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Surgeons: Life in Their Hands - Season 2 Episode 5
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01:4331-year-old Robert and his fiancée Louise live on a 20-acre property on the western outskirts of Sydney.
01:55Not a good strawberry? Not a good strawberry.
01:57Things were good until a diagnosis of epilepsy came crashing into his life. Literally.
02:04I was driving home with my mum from the city, going down an 80km road around a turn.
02:10Just had the seizure, went straight instead of turning, got very lucky and didn't hit a truck or, you know, anyone hit me or anything like that.
02:19Did a whole bunch of tests after to try and work out what was wrong.
02:24And then, yeah, the verdict was epilepsy.
02:27Oh, there's a strawberry.
02:28Four years and six kinds of medication later, Robert is still suffering seizures.
02:34He'll physically seize for about two minutes.
02:38I need you to breathe, OK?
02:39His jaw clenches up, his right hand kind of gets raised.
02:46Sometimes he makes a noise with his jaw, like he's grinding his teeth.
02:52We've been on such a long process with, like, Rob's journey.
02:55It's kind of like, ah, can we just find the solution and fix it already?
02:59Oh, here's a good one.
03:00Would you like to eat it, Louise?
03:04Thanks, Rob.
03:06The seizures themselves have remained pretty consistent.
03:10The physical seizing and then around 20 minutes to half an hour, then he's back in the room, I say.
03:16Like, he's fully back.
03:17Whereas we're engaged, we often joke that we skip straight to the sickness and health part of being married without the fun side of it.
03:25Living in a rural location, a car is essential, so Louise always has to take the wheel.
03:34The thing that irritates me the most is not being able to drive.
03:42I used to just get up in the morning and just go take some photos somewhere or go for a hike.
03:47It was nice and relaxing, and that's how I would cope with the stresses of life.
03:52Well, we can do a quick beach walk, and then we can go somewhere for lunch, and we'll find somewhere with a hike around it at that time as well.
03:59OK.
04:00OK.
04:00But now I'm sort of locked at home.
04:02If I want to do something, I have to keep irritating Louise, and it makes it a bit harder.
04:07You're not that irritating.
04:08It's fine.
04:10Recently, Robert's seizures have increased in frequency from once a week to three times a day.
04:16Yeah.
04:17Time for drastic action to find out which part of his brain triggers the seizures.
04:22They'll drill maybe 20 holes in my head and insert probes into my brain.
04:28The doctors have told me that they know the suburb that the problem is in my brain, but they don't know the exact focal point.
04:38And because the brain is so active, that one suburb could have a lot of focal points.
04:45So that's why the probing will help them work out the exact depth and location.
04:49If the exact location can be pinpointed, surgery to remove that part of his brain is an option.
04:57We're engaged, you know, we're Rob's 31, I'm 27.
05:01We want to get married, we want to have kids, we want to do life.
05:04And there is a bit of pressure on that.
05:07Without having him driving, it'll be a bit hard.
05:23Clocking on for her 10-hour shift in emergency is experienced ED consultant Dr. Rebecca Davis.
05:30RPA is in Camperdown, which is right near the centre of the city of Sydney.
05:34We've got a really diverse community that we look after and it is unique.
05:40We have patients from every walk of life, every age from 0 to 110.
05:46An early casualty today is a type of patient that almost became extinct during COVID.
05:53The Pommie Backpacker.
05:5620-year-old Ruby stabbed herself while moving into her new share house.
06:00So I was in the kitchen in my new house and I was trying to cut the cutlery open with a knife.
06:08And stupidly went straight into the hand, like slipped off the cable tie, straight into the hand.
06:16Yeah.
06:17The blood started like pumping out and like everywhere, all over the new house.
06:22I'm quite like an accident prone person, so like stuff like this happens to me a lot.
06:27Ruby, do you want to come hop over on the bed and we'll have a look at your hand?
06:30Yeah.
06:31Most people who come to emergency are either in pain or worried or distressed in some way
06:36or just very, very unwell.
06:38So, you know, with that, you have to acknowledge that their distress and their fear in that environment.
06:46Looks very impressive.
06:47What do you do for work?
06:49Um, waitress.
06:51Your waitress?
06:52Yep, so no curry and trays for me.
06:55Did it go all the way through?
06:56Not that I'm aware of.
06:58Let's just give it a little bit of a clean.
07:00No, so it doesn't look like you've gone through any tendons.
07:02I guess it does look reasonably deep.
07:04Um, so I think we should give it a really good washout and then if we can't see the bottom
07:09of it, then we probably should get our plastic surgeons to have a look at it.
