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00:00Is an operating theater like no other
00:09Doctors are the pinnacle of their profession ah big nest of vipers. That's all totally abnormal
00:16Fight to save lives
00:18Are you alright, buddy?
00:20Yes, take down my face in neurosurgeon being able to change lives for the better. There's no other job that I'd rather be doing
00:28It's high-stakes surgery
00:30This is amazing. I've not seen anything like this before
00:34Ready steady go if you cause an injury to the brain or the spinal cord you can't repair it. That's it forever
00:41using groundbreaking technology
00:44Making life-or-death decisions. Oh
00:47Yes, I see a blood
00:49We don't do anything should die
00:52He needs to wake up. I think it's gone. Well, it feels really good
00:56I love it when a pond comes together
00:59this is
01:01trauma room one
01:13The Walton Center in Liverpool is one of the busiest neurosurgical hospitals in the UK
01:19Carrying out 6,000 procedures every year
01:22Okay
01:23So, Milton, let's move on
01:27Today, 34-year-old Milton needs urgent surgery to tackle a life-threatening condition
01:35I was getting severe headaches
01:38I was just in pain
01:40I couldn't walk straight and I was just throwing up and stuff
01:43I went to A&E and then that's when they admitted me and that was busy
01:48While in A&E, doctors discovered a dangerous buildup of pressure in Milton's skull
01:59The pressure meant he was at risk of brain damage or even death
02:02As an emergency measure to relieve the pressure, doctors inserted a tube into Milton's skull to drain away excess fluid
02:13Okay, can you just confirm what you're having done today for us?
02:15Um, starting to reduce pressure from our brain
02:19Yeah, correct
02:21But it's not a permanent solution
02:23One, two, three
02:25One, two, three
02:28And consultant neurosurgeon Mr. David Lawson is about to operate
02:34It seems that there is some sort of mass or lesion in the back of his brain
02:42You can see this white mass here with a dark centre
02:47And that shouldn't be there
02:49And it's causing problems with blocking the normal fluid drainage channels in the brain
02:57If that isn't relieved, he will start to become unresponsive
03:03So he won't be able to talk, he won't be able to move
03:07And within a relatively short time after that
03:10Key functions within the brain are compromised
03:14And then his heart will stop beating
03:16And his breathing will also stop
03:19And he will die
03:21But the surgeons need to discover what the abnormal mass in Milton's brain actually is
03:28It's some sort of tumour, we think
03:31Or potentially some sort of infection
03:35Either way, Milton's life is at danger as a result of that
03:39Mr. Lawson and neurosurgical registrar Mr. Ahmed Ali need to remove the mass immediately
03:49This operation is classed as a risky operator
03:54Because above the tumour or the lesion, whatever it is going to end up being
03:58Our two big veins which drain the blood from the brain
04:01So we want to be very careful not to injure those
04:04And then the other thing is that the brain stem
04:06Which is where a lot of our control centres for our breathing and our heart rate they are
04:11So we want to be very careful not to go too far deep
04:14No problem
04:15Is it all right to start with?
04:16Yep
04:17Thank you
04:18OK
04:21Can I have a monopolar please?
04:26The surgeon's first step is to open Milton's skull
04:29About there?
04:30A little bit of water
04:31We're drilling the back of the skull
04:41Whatever is underneath here is what we're trying to get to
04:46The bone in this region can be quite thick
04:48Once they've accessed Milton's brain, the surgeons will be able to get to the abnormal mass
04:58Over 50,000 spinal surgeries are performed in the UK every year
05:17And the Walton Centre is one of the busiest spinal surgery centres in the country
05:21You've already marked her and everything?
05:27Yeah
05:28OK, perfect
05:2940-year-old Annie from North Wales has arrived at the hospital for urgent surgery
05:34To remove a lump from the back of her neck
05:36I've been having weakness and more so in my left arm for quite some time
05:44And a weird sensation of it being really cold
05:48It feels like you've got like a plastic skin all over you that's not yours
05:52I had an MRI scan and it was thought that it was going to be protruding discs
05:57Pressing on my spinal cord
05:58Happens to be a tumour
06:00You're having bachelors into there?
