- 5 weeks ago
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00:00:00The clock is ticking.
00:00:03This is a serious life-saving operation.
00:00:07He's at risk of dying from this procedure.
00:00:13We can go from under control to emergency in a flutter of an eyelash.
00:00:19A beep means don't do that again.
00:00:23It is very personal for me.
00:00:30If you put a hole in here, you'd be at risk of dying on table.
00:00:34This is either life or death.
00:00:45It's a scary prospect. It's your independence.
00:00:48This is inside the belly of the beast.
00:00:54We are in the tumour now.
00:00:56It's bleeding, and that can cause massive stroke.
00:01:03Am I going to go, Steve, and not wake up?
00:01:05Your life is literally in someone else's hands.
00:01:13The longer the heart is out of the body,
00:01:16the worse the outcome,
00:01:18and the risk of the patient dying.
00:01:25Oh, God, it is scary, isn't it?
00:01:32This tube is like a parasite feeding on Anna's body,
00:01:35which can be deadly.
00:01:37We are racing against time.
00:01:39So today we're going to be operating on Liz.
00:01:55She's got quite a sizable, plum-sized tumour on the left-hand side of the back of her brain,
00:02:02quite deep, deep inside.
00:02:06The tumour is underlying a piece of brain that controls vision,
00:02:10which is obviously a really important thing for anybody.
00:02:13But in particular, when it's at risk,
00:02:15we need to be extremely careful about the way we handle that brain.
00:02:18There's other things at risk as well, such as stroke, major stroke, bleeding, infection, seizures and epilepsy.
00:02:25We do not really have any other option other than to operate.
00:02:30If we do not operate, it will continue to grow and may pose a real threat to her life.
00:02:37She's clearly going to be nervous.
00:02:39She's clearly going to be frightened.
00:02:41There's a lot at stake for Liz.
00:02:43Hello.
00:02:52Oh, ladies first. Ladies first.
00:02:54How do you do? How do you do? It's so good to meet you.
00:02:57Yeah.
00:02:58Yeah, I'm fine.
00:02:59Thank you, sir.
00:03:00Thank you, sir.
00:03:01So we're hoping to nip this in the bud.
00:03:03Yeah.
00:03:04To get it all out and to essentially get you on with the rest of your life.
00:03:07Yeah.
00:03:08I really don't want to frighten you because you frighten enough as it is.
00:03:12But the tumour is in a position next to the visual areas of the brain.
00:03:19It's also next to areas of planning your movement.
00:03:22So should anything be injured, you wouldn't expect just a right eye going.
00:03:28It doesn't work like that.
00:03:29That would be an optic nerve injury.
00:03:31It would be the right side of both your eyes.
00:03:34Oh, both eyes?
00:03:35Right.
00:03:36Yes, like that, you see.
00:03:37So it's a little bit more complicated than one whole eye.
00:03:40And we will also be monitoring the activity of the cortex, that brain, while we're operating.
00:03:47Okay.
00:03:48To try and minimise it, but still a risk.
00:03:50Still a risk.
00:03:51But I will still have vision.
00:03:53Yes.
00:03:54There isn't a clear operative factor that would lead you to be completely blind, unless there was a very large stroke concerning the large blood vessel in the middle.
00:04:07So I'm not going to say it's impossible.
00:04:09You're a really sensible lady, and you know what we're doing, and there is a small risk to life with it.
00:04:22Yeah.
00:04:23It's scary.
00:04:24Of course it is.
00:04:25Of course it is.
00:04:26It's very scary, but we, you know, we've talked about it.
00:04:29Yeah.
00:04:30I've made the decision, and I take your advice.
00:04:32I've never been in your seat, so I can't imagine how difficult it is.
00:04:36But rest assured that we will be being as careful as we possibly can be.
00:04:40At no moment we'll be taking it for granted, and we'll really be trying to do the very best that we can.
00:04:46Yeah.
00:04:47Thank you, David.
00:04:48And I'll see you again very soon.
00:04:51Okay.
00:04:53You're welcome.
00:04:55Thank you, David.
00:04:56Not at all.
00:04:57Not at all.
00:04:58I started to get migraine headaches, which were unusual for me.
00:05:03I'd had them years ago, but nothing like this.
00:05:06And it was sort of every few weeks, and they felt a bit different, really.
00:05:11So I thought, I'd better go to the GP.
00:05:13He assured me he thought they were migraines, but he said,
00:05:18if you're worried, I will send you for a CT scan.
00:05:22They looked it up and gave me the shocker, and said that you've got a lesion.
00:05:28And I said, you mean a tumour?
00:05:30And he said, yes.
00:05:34So, to lose my sight would be my biggest fear, I think.
00:05:39It's a scary prospect.
00:05:41It's your independence.
00:05:52Obviously, there's fears.
00:05:54You don't know how you're going to be afterwards.
00:05:57You get so emotional, because you don't know the future.
00:06:01So, it's scary.
00:06:04Yeah.
00:06:05You'll be there.
00:06:07Yeah.
00:06:08You'll be there, David.
00:06:19Okay, so here we've got Liz's MRI scan.
00:06:23These are her eyes.
00:06:24This is Liz's nose.
00:06:26At the back part of her brain, on the left-hand side, there it is.
00:06:30This is the meningioma.
00:06:33It's about four centimetres.
00:06:35It's a plum size, or a good-sized plum, or the size of perhaps a small, easy-peel orange.
00:06:44The tumour's actually very deep.
00:06:45It's close to being in the middle of her head.
00:06:48So, our approach.
00:06:50We will need to move the brain out of the way, and then progress to reach the tumour underneath it.
00:06:58Brain does not like to be moved.
00:07:00It really does not like to be moved.
00:07:02And this is something that we need to be very, very careful about.
00:07:09There are a great deal of risks.
00:07:11Critically, vision.
00:07:13This is the vision cortex here.
00:07:15So, we need to be very careful working around here.