07:15But as registrar Zoe Lambert tries to clean the wound, it won't stop bleeding.
07:20It is a bit pulsating.
07:22Yeah, I could kind of see it.
07:24Yeah, I can see it now.
07:26It makes me worried that it is a small arterial nick.
07:28I will go and talk to Bec and the plastic surgeons, okay?
07:35If she has nicked an artery, Ruby won't be able to finish unpacking those boxes anytime
07:40soon.
07:44Epilepsy sufferer Robert is contemplating brain surgery to cure his condition.
07:49But before that can happen, he needs electrodes inserted into his skull to find where the attacks
07:57are triggered.
08:00The 31-year-old and his fiancée Louise are at RPA to discuss the electrode procedure with
08:06neurosurgeon Benjamin Yonker.
08:08Thanks for coming in today.
08:10I thought we might go through your history and talk a little bit about what we have planned.
08:13In the 95% of times where neurosurgery goes as you expect it to and everything goes well,
08:21it's absolutely fantastic.
08:22You often change people's lives and fortunately ended up in areas of neurosurgery where I really
08:27think you can make a positive difference.
08:30Now, some people with epilepsy will have an abnormality on their MRI that we can pinpoint
08:35and say, hey, this is the cause of your epilepsy.
08:38This is where these little fires are starting.
08:40Some people don't.
08:42We do know, for example, that we think that your left frontotemporal region, somewhere
08:47here, or if you can imagine on this little brain model, somewhere here or here or in
08:52the deep lobe in between, that's the kind of region that we think that your seizures are
08:57coming from.
08:58But the problem is we can't see it on the MRI.
09:01But we've got a technique that's really only been around, at least in Australia, for the
09:04last 10 years or so called stereotactic EEG.
09:08We're going to put maybe 15 or so electrodes inside your brain, each with multiple little
09:14contacts on it that allow us to get a three-dimensional EEG of your brain.
09:20And I'm always kind of amazed by patients.
09:23I'm amazed by their ability to come in with this complex or difficult problem and to sort
09:29of just ask questions about it and carry out a conversation about it when it must be something
09:35that's incredibly frightening.
09:36So you'll be putting 15 holes into my head?
09:39Yeah, roughly.
09:40If you've seen it on TV where people use a blackened deck of drill for drilling a hole
09:44in someone's head.
09:45Well, neurosurgery, we never do that, except for this operation, where we kind of do something
09:50a little bit like that.
09:51There's a very small risk every time that we pass an electrode into your brain of causing
09:54a bleed.
09:56If we were to cause a bleed, that could cause anything from no symptoms at all through to
10:01a significant problem, even a stroke-like kind of problem.
10:05Despite the risks, Robert wants to forge ahead and find the part of his brain that's triggering
10:11his seizures.
10:13If the procedure is a success, and the focal point is found, he'll have an even tougher
10:18decision later on whether to have surgery to remove that part of his brain.
10:23Yes.
10:2578-year-old ex-truckie Gary has earned his retirement.
10:37I drove trucks roughly about 25 years.
10:42Yeah, like driving all over New South Wales, up the Queensland border, down to Victoria.
10:49When I was driving trucks, I used to put it up on the window or on my lap.
10:53I used to drive one-handed.
10:54I found my first skin cancer on my arm.
11:01Wife of 57 years, Jeanette, spotted many of the 60 skin cancers Gary's had removed.
11:07But now, he's facing the battle of his life, with deadly melanomas found for a second time
11:18in the lymph nodes under his arm.
11:20This surgery is bigger than the first one.
11:24Long time on recovery.
11:25So, we just hope when they do this, that it comes back, that it's clear and it's not
11:32there anymore.
11:33Well, it's got to be done.
11:34It's got to be done.
11:35It's a worry.
11:36It's a worry.
11:37It's a worry.
11:38I keep saying, I won't go.
11:39It's your goal.
11:41You'll be dead in six months.
11:43Gary's a reluctant patient, but he has a lot to live for.
11:47We have four children, 10 grandchildren and nine great-grandchildren.
11:54I'm feeling very anxious because I don't know what the outcome of this is going to be.
12:00You know, I don't know how he's going to handle it.
12:03And it's hard.
12:04It's not easy.
12:05It's hard to see someone that you love go through this.
12:10This time, I am scared.
12:12I wonder what she's going to say today.
12:22We'll just have to wait and see when we see her.
12:25Yeah.
12:26Hi, Gary.
12:27Hi.
12:28Nice to see you.
12:29Come on in.
12:30Okay.
