20:11with 10 times magnification is inserted.
20:14Beautiful.
20:15Good job.
20:16So we've just entered into the cavity.
20:19All right.
20:19Let's lower the table.
20:20Let's dock the robot.
20:21Thanks.
20:23Yep.
20:23Keep coming.
20:24Keep coming.
20:26That's perfect.
20:26Thank you so much.
20:28Then micro-sized surgical instruments
20:30are attached to the robotic arms.
20:32All right.
20:35Let's have a look here, man.
20:38Then the whole idea is that
20:40we're able to perform very delicate,
20:42refined manoeuvres
20:43in different parts of the chest
20:46without having to put our hands
20:47into the chest.
20:49So we're able to enhance recovery.
20:52And sometimes what we're able to see
20:53and what we're able to do
20:55in terms of movements
20:56is far superior
20:58than even the open approach,
21:00say if we made a very big cut.
21:01Here I'm going to show you the cancer,
21:04where the cancer is actually located.
21:06The cancer is located
21:07in the left upper lobe.
21:09You can just see its appearance
21:11just over here.
21:12You can see it's a very
21:12sort of angry-looking lesion
21:14in the middle of the screen right here.
21:17So that's where the cancer is.
21:18To ensure all the cancer
21:20is safely removed,
21:22Dr. Kayo is taking out
21:23the whole top half
21:24of Velma's left lung
21:26rather than just the tumour.
21:27As he does this,
21:29he's also removing
21:30as many lymph nodes
21:32as he can find.
21:34We should take this lymph node,
21:35don't you agree?
21:36Yeah.
21:37Even though it's very delicate,
21:38right on top of the main pulmonary artery,
21:40we're going to be able to do this
21:41with a reasonable degree of precision.
21:43The danger is
21:45that the cancer has already spread
21:47through the lymph nodes.
21:48So all the ones that he removes
21:50will be sent for testing.
21:52If they are cancerous,
21:54Velma will need chemo
21:55and radiotherapy afterwards.
21:58That's the heart here.
22:00That's the aorta.
22:01Obviously,
22:02every millimetre matters here.
22:05It's a pulmonary artery
22:06coming just here, Matt.
22:08Can you see it?
22:10Yeah, just over here, you see?
22:12Right.
22:12The critical moment
22:14has arrived,
22:16detaching the upper lobe
22:17of Velma's lung
22:18without nicking
22:19the pulmonary artery.
22:20This is the one
22:22of the most dangerous parts
22:23of the operation.
22:25The main pulmonary artery
22:25is just here.
22:26This is pumping blood
22:27to the entire left lung.
22:29Problems here,
22:31the problem will be very big
22:32in a matter of seconds.
22:33After a tense
22:44three-week wait,
22:4550-year-old Peter's back
22:46for the next round
22:47of his fight
22:48against an aggressive
22:49stomach tumour.
22:51Ready to go.
22:52We'll just see what happens
22:53once they go back in.
22:54The father of three
22:55is about to have
22:56his own genetically
22:57modified T-cells
22:59injected into his bloodstream
23:01to hopefully
23:01destroy his cancer.
23:03How are you?
23:04Good, thank you.
23:04Today's the day.
23:06The radical new treatment,
23:07first trialled
23:08by Professor Ho
23:09just four years ago,
23:10costs several hundred
23:12thousand dollars.
23:13But it can have
23:15terrifying side effects.
23:17They can produce chemicals,
23:20which,
23:21the aim of which
23:21is to kill the T-cells
23:23but can lead to
23:24low blood pressure
23:25or shortness of breath
23:26or high fevers
23:27and can also impact
23:30on a patient's
23:31brain function.
23:33For Peter,
23:34this is do or die.
23:3675% of people
23:37who are given
23:38this treatment
23:38are still cancer-free
23:40after two years.
23:42Without it,
23:43life expectancy
23:44is around six months.
23:47Like in all medicine,
23:49we try to do
23:50the best we can
23:51at each time
23:52and with each patient
23:54but ultimately
23:55I will say
23:56that if I've done
23:58the very best I can,
24:00that's all I can do.
24:03The T-cells
24:04have been frozen
24:05to stop deterioration
24:06and have to be thawed.
24:13How long do they take
24:14to thaw them out?
24:15About five to six minutes.
24:17Oh, right.
