- 12 minutes ago
Surgeons: A Matter of Life or Death - Season 3 - Episode 02
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Short filmTranscript
00:00:01The 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 the flutter of an eyelash.
00:00:19The beef means don't do that again.
00:00:27It is very personal for me.
00:00:29If you put a hole in here, he'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.
00:00:51This is inside the belly of the beast.
00:00:54We are in the tumour now.
00:00:56It's bleeding.
00:00:57And 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, the worse the outcome.
00:01:18And the risk of the patient dying.
00:01:25Oh, God. It's scary, isn't it?
00:01:31This tumour is like a parasite feeding on Anna's body,
00:01:35which can be deadly.
00:01:37We are racing against time.
00:01:53We are racing against time.
00:01:53So today we are going to be operating on Liz.
00:01:56She's got quite a sizeable, plum-sized tumour on the left-hand side of the back of her brain, quite
00:02:03deep, deep inside.
00:02:06The tumour is underlying a piece of brain that controls vision, which is obviously a really important thing for anybody.
00:02:14But in particular, when it's at risk, we 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.
00:02:27We 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. She's clearly going to be frightened.
00:02:41There's a lot of state for Liz.
00:02:49Hello.
00:02:52Oh, ladies first. Ladies first.
00:02:54Ladies first.
00:02:54How do you do? How do you do? It's so good to meet you.
00:02:57Yeah.
00:02:57Yeah, I'm fine.
00:02:58How do you do, 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're frightened 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.
00:03:35Oh, both eyes.
00:03:35Yes, 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,
00:03:45while we're operating.
00:03:47Okay.
00:03:47To try and minimise it, but still a risk.
00:03:50Still a risk.
00:03:51But I will still have vision.
00:03:53Yes.
00:03:53Yes.
00:03:55There isn't a clear operative factor that would lead you to be completely blind
00:04:00unless 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.
00:04:10You're a really sensible lady and you know what we're doing and there is a small risk to life with
00:04:18it.
00:04:18Yeah.
00:04:21So, how do you feel about all that?
00:04:24It's scary.
00:04:25Of course it is.
00:04:25Of course it is.
00:04:26It's very scary, but we've talked about it.
00:04:29I'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.
00:04:37But rest assured that we will be being as careful as we possibly can be.
00:04:41At no moment we'll be taking it for granted and we'll really be trying to do the very best that
00:04:45we can.
00:04:46Yeah.
00:04:46Thank you, David.
00:04:49Thank you very much.
00:04:50And I'll see you again very soon.
00:04:51Okay.
00:04:53Here we are.
00:04:55Thank you, David.
00:04:56Not at all.
00:04:56Not at all.
00:04:57I started to get migraine headaches, which were unusual for me.
00:05:03I'd had them years ago, but nothing like this.
00:05:05And it was sort of every few weeks.
00:05:08And they felt a bit different, really.
00:05:10So I thought I'd better go to the GP.
00:05:13He assured me he thought they were migraines.
00:05:17But he said, if 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.
00:06:03Yeah.
00:06:06You'll be there.
00:06:07Yeah.
00:06:08You'll be there.
00:06:09Yeah.
00:06:18Okay.
00:06:19So 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.
00:06:36It's a plum size, or a good-sized plum,
00:06:40or the size of perhaps a small, easy-peel orange.
00:06:44The tumour is actually very deep.
00:06:45It's close to being in the middle of her head.
00:06:47So our approach, we will need to move the brain out of the way
00:06:54and then progress to reach the tumour underneath it.
00:06:58The brain 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.
00:07:12Critically, vision.
00:07:13This is the vision cortex here.
00:07:15So we need to be very careful working around here.
00:07:19The other problem is there's large blood vessels
00:07:22around the area in which we wish to enter.
00:07:25These 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
00:07:38should actually we injure it.
00:07:40Any injury to this greatly increases the risk of stroke for Liz.
00:07:48We're in a window at the moment.