12:31Gary's life-saving surgery is in the hands of RPA's surgical oncologist, Dr. Robin Saw.
12:39She successfully performed his first operation four months ago.
12:43So how I came to do melanoma is that it was actually my first term at RPA when I was an intern.
12:50So a training doctor.
12:53So we're here today because we need to talk about the operation next week.
12:57I realised, like, medical school was actually quite stressful for me.
13:01I didn't do very well, I have to say.
13:03But once I started working, like, you know, that first term doing melanoma, oh my goodness.
13:09It was like, there was a light.
13:12It was, just loved it.
13:15And it was, I guess, the interaction with the patients, knowing that I could make a difference.
13:22Gary is one of the unlucky 20% where the cancer has returned to the same area under his arm.
13:28Okay.
13:29Okay.
13:30So let me go through the details of the bigger operations.
13:33Yeah.
13:34So, general anaesthetic.
13:35Yeah.
13:36We cut from here.
13:38Yeah.
13:39Into the armpit.
13:40And through that cut, I take out the envelope of fat and lymph nodes.
13:43Right.
13:44So if this lump is wrapping around one of the nerves, I can't leave the nerve behind.
13:50You've got to take it.
13:51I have to take it.
13:52Yeah, you've got no choice.
13:53So you will be weaker.
13:54But you can still do stuff here, right?
13:56Yeah.
13:57Second thing you'll notice is that you'll have some funny feeling here.
14:01And also sometimes here.
14:03And the funny feeling is tingling, sometimes some sharp stabbing pain.
14:08That area will not be normal from a sensation point of view ever again.
14:13Okay.
14:14You still have strength in that arm?
14:15You will still have strength in that arm.
14:16Right.
14:17Okay.
14:18My strategy to deliver bad news to patients is honesty.
14:22I think it's the most important quality that we can have when we're actually talking to our patients.
14:30If we're not honest with them, they don't know the facts about their cancer, about their melanoma.
14:36And it doesn't work.
14:38They need to know what's going on.
14:40So let's see.
14:41You've healed really well.
14:43What's that on...
14:46Um...
14:47It looks like Dr Soar has spotted another skin cancer, which is one more melanoma too many.
14:5731-year-old Robert and fiancé Louise are at RPA to have holes drilled in his head.
15:12Sounds like a horror movie.
15:14No one here is busy.
15:15Yeah, well it's 6am.
15:16But it's the only way he can find the area in his brain that's triggering epileptic seizures.
15:23I'm feeling pretty relaxed and maybe even a bit excited today.
15:27I was definitely pretty anxious leading up to it.
15:30While Robert's sedated ahead of the op, neurosurgeon Dr Ben Yonker is beginning a very complex process.
15:38If you're going to submit to having someone operate on your head,
15:42you want to feel pretty sure that the person who's doing that has suggested the right thing
15:48and is going to do the right thing by you.
15:50This is a stereotactic head frame.
15:52This is going to go onto Robert's head.
15:54We're going to secure it tightly with these four little pins.
15:57They just puncture the skin and sit on the surface of the skull.
16:00They don't go inside the head.
16:02And with it fixed in position, we can then work out exactly the XYZ coordinate of any point in the brain.
16:09I've just got to loosen it a bit more so I can...
16:12Yeah, there we go. That's it.
16:13If this shifted, it would be a total disaster.
16:15And now what we want to do is get his shoulders roughly in line with the top of that part.
16:20So if we can bring him up on three. One, two, three. That's it.
16:25And so now we need to work out where his brain is in relation to the frame
16:29so we can then work out where we need to put the electrodes.
16:32It's part of my job to turn that conceptual diagram into an actual plan on the scans of the patients,
16:41taking into account what's safe, where the blood vessels are, those sorts of things,
16:46so that we can make sure that the electrodes are following a safe path.
16:50Working in tandem with Dr. Yonker is neurologist Dr. Armin Nikpoh.
16:5538.9 left.
16:57My job is to make sure that the coordinates are communicated and double checked
17:02so they have the right trajectories for the insertion of the electrodes.
17:05Excellent. OK, just about ready to go.
17:08So what was our ring angle for the first one?
17:11Minus 0.8 left.
17:15OK, guide tube in.
17:17We've set up the frame to the target of one of our electrodes.
17:20Just going to make a little hole in the skin so that the drill wants to stay where we put it.
17:27OK, let's have the drill.
17:29Drill.
17:30Drill.
17:31What was our bone thickness here?
17:34Two millimeters.
17:36Often the skull is like eight or ten millimeters thick, but two millimeters is obviously very thin.