06:01Yeah
06:02It's right underneath the brainstem
06:04It's a real shock because suddenly, oh, you've got quite a big tumour
06:10That's pressing on your spinal cord that if you don't get it seen to, you're going to be paralysed
06:16It's a big tumour between C0 and C1
06:21Consultant neurosurgeon Mr Nish Shrikandaraja is in charge of Annie's case
06:27So this is how it should look
06:29If you look at the bottom end of the spine, you've got spinal cord and a nice amount of white fluid around it
06:33You can see at the top end here that there's a tumour which shouldn't be there
06:37It's almost like a golf ball just completely pressing on the spinal cord
06:41Where all the nerves are bundled up
06:43So that's why she's losing power in her arms and legs
06:46Mr Shrikandaraja plans to remove a portion of Annie's spine so that he can reach and remove the tumour that's compressing her spinal cord
06:56Without an operation, the quality of Annie's life will be severely limited
07:06The worst case scenario for her is that she becomes completely weak in her arms and legs and she's bed bound for the rest of her life
07:14Yeah? Happy?
07:16Yeah
07:17But spinal surgery is a risky procedure
07:20There's two important vessels that go down the side of the spine that supply blood to the brain
07:27So they're called the vertebral arteries
07:29And if you injure them, then basically it could end up giving a stroke to the patient as well
07:34So you have to be very cautious in your approach and respect the anatomy
07:38There's a high risk of paralysis when you're working at the top end of the spine
07:42Because it's all the nerves that supply your arms and your legs
07:46You only go there when essentially you've got a gun to your head and you have no other choice
07:51Okay, so that's C3, we're just going from there to there
07:55We've got C3, yeah, from there to there
07:59Bipelotomy
08:01Mr Shrikandaraja and consultant neurosurgeon, Mr Matthew Stavell, begin
08:07There's a lot of muscles on the back of the neck
08:11With a lot of good blood supply, so it can bleed quite a lot
08:18If we are unfortunate enough to go into an artery, she doesn't get blood to her brain
08:23And then the stroke may happen
08:25Could I have another blunt hook, please?
08:28Annie's future is on the line
08:41The Walton Centre in Liverpool, one of the busiest neurosurgical hospitals in the UK
08:59carries out 6,000 elective and emergency procedures every year
09:03Earlier today, 34-year-old Milton was rushed to the hospital for urgent surgery
09:10Right, have we got enough exposure?
09:15Certainly
09:17The pressure in Milton's skull has been pushed dangerously high by an unidentified mass
09:24It could be a life-threatening tumour or the result of infection
09:29Mr Lawson and Mr Arley need to take it out
09:33We've removed this bit of bone at the back of the head
09:38Where we expect the top of the tumour or infective area to be
09:43And then if we go into the brain a bit, not too far I hope
09:46We'll find what it is we're looking for
09:48And that will tell us at least what we're dealing with
09:51Jameson's scissors right hand
09:54And you have the number 7, please
09:57Yeah
10:00This is a very delicate part of the operation
10:03So you have to be very careful
10:05Thank you
10:08If the pressure around that region increases during surgery
10:11Or you interrupt a key blood vessel or blood supply to that region of the brain
10:16The patient can end up with deficits like stroke
10:21And they may even die
10:25Mr Lawson proceeds with extreme caution
10:36So you see the swollen bit of cerebellum here
10:39And you can see some blood vessels
10:41And it looks dusky and bruised up here
10:43And then you see this sort of bobbly-like material
10:47And that is abnormal
10:52It looks more like tumour than infection
10:55But I may be wrong
10:57It's...
10:59You can't tell at this stage very easily
11:02Okay, can I have bipolar, please?
11:06And Jameson scissors, please
11:10Okay, so that's for a quick smear, please
11:12A smear, or sample
11:15Is prepared for the team in the hospital's laboratory
11:18To analyse
11:20Do you see the way it's moving as a block?