00:07:18The other problem is, there's large blood vessels around the area in which we wish to enter.
00:07:24These are referred to as the sagittal sinus.
00:07:28It is not a blood vessel, which is like a hose.
00:07:31It is more like a carrier bag full of blood.
00:07:35And therefore, it's very difficult to repair should actually we injure it.
00:07:39Any injury to this greatly increases the risk of stroke for Liz.
00:07:43We're in a window at the moment.
00:07:50We have an opportunity to remove this.
00:07:53And hopefully, strong word, we don't often use it in neurosurgery, but we will hope to cure her.
00:08:00Thank you, Rachel.
00:08:03Very good.
00:08:12I'll be right.
00:08:13I'll be right.
00:08:14I'll be in a minute.
00:08:15You're good.
00:08:16I like them.
00:08:17See you later.
00:08:18I'll see you the other side.
00:08:19It'll be okay.
00:08:20Yeah.
00:08:21Only a few hours.
00:08:22We'll be back.
00:08:23Yeah.
00:08:24See you later.
00:08:25Okay.
00:08:26Thank you very much.
00:08:27Bye, then.
00:08:28Take care.
00:08:29And you.
00:08:30Are you okay with the way out?
00:08:31Yeah.
00:08:32I'll find me way.
00:08:33We're basically a team.
00:08:34We always have been.
00:08:35And one doesn't function that well without the other.
00:08:41The main risk is bleeding, bleeding and damage to the major blood vessels in the sinus.
00:09:02And then, once we open up, then I'd like to see the tumour.
00:09:08And once I've seen the tumour, I'll be happier because I know I'm in the right place.
00:09:16There's a lot at stake for Liz.
00:09:18A successful outcome will allow her to live the rest of her life as she's living it now.
00:09:22An independent lady.
00:09:23If we either do nothing or the surgery is dogged by complication, she has the capacity to lose all of that.
00:09:33It's possibly one of the most significant moments of her life.
00:09:37hello.
00:09:46Hello.
00:09:47I'm in the theatres.
00:09:48What's the time to see the side inside?
00:09:53So, it is a left-sided craniotomy, or occipital meningioma.
00:10:11Drilling over the sinus.
00:10:14Let's just get it in a position that we can work with it.
00:10:21We will set up our image guidance, which is essentially our sat-nav, so that when we
00:10:27know in space where any part of her head and brain are, in order to plan the position of
00:10:33our craniotomy.
00:10:35I do like to see what we're doing, so that's our tumour dead centre.
00:10:41I'm just marking the midline, there's a very large vein there, but we want to make sure
00:10:46we know where it is, and the tumour we know just lies next to that vein.
00:10:50Mid-tumour.
00:10:51Mid-tumour lateral border, yeah.
00:10:55Right, so tumour dead centre is approximately here.
00:11:00Okay, let's get rid of some of this lovely hair, unfortunately, bless her.
00:11:10That is our incision, and our craniotomy will be summing around like that, as you say.
00:11:21Okey-doke, let's start.
00:11:25Swab and knife, thank you.
00:11:26Is that the clock?
00:11:27Yeah, we will do a sort of two-piece opening.
00:11:36Knife bath, thank you.
00:11:38We use this monopolar to stop the bleeding as we go through.
00:11:42If you just use a knife, it can just cut through all the blood vessels and you get a lot of
00:11:45bleeding.
00:11:46The one thing we don't like in neurosurgery is blood.
00:11:49We're now just stripping the muscles off the surface of the skull.
00:11:58Lovely.
00:11:59Shall we do midline and sinus?
00:12:01So we're just marking out these big blood vessels that we want to know where they are.
00:12:05Yeah, we'll go out like that, just round the outside of it.
00:12:09And then we'll have one, two, three bills, just the other side.
00:12:16This essentially is our craniotomy.
00:12:19Yeah, do the distal one.
00:12:21Lovely.
00:12:22And suction to myself, thanks.
00:12:23Nice and perpendicular.
00:12:24Good one, Nick.
00:12:26So this is a bit that we're a bit careful about because we're going right over the sinus.
00:12:37And that's a big, big blood vessel.
00:12:39So we need to be careful.
00:12:41There are multiple things that we need to worry about.
00:12:45If it actually gets damaged and clots off, that can cause massive stroke.
00:12:50If it bleeds and gets injured, for example, if the drill catches it and tears it,
00:12:55you can bleed out.
00:12:57People have died within minutes.
00:13:14Matthew's 37 and he has the condition of his heart where the chains of the heart are swollen
00:13:21and that means the heart doesn't pump as efficiently as it should do.
00:13:27He's been in the hospital with us now for about three weeks and his heart is pulling so poorly
00:13:33that we need to put him on a special machine, a BIVAD, which sits outside of his body
00:13:38and takes over the function of his heart.
00:13:40But it's a temporary device and it can only stay in for so long.
00:13:44So he needs a heart transplant.
00:13:46Matt has a chance of dying if he doesn't get the operation.
00:13:50But equally, there's a chance of dying if he does get an operation.
00:13:53You okay?
00:13:54Yeah, I'm up.
00:13:55Yeah.
00:13:56This is an ultrasound scan of Matt's heart.
00:14:08So this is the left ventricle, the main pumping chamber of the heart.
00:14:12And it's very big and dilated and it's pumping very inefficiently.
00:14:16On top of that, Matt keeps on having very fast irregular heart rhythms
00:14:21and that makes this pumping chamber pump even less efficiently.
00:14:25And so Matt's in real trouble when that happens.
00:14:28Being on the BIVAD means that this is a time pressured situation for Matt.
00:14:32He's been placed on the highest category of heart transplant waiters in the country,
00:14:37the super urgent list.
00:14:39Without a transplant, he would die.
00:14:41Before this happened, I was a really keen cyclist.
00:14:47I used to be sort of like a good amateur road cyclist.
00:14:53So lots of races up and down the country.