17:43After a hole is drilled into the very thin two millimeter skull, a tiny bolt will secure it
17:49and provide an anchor for the electrode to feed through.
17:52We'll just see how that goes.
17:54Yep.
17:55I mean, it just feels a bit spongy and I don't want to keep pushing it in this case.
17:59Neurosurgery always has some potential for, you know, a real disaster.
18:04You just have to do your best for every patient and know that you're doing things to a high standard,
18:09but there is a small chance of something coming up unexpectedly.
18:14Would the SAEG be useful if we didn't manage to get all these temporal electrodes in?
18:19No.
18:20The answer is no.
18:21Dr. Yonker needs to quickly work out if there's another location nearby, he can move that electrode too.
18:28Otherwise, the procedure will be a waste of time.
18:3420-year-old backpacker Ruby cut her left hand open while moving into her new house.
18:46I just get, like, giggly about things.
18:49Like, I'm just like, this is now the second time I've been in hospital in Australia
18:54and I've only been here, like, a couple of months and I'm, like, a young, like, healthy 20-year-old.
18:59I don't understand how I end up in so much trouble, but, yeah.
19:04Ruby's wound is deep and won't stop bleeding.
19:09Concerned they can't see what parts of her hand might be injured,
19:13the ED teams called in a plastic surgeon.
19:16Ruby?
19:17Yeah.
19:18Hi, my name's David.
19:19I'm one of the hand surgery doctors.
19:20Nice to meet you.
19:21Nice to meet you.
19:22Is that an English accent I detect?
19:24Yeah, yeah.
19:25Are you visiting or living here?
19:26Um, on a working holiday visa.
19:28Oh, nice.
19:29Yeah.
19:30So I'm doing, like, waitressing at the moment.
19:31Cool.
19:32Just got an apartment and then...
19:33Very nice.
19:34...was opening the cutlery and...
19:36This is what happened?
19:37This is what happened.
19:38Oh, so you just moved in?
19:40I don't know.
19:41Oh, God.
19:42I came here on a working holiday about nine years ago and...
19:44Really?
19:45Now I've got a wife who's Australian, a baby that's Australian and...
19:48Oh, that's so nice.
19:49Yeah, live here permanently, so you never know what might happen.
19:51I love that.
19:53Based on your examination, it seems like you've cut some of the muscles
19:56in the thumb and the one that moves your index finger this way.
20:01And that usually heals up by itself.
20:03Scar tissue forms between the two ends of the muscle
20:05and you can go back to your normal life.
20:08However, when you have a sharp injury like this, a penetrating injury,
20:11we do like to look inside the wound and just confirm.
20:13In about 10 or 15% of cases, we miss injuries to tendons on examination.
20:18So you might have a partial injury that isn't sore.
20:21But over time, if you use the tendon normally, it can snap.
20:25So for that reason, we have a look in the operating theatre.
20:28You'd have to extend the wound a little bit to look in.
20:30Yeah.
20:31Make sure everything's okay.
20:32We'll probably buzz that artery that's bleeding.
20:34Yeah.
20:35Just grab some tape and I'll take this back up.
20:38This is fairly routine for us.
20:40We have a fairly high-volume service here in RPA.
20:43Lots of people injuring themselves.
20:45This would probably be on the lower end of the severity spectrum.
20:48But I guess for Ruby, you know, it's on the higher end of the severity spectrum
20:52because she's going in for an operation.
20:54So it's routine for us, but we know it's out of the ordinary for her.
20:57When you're 20, far from home, injured and alone, what you'd really need is a comfort call with Dad.
21:04Hi, Dad.
21:05To help put things in perspective.
21:07Um, I'm having a bit of a crazy day, to be honest.
21:11Why?
21:12I'm in hospital.
21:14What's up?
21:15Um, I was, I've caught myself with a knife and it's, it's not good.
21:22What have you done?
21:23Um, so I need surgery on it.
21:26You just took my pen.
21:28I know.
21:29Are you going to be alright?
21:31Yeah, I'm fine.
21:38After a six hour wait for surgery, with no food, a bored and hungry Ruby gets the bad news.
21:45Unfortunately, we're not going to be able to get to your operation tonight.
21:48Um, there's been too many cases booked and at the moment it's looking like it's going to be after midnight.
21:53And for this type of operation, you don't want to get a quick result, you want to get a good result.
21:58So, what I think we should do is cancel it tonight and bring you back tomorrow morning.
22:03Oh dear.
22:04Okay.
22:05What a day.
22:06I know, I know.
22:07Yeah.