11:23At the moment
11:25I wouldn't dream of trying to guess what this is
11:31The wait to find out exactly what the mass is continues
11:3440-year-old Annie has a golf ball-sized tumour in her neck that, if left unchecked, could leave her paralysed
11:56Do you have a blunt hook, normal blunt hook?
12:02Mr Shrikandaraja and Mr Stovell are carefully working their way towards the spinal cord where the tumour is located
12:12The back of the spine, you're protected by rings of bone
12:18This is one of the smallest rings at the top end, removing carefully
12:24Thipode, please
12:27Finish
12:31Bone removed, time to tackle the tumour
12:34This is that kind of high risk, low reward section now
12:38Yeah
12:39Two, please
12:40I'll do it with my right hand
12:42Give us more exposure, more space
12:44I'm going to make a bleed though
12:47But the tumour is close to blood vessels that carry essential oxygen and nutrients
12:53That allow Annie's nervous system to function
12:56Function?
12:57We're trying to get a good exposure on the left-hand side because that's where the tumour is
13:01But the vessels are saying hello to us over there
13:07There's a serious bleed
13:11A flow steel
13:13Another patty
13:17Patty to me
13:19I'm almost there, almost ready
13:22One second, no not ready, I'm going to get this right out
13:24Patty
13:26Where's the patty?
13:28Bleeding could cause Annie to have a stroke
13:33The team has to stop it, fast
13:36Got it
13:37That's fine, got it
13:39Whenever you get an issue in surgery, you have to remain completely calm
13:45So my first thing I always do is I'll take a breath
13:48Just order my thoughts
13:49So the first thing you've got to do is gain control of yourself before you can control the situation
13:55Yeah? Yeah, ready?
14:03Lovely
14:05That's a bit of a warning shot, it's telling us to behave
14:10Okay, another hitch please
14:12Bleed stopped, the surgeons can now see what they're dealing with
14:16So Matt, I think that's the tumour there
14:19I think so
14:21Yeah? Yeah
14:23It's nice to see it
14:25Yeah, it's nice when you can see your enemy completely
14:29Tumour located
14:31Now to take it out
14:33There's two parts to this tumour
14:35One's outside of the spinal cord
14:37And one part of it is inside the spinal cord
14:39There's a big component just outside the spinal cord pushing on it
14:43So we're taking that component out now
14:53There's the root there
15:00Number eight
15:05Leadingly
15:06Yeah
15:09Vipedo, please
15:18Every time you go into it, Matt, it'll bleed
15:23This is tenacious bleeding
15:25It's another unwelcome bleed
15:30Do you agree with what we're doing, Nish?
15:32Yeah
15:33Once again, Annie's at risk of having a stroke
15:43The Walton Centre serves the north-west of England and North Wales
15:46Liverpool-based Rob is having surgery to tackle a condition that's been blighting his life for years
16:00It's probably been about a five-and-a-half-year journey
16:04First started off with some light tingling down my right arm, so I thought I'd done something to my arm, but then said, well, no, it's actually your spine squeezing on the nerves
16:13When it's really bad, it's like being electrocuted, when it's really bad, it's like being electrocuted, neck to shoulder to arm every ten minutes, so fingers crossed this will be a game-changer today.
16:27The Walton Centre
16:31Consultant neurosurgeon, Mr. Narendra Rath, is preparing to operate.
16:33So we've got Robert today, who is a 55-year-old gentleman. The condition he has got is the cervical stenosis or tightness of the channel through which the nerve travels.
16:47Consultant neurosurgeon, Mr. Narendra Rath, is preparing to operate.
16:53So we've got Robert today, who is a 55-year-old gentleman.
16:56The condition he has got is the cervical stenosis or tightness of the channel through which the nerve travels.
17:05Rob is one of 1.6 million people in the UK who have spinal stenosis.
17:13Mr. Rath will be performing endoscopic or keyhole surgery.