00:14:57Very fit, very fit with help.
00:14:59And basically one of those fitness fanatics.
00:15:01And I've been staying with my dad and they heard a noise one Thursday night.
00:15:07He was lifeless on the bed.
00:15:13So I pulled him onto the floor and we started CPR.
00:15:19Matt did come round, which was amazing.
00:15:22I did feel his ribs crack, which you hear.
00:15:26You know, when you do CPR properly, you do break ribs.
00:15:30So, so I heard that.
00:15:34We put him into recovery position.
00:15:36Not long later, the first of the, um, uh, first responder turned up.
00:15:43His dad called me, got myself to the hospital and they took us into, like,
00:15:47the little family room and said, like, we're in a quite precarious situation now.
00:15:53Um, we need to do something quite fast, basically.
00:15:58It was quite hard to suddenly find myself in here, strapped to a machine.
00:16:03Knowing that was keeping me alive.
00:16:05I'm currently just playing the waiting game until they come and tell me.
00:16:10They might have a heart for me.
00:16:12Love you. Love you too.
00:16:14Love you too.
00:16:18Every day without a new heart is critical for Matt.
00:16:21We're now waiting for a phone call to say that the suitable heart is available.
00:16:26Hello?
00:16:27Hey, hey, hey, hey, Simon, you alright?
00:16:34Thanks very much, Simon. I appreciate that.
00:16:36I think that sounds reasonable. I think it's a reasonable thing to, uh, to, to proceed.
00:16:40We've had phone calls saying there's a donor heart available
00:16:44and we're in the process of assessing that heart.
00:16:47This heart will mean a new life for Matt.
00:16:50We know that, with a transplant, Matt has the best chance of long-term survival
00:16:55and a good outlook.
00:16:57I'm assuming that you know his heart in waste.
00:16:59Yes, I've got it all. Yeah, yeah.
00:17:00Fine.
00:17:04This means everything to Matthew.
00:17:06It will mean a huge amount to him and his family.
00:17:10Hello.
00:17:11Hello.
00:17:12Hello, you okay?
00:17:13Yeah.
00:17:14How are you feeling?
00:17:15Nervous.
00:17:16Yeah?
00:17:17So, as soon as everything is together, we are going.
00:17:18Yeah.
00:17:19The heart looks good.
00:17:20Brilliant.
00:17:21The team are happy with the function.
00:17:22Brilliant.
00:17:23So, no sign of any disease.
00:17:24It's, it's overcome every hurdle, so.
00:17:26Yeah.
00:17:27Yeah, brilliant.
00:17:28This is the good part.
00:17:29Yeah, yeah, yeah.
00:17:30So, I'm a bit dazed.
00:17:31No, of course you are.
00:17:32That's absolutely fine.
00:17:33Are you okay?
00:17:34Yeah.
00:17:36Have you got any tissues?
00:17:37Are there any tissues?
00:17:38Oh my God.
00:17:42So, what happens from here is the perfusionists will get, they look after the machine, so
00:17:47we're kind of dictated by them and getting everything together.
00:17:50Yeah.
00:17:51We'll go round to theatre.
00:17:53We'll skip the anaesthetic room, because of the size of the machine, stay with you until
00:17:56you're fast asleep.
00:17:57Yeah.
00:17:58And then, throughout, we'll be there.
00:17:59Yeah.
00:18:01Yeah, yeah, yeah.
00:18:02Thank you very much.
00:18:03Thank you so much.
00:18:04It's happening fast.
00:18:06I know, yeah, it's faster than we thought, isn't it?
00:18:08I'm excited. I'm super nervous.
00:18:11I don't really know. It's a whole new experience, obviously.
00:18:15I just don't like what it does to other people.
00:18:17Sorry, I was emotional.
00:18:19She's been my rock.
00:18:22We've been dating, what, five months before this happened?
00:18:25But we've been talking about all sorts of things.
00:18:27Marriage, kids, moving in together.
00:18:30Kids? No.
00:18:32I don't know, I think we just opened up to each other,
00:18:35perhaps in a way that you wouldn't necessarily
00:18:37if you weren't in a situation like this.
00:18:41But, you know, that's, I think,
00:18:44sometimes some of the benefits of these situations, you know?
00:18:47You realise how much you love someone.
00:18:49And, yeah, it's a nice thing to realise.
00:18:54Yeah.
00:18:58He's got so many things he wants to do,
00:19:01wants to get out and see the world and do things,
00:19:04and I think this, hopefully, will let him, you know?
00:19:07Yeah.
00:19:09New beginning.
00:19:10New beginning.
00:19:11I like my...
00:19:12I get it all the time in a month.
00:19:18Hello.
00:19:19Hello.
00:19:20Hello.
00:19:21Thanks, Jamie.
00:19:22Yeah.
00:19:24Yeah.
00:19:25Yeah.
00:19:30Yeah.
00:19:32It feels quite unfair on the donor,
00:19:34but then you've also got to remind yourself that
00:19:36every day people do pass away,
00:19:38and I feel very lucky that that person's agreed to,
00:19:42to help me on my job.
00:19:45I'm quite nervous,
00:19:46but the unknown is always a bit scary.
00:19:50Am I going to go, Steve, and not wake up?
00:19:52Your life is literally in someone else's hands.
00:19:55Let's take a nice deep breath.
00:19:58So, we have confirmed that this patient at the table is Matthew.
00:20:16So, at this moment in time,
00:20:18the donor heart that has been slated for Matthew
00:20:22is on its way to the hospital.
00:20:25It's an hour before the new heart arrives.
00:20:29We'll start our operation at this end,
00:20:31so that we can minimise the amount of time
00:20:33the heart stays out of the body.
00:20:36The longer the donor heart spends out of the body,
00:20:38the greater the risk of it not functioning
00:20:40when we implant it.
00:20:43Expected blood loss?
00:20:45Expected 500.