22:11During a pre-surgery check of 78 year old melanoma sufferer Gary,
22:16Surgeon Dr Soar discovers disturbing looking spots.
22:20That thing on your neck, I think we should take off at the same time.
22:23And one on his arm too.
22:25Together with the armpit, we'll do the neck, we'll do the forearm.
22:30This one, I think needs a little biopsy to tell us what it is.
22:34So we might do that on the same day as well.
22:36Yeah.
22:37It's easier if he's under.
22:38Yeah, I agree.
22:39It's an even bigger surgery than first thought.
22:47Theatres is my happy space.
22:49It's bringing together my training, which was enjoyable, and my skills.
22:56And I interact with people who I like.
23:01And it's a team.
23:03A team that actually pulls together for the best efforts for a patient.
23:08Just take a few more deep breaths.
23:10We'll be within here for the whole time, okay?
23:12We'll take good care of you.
23:15This is a teaching hospital, so we train surgical registrants.
23:20That might actually be the most stressful part of the operating, but it'll be fine.
23:27Okay.
23:29I'll get you to do the skin flaps and start.
23:31I might have to take over, yeah?
23:33Yeah, that's no worries.
23:34But that's all right.
23:35Thank you.
23:36Surgical registrar Dr Daniel O will take the lead with Dr Soar guiding him.
23:41You can start.
23:42Yeah, thanks.
23:45All his wife of 57 years, Jeanette, can do is wait.
23:49I'm feeling anxious for him, you know, because it's still the unknown, right?
23:56Even though they explain everything to you, things can go wrong.
24:01So Skye, this is the little bit that I've taken from his net.
24:07Thank you.
24:08Yep.
24:09He's here really to be treated for his melanoma, but I've elected to remove them as well for him.
24:15The three suspects' skin spots are removed first.
24:18They'll be sent to pathology for more tests, hoping they aren't also melanoma.
24:25Okay, so we're about to start the main part of the operation.
24:30We're going to make a cut in the armpit, and through that cut we take out the envelope of fat and lymph nodes,
24:37trying to avoid the main vein to the arm, and also hopefully avoiding the nerves to some muscles.
24:45So Daniel's going to make his incision, so go for it.
24:52Go straight down.
24:54Yeah.
24:56So what we're doing is the skin flaps are going down to the muscles of the axilla, or armpit.
25:02So this is when you have to be a little bit careful not to damage the nerve.
25:10It's a crucial stage of the operation.
25:13If the nerve is damaged, Gary may lose the strength and range of movement in his arm.
25:18It's two days since 20-year-old backpacker Ruby rushed to the ED with a deep cut in her hand.
25:32Now she's back for surgery.
25:34It's my first surgery going under general anaesthetic that I can remember.
25:39So I've never had it before. I don't know how I'm going to react to it, but hopefully it should all be okay.
25:46I just feel a bit nervous, obviously.
25:48It's difficult with my family being back in England to not really have anyone here.
25:53So that's just causing nerves at the moment.
25:57I don't think it's hit me. I've just been laughing it off until this point.
26:01And now I feel like it's starting to become a bit more real.
26:05Once Ruby is sedated, plastic surgeon registrar, Shivani Agawalla, will investigate just how bad the damage is.
26:13She's put a kitchen knife through her first web space on the back part of her hand.
26:18We call that the dorsum of the hand.
26:20And so today she's going to have an operation to have a look at what structures she's actually injured.
26:25If you cut a tendon in the front of your hand, those are called your flexor tendons.
26:32If that's not repaired or splintered to protect it, often those tendons can retract into your forearm.
26:38So say I cut the tendon to my ring finger, I will either not be able to bend my ring finger at that point
26:44or not be able to bend my ring finger at that point.
26:46Yeah, so it's really important to get that checked out.
26:48So I've got a tourniquet up here on Ruby's upper arm.
26:52What that does is temporarily stops or reduces blood flow to the hand so that we're operating in an essentially bloodless field.
27:00Okay, can we get tourniquet up please?
27:02At the moment she's got a lot of haematoma in here, so that's blood clot.
27:07So I think it's probably worthwhile giving this a wash before we start exploring it.
27:10She's got a tendon running here, which I don't think she's injured, tendon running here.
27:16So I think she's quite lucky where she's made her cut.
27:19The main thing here is going to be two muscles.
27:22That's all muscle that she's cut through there.
27:25Like you can kind of see that's frayed.
27:27So that's all the muscle needed, just one stitch, and now I'm just stitching up her skin.
27:48A few hours later, Ruby's ready to get back to her working holiday.