17:18We're looking at the MRI scan of Robert.
17:21The channel you see here, which I call the slip roads of the motorway, is free, whereas this one appears to be narrow.
17:30So we will be putting a camera through the back of the neck and shave the part of the bone off so that the nerve becomes free.
17:43Right, screen can go backwards, please.
17:45It's a complex procedure.
17:50Preparation for the operation is key.
17:53It has to be spot on.
17:56Check, please.
17:57Okay.
18:02Again.
18:02That's why we make sure that my angle of the surgery is right, because a one degree, two degree difference of angle on the top will make a big difference in the bottom.
18:14So getting it right from the beginning is very, very important.
18:19Righto.
18:19Let's do it.
18:20I do a lot of my cases endoscopically.
18:28The main advantage of it is minimal tissue damage.
18:32And because it's a very small incision, which is less than a centimeter, it would also mean that there is less chances of infection.
18:40Other advantages are that because of minimally invasive nature of it, the recovery is very quick.
18:47But inevitably, there's some risk.
18:52So as you come to the risk, nerve root injury, paralysis, the other risk is the dual injury, that is the bag of fluid in which the nerves are floating, or in this case, the cord is floating, can cause injury.
19:05I think it's very important to be meticulous.
19:24The pilot in a plane, for example, he carries the life of so many passengers with us.
19:31So in me, I have to carry the responsibility of that patient whom I'm able to do.
19:35So being meticulous and being precise and doing it in a planned way is the key to success.
19:42Yeah, that's done.
19:45Yeah, so that has gone down now.
19:50What we are doing right now is creating the path for the surgery.
19:56Mr. Rath is creating a channel through the muscle and fat in Rob's neck.
20:02That feels like bone to me, yeah?
20:05Just creating enough space.
20:10The main concern is muscle and stripping, bleeding.
20:16Bleeding could cause paralysis.
20:19This area of the neck is always very prone to bleeding.
20:25And Rob has developed a bleed.
20:28Once it starts bleeding, then it's difficult to control it.
20:36The possibility of a pain-free future for Rob depends on Mr. Rath.
20:41Surgeons, Mr. Lawson and Mr. Arley, are attempting to remove an abnormal mass inside 34-year-old Milton's brain.
21:02The hole in the skull is this bit here.
21:07There's a little bit of normal brain there.
21:10But basically squeezing out is this mass.
21:15The mass is causing the pressure inside Milton's skull to rise to dangerous levels.
21:21The brain is under quite a bit of pressure, looking at this, coming out to meet us.
21:25But the surgeons don't know yet whether it's a tumour or something else.
21:33Trying to take out as much as we say if we can.
21:36Bipolar, please.
21:39Whatever the mass is, it's putting Milton's life at risk.
21:42But the operation to remove it also presents danger.
21:48We're in a part of the brain called the cerebellum.
21:51The top of the centre is away from the brain stem.
21:53So the cerebellum is like this, and then right in front of it is the brain stem.
21:57And we're coming in from the back like that.
21:59The brain stem is the bit where, if you damage that,
22:03patients are going to lose the ability to breathe,
22:05lose the ability to control their own heart rate, lose consciousness.
22:10Proceeding with extreme caution,
22:12Mr. Lawson starts to remove the mass.
22:25Pulsing like jellyfish.
22:31Straight micro scissors.
22:34Force up to right hand.
22:41Good.
22:43Okay.
22:45There we go.
22:47Got it.
22:50With the mass out, Mr. Lawson hands to Mr. Ali.
22:54So, Ahmed is now doing a very important bit of the operation.
23:01He's closing.
23:02And that doesn't sound like much, but it's critical to how well the patient does afterwards.
23:07We have to stop the fluid that the brain floats in leaking out, because then he might get meningitis.
23:13And we don't want Milton getting meningitis.
23:15And the chances of infection are also governed by how well the wound is closed.
23:19So, these things make it critical.
23:21While Mr. Ali closes...