00:07:50We have an opportunity to remove this.
00:07:54And hopefully, strong word, we don't often use it in neurosurgery,
00:07:58but we will hope to cure her.
00:08:02OK.
00:08:03Thank you, Rick.
00:08:05Thank you, Rick.
00:08:06Thank you, Rick.
00:08:09Very good, sir.
00:08:10Oh, I'm all right.
00:08:11I want to be a bit of a killer.
00:08:14All right.
00:08:15Oh, I don't.
00:08:20See you later.
00:08:21Yeah, I'll see you the other side.
00:08:23It'll be OK.
00:08:26Only a few hours.
00:08:27We'll be back.
00:08:28Yep.
00:08:29See you later.
00:08:31OK.
00:08:31Thank you very much.
00:08:32Bye, then.
00:08:33Take care.
00:08:33And you.
00:08:34You OK with the work?
00:08:35Yep.
00:08:36I'll find you later.
00:08:37We're basically a team.
00:08:39We always have been.
00:08:41And one doesn't function that well without the other.
00:08:57The main risk is bleeding.
00:08:59Bleeding and damage to the major blood vessels in the sinus.
00:09:03And then, once we open up, then I'd like to see the tumour.
00:09:09And 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.
00:09:21An independent lady.
00:09:23If we either do nothing or the surgery is dogged by complication, she has the capacity to lose all of
00:09:32that.
00:09:33It's possibly one of the most significant moments of her life.
00:09:36An independent lady.
00:09:38So, let's go.
00:09:46And then she's got her turn together.
00:09:47Hello, am I in the understers?
00:10:03Hello, am I in the understers?
00:10:06So it is a left-sided craniotomy, or occipital meningioma.
00:10:11Principal steps.
00:10:12Drilling over the sinus.
00:10:17Let'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,
00:10:26so that we know in space where any part of her head and brain are
00:10:31in order to plan the position of our craniotomy.
00:10:36I do like to see what we're doing.
00:10:39So that's our tumour dead centre.
00:10:41I'm just marking the midline.
00:10:43There's a very large vein there, but we want to make sure we know where it is.
00:10:47And the tumour we know just lies next to that vein.
00:10:52Mid-tumour.
00:10:53Mid-tumour lateral border, yeah.
00:10:55Right, so tumour dead centre is...
00:10:58There.
00:10:59...opximately here.
00:11:00OK, let's get rid of some of this lovely hair, unfortunately.
00:11:04Bless her.
00:11:11That is our incision.
00:11:15And our craniotomy will be swimming around like that, as you say.
00:11:21OK-doke, let's start.
00:11:26Swab and knife, thank you.
00:11:297 o'clock.
00:11:30Yeah, we will do a sort of two-piece opening knife 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
00:11:45of bleeding.
00:11:46The one thing we don't like in neurosurgery is blood.
00:11:50We're now just stripping the muscles off the surface of the skull.
00:11:58Lovely.
00:11:59Shall we do midline and sinus?
00:12:02So we're just marking out these big blood vessels that we want to know where they are.
00:12:06Yeah, we'll go out like that, just round the outside of it, and then we'll have one, two, three bills,
00:12:15just the other side.
00:12:16This, essentially, is our craniotomy.
00:12:20Yeah, do the distal one.
00:12:21Lovely.
00:12:22And suction to myself.
00:12:23Thanks.
00:12:24Nice and perpendicular.
00:12:25Good one, Nick.
00:12:33So 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.
00:12:40So we need to be careful.
00:12:42There 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 and, for example, if the drill catches it and tears it, you can bleed
00:12:57out.
00:12:57People have died within minutes.
00:13:15Matthew's 37, and he has the condition of his heart where the chains of the heart are swollen.
00:13:22And 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 that
00:13:34we need to put him on a special machine, a BIVAD,
00:13:36which sits outside of his body and takes over the function of his heart.
00:13:41But it's a temporary device, and it can only stay in for so long.
00:13:44So he needs a heart transplant.