24:17With the cells
24:21now at room temperature,
24:22it's all good to go.
24:25The infusion itself
24:26is between 10 mils
24:27to 20 mils
24:28per minute.
24:29Probably is about
24:29six, seven minutes.
24:31You know?
24:32Hmm.
24:32Mind-boggling
24:33to be honest with you.
24:35Unless you know
24:36what it is.
24:36To me,
24:37it's just mind-boggling.
24:38Yeah.
24:38And to think
24:40that in that
24:41small bag up there
24:42there's 200 million
24:44cells of
24:44good stuff
24:47that, yeah,
24:48it's incredible
24:49to think of that.
24:52Okay.
24:53You ready?
24:53Yep, ready to go, mate.
24:54Let's go.
24:54Whilst the process
24:55is short and sweet,
24:57taking only six minutes,
24:59a long month
25:00lies ahead
25:01while Peter waits
25:02to see if he's
25:03hit by side effects
25:04and if,
25:05finally,
25:06he's beaten
25:07the enemy inside.
25:08So, you know,
25:09that's the big one.
25:11Hopefully it's all gone,
25:12which is what
25:13everybody wants
25:14and we all want.
25:16So, yeah,
25:16leading up to that
25:17is going to be
25:17fairly interesting
25:18next month.
25:2444-year-old
25:25tradie Nicky
25:26is in the ED
25:27after falling off
25:28a ladder
25:28at work this morning.
25:29You had a bit
25:30of a laceration
25:31for your scalp.
25:33That head wound
25:34will need stitches.
25:36That's pretty good
25:37so far.
25:37But,
25:38fortunately,
25:38the CT scan
25:39is showing
25:40no brain
25:41or other
25:41internal injuries.
25:43Hi, my name's
25:43Dr. Hannah.
25:44Nice to meet you.
25:45Hello, I'm Rochelle.
25:46Hi, I'm working
25:47with Dr. Ian today.
25:48He's still smiling.
25:50Sound kind of?
25:51Yep.
25:53Not flinching.
25:54He's tough.
25:56Six stitches later,
25:58attention can now
25:59turn to Nicky's
25:59badly dislocated shoulder.
26:01So the way we do it
26:04is we give him
26:05sedation so that
26:06you're nice and relaxed.
26:07We pull the arm
26:08so that it clinks
26:09back into place.
26:10There'll be a couple
26:11of people to give it
26:12a really good pull
26:13because it looks like
26:14you've got good muscle
26:15turns.
26:15Yeah.
26:18When you're nice
26:18and muscle,
26:19it does take a little
26:19bit of muscle
26:20on our end as well.
26:21Yeah.
26:22How are we doing?
26:23His hand's cold.
26:24I'm trying to warm him up.
26:25Cold hands, warm heart.
26:26That's what they say,
26:27isn't it?
26:27Yeah, they do it.
26:28So what we'll do is
26:29we'll give you the
26:30sedation, some pain
26:31control, and then
26:33the aim is just
26:34basically to get you
26:36drowsy and sleepy
26:37enough to relax the
26:38muscles here so we can
26:39pull it back into place,
26:40okay?
26:41Getting sedation
26:42right is a fine
26:43balance.
26:44Too much and Nicky
26:45could stop breathing.
26:47Too little and his
26:48pain could be
26:49excruciating.
26:50Now, do you want
26:51to watch this
26:52happening?
26:53A lot of the time
26:53the family members
26:54prefer to sit out
26:55because
26:55you're going to see
26:58him looking quite
26:59affected, he might
27:00go unconscious, so
27:01if you want you can
27:02go for a 30 minute
27:03coffee and come back
27:04or you can stay, it's
27:06completely up to you.
27:07Despite the warning,
27:08Rochelle refuses to
27:09leave Nicky's side.
27:11How are you doing?
27:13Yeah, I'm pretty good.
27:15Yes, it's still
27:15good.
27:17Good?
27:18Yeah.
27:21Oh, it's warm
27:22in the way.
27:25The sedation and
27:38some precision
27:39manoeuvring has
27:40done the trick
27:40and the shoulder
27:41joint is back in
27:43place.
27:44Good.
27:45Amazing.
27:46Well done.
27:48There's the shoulder
27:49joint and there's the
27:50arm.
27:50It's all back in place.
27:51He's done very well.
27:52He did so well
27:54during my life.