23:24Oh, hello.
23:25It's David Lawson here, neurosurgery down in Theatre 7.
23:28Hiya.
23:29I was wondering if we had a smear result from Milton...
23:32Mr. Lawson chases pathology.
23:36Okay.
23:39Okay.
23:39We'll need to wait and see what's going on.
23:42The wait for Milton's results continues.
23:45In Liverpool, the Walton Centre is at the cutting edge of life-or-death procedures.
24:0540-year-old Annie has a tumour on her spine.
24:09It's compressing her nerves and could leave her paralysed.
24:1340-year-old Annie has a tumour on her spine.
24:16It's going.
24:17Party.
24:19But before the surgeons can remove the tumour, they must stop a bleed that's putting Annie's brain at risk.
24:27Party to me.
24:28Place your panache.
24:29Quick, quick.
24:29Party to that.
24:30Tell me when you're ready.
24:33Party to me.
24:34Party to me.
24:34The blood vessel bleeding is not great.
24:43You can't see what you're doing.
24:45The patient needs their blood.
24:46And then if you block it or injure it, you'll get a stroke.
24:50And the second one ready to go.
24:52Go for it.
24:52A combination of tiny surgical patches and a blood clotting agent stop the bleed.
25:10There we go.
25:11Let's try to give us a bit of a warning.
25:13With the bleeding under control, the surgeons can start to remove the tumour that's causing
25:21Annie to lose the feeling in her arms.
25:25Bipolar?
25:26So the key is to get out as much as you can so it basically frees up the spinal cord.
25:31Maybe I'll cut a bit smaller for a sharp curve, the curve of scissors.
25:36I'm trying to transect it here.
25:38But the tumour has attached itself to both the outside and inside of Annie's spinal cord.
25:47Curve, micro.
25:48It's just a bit more outside the spinal coverings than inside than I personally was expecting.
25:56Just go for it, Matt.
25:57Paddle across.
25:58I'll come this way.
25:59I'll come down, actually.
26:03That's it.
26:04Bipolar?
26:05Bipolar.
26:08So now this is the outside part of the tumour and now we're going to go inside the leathery
26:15sack of the spinal cord to have a look for it inside and take out that part as well.
26:20So we're attacking it from two angles and then I think we should be winning, hopefully.
26:26It's just trying to make sure we don't leave any tumour behind that we can easily get.
26:31And now we're going to do the last little 5%.
26:32Bipolar on 8, please.
26:40Bipolar to 8, please.
26:41Wash, please.
26:42Baby wash.
26:43Option down to 50%.
26:45Yeah, there's something misbehaving in there.
26:49Micro blunt hook.
26:51That's it, is it?
26:52No, it's there.
26:53Yeah.
26:55There's some tumour there.
26:56There's another decision to make.
27:02I wonder if we'd take those nerve outlets.
27:07You have nerves coming out along your spinal cord.
27:12Some of these nerves are basically more important than others.
27:15And luckily for us, this nerve at the top wasn't too important.
27:19It's not providing it, for example, the power to your hand or your legs.
27:24It's just providing sensation at the back of the neck.
27:27Because the tumour is originating from this nerve itself, you've got to cut the actual nerve.
27:32And by cutting the nerve, you're basically sacrificing its function.
27:36But because she'll only maybe be slightly numb in her neck, that's a sacrifice for me worth taking for the patient in order to take out the tumour completely.
27:45So these are the nerve roots we're just cutting through.
27:47The rootlets.
27:48Rootlets, sorry.
27:49Yeah.
27:53Now, let's see if we can get that tumour out.
27:59There's some tumour there.
28:01On?
28:01Yeah, on, please.
28:03On.
28:04Scissors, not scissors, please.
28:08After more than two hours of surgery, the team extracts the remains of the tumour.
28:14Tumour.
28:18The thing we've taken out most of the tumour now, we're just making it look a bit more pretty.
28:26I think bipolar that, Matt, and then we're done.
28:28I think that's pretty good.