27:52The first day, all I could see was blood and you sort of just want it stitching up there and then.
27:58But I'm glad that I had the surgery because it's your hand at the end of the day.
28:02You use it for everything and it's important to get it done right and catch these things earlier rather than later.
28:08Ruby's flatmate Maisie has arrived to safely escort her home.
28:13How are you feeling?
28:15Good, I'm okay.
28:17I feel a bit woozy Bob.
28:19A bit woozy.
28:20Yeah.
28:21Well no more cooking for you.
28:22No.
28:23No.
28:24No knives for me.
28:26Stay away.
28:28Ruby's Aussie adventure is back on track.
28:32And after a sleepless night on the other side of the world, Dad will no doubt be glad to hear his Muppets all good.
28:39It's home sweet home.
28:4031 year old Robert is having exploratory surgery to try and find where the epileptic seizures are coming from in his brain.
28:53The plan was to insert up to 18 electrodes, but Robert's unusually thin skull is making that look impossible.
29:01Would the SAEG be useful if we didn't manage to get all these temporal electrodes in?
29:06No.
29:07The answer is no.
29:09I want to just make sure that we've got bone underneath us.
29:13We have this principle in medicine of first do no harm.
29:17We don't want to actually cause a problem by persisting where we shouldn't.
29:21Dr. Yonker opts for caution, removing the bolt and trying for the next position.
29:28Now what was our arc angle and our ring angle?
29:31So the arc angle is 6.5 anterior.
29:34So this is B prime.
29:36This one's going into something called the amygdala at the front of the temporal lobe.
29:40Success.
29:42The second electrode is securely in place.
29:45This is our brain electrode here, and you can see that it's very thin.
29:49It's less than a millimetre in diameter.
29:51This particular one's got eight or ten contacts on it.
29:58Okay.
30:00After a tricky start, it's smooth sailing the rest of the way.
30:10Beautiful.
30:11So that's 140.
30:13140.
30:15Oh, that's a beauty.
30:19That's a beauty.
30:21Oh, yeah.
30:22And here comes the frame.
30:24Yeah.
30:25In total, 15 electrodes have been embedded into Robert's brain.
30:30A CT scan confirms none of them are causing any bleeding.
30:35Yeah.
30:36All right.
30:37They look good.
30:38Neurologist, Dr. Nikpaw, is confident 15 electrodes will be enough.
30:42But wants them tested before Robert is sent to ICU.
30:46So we just want to make sure that all the contacts are recording.
30:50There's a problem or there's a defective electrode.
30:52We have an opportunity to fix it right now and then.
30:54So we just quickly check all of them and they were working fine.
30:57Robert now faces a long 10 days stuck in a hospital bed having dangerous seizures induced that could leave him permanently damaged.
31:06But it's the only way to find out which part of the brain is causing them.
31:18So I'm separating the blood vessels that are supplying the muscle here.
31:25Melanoma surgeon Dr. Soar is navigating around the nerves in 78-year-old Gary's armpit so he can keep the full use of his arm.
31:34What I'm doing now is I'm going across the axillary vein which is the main vein of the arm and all the tissue below it is what I'm going to take.
31:47So that's actually a major part of the dissection done.
31:52Okay, so this is the specimen. There's a lymph node here and I think that's the involved lymph node.
31:58You can see it's black. That's not normal.
32:02It's quite impressive for melanoma.
32:05Yeah, I'm happy with the way it's gone.
32:08We've got the tumour out. We've done the other lesions and it just remains to see how he recovers from it.
32:14Oh, hi Jeanette. It's Robin Saw speaking.
32:22Hi, good.
32:24It's gone very, very well.
32:26So the two nerves that I thought could potentially be damaged, they're fine.
32:31We've been able to preserve them and the bulk of the lymph nodes, all of the lymph nodes are removed from that area.
32:38So he will go to recovery soon and it'll probably be about an hour before he gets to the ward.
32:47That's all right. It's a pleasure. Pleasure.
32:51Once I hear his voice that I know then that he's okay.
32:56No.
32:58No, you're waking up. The operation's finished.
33:01Take some really deep breaths.
33:04Take some deep breaths.
33:05Gary's not responding.
33:09Yeah, just, I want him right up the top so we sit him up.
33:12It's gone really well. Can you squeeze my hand?
33:15Gary?
33:25Three days ago, epilepsy sufferer Robert had surgery to insert 15 electrodes into his brain.
33:31The 31-year-old survived the procedure and now is having electrical currents run through those electrodes to try and stimulate a seizure and pinpoint where in his brain they are coming from.