27:54Okay?
27:55Yeah.
27:56Yeah, they just needed
27:59more drugs to knock
28:00you out, baby.
28:01Good to get out.
28:02Oh.
28:03Emotional.
28:09Don't like to see him
28:09in pain and like this.
28:11Like, yeah, he's a
28:13strong man so it's hard
28:14to see him like this.
28:16But at least everything
28:18went well.
28:19Well, now it's back in
28:19but you're going to be
28:21sore.
28:22This is a little
28:22uncomfortable.
28:2350-year-old Peter is
28:32back at RPA with his
28:33mum Rainier.
28:35It's been the longest
28:36month of his life.
28:38His modified T-cells did
28:40make him ill but it will
28:42be all worth it if scans
28:43today show the
28:44revolutionary new
28:45treatment to cure his
28:46stomach cancer has
28:48worked.
28:49If not, he's out of
28:51options.
28:51If it hasn't worked,
28:52what happens?
28:54So there's, and that's
28:56the big one.
28:57Because I've got family.
28:58I've got, you know, all
28:59that sort of thing.
29:00So, yeah, that's the,
29:04yeah, there's a lot,
29:05there's a lot playing on
29:06the mind.
29:06There's a lot, there's a
29:07lot riding on it.
29:09Your thoughts when
29:12you're on your own, I
29:13think to me, are the
29:15hardest when you get into
29:16a bit of a night time
29:17and your, your mind's
29:19just...
29:19You can't turn it off.
29:20No, your mind's just
29:21going.
29:22Peter is about to
29:23undergo a PET and CT
29:25scan simultaneously that
29:27will give a comprehensive
29:28view of what's going on
29:30in his body.
29:33OK, so this is images
29:34from today.
29:35We have a CT, we have
29:37the PET on its own and we
29:39have the CT and the PET
29:40that are fused together.
29:42Putting these together
29:43helps us localise exactly
29:45where we see disease.
29:46So we start with the
29:47head.
29:48You can see the brain
29:48in there, it's very hot,
29:50full of it, radiative
29:51to glucose, moving
29:52through the head down
29:54to the chest and thorax
29:55where we can see the
29:56heart and down into the
29:58legs and we can detect
30:00disease anywhere.
30:01OK, Peter, your scan's
30:04all done now.
30:05I'll bring the bed out.
30:06So after the longest month
30:10of his life, Peter must now
30:12face the longest night of
30:13his life to get the
30:15results.
30:18Former ballet dancer 86-year-old
30:20Velma is under the care of
30:22robotic surgeon Dr. Chris
30:24Kayo.
30:25He's about to remove the
30:27entire top half of Velma's
30:29left lung, which has a
30:30cancerous tumour buried
30:32inside.
30:33So basically separating
30:34the upper lobe from the
30:35lower lobe here.
30:36All right.
30:37Here we go.
30:43Good job.
30:44All right.
30:44That's good.
30:45But before the two halves
30:47can be fully separated,
30:48Dr. Kayo has to seal off
30:50four branches of the main
30:52pulmonary artery.
30:54This cuts the blood supply.
30:56All right, Matt, we're
30:57making good progress.
30:58I'm going to try to get
30:58around this next branch of
30:59the pulmonary artery, Matt.
31:01Yeah.
31:01And after that, we should,
31:03I think, have one more very
31:04dangerous branch, and that
31:05should be hopefully the last
31:06branch.
31:07Do you understand what I'm
31:07saying?
31:08Yeah.
31:08All right.
31:09So we're making good
31:09progress.
31:10Just carry on.
31:11Do every step methodically.
31:12Any slip could be
31:14catastrophic.
31:15So now what we're going to
31:16do is work around one of
31:17the branches of the
31:18pulmonary artery.
31:19Pulmonary artery is the
31:19most dangerous artery in the
31:20whole body in the sense
31:21it's the thinnest vessel.
31:23I'd be very delicate here
31:24in getting around these
31:25arteries.
31:26The arteries and veins have
31:28been divided and the
31:29tissue between the top and
31:31bottom of the left lung has
31:32been cut away.
31:34There's just one more step.
31:36And now we're at the final
31:37step, which is the bronchus.
31:39This is the airway that needs
31:41to be divided.
31:42That's going to the upper
31:43lobe.
31:43It should be free after this
31:45final division.