00:20:46Potential to catastrophe.
00:20:48This is a very high-risk operation for him.
00:20:50It carries the risk of infection,
00:20:52bleeding, kidney damage.
00:20:54Not everyone will survive a heart operation,
00:20:56but this operation is really the only chance that Matt has.
00:20:59It has to be quite steady with this drill.
00:21:01It has to be quite steady with this drill.
00:21:02It has to be quite steady with this drill.
00:21:04It has to be quite steady with this drill.
00:21:07It has to be quite steady with this drill.
00:21:08It has to be quite steady with this drill.
00:21:10You have to be quite steady with this drill.
00:21:36Oh, they are right over the sinus.
00:21:38We have achieved what we want to achieve.
00:21:40Because that is the major vein, the sinus.
00:21:44And it's safe.
00:21:46Now I can continue removing the skull and get access to the tumour.
00:22:00Nice.
00:22:01Through.
00:22:02Yeah.
00:22:04Lovely.
00:22:05Okey-doke, so we open it up from this way to that way.
00:22:07Can I get two forceps, please?
00:22:10Yeah, if you grab a little bit.
00:22:11Can I grab a boulder?
00:22:12Yeah.
00:22:18We're ready with a watch swab.
00:22:20Okay.
00:22:21So this is the brain.
00:22:22First view that you've really had of it.
00:22:35So we've essentially stripped the bone off it.
00:22:41This is the dura.
00:22:43This is the tough layer.
00:22:45Give us a clip onto the tissue under there.
00:22:49Lovely.
00:22:50Cut, thank you.
00:22:51This major vein here, which I have to watch, preserve at all costs.
00:22:58The tumour is underneath the vein, so to create room to access it,
00:23:03and you can gently separate the two sides of the brain.
00:23:07So if we just suck on the end of my brain strips.
00:23:09Yeah.
00:23:10If we're pulling on the brain and moving it with a metal spatula,
00:23:16the brain doesn't really like being moved.
00:23:19It really doesn't.
00:23:20And so you've got to try and do it in the most atraumatic way possible.
00:23:24You've got to coax it so as to prevent injury to it.
00:23:30If it's a pain, it's a pain.
00:23:35If it's injured, it can lead to things like epilepsy or seizures,
00:23:42or confusion or bleeding, and critically a risk to Liz's vision.
00:23:49And then we're just using the patty to expose the tumour.
00:23:59So there's the tumour.
00:24:01There it is, that purply, purple-looking thing there.
00:24:05That is the tumour.
00:24:11So here we have brain moved aside.
00:24:12There's the tumour there.
00:24:14Literally there.
00:24:15Now we're at the critical part of the operation, removing the tumour.
00:24:21And then we'll get the buddy halo in.
00:24:27Let's just adjust the microscope at this point.
00:24:31Because you can get a better appreciation.
00:24:34Right.
00:24:35OK.
00:24:36I'll come in with a retractor.
00:24:37Yeah.
00:24:39Wash in one hand.
00:24:40Wash, please.
00:24:45Where's that bleeding coming from?
00:24:51OK.
00:24:53It's a better today.
00:24:54Big wash.
00:24:55It looks terrible at the moment, doesn't it?
00:24:56Yeah, we'll get that out.
00:24:58Big wash, please.
00:24:59The issue is, is that, like most tumours, they require a blood supply to grow,
00:25:06and meningiomas have a particularly good blood supply.
00:25:12So there's a fair bit of blood there.
00:25:15The bleeding that occurs within the tumour can lead to catastrophic blood loss.
00:25:20Liz is now at a very high risk of suffering a serious deep brain stroke.
00:25:24Oh, jeez.
00:25:25Oh, jeez.
00:25:26Oh, jeez.
00:25:27Oh, jeez.
00:25:28Oh, jeez.
00:25:29Oh, jeez.
00:25:30Ah, yeah.
00:25:31That's OK.
00:25:32Now I go to Riverside Nine- compa.
00:25:34There is a vaccination vaccination, if you could even come down with a
00:25:58Okay, it's done.
00:26:04So we've managed to open the breastbone safely.
00:26:15Now we're just trying to identify the structure of the heart
00:26:18so we can take this heart out safely.
00:26:21It's one of the crucial steps in this operation.
00:26:28Yeah.
00:26:32Yes, please.
00:26:34Right.
00:26:37Half eight.
00:26:39Arrival.
00:26:40Chris, is it aware of?
00:26:42Great.
00:26:44Now a half eight arrival.
00:26:47The transport company have just phoned to say
00:26:50that they've made a bit of headway with their travel time.
00:26:53ETA, 20 minutes.
00:26:55All right, let's make some progress.
00:26:58The biggest worry now
00:27:00is that we need to be ready to take Matt's heart out
00:27:02as soon as the donor heart arrives.
00:27:05These are the pipes which will connect Matthew
00:27:08to the heart and lung machine.
00:27:10So the heart and lung machine takes over the function
00:27:13of the patient's heart and lungs.
00:27:16And that makes sure the patient stays alive
00:27:19while the heart's not beating
00:27:20because it's then sending oxygenated blood around
00:27:23to the brain and the rest of the body.
00:27:26And then we'll remove Matthew's heart
00:27:29and implant the new heart.
00:27:36Okay.
00:27:40Okay.
00:27:41Just give me one second.
00:27:43We're going to go down to meet the team.
00:27:45Okay.
00:27:45Okay.
00:27:48This is a time-critical part of the operation.
00:27:51The donor heart's arrived
00:27:52and the longer it stays out of the body,
00:27:54the greater the chance of it failing.
00:27:56If that happens, Matt could die.
00:28:01So we're just going outside
00:28:02to meet the retrieval surgical team
00:28:05to get the heart and escort them up to theatre.
00:28:08Okay.
00:28:15After you guys.
00:28:18We have to move quite quickly
00:28:21just in order to optimise the outcome of the heart.