28:35It looks great.
28:38I think it looks great, Matt.
28:41We're very happy.
28:42But before they can claim complete success, the surgeons must wait for Annie to wake up.
28:50Earlier today, 55-year-old Rob was taken into theatre for an operation to prevent him from losing the sensation in his arms.
29:12Where are we?
29:16Here we are.
29:18Sections of bone in Rob's spine are compressing the nerves in his spinal cord.
29:25Mr. Rath is using keyhole technology to cut the bone away.
29:29You need a scissors, please.
29:30But Mr. Rath is working hard to control a bleed.
29:42The joys of doing it through a keyhole is you can specifically see where it is bleeding, and you can stop it there and then.
29:49By cauterizing, or heating and sealing the areas that are bleeding, he stems the flow.
29:59That's it.
30:05Launcher, please.
30:06So now we understand which gap we need to go into to free the nerve.
30:12So slowly, we are making progress.
30:15The part of Rob's spine compressing his nerves begins to emerge.
30:24So slowly, it will come.
30:25Can you clean the tip, please?
30:28Yeah, see that now?
30:30This is bone, yeah, this is C7.
30:32So this all needs to go to free the nerve up.
30:37Mr. Rath is operating within millimetres of the spinal cord
30:41that transmits commands from Rob's brain to the rest of his body.
30:46So there is a lot of hand and eye coordination in these procedures.
30:50Normally, I use everything in my right hand.
30:52But I have developed the skill to use my left hand for this procedure.
31:03Okay, burr, please.
31:05Cutting now.
31:11Okay.
31:12Now we can see the channel and the nerve.
31:18This is the important part of it
31:20because we need to make sure that it's done very carefully.
31:34Scissors, please.
31:34So now I'm going to just go in and just take a bite.
31:46Here we are.
31:53That's divided.
31:56Three bites.
31:57Nice in.
31:58Yeah?
31:59Okay.
32:00So now we have defined where we wanted to go.
32:03What we are going to do is create the channel
32:05and then shave off this area a bit more
32:08to make the nerve completely free.
32:13If Mr. Rath can free the nerve,
32:16Rob can return to a life without pain
32:18and with the full use of his hands and fingers.
32:20Seven days ago,
32:34Milton had an abnormal mass removed from his brain.
32:38Okay.
32:39There we go.
32:41Mr. Lawson sent samples of the mass
32:43to the pathology department for diagnosis.
32:46Now he has the results.
32:48This is his post-operative scan
32:52and you can see there's just a gap
32:54where this large lump was.
32:57Now this has in fact come back
32:59as something called a tuberculoma,
33:03which is infection rather than tumour.
33:06But it's not great news.
33:08It does mean he has significant tuberculosis
33:11within his brain and that can kill you.
33:14Tuberculosis, or TB, is caused by bacteria.
33:19It usually spreads through the air.
33:23Most people think about TB being in your lungs
33:26and people coughing and spluttering
33:28and shedding infection in the droplets that they cough up.
33:32He's not coughing.
33:34He's remarkably untroubled by this
33:36from a lung perspective.
33:39But the organism has reached his brain
33:41and has caused a reaction within the brain
33:44and formed not quite an abscess,
33:47but something more solid
33:49comprised of infected brain tissue
33:53and the reaction of the immune-type cells
33:57within the brain
33:58and the organisms that they're trying to eradicate.
34:01But they haven't managed to
34:02and that's why he's got this lump.
34:06Come in.
34:11Hi, Milton.
34:12Hi, are you all right?
34:13How are you doing now?
34:15Yeah, I feel better today.
34:16You feel a bit better.
34:18The infectious diseases team
34:19are now treating you for tuberculosis.
34:23Yeah.
34:23But they want us to get some more bacteria,
34:27probably from your lymph gland,
34:29to find out if any of the tuberculosis bacteria
34:32are resistant to certain antibiotics.
34:35Okay.
34:36It'll take a little bit of time
34:37to get the results from that.