00:13:47Matt has a chance of dying if he doesn't get the operation, but equally, there's a chance of dying if
00:13:53he does get an operation.
00:14:05This is an ultrasound scan of Matt's heart.
00:14:08So this is the left ventricle, the main pumping chamber of the heart.
00:14:13And it's very big and dilated, and it's pumping very inefficiently.
00:14:18On top of that, Matt keeps on having very fast, irregular heart rhythms, and that makes this pumping chamber pump
00:14:24even less efficiently.
00:14:26And so Matt's in real trouble when that happens.
00:14:29Being on the BIVAD means that this is a time-pressured situation for Matt.
00:14:33He's been placed on the highest category of heart transplant waiters in the country, the super urgent list.
00:14:39Without a transplant, he would die.
00:14:44Before this happened, I was a really keen cyclist.
00:14:48I used to be sort of like a good amateur road cyclist, so lots of racers up and down the
00:14:57country.
00:14:58Very fit, very fit with healthy, and basically one of those fitness fanatics.
00:15:02And I've been staying with my dad, and they heard a noise one Thursday night.
00:15:10He was lifeless on the bed.
00:15:14So 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, you 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.
00:15:37Not long later, the first of the, um, first responder turned up.
00:15:44His dad called me, got myself to the hospital, and they took us into, like, the little family room.
00:15:49And said, like, we're in a quite precarious situation now.
00:15:54Um, we need to do something quite fast, basically.
00:15:59It was quite hard to suddenly find myself in here, strapped to a machine.
00:16:04Knowing that was keeping me alive, I'm currently just playing the waiting game until they come and tell me they
00:16:10might have a heart for me.
00:16:13Love you.
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 a suitable heart is available.
00:16:27Hello?
00:16:28Hey, hey, hey, hey, Simon, you alright?
00:16:35Thanks very much, Simon, appreciate that.
00:16:37I think that sounds reasonable, I think it's a reasonable thing to, uh, to proceed.
00:16:42We've had phone calls saying there's a donor heart available, and we're in the process of assessing that heart.
00:16:49This heart will mean a new life for Matt.
00:16:51We know that, with a transplant, Matt has the best chance of long-term survival and a good outlook.
00:16:57I'm assuming that you know his heart in waste.
00:17:00Yes, I've got it all, yeah, yeah.
00:17:01Fine.
00:17:05This means everything to Matthew, it will mean a huge amount to him and his family.
00:17:10Hello.
00:17:11Hello, are you okay?
00:17:13Yeah.
00:17:14How are you feeling?
00:17:15Nervous.
00:17:16Yeah?
00:17:16So, as soon as everything is together, we are going.
00:17:19Yeah.
00:17:19The heart looks good.
00:17:20Brilliant, yeah.
00:17:20The team are happy with the function.
00:17:22Brilliant.
00:17:22So, no sign of any disease, 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.
00:17:29So, I'm a bit dazed.
00:17:30No, of course you are.
00:17:31That's absolutely fine.
00:17:32Are you okay?
00:17:32Yeah, yeah, yeah.
00:17:33Oh!
00:17:36Have you got any tissues?
00:17:37Are there any tissues?
00:17:38They're not.
00:17:42So, what happens from here is the perfusionist will get, they look after the machine, so
00:17:47we're kind of dictated by them and getting everything together.
00:17:50Yeah.
00:17:52We'll go round to theatre, we'll skip the anaesthetic room because of the size of the machine,
00:17:56stay with you until you're fast asleep, and then throughout we'll be there.
00:17:59Yeah, thank you.
00:18:00Yeah, yeah, yeah, thank you very much.
00:18:02Thank you so much.
00:18:04All right.
00:18:04Okay.
00:18:04It's happening fast.
00:18:06I know, yeah, it's faster than we thought, isn't it?
00:18:08Yeah.
00:18:08I'm excited, I'm super nervous, I don't really know, I just, it's a whole new experience,
00:18:14obviously.