00:28:25Then we can work to implant it straight away.
00:28:29Okay.
00:28:30So it's theatre eight, which is just this one.
00:28:32The heart is in a perfusion device.
00:28:38It reanimates the heart,
00:28:40perfuses it with blood supply
00:28:42and paces it so it's a beating heart outside the body.
00:28:45Heart has arrived.
00:28:49Stop, stop, stop, stop, stop, stop.
00:28:51Keep going.
00:28:53On you go.
00:28:54Okay.
00:28:55Going on bypass.
00:28:58Okay.
00:28:58So we're only on bypass now.
00:29:03So we're on the heart-lung machine now.
00:29:06The next stop will be to stop Matt's heart
00:29:09and then take it out.
00:29:14So the heart has stopped completely now.
00:29:16So now we're going to start removing Matt's heart.
00:29:33Seven inches.
00:29:33That's where it saves off the auto, isn't it?
00:29:38The heart is about to come out
00:29:40and the heart is out.
00:29:42Significant moment for Matthew.
00:29:50This is the point of no return for Matt.
00:29:52We've taken his old heart out
00:29:53and we can't put it back in.
00:29:56If the new heart doesn't work,
00:29:58then Matt may not make it through.
00:29:59This is essentially inside the belly of the beast.
00:30:29We are literally in the tumour now
00:30:31and it seems to be,
00:30:33it's bleeding quite a lot.
00:30:36It's just bleeding a lot.
00:30:37I'm trying to get behind it
00:30:38and every time I move it,
00:30:39it bleeds.
00:30:39More or less, sir.
00:30:40Definitely.
00:30:41Every time I move it, it bleeds.
00:30:47This in many ways
00:30:48is one of the most worrying bits of the surgery.
00:30:50Oh, no, it's bleeding.
00:30:59To be honest,
00:30:59it's just oozing away quite badly now.
00:31:04I need to sort of get on top of it.
00:31:09Oh, dear me.
00:31:10Big wash, thank you.
00:31:23No, this is not great, is it?
00:31:30Yes, if you clad it there,
00:31:32buzz the outside of the tumour.
00:31:33We're doing some cauterisation
00:31:38to try and stop the bleeding.
00:31:46There we are, sir.
00:31:48The bleeding now
00:31:49is actually under a bit more control.
00:31:52We can make headway forward.
00:31:55Although the bleeding has stopped,
00:31:58the vessel is still attached to the tumour.
00:32:01Before I can take the tumour out,
00:32:03I really need to get underneath it
00:32:04and separate it from this vessel.
00:32:07So what we've been doing so far
00:32:08is essentially trying to,
00:32:11you know, get around it very gently,
00:32:13but it's getting to the point now
00:32:16where we want to really just
00:32:18try and get it out more quickly.
00:32:22She doesn't have time
00:32:23to stay under anaesthetic all day
00:32:27and put up with the stress
00:32:30of this happening all day.
00:32:32Let's start making some bloody progress.
00:32:42Yeah, yeah.
00:32:46And we have a little bit of change.
00:32:51We have ongoing monitoring of the brain.
00:32:54The body will fire us a warning shot
00:32:56if we're too close
00:32:57or if we start to do something
00:32:59that's harmful.
00:33:02Right.
00:33:03There was an indication
00:33:04that some of the vision
00:33:06was being threatened,
00:33:07so we need to be careful.
00:33:10So we've had our warning shot
00:33:12and that's unfortunate.
00:33:15We are going in between,
00:33:18or rather,
00:33:19to the side of the part of the brain
00:33:22that controls vision.
00:33:23And we're having to move it out of the way
00:33:26and keep it out of the way
00:33:27while we work on the tumour.
00:33:29It's actually quite challenging
00:33:30because we have to keep giving it rest.
00:33:32and now it seems
00:33:34that we may have irritated it a little bit.
00:33:36It's still working,
00:33:37but there is a reduction
00:33:38in the actual signal
00:33:39that we're getting.
00:33:40So it means
00:33:42we just have to proceed
00:33:43and get it out
00:33:44as quick as possible.
00:33:45Let me get behind you.
00:34:01Oh my God.
00:34:02Oh yes.
00:34:03There we go, Dad.
00:34:04Oh, bloody right.
00:34:05Yeah, we're on the right side of it now.
00:34:06I'll hold it there.
00:34:07Yeah, good lad.
00:34:08Good lad.
00:34:11Oh, that's better.
00:34:12That's better.
00:34:13We're on the other side of it.
00:34:14This is the underside of the tumour.
00:34:16This is the back of it.
00:34:18There it is.
00:34:22So this is where the tumour comes from
00:34:24and gets its blood supply from.
00:34:27This bit now,
00:34:28which I'm
00:34:29cauterizing now.
00:34:38I think we're nearly there now.
00:34:40Here it is.
00:34:40Here's the tumour.
00:34:44Just got them round it all the way.
00:34:47And there.
00:34:53At last.
00:34:55Big wash, thanks.
00:34:58We've got it out now.
00:34:59So it's now just a matter of sorting out all the leftover bleeding
00:35:05and hopefully finishing.
00:35:12Give her a nice closure.
00:35:16Just removing all of her monitoring,
00:35:19cleaning her up,
00:35:20making sure that essentially she's able to wake up comfortably
00:35:23and safely and safely.
00:35:36Right now,
00:35:37I feel I've done my job to the best of my ability.
00:35:39But what's going through our mind now is,
00:35:41you know,
00:35:42whether or not we've done any serious damage.
00:35:43It was a vision.
00:35:44But you never know.
00:35:47You just simply do not know until they wake up.
00:35:50I'm going to go and see Anna.
00:36:07It was one of my patients
00:36:08with a big,
00:36:10massive tumour of her breast,
00:36:11which is invading the chest wall.
00:36:13This tumour is really growing very fast.
00:36:15And actually,
00:36:16it has broken already through the skin,
00:36:18what we call it,
00:36:18the term fungating.