33:45He is monitored 24-7 by nurses and fiancee Louise.
33:49The cabin fever is starting to set in.
33:53Sitting in here is not fun, especially with all this on my head. Like, you know, I can't wear my glasses properly. I can't lay down or sit properly because it hurts my neck. It's, yeah. I'm very keen to get all this taken off and get out. But at the same time I'm, you know, came here to get some results so hopefully we find out.
34:12Sleep-deprived and on reduced medication, when a seizure starts, an alarm goes off.
34:18During the seizure, Robert's cognitive abilities are immediately tested.
34:35We don't offer this to everybody because some people might not have the stamina or the strength to withstand this.
34:47Louise has been very, very supportive and Robert is very realistic. Together they're a fantastic team.
34:54As well as finding out where the seizures are coming from, Dr. Nick Paw wants to determine what might happen to Robert's speech and memory if that part of the brain is removed.
35:07Once upon a time there was a group of frogs who lived as happily as could be in a marshy swamp.
35:15So they stopped. So what was that story about?
35:18Frogs who wanted God and they prayed to Zeus.
35:21His verbal memory is not great. He does rely on a lot of lists and notes and stuff to remind him.
35:28And that's not an uncommon complaint in epilepsy. So he's already impaired.
35:32Point to ceiling. Point to wall.
35:34I think there's a good chance we have found something. I just don't want to commit until I look at it properly.
35:39And I think there's a good chance, I think the risk to him will be small.
35:46Whether it will be acceptable to him or not, I can't answer that for him. He has to tell me.
35:55Gary? You okay?
36:01Can I have the Hudson mask please? There you go.
36:04After a surgery to remove cancerous lymph nodes, 78-year-old Gary's not waking up.
36:10Gary? Do you have any pain?
36:14So Gary, we're taking you out to recovery now.
36:18It's been ten minutes and the team is worried.
36:23Hey Gary. Hello.
36:26It's me. I'm Veronica the anaesthetist.
36:29Gary, can you open your eyes?
36:30Yeah.
36:34Finally, Gary starts moving and everyone lets out a sigh of relief.
36:39All done really, really well.
36:43The following day, Gary is ready to hear from Dr Soar on how the surgery went
36:49and if he'll still have full range of movement in his arm.
36:52Good morning.
36:54Now I know your face.
36:55Yes.
36:56It's a bit different, isn't it?
36:58How are you?
36:59Good.
37:00How's your night?
37:01So, so, what was the problem?
37:03Pain?
37:04Pain, sleeping, doors banging.
37:06You can't sleep in hospital.
37:08I know.
37:09Alright.
37:10Pain we can get control of though.
37:11Let me have a quick look.
37:13That's alright.
37:14I can just sit this down.
37:16Oh, that's beautiful.
37:17Your wound looks beautiful.
37:20Perfect word.
37:21I have a feeling that, ooh, sorry, sorry.
37:24Your ear is going to need more done.
37:28Yeah.
37:29The operation went really well.
37:30No problems at all.
37:33We were able to leave the two nerves in, so no problems with lifting your arm up.
37:40We actually saw the lymph node, so it was black and really not happy.
37:46So I've taken a little bit for research purposes, but the rest I've sent off for testing.
37:52Okay.
37:53I feel fine.
37:55Bit sore.
37:56It feels good that the melanoma has gone off for research to help someone else.
38:01Gary's wife Jeanette will be able to take him home soon, but further treatment is likely to come.
38:09I'm still waiting for the results of the lymph node.
38:12Just have to wait and see what happens.
38:14You feeling alright?
38:15Yeah.
38:16Yep.
38:17I think it's...
38:18That's it.
38:19Back here again.
38:21Six weeks ago, epilepsy sufferer Robert had 15 electrodes inserted inside his skull to discover which part of his brain triggers his seizures.
38:33And today, the 31-year-old and his fiancee Louise will find out if doctors succeeded.
38:42The two options are either he keeps having seizures or they can do brain surgery and fix the seizures.
38:48They're not light-hearted either way.
38:52How are you doing?
38:53Nice to see you Louise.
38:54Nice to see you too.
38:55Boss.
38:56Nice to see you.
38:57Look at that haircut.
38:58I like it.
38:59You're healing well.
39:00Come on.
39:01Nervous?
39:02Yeah, a bit tense.
39:03A bit.
39:04Dr. Nickpaw can confirm which part of the brain is triggering the seizures.
39:09Looking after your results, it looked like it was coming from this region.
39:14So the one that was the most active and most involved was the contact in the inner part of the temporal lobe.