31:46What I'm going to do is I'm
31:48going to get this robotic
31:49stapler around the airway.
31:51I'm going to close it and
31:52clamp it.
31:53And then I'm going to ask my
31:54anethotis, Dr. Joe Irons, to
31:56inflate the left lung.
31:57and we should be able to see
31:59the left lower lobe inflate
32:00but the left upper lobe not
32:02inflate.
32:03If that is the case, then I
32:04will fire the stapler and the
32:06left upper lobe or the top
32:07half of the left lung should
32:08be separated from Velma.
32:11Give me a second here.
32:12Let me focus.
32:16Okay.
32:17So what I want you to do, Joe,
32:18now is to inflate the left
32:19lung, please.
32:20What?
32:21I'm coming up.
32:23You can stop there.
32:24All right.
32:25Very good.
32:25All right.
32:25I'm going to fire here.
32:31Watch out for bronchio artery
32:33bleeders here.
32:34That's a successful firing.
32:36The top half of the former
32:38ballet dancer's left lung is
32:39now floating free in the chest
32:41wall.
32:45A bag is inserted to remove it.
32:48I'm going to do this.
32:49So once I get the mouth of this
32:53thing out, it should be safe.
32:55I can see the mouth.
32:58So that's already out.
33:00It's vital the diseased lung
33:02remains encased in the retrieval bag.
33:04And the bag is safely out.
33:10That's half of her lung out removed.
33:14All right.
33:15Good job.
33:15We're just closing up now.
33:16We should be done in the next five
33:17or ten minutes.
33:18So very happy with the operation.
33:20While Dr.
33:21Keo hopes he's removed all of Velma's
33:23cancer, he won't know for sure until test
33:26results come back in a few days on the
33:28lymph nodes he's also removed.
33:3050-year-old Peter's been battling an
33:42aggressive stomach tumour for two and
33:44a half years.
33:46All the usual treatments have failed.
33:50Today he's here with his mum and dad to
33:52find out if a radical new therapy has
33:55saved his life.
33:56There's a lot riding on this scan too.
33:58Hopefully, well, a miracle happens and
34:02it's gone.
34:03He knows that, you know, this one's got
34:05to work.
34:06How are you feeling, Peter?
34:08I'm a very anxious doctor.
34:09Yes.
34:10But in yourself, feeling okay otherwise?
34:13Yes.
34:13Yes.
34:14And how are you both, Rainier and Bob?
34:16Been a long morning.
34:17A bit difficult, isn't it?
34:19Yeah.
34:19So we've had the first PET scan at one
34:23month and I do have the results.
34:25So it shows that there has been a
34:29reduction in the size and the activity
34:32of the mass.
34:35But the mass is still there.
34:37Okay?
34:38And we call this a partial response,
34:42a partial metabolic response.
34:44Sorry.
34:45Sorry, I didn't mean to interrupt.
34:47No, please do.
34:47Did you say the mass is small now?
34:48Quite small?
34:49It is small, yeah.
34:50It's approximately two centimetres.
34:55Really?
34:56Yeah.
34:56And that's it?
34:58Oh, my God.
35:01Why couldn't I get rid of that last bit?
35:02Can you tell how big it was before he had the treatment?
35:07Yeah, it was approximately just over four centimetres.
35:11So it's hard.
35:12So it's hard, pretty much.
35:13Yeah.
35:14It's a small mass, even though it is still quite active.
35:18Right.
35:18And there's no worsening of any of the condition,
35:23like appearance of any new masses in the scan at all.
35:27Okay, well, that's good.
35:29Okay.
35:30Two centimetres.
35:31Wow.
35:31We do know that CAR T cells can continue to work.
35:36Yeah.
35:37Our current plan is that we should wait for the third month scan
35:43because that, we know, is a very important landmark.
35:46Yeah.
35:46If you have a good response at that time,
35:49your overall outlook is much better than it, if not.
35:53Okay, right.
35:53Yes.
35:55Well, I guess, look, it's not perfect,
35:58but at least we've had a response.
35:59At least there's something to work with, I guess, isn't there?
36:02So...
36:02Yeah.
36:03We would have liked to see a complete disappearance,
36:06but like a lot of things in life and medicine,
36:10it doesn't always follow the script,
36:12but the hope is that the response will continue to deepen.
36:16So that's what we are continuing to hope for.