00:36:20And this means also that the,
00:36:21the,
00:36:22the tissues are necrotic
00:36:25and rotten
00:36:26and actually smelling.
00:36:27That's why it's,
00:36:28it's having a great impact on our life.
00:36:30We're going to be planning
00:36:32to remove this tumour
00:36:34quickly
00:36:37and also reconstruct the chest wall
00:36:39because if we leave it,
00:36:41it will be inoperable
00:36:43and actually can kill us.
00:36:47Hey.
00:36:48How are you feeling?
00:36:50Scared.
00:36:51Nervous.
00:36:52I am.
00:36:52Hmm.
00:36:54My breast was getting larger
00:36:56and I was just hiding it.
00:36:59So you shut down,
00:37:00didn't you?
00:37:01I shut down, yeah.
00:37:01I shut everyone out.
00:37:03And I've been, yeah,
00:37:04I've kept pushing people away.
00:37:06So I didn't have to spend time with people.
00:37:10So I'm in Harley's
00:37:11and she's come home from work
00:37:13and she's asked me several times
00:37:15what the smell was.
00:37:17She thought I had an infection
00:37:19so she was going to phone the doctors
00:37:21to get me some antibiotics.
00:37:24In the end,
00:37:25I said it's not an infection.
00:37:26Well, it is an infection.
00:37:27It's a big infection.
00:37:29But I showed her,
00:37:31I didn't show her the tumour.
00:37:34I showed her my breast
00:37:36and it was just so upsetting
00:37:38and we went to the hospital.
00:37:41And she said,
00:37:43I'm dying
00:37:43and this big lump appeared.
00:37:46When I took her to A&E,
00:37:47I said to the receptionist,
00:37:49I said,
00:37:50my mum has got a lump.
00:37:51I said,
00:37:52and it's the size of my head.
00:37:54Like, we need to be seen right now.
00:37:59It's just not true for six, hasn't it?
00:38:00Yeah, it has.
00:38:03She took over my whole life.
00:38:06Because everything is to think.
00:38:08From when you wake up
00:38:09to you go to sleep at night,
00:38:11I have a tumour.
00:38:12Oh, God, it is scary, isn't it?
00:38:20So, as you can see,
00:38:33this is the CT,
00:38:34which has been done recently.
00:38:37And this is the upper part of the chest.
00:38:39You can see the lungs
00:38:40and the heart is there.
00:38:42The tumour is starting to appear there.
00:38:44Big lump there as we're going.
00:38:45This is growing up.
00:38:47This is over 20 centimetres plus.
00:38:50You can see it is protruding
00:38:52through the skin here.
00:38:54It's forming like a mushroom type of,
00:38:57you know, growth there.
00:38:59Anna has had this tumour for four months.
00:39:02This area is now infected
00:39:04because it is not covered by skin.
00:39:08And it's invading the ribs there.
00:39:11This is the rib there.
00:39:12This is another rib there.
00:39:13And then the muscles in between the ribs.
00:39:15All this is in the tumour is invading that.
00:39:19And so the plan for the surgery,
00:39:22it's to try to get this big tumour out
00:39:26in a safe way.
00:39:27And also at the same time,
00:39:29including a negative margin
00:39:31as much as possible surgical margin
00:39:33around the tumour.
00:39:36A surgical margin means
00:39:38that there is no cancer left behind.
00:39:41This very rare tumour
00:39:42has a very high instance of recurrence
00:39:45coming back
00:39:46if we do not get a surgical margin.
00:39:50The risks involves bleeding,
00:39:52surgical site infection,
00:39:54problems with infection in the chest.
00:39:56We call it pneumonia
00:39:57that could end up by respiratory failure,
00:40:00which means she cannot breathe.
00:40:02She has a big battle ahead of her.
00:40:05We are racing against time.
00:40:09Hi, good luck.
00:40:10Don't, don't, don't.
00:40:11Good luck.
00:40:14Love you.
00:40:15Love you.
00:40:16Bye, Jan.
00:40:20I think she was really scared.
00:40:22She was really scared.
00:40:23And that's why she's hid it.
00:40:24I've been thinking,
00:40:27well, what did I miss?
00:40:28Where, where was the point
00:40:30that I should have picked up on this
00:40:31and there wasn't?
00:40:33Hello.
00:40:34Hi, love.
00:40:35Nice to meet you.
00:40:37My name is Hannah.
00:40:37I'm your theatre support worker.
00:40:38I'll be taking you down to surgery.
00:40:40Hi.
00:40:41I'll be with you throughout the whole surgery.
00:40:43So if you feel nervous or anything,
00:40:44you've got my hand to squeeze.
00:40:47Mum's really, really strong.
00:40:50Mum's trying to stay
00:40:51in the most positive frame of mind for her
00:40:54because I just think
00:40:56she needs people around her
00:40:57that are saying,
00:40:58it's going to be fine
00:40:59and we are going to get through there.
00:41:02We'll get rid of there.
00:41:14You don't have any questions, Hannah?
00:41:15I don't, no.
00:41:16Everything's clean for you?
00:41:18It's nice.
00:41:19Okay.
00:41:20And hopefully everything goes okay.
00:41:21And that you'll behave yourselves.
00:41:23I will behave myself,
00:41:25I promise to God.
00:41:27Okay.
00:41:28Let's see where the need is
00:41:29and then we'll come back, okay?
00:41:30Okay.
00:41:40Morning.
00:41:41My name's Sam.
00:41:43Okay?
00:41:44That's good.
00:41:44I've come to hold your hand.
00:41:49Relax your hand, eh?
00:41:51Now let us do it, Matthew.
00:41:52Okay.
00:41:53Just from simple.
00:41:54You think happy for work?
00:41:55Happy day.
00:41:56Yeah, I'm just going to fall into the night.
00:41:58I'll do it.
00:41:59I'll do it.