39:21Even though they know where the focal point is, surgically removing it won't be easy.
39:27But to get to it, he'll have to take a bit of the front end of this because he can't get to it otherwise.
39:33So he'll take the front of the temporal lobe out.
39:36So he'll open the skull, take that bit out and then operate backwards and remove most of this organ, which works mainly to file away memories.
39:47And I think we have a good chance of making you seizure free.
39:50I would say around 60 to 60 to 70 percent chance.
39:54The other side of that number is 20 to 30 percent that we might fail.
39:58Yep.
39:59Failure means the seizures continue.
40:01The part of the brain Dr. Nickpaw is talking about removing could impact Robert's memory, language and speech.
40:08But if he doesn't have the surgery and his uncontrollable seizures continue, the outcome could be worse.
40:15But continuing to have seizures where you could injure yourself, fall, break bones and all the limitations it puts on your life.
40:27And you're a young man for the next decades.
40:32Yeah.
40:33If I don't end up with no epilepsy, could the surgery still help the epilepsy?
40:40Correct.
40:41About 20 to 30 percent of people get an improvement in their seizure frequency.
40:45So they're not as severe, not as frequent, and they do get better from that point of view.
40:50So that's also a win.
40:51So that's what you two have to sit down and think about.
40:54There's a lot to weigh up and Robert's in no hurry to make a decision about going ahead with the surgery.
41:01I want to do the surgery.
41:03I am, you know, I'm a bit anxious about the whole thing, about having a bit of my brain chopped out and everything like that.
41:10But yeah, I want to do it.
41:12I'll just, I want to think about it a bit first, get comfortable with the side effects and what's happening and everything like that.
41:19And then, and then I'll probably say yes.
41:22We were worried that we wouldn't, that he wouldn't have any options at all.
41:26They'd be like, no, it's too risky.
41:27We're not going to do it.
41:28And that was probably the scariest thing.
41:30But even in them saying, yeah, we can do it, it gives us the choice.
41:34It's not, we're just stuck with it kind of thing.
41:37She'll help me make a decision.
41:38But yeah, at the end, it's going to be how, how I feel with it all.
41:44It's been an anxious two weeks waiting for the pathology results after 78 year old Gary's life saving melanoma surgery.
41:56You feel nervous because you don't know what they're going to be.
42:00If they're positive, we're in big trouble.
42:03Hello.
42:04Hi.
42:05You're stripped already.
42:06He's right waiting for you.
42:08I know.
42:09You want this one off?
42:11In a minute.
42:12We've got to say hello first.
42:14How have you been coping at home with the drains and everything?
42:17Drains are all right.
42:18All right.
42:19All right.
42:20So the little bits that I took out, they're the minor bits.
42:25So the ear was a solar keratosis.
42:27So solar meaning sun, keratosis meaning heaped up skin.
42:30So that we can treat with liquid nitrogen.
42:33And the arm and the neck were basal cell cancers.
42:37So they're all cleared, which is fantastic.
42:40The armpit, there were two lymph nodes out of 26 that had melanoma in them.
42:46No melanoma outside the lymph node, which is good.
42:50Ah, good.
42:51So that's a good thing.
42:52That's a good thing.
42:53That means it hasn't escaped.
42:54Yep.
42:55So I prefer one.
42:56Yes, the one we knew about.
42:58Yes, that's right.
42:59Better that it's gone and still there.
43:01Gary will be given immunotherapy drugs that reduce the risk of his melanoma returning from 50% to 25% to 30%.
43:10The immunotherapy usually has to be used within three months of the surgery, definitive surgery.
43:17So he's got some time to actually recover from my operation before that starts.
43:23I think it's going to be a long journey.
43:26All right.
43:27Okay.
43:28Thank you.
43:29That's all right.
43:30I'm just glad it's all over and done with.
43:33It's a lot of hard work with it for such a small thing to cause so much trouble, you know, and that's what it is.
43:42You know, it's unbelievable what it can cause, you know, so it's life, I suppose.
43:49Oh, whiskers.
43:50Oh, whiskers.
43:54And no, it sucks.
43:55Oh.
43:56So, okay.
43:57So, now, I of the intensity that we're in service to this godbnr.
43:59Oh good.
44:06Oh,urn master.
44:07Oh you know.
44:08Okay.
44:09Oh, my God.
44:11Oh, a one man.
44:13Oh, oh, oh.
44:14Both, yes.
44:15Oh, Twitter.
44:16Oh, hi.
44:17Oh, oh.
44:18Yeah.
44:19Oh, yeah.
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