36:19It's not the miracle Peter was praying for.
36:22With luck, the three-month scan will show more progress.
36:26Just so stubborn, it doesn't want to go on that.
36:28That worries me.
36:29I'm obviously disappointed.
36:31It's mind-blowing to think how frustrating that is
36:33that that last bit just didn't get eliminated.
36:36eliminated so, yeah, it's pretty frustrating
36:41and it's, yeah, I've just got to process that now.
36:51Six hours after he arrived in the emergency department
36:54with a dislocated shoulder,
36:5644-year-old tradie Nicky is ready to go home.
37:00Hello.
37:01How are we doing?
37:02Hello.
37:04Better?
37:04Better?
37:05Yeah.
37:06Yeah.
37:06Just take it easy physically.
37:08Take it easy cognitively, all right?
37:11Yeah.
37:11And see how you go.
37:12OK, follow-up.
37:14MRI of your shoulder.
37:15Thank you, Doctor.
37:16Welcome.
37:17We appreciate you looking after him and all the team.
37:20Welcome, welcome.
37:20Everyone's been amazing.
37:21Pass it on.
37:22All right, OK, all right.
37:23All right, thank you.
37:26Time to go home and rest.
37:30Yeah, rest?
37:31Do you know what that is?
37:33No, I wasn't going to be able to find out.
37:39It's less than 24 hours
37:41since Velma underwent a three-hour operation
37:44to remove part of her left lung
37:46which contained a cancerous lump.
37:48But nothing slows down
37:50this 86-year-old former ballet dancer.
37:53I still can breathe deeply
37:55and I had a walk around
37:59the ward today
38:02so I think I'm all right.
38:06Surgeon Chris Kayo
38:08is keen to confirm Velma's self-diagnosis.
38:11Hi, Velma.
38:11How are you going there?
38:13We've had the operation now
38:14and less than 24 hours ago.
38:17I'm very happy with the operation.
38:19Yes.
38:20As soon as I went in there
38:22I was able to see the lesion
38:24where the cancer is.
38:25Your x-ray looks great.
38:27Your chest tube looks great.
38:28But the most important thing
38:29is that you look great.
38:30Tell me how you feel.
38:31Yeah, I feel really good.
38:34I'm happy it's over, of course.
38:37Absolutely.
38:37Which is natural.
38:40But it really was because of you.
38:46You make me feel really good.
38:47That's very sweet of you.
38:50All right.
38:50Any other questions?
38:52Yeah, I was just wondering
38:53about the remaining part of the lung.
38:55How long does that take to heal?
38:57What's encouraging with Velma
38:59is that she has zero air leak.
39:01And so air leak occurs
39:03when your lung has a bit of a raw surface area.
39:06And that's indicated by some bubbles
39:08that come out of the drain.
39:10But she has none of that already.
39:11So it's already sealed over.
39:13Now it's just waiting
39:15for her body's inflammatory response
39:17to come down a little bit.
39:19Once the amount of fluid
39:20comes down a little bit,
39:21we can take the tube out
39:22and she can go home the next day.
39:24So when you ask me
39:24how quickly it's recovering,
39:26it's already doing a very, very good job.
39:28And the x-ray's good.
39:29The drainage is working.
39:31She looks fantastic.
39:32She looks amazing.
39:33And so I can't really ask for anything better,
39:36to be honest with you.
39:38You guys have made a great team.
39:39She may be getting on in years,
39:41but Velma's still got a twinkle in her eye.
39:44I'll keep on seeing you every day.
39:46And if any issues,
39:46anything I can help you with,
39:47just let us know.
39:48How lucky am I.
39:49Oh, gosh.
39:51Although Dr. Keo is pleased with the surgery,
39:54one question still has to be answered.
39:56Has all the cancer been captured?
39:59Velma will now have to wait
40:00for her pathology results
40:01to know if she can pirouette her way out of here
40:04and head home.
40:05There have been many bumps in the road
40:12as 50-year-old Peter
40:13has battled an aggressive stomach tumour.
40:18Radical new treatment
40:19had disappointing early results.
40:24They said that it shrunk
40:26from four centimetres down to two.
40:28Naturally, you're disappointed
40:31because you think it hasn't worked.
40:33Since then,
40:34he's been clinging to the hope
40:36that the treatment will continue to work.
40:39Today's scan is the big one.