00:42:00I'll do it.
00:42:06The challenge is to make sure
00:42:07that we remove this tumour
00:42:10with a good safety margin
00:42:12and also try to avoid contamination
00:42:16and also try to avoid contamination
00:42:17of the surgical field.
00:42:19It's a very complex operation.
00:42:21She has a very high risk of bleeding,
00:42:24infection,
00:42:25a clot in her leg,
00:42:26which can travel to her lungs.
00:42:29But if she doesn't have the surgery,
00:42:30we know there's only one outcome,
00:42:32which is basically the tumour growing
00:42:34and invading the whole her body
00:42:37and eventually losing her life.
00:42:40We have to do the best
00:42:41as a multidisciplinary team for her.
00:42:48So, blood pressure?
00:42:50Yeah.
00:42:50Yeah.
00:42:50I'm happy.
00:42:53This surgery is complex
00:42:54and high risk.
00:42:56So, we need two surgeons.
00:42:59My throthic colleague, Mr. Calcutt,
00:43:00will be removing the tumour
00:43:02and Anna's affected ribs.
00:43:05And then we'll reconstruct Anna's chest wall
00:43:08after the infected mass has been taken away.
00:43:11We'll take the dressing off
00:43:13and then we will clean the area around it
00:43:17and then we'll isolate that mass
00:43:19because it has opened up
00:43:20and it is smelling
00:43:22and it is going to be infected.
00:43:24The things which concern us
00:43:27is this is an infected mass,
00:43:29so we have to make sure
00:43:30the surgical field remains sterile.
00:43:34If not, the infection can spread
00:43:36to the surrounding tissues.
00:43:39Can I remove the dressing now, guys?
00:43:54You can see the fungating mass there.
00:44:07You can see the fungating mass there.
00:44:07It has grown to that size so rapidly
00:44:24that it has just opened up.
00:44:27It is all that dead tissue
00:44:29which is grafted.
00:44:31There's no breast tissue.
00:44:34All the breast has been replaced
00:44:35by the tumour itself.
00:44:38Now the tumour is exposed.
00:44:39We really have to work carefully
00:44:40so the infected mass doesn't contaminate
00:44:43any other parts of Anna's body.
00:44:45Hello, please listen to the name of the reception.
00:44:55How can I help?
00:45:01I've got a bend here on there.
00:45:03That's a place for bendage.
00:45:04The retrieval team are preparing
00:45:25to take the hards off the perfusion machine,
00:45:28the OCS machine.
00:45:31Go for it.
00:45:32Take it off the rig.
00:45:34Heart is out.
00:45:42All right, Anna.
00:45:44Thank you very much.
00:45:47It's important to implant the heart
00:45:49as quickly as we can
00:45:51because at the moment
00:45:52the heart is not getting a blood supply to it.
00:45:56We know that the longer the heart is
00:45:58out of the body,
00:46:00the worse the outcome
00:46:02and the risk of the patient dying.
00:46:04We want the heart to get the oxygen
00:46:07and the blood
00:46:08and its normal nutrients
00:46:10back to it as quickly as possible.
00:46:12So we just need now
00:46:13to trim things to the right length
00:46:15so we can sew it in.
00:46:16We can sew it in.
00:46:17Be very careful with that.
00:46:21Okay, veins, veins at the back.
00:46:23Let's take care.
00:46:24So one, two, this is three and four.
00:46:30That's right.
00:46:31Can I have a swab, please?
00:46:32Water on the blues, please.
00:46:34The donor heart is put in place
00:46:45so we're just starting to sew the heart in.
00:46:48We're doing the left atrium
00:46:50and that's what takes all the blood
00:46:51back from the lungs
00:46:53and then it'll eventually go into the left ventricle,
00:46:56the main pumping chamber of the heart.
00:46:58Right up on your suckers.
00:47:01Right up on your suckers.
00:47:03So we're just joining the inner frida vena cava.
00:47:08Force it, please.
00:47:09Put me up, please.
00:47:11Okay.
00:47:14So now we've joined all the bits of the heart up
00:47:17and in a moment,
00:47:19we're gonna let the blood flow back into the heart.
00:47:23So we gradually reduce the flow of blood
00:47:27from the heart-lung machine
00:47:29and start to return the blood back to the body.
00:47:33So that's the point at which we see
00:47:34whether the heart starts to beat or not.
00:47:37Okay, um, gently run some warm blood into the roof.
00:47:43Gently running some warm blood.
00:47:45Blood only.
00:47:55That's gross.
00:47:58Still running warm blood, yeah.
00:47:59How much are you given?
00:48:00About 600.
00:48:07My fear is if the new heart doesn't restart,
00:48:10that could be fatal for Matt.
00:48:14Hold your nerve for a bit.
00:48:20PVI at 60, please.
00:48:22Feel free to pull it out at any point.
00:48:37I can see it moving.
00:48:40Slowly starting to contract.
00:48:45And the heart is just gradually starting to beat
00:48:47a little bit stronger.
00:48:48Which is a good start.
00:48:59We're completely off the heart-lung machine
00:49:01and Matt's new heart is doing all the work.
00:49:05So at the moment we're just taking out the pipes
00:49:08which are in the heart for the bypass
00:49:12and then close the chest.
00:49:20The heart function is reasonable.
00:49:25Bain's needing quite a lot of drugs
00:49:28to keep his blood pressure up.
00:49:35Matt can go back to the intensive care unit.
00:49:41We're not quite out of the woods yet
00:49:43so we'll continue observing very closely.
00:49:46But now Matt's got a chance
00:49:48of a new life.
00:49:49I need a bowl
00:49:58with the betadine and the huck towels and the stapler.
00:50:01We are basically trying to isolate the tumour,
00:50:07which is infected and opened up to air,
00:50:10so that we can work around it
00:50:12and keeping our tumour
00:50:13which is infected and opened up to air
00:50:16so that we can work around it
00:50:18and keeping our field of surgery as clean as possible.