00:18:15I just don't know what it does to other people.
00:18:17It's all right, I'm just emotional.
00:18:20She's been my rock.
00:18:22We've been dating, what, five months before this happened?
00:18:24Yeah.
00:18:25But we've been talking about all sorts of things.
00:18:27Marriage, kids, moving in together.
00:18:29Kids, no.
00:18:30So, yeah.
00:18:32It just, I don't know, I think we just opened up to each other perhaps in a way that you
00:18:37wouldn't necessarily if you weren't in a situation like this.
00:18:42But that, you know, that's I think sometimes some of the benefits of these situations, you
00:18:46know, you realise how much you love someone.
00:18:49And, yeah, it's a nice thing to realise.
00:18:54Yeah.
00:18:55Very nice.
00:18:58He's got so many things he wants to do, wants to get out and see the world and do things.
00:19:04And I think this hopefully will let him, yeah.
00:19:09New beginning.
00:19:12I get it all the time in the morning.
00:19:20Yeah.
00:19:21Thanks, Jay.
00:19:23Yeah.
00:19:26Yeah.
00:19:30Yeah.
00:19:31Yeah.
00:19:32It feels quite unfair.
00:19:33I'm a donor.
00:19:34But then you've also got to remind yourself that every day people do pass away and I feel
00:19:40very lucky that that person's agreed to help me on my job.
00:19:46I'm quite nervous, but the unknown is always a bit scary.
00:19:51Am I going to go steep and not wake up?
00:19:53Your life is literally in someone else's hand.
00:19:57Take a nice deep breath.
00:20:10So, we have confirmed that this patient on the table is in Matthew.
00:20:16So, at this moment in time, the donor heart that has been slated for Matthew is on its
00:20:24way to the hospital.
00:20:25It's an hour before the new heart arrives.
00:20:29We'll start our operation at this end so that we can minimise the amount of time the
00:20:33heart stays out of the body.
00:20:36The longer the donor heart spends out of the body, the greater the risk of it not functioning
00:20:40when we implant it.
00:20:47This is a very high risk operation for him.
00:20:50It carries the risk of infection, bleeding, kidney damage.
00:20:54Not everyone will survive a heart operation, but this operation is really the only chance
00:20:59that Matt has.
00:21:15He has to be quite steady with this drill.
00:21:36Oh, there we are, right over the sinus.
00:21:37We have achieved what we wanted to achieve because that is the major vein, the sinus, and it's safe.
00:21:46Now, I can continue removing the skull and get access to the tumour.
00:22:00Nice.
00:22:00Straight through.
00:22:02Yep.
00:22:03That's it.
00:22:04Lovely.
00:22:05Okie doks.
00:22:05We open it up from this way to that way.
00:22:08Can I get two forceps, please?
00:22:11Yeah, if you grab a little bit.
00:22:12Yep.
00:22:18We're ready with a watch swab.
00:22:30So this is the brain.
00:22:32First view that you've really had of it.
00:22:38So we've essentially stripped the bone off it.
00:22:42This is the dura.
00:22:43This is the tough layer.
00:22:48Give us a clip onto the tissue.
00:22:53Lovely.
00:22:54Cut, thank you.
00:22:56This major vein here, which I have to watch, preserve at all costs.
00:23:01The tumour is underneath the vein.
00:23:04So to create room to access it, and you can gently separate the two sides of the brain.
00:23:11So if you just suck on the end of my brain strips.
00:23:14Yeah.
00:23:17We're pulling on the brain and moving it with a metal spatula.
00:23:21The brain doesn't really like being moved.
00:23:24It really doesn't.
00:23:25And so you've got to try and do it in the most atraumatic way possible.
00:23:29You've got to coax it so as to prevent injury to it.
00:23:38If it's injured, it can lead to things like epilepsy or seizures or confusion or bleeding.
00:23:45And critically, a risk to Liz's vision.
00:23:49And then we're just fusing the path to expose the tumour.