40:42If he's not given the all-clear today,
40:45there's nothing more doctors can do to help him.
40:48All right, so you're OK like that?
40:50OK.
40:51OK, excellent.
40:52We'll get that started.
40:54You wouldn't be normal
40:54if you didn't get nervous after a pet scan
40:56because you just don't know.
40:57So, yeah, anxious
41:00and will be until she tells me.
41:03I'll see you later on, so Dr. Ho.
41:07So, how have you been the last month or so?
41:10A couple of months.
41:11A couple of months, yeah.
41:11Yeah, no, I've been fine.
41:12Haven't had any issues.
41:13I'm still going along as normal.
41:15I've got the result of this morning's pet scan.
41:18Essentially, the original area of the lymphoma,
41:23there is no evidence of disease there.
41:25Really?
41:27Which is great news.
41:28Excellent, yep.
41:29We will consider you to be a complete response.
41:35We're mission.
41:35There was one point we didn't know we were going to get here,
41:38did we?
41:39That's right.
41:40Yeah, that's great.
41:41Thank you, Peter.
41:42Always appreciate what you do for us, Dr. Ho.
41:44If it wasn't for the CAR T-cells,
41:46it may not have turned out this way.
41:50I'm very thankful and grateful
41:53to have had the career that I've had
41:55to use the knowledge and skills
41:58that I've acquired to help patients.
42:02How do you feel?
42:05Good?
42:06Yeah, good now.
42:06Good?
42:07Yeah.
42:07Yeah, so I've got good news.
42:09I'm all cleared, officially in remission.
42:11So, yeah, a good day for all of us.
42:15RPA and Dr. Ho saved Peter's life
42:19and given him a future.
42:20So, yeah, no, can't speak too highly of it.
42:23Yeah, amazing people.
42:25Yeah.
42:25Forever indebted to them.
42:26Yeah, for sure.
42:27It's been three days
42:40since 86-year-old Velma
42:41had robotic surgery
42:43to take out a cancerous growth
42:45in her left lung.
42:46Listen, I've got some news for you.
42:48We just got the pathology back this morning, okay?
42:51Yes.
42:53The cancer was a type of cancer
42:55called adenocarcinoma.
42:57It measures about 22 millimetres,
42:59roughly the size of a 20-cent piece.
43:02Yes.
43:02Right.
43:03All right.
43:04The surgical margins are clear.
43:06What that means is that
43:07it was completely removed.
43:11In addition to that,
43:12I found at least a dozen lymph nodes
43:15that I took out around the lung tissue.
43:18And the very good news is that
43:20none of them had any cancer cells in them.
43:22Hmm.
43:23Ah.
43:24So that's the...
43:25That's a relief, then.
43:26Yes.
43:27So that's the best news
43:28we can hope for.
43:29Best news we could have.
43:30All the cancer is out of your body.
43:32You don't need any chemotherapy
43:33and you don't need any radiotherapy.
43:35Oh.
43:35It gives you the best chance of curing it.
43:37Curing it completely.
43:39Mm.
43:39That's amazing.
43:40I'm just very happy with the news, okay?
43:43Yes.
43:43And I think you've had a terrific recovery,
43:46but also it means that your long-term outcome
43:48is going to be very good.
43:50Oh, how do you say thank you?
43:52You're very welcome.
43:53I had a look at who you were after the operation
43:56because I don't want that to affect me,
43:58but I understand you've had a very amazing career,
44:01you know, earlier.
44:02Yes, I did.
44:02So I'd love to hear about it sometime.
44:06We'll meet up, I'll tell you.
44:08Yeah.
44:09I've had some amazing things happen to me in my life,
44:12but I think this one tops the lot.
44:14That means a lot to me.
44:16Thank you.
44:18Give us a hug here.
44:19Yeah.
44:20Okay.
44:20Really happy for you.
44:22Thank you.
44:23All right.
44:23Thank you.
44:24You're welcome.
44:25Thank you so much.
44:26All right.
44:29I've fought all the way and I'll fight again.
44:35A few days later, Velma's given a suitable send-off.
44:39Bye.
44:41Thank you so much, everyone.
44:43Velma still has the moves, but it's early days.
44:47It'll be a long time before this ballerina
44:51is well enough to dance back into the spotlight.
44:53Well done.
44:55Amazing.
44:56Amazing.
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