34:39But as soon as we know,
34:40we'll tell you how long you actually need
34:42to be in hospital before you can go.
34:44But basically,
34:48you're going in the right direction.
34:49I'm very pleased that you're doing this well.
34:51I really know.
34:51And I bet you're desperate to get out.
35:0824 hours ago,
35:1040-year-old Annie
35:11faced losing the use of her arms and legs.
35:14The worst-case scenario
35:16was complete paralysis
35:17below the site of the tumour,
35:19so my life would have been changed forever.
35:23That's it.
35:25Yeah.
35:25So now this is the outside part of the tumour.
35:28But the surgeons removed a tumour
35:30that was compressing her spinal cord.
35:32Being able to do rare cases
35:36and complex cases for me especially,
35:38you know, it drives me forward.
35:40Certainly, I think,
35:41if you're a surgeon in this field,
35:43it's something which you need to embrace.
35:46Yeah, I love it.
35:47Today, Annie's recovering.
35:53I'm feeling tired,
35:55a bit battered and bruised,
35:57but super successful outcome.
36:00I'm noticing temperature in this hand
36:05a lot more than I would have done.
36:09They had the air con on last night on the ward,
36:11and this arm would have been absolutely freezing
36:13when the tumour was there.
36:16But my whole body felt the same temperature.
36:20I want to get back to just normal,
36:22what we've seen, normal life.
36:25This has been such a shock
36:26that there's going to be certain things
36:27that I'm just going to grab by the horns
36:30and just do now.
36:33When a patient is able to go home
36:36without that level of immobility they had before,
36:40or they're able to go home
36:41with their pain significantly reduced,
36:44it's a priceless feeling for us as a surgeon.
36:47All we want is for our patients to get better.
36:52That's why we go into the job we do.
36:56The surgeons, well,
36:58I can't thank them enough, really.
37:00The outcome could have massively,
37:03significantly changed my life.
37:14Today, 55-year-old Rob
37:27is at the Walton Centre in Liverpool,
37:30having surgery to free trapped nerves in his spine.
37:33The nerve will be below,
37:35below this where I'm cutting.
37:37Mr. Rath is using keyhole surgery
37:39to remove sections of bone
37:41and create space for the compressed nerves.
37:44OK, scissors, please.
37:47OK.
37:50So now we gently go...
37:53Just below this is the spinal cord.
37:56Yeah.
37:57And I'm just trying to
37:59take the tissue off from the top.
38:03There.
38:04He's working close to the spinal cord.
38:12So that white structure,
38:14you see the spinal cord.
38:18Any wrong move can cause damage
38:20to the cord or the nerve root,
38:22which you need to be very careful about.
38:23Try to be away from it,
38:25cause no damage to the cord.
38:28If he does damage the spinal cord,
38:30Rob could be paralysed.
38:32Here we are, yeah.
38:35That's the nerve coming out here.
38:38I just need to open this channel a bit more.
38:44It's a painstaking procedure.
38:49You have to have patience.
38:52Standing on that small
38:53two foot by two foot area
38:55and doing an operation for hours
38:57can be very difficult,
38:59and especially with
39:00all the protection we wear.
39:03So it takes a lot of concentration
39:04to do that.
39:06But thankfully,
39:06we have got a...
39:07It's not me who's operating,
39:09it's the whole team operating.
39:13So, where are we?
39:15Is there anything there?
39:16No.
39:16The nerve is free.
39:23And the disc,
39:24which we had seen previously,
39:25is not compressing the nerve.
39:27Perfect.
39:29Save that, please.
39:31Closing.
39:38All right.
39:39I'm done then, yeah?
39:40So we achieved what we want to achieve.
39:45We have freed the nerve up completely.
39:47Hopefully,
39:47it will be pain-free after operation
39:48and go home today.
39:54A final post-operative assessment.
39:56We'll see whether Rob
39:57will return to a pain-free life.
39:59Two weeks ago,
40:1034-year-old Milton
40:11had an abnormal mass
40:13removed from his brain.