00:50:33We need to ensure the infection doesn't spread
00:50:35to other parts of Anna's body.
00:50:37We need to ensure the infection doesn't spread
00:50:39to other parts of Anna's body.
00:50:41OK, good, well done.
00:50:55So the next test will be,
00:50:56we will try to remove the whole mass
00:51:01along with the rib cage to which it is attached.
00:51:07It is crucial that we do not leave
00:51:09any tumour cells behind.
00:51:11It is an aggressive tumour.
00:51:13It will grow back and Anna's life will be in danger.
00:51:20We are trying to just go around the tumour,
00:51:24try to separate it from the normal area.
00:51:27We will just try to keep it at least
00:51:30about a couple of centimetres all around.
00:51:32So we will like to have as clear margins as possible.
00:51:36You can see the blood vessels
00:51:40which are supplying the tumour there.
00:51:44There's another big blood vessel there.
00:51:46There's lots of big blood vessels
00:51:48supplying the tumour.
00:51:50Because this tumour needs blood to survive.
00:51:56This tumour is like a parasite
00:51:57feeding on Anna's body.
00:52:00And to remove it,
00:52:00we have to cut through these vessels.
00:52:02But we must be careful
00:52:03so that we don't cause a major bleed
00:52:06which can actually be deadly.
00:52:09Can we have the ligature for Mr. Kalkit?
00:52:14So we're just going to secure this blood vessel.
00:52:18At the moment,
00:52:19I think we are just trying to control the bleeding.
00:52:23Give me liga, liga.
00:52:25Yeah, that's perfect.
00:52:35You can see now it's starting to peel off
00:52:37a little bit from the chest wall.
00:52:43Yeah, but you can see
00:52:44the ribs are there.
00:52:46So we were down to the ribs
00:52:47and the chest wall muscle.
00:52:50So we are just about to take the whole tumour out
00:52:55along with the two ribs.
00:52:58So this is all coming out as one big mass.
00:53:04There it is.
00:53:05So we have taken two ribs.
00:53:21That also goes away.
00:53:27Yeah, so we have just taken two ribs.
00:53:31So we have taken them out
00:53:32along with the tumour.
00:53:35This is the tumor there, this is the breast area, and this is the muscles of the chest, and these are the ribs.
00:53:44I'm confident that we have removed the whole tumor, but our worry is that on an anesthesia scan,
00:53:49there looked that there was a shadow on her lung, and we need to make sure and to check if the tumor has spread deeper into her chest or not.
00:53:59So that's the heart.
00:54:08At the moment, we have collapsed the right lung, so she is at the moment being ventilated only on one lung, which is the left one.
00:54:17When the lung is collapsed, as you see, you can basically feel the lung.
00:54:29If there is any shadow or any nodules, you'll feel it against your fingers.
00:54:36We are just going to feel it.
00:54:44Is it there?
00:54:45Is it there?
00:54:46you
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01:01:17yeah it's good news the flow and the blood vessel is good we are looking good we're looking good
01:01:39we're now closing the skin it seems that someone up there is taking care of us
01:01:47went quite as planned today i'm pleased with anna she's behaved herself as she promised before the
01:01:55surgery i think she's going to be quite very emotional when she wakes up and see that this
01:02:03has gone it's gone it's all gone you did behind yourself you did yes
01:02:18but you feel lighter yeah yeah i'm not sure you'll get your chinese tonight but hopefully you'll get it
01:02:27tomorrow hoping that the flap continues to work and anna recovers with her chest wall functions
01:02:47we will be monitoring the flap we'll be monitoring her vital signs anything can happen at any point
01:02:57you know hi matt hi how are you oh very well thank you yeah good thanks to you good to see you and you
01:03:10yeah good to see you so just over two weeks now yep how are you feeling i'm feeling pretty good all
01:03:16things considered good yeah yeah building up my strength back up um when you're back on the bike
01:03:20uh well how long is a piece of string let's see but not not just yet but um yeah i'd like to you
01:03:27were fit beforehand yeah that's it and so that's all good all good things for you yeah no it's getting
01:03:32you back to that yeah that's it that's it yeah and we'll hold you to getting you back on the bike
01:03:37it's amazing thank you it's not enough really but it's uh incredible so um yeah i feel i feel very
01:03:44blessed so thank you good cheers thank you thank you i think life after this and that will be
01:03:59different i think you'll have a different outlook on life and it'll want to grasp life with both hands
01:04:05it's given me an appreciation as well for what medical science can do as well because here i am you
01:04:10know um with a new new chance ahead um a second chance and you know i've already got some big plans
01:04:17and uh yeah just just looking forward to it hello hello how are you how are you how are you doing
01:04:39do you know i feel so much better today i think i would like to just check quickly what's happening
01:04:48i'm just gonna open this that looks absolutely fine
01:04:55listen you're gonna be free like an eagle now all right once i've had my chinese yeah so all this is
01:05:03out of the way now thank you so much god bless take care of yourself take care of yourself take
01:05:11keep on bathing keep on moving thank you young men i wish i'm younger i'm getting older now
01:05:18and it's doing really great i'm really pleased to remove the dressings today and uh the wounds looks
01:05:28perfectly fine there's no signs of any infection she's gonna be able to go back to her normal daily
01:05:36activities normal social life and i believe that this has dramatically improved her quality of life
01:05:45and she can gain back the control on her life again
01:05:49i'll probably think it for the rest of my life now how did they get rid of that it was like
01:05:59a miracle and it was a miracle lived in on me
01:06:04i got a significant bleed there is a chance of death stroke and blindness
01:06:28he's a big monster i didn't think it was going to be this bird it's a nightmare
01:06:34not only can the patient bleed to death if it's injured it can cause stroke
01:07:04not only can the patient bleed to death if the patient bleed to death if it's injured it can cause
01:07:09a baby
01:07:13so
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