00:23:59So there's the tumour.
00:24:01There it is, that purple-looking thing there.
00:24:06That is the tumour.
00:24:11So here we have brain moved aside.
00:24:13There'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.
00:24:32Because you can get a better appreciation.
00:24:34Right.
00:24:35OK.
00:24:36I'll come in with a retractor.
00:24:38Yeah.
00:24:39Wash in one hand.
00:24:40Wash, please.
00:24:45Where's that bleeding coming from?
00:24:51OK.
00:24:53Big wash looks terrible at the ball, doesn't it?
00:24:56OK.
00:24:57Yeah, 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.
00:25:26Oh, jeez.
00:26:12So we've managed to open the breastbone safely.
00:26:15Now we're just trying to identify the structure of the heart so we can get, so we can take this
00:26:19heart out safely.
00:26:21It's one of the crucial steps in this operation.
00:26:27PHONE RINGS
00:26:29Yeah.
00:26:31Yes, please.
00:26:34Hi.
00:26:36Half eight.
00:26:39Arrival.
00:26:47The transport company have just phoned to say that 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.
00:26:59The biggest worry now is that we need to be ready to take Matt's heart out as soon as the
00:27:03donor heart arrives.
00:27:06These are the pipes which will connect Matthew to the heart and lung machine.
00:27:10So the heart and lung machine takes over the function of the patient's heart and lungs.
00:27:16And that makes sure the patient stays alive while the heart's not beating because it's then sending oxygenated blood around
00:27:23to the brain and the rest of the body.
00:27:27And then we'll remove Matthew's heart and 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.
00:27:48This is a time-critical part of the operation.
00:27:51The donor heart's arrived and the longer it stays out of the body, the greater the chance of it failing.
00:27:56If that happens, Matt could die.
00:28:01So we're just going outside to meet the retrieval surgical team to get the heart and escort them up to
00:28:08theatre.
00:28:12Okay.
00:28:15After you guys.
00:28:18We have to move quite quickly just in order to optimise the outcome of the heart.
00:28:24Then we can work to implant it straight away.
00:28:29Okay.
00:28:30So it's theatre eight, which is just this one.
00:28:33The heart is in a perfusion device.
00:28:38It reanimates the heart, perfuses it with blood supply and paces it so it's a beating heart outside the body.
00:28:45Heart has arrived.
00:28:49Stop, stop, stop, stop, stop.
00:28:51Go.
00:28:53On you go.
00:28:54Okay, going on bypass.
00:28:58Okay, so we're only on bypass now.
00:29:03So we're on the heart and lung machine now.
00:29:06The next stop will be to stop Matt's heart and then take it out.
00:29:14So the heart has stopped completely now.
00:29:28So now we're going to start removing Matt's heart.
00:29:33Seven inch, please.
00:29:38The heart is about to come out.
00:29:41And the heart is out.
00:29:46Significant moment for Matt here.
00:29:50This is the point of no return for Matt.
00:29:52We've taken his old heart out and we can't put it back in.
00:29:56If the new heart doesn't work, then Matt may not make it through.
00:30:02The heart is about to be lost and we can't stop.
00:30:08The heart is the root of Matt.
00:30:12This is the root of Matt.
00:30:19The heart is about to be lost.
00:30:26This is essentially inside the belly of the beast.