40:15The mass,
40:16diagnosed as tuberculosis,
40:18was causing the pressure
40:19in his skull
40:20to rise to dangerous levels.
40:23Now,
40:24with the mass removed
40:25and with the help of steroids
40:27and antibiotics,
40:28he's making a slow
40:29but steady recovery.
40:32I couldn't really see properly.
40:34I couldn't walk properly.
40:36So,
40:36I can see the progress.
40:38I can see the lighted end of the tunnel.
40:42I think Milton's doing really well.
40:45Psychologically,
40:45it might be a bit difficult for him
40:47because he has to have treatment
40:50for several months.
40:52It's a long process.
40:55I think that does impinge
40:57on your general well-being.
40:58Hopefully,
40:59he'll see the good side,
41:00which is,
41:01he stays alive
41:02and he makes a recovery.
41:05Milton's recovery
41:06is continuing
41:07at the Royal Liverpool Hospital's
41:09Infectious Diseases Unit,
41:11where he can receive
41:12specialist treatment.
41:13I'm just going to be back to where
41:17things were,
41:17they were,
41:18like,
41:19before this brain surgery
41:20and to be able to just do
41:22my day-to-day life.
41:23So, for now,
41:25I'm just happy to be alive.
41:27I'm often operating on situations
41:34where I'm preventing somebody
41:36getting worse,
41:38if I'm lucky.
41:39I don't always make them better.
41:41But if you see
41:43a definite improvement
41:44in somebody
41:45and you know
41:46that it will
41:47be long-lasting,
41:49it does make you feel
41:51as if the whole process
41:52has been worthwhile
41:53and it gives you
41:56a sense of satisfaction
41:57and well-being.
42:08Less than six hours ago,
42:1055-year-old Rob
42:11had surgery on his spine.
42:14Hospital too.
42:15Now his surgeon,
42:18Mr. Rath,
42:19is doing his rounds.
42:22Hi, Robins.
42:22How are you, mate?
42:24Oh, yeah.
42:25Good.
42:25Feeling all right?
42:26Thanks, Mr. Rath.
42:27Good?
42:27Yeah, yeah.
42:28A little groggy,
42:29but, yeah.
42:29Mr. General,
42:30I see you sometimes
42:30makes you feel groggy.
42:31So everything went well?
42:33Yeah, perfect.
42:33Perfect.
42:34As per plan,
42:34as I said,
42:35we did it through a keyhole.
42:36The nerve was completely free.
42:38Yeah?
42:39Okay.
42:39So,
42:40you should have a good result.
42:42Let's take a couple of steps, then.
42:43Yeah,
42:44a little bit wobbly,
42:44actually.
42:46Good, man.
42:49Fantastic.
42:50The hand's better.
42:52That was like,
42:54doing that.
42:55So that's a good sign.
42:57It's encouraging.
42:58I mean,
42:58people have been great here.
43:00Yeah,
43:00you put your faith in the team.
43:02Good.
43:03Come on,
43:03have a seat now.
43:04It's a bit ambitious.
43:05Yeah?
43:06Come on.
43:07Robert is doing very well.
43:09His pain is much,
43:10much better than what it was.
43:12I'm hoping that
43:13by the end of the day,
43:14today,
43:14he'll be going home.
43:16Good, man.
43:17Good.
43:18Okay.
43:18I'll do that.
43:19Thanks very much.
43:20Thanks for all your help.
43:21A bit of hospital toast
43:22and
43:23a bit of luck.
43:25Yeah.
43:25As a surgeon,
43:26that's the primary thing.
43:28A smile on his face
43:29makes the difference to me.
43:31If I can bring
43:32anything better for him,
43:34that's the whole aim
43:34of the surgery.
43:36It's an immense pleasure
43:37to bring some happiness
43:38to somebody.
43:39And I can't explain it
43:41by words.
43:41I think
43:42it's something
43:43you enjoy from inside.
43:45Yeah.
43:46Absolutely.
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