00:30:29we are literally in the tumour now and it seems to be it's bleeding quite a
00:30:35lot just bleeding a lot I'm trying to get behind it and every time I move it
00:30:41every time I move it bleeds
00:30:47this in many ways is one of the most worrying bits of the surgery
00:30:57oh no it's bleeding to be honest it's just oozing away quite badly now
00:31:02I need to sort of get on top of it
00:31:09oh dear me
00:31:17big wash thank you
00:31:23no this is not not great is it
00:31:30yes if you grab it there
00:31:32buzz the outside of the tumour
00:31:33yep
00:31:37we're doing some cauterisation to try and stop the bleeding
00:31:46there we are so
00:31:47the bleeding now is actually under a bit more control
00:31:52we can make headway forward
00:31:57although the bleeding has stopped the vessel is still attached to the tumour
00:32:00before I can take the tumour out I really need to get underneath it and separate it from this vessel
00:32:06so what we've been doing so far is essentially trying to get around it very gently but it's getting to
00:32:16the point now where we want to really just try and get it out more quickly
00:32:21she doesn't have time to stay under anesthetic all day and put up with the stress of this happening all
00:32:31day
00:32:32let's start making some bloody progress
00:32:45yeah yeah
00:32:46and we have a little bit of chain
00:32:51we have ongoing monitoring of the brain
00:32:53the body will fire us a warning shot if we're too close so if we start to do something
00:33:00it's harmful
00:33:02right
00:33:03there was an indication that some of the vision was being threatened so we need to be careful
00:33:10so we've had our warning shot
00:33:14and that's unfortunate
00:33:16we are going in between
00:33:18or rather
00:33:20to the side of the part of the brain that controls vision
00:33:23and we're having to move it out the way
00:33:26and keep it out the way while we work on the tumour
00:33:29it's actually quite challenging because we have to keep giving it rest
00:33:32and now it seems that we may have irritated it a little bit
00:33:36it's still working but there is a reduction in the actual signal that we're getting
00:33:40so um it means probably just have to proceed and get it out as quick as possible
00:33:47yeah
00:33:47can you give us some retraction again
00:33:51it's squirming
00:33:55come on come on you bastard
00:33:57let me get behind you
00:34:01oh my god
00:34:02oh yes
00:34:03there we go there
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
00:34:13that's better we'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 which i'm
00:34:31cauterizing now
00:34:38i think we're nearly there now
00:34:40here it is here's the tumour
00:34:43just gotten 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
00:35:01so it's now just a matter of sorting out all the leftover bleeding and hopefully finishing
00:35:12give her a nice closure
00:35:16just removing all of her monitoring
00:35:18cleaning her up
00:35:19making sure that essentially she's able to wake up comfortably and safely
00:35:36right now i feel i've done my my job for the best of my ability but
00:35:40what's going through our mind now is you know whether or not we've done any serious damage
00:35:43for the patient
00:35:46but you never know you just simply do not know until they wake up
00:36:06i'm gonna go and see anna who's one of my patients
00:36:08there's a big massive tumour of her breast which is invading the chest wall
00:36:13this tumour is really growing very fast and actually it has broken already through the skin
00:36:17what we call it the term fungating
00:36:20and this means also that the the the tissues are necrotic and rotten and actually smelling
00:36:27that's why it's it's having a great impact on our life
00:36:31we're going to be planning to remove this tumour quickly and also reconstruct the chest wall
00:36:39uh because if we leave it uh it will be inoperable and actually can kill us
00:36:47hey
00:36:48how are you feeling
00:36:49scared
00:36:50nervous
00:36:51oh yeah
00:36:52i am
00:36:52hmm
00:36:54my breast was getting larger and i was just hiding it
00:36:58so you shut down didn't you
00:37:00i shut down yeah
00:37:01and shut everyone out
00:37:02and i've been yeah i'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 and she's come home from work and she's asked me several times what the smell was
00:37:17she thought i had an infection so she was going to phone the doctors to get this antibiotics
00:37:24in the end i said it's not an infection well it is an infection it's a big infection
00:37:29but i showed her i didn't show her the tumour i showed her my breast and it was just so
00:37:38upsetting
00:37:39and we went to the hospital
00:37:41and she said i'm dying and this big lump appeared
00:37:46when i took her to a and a i said to the receptionist i said my mum has got a
00:37:51lump i said
00:37:52and it's the size of my head like we need to be seen right now
00:37:58it's just not true for six hasn't it
00:38:00yeah it has
00:38:03it's took over my whole life
00:38:06because everything is to think
00:38:08from when you wake up to you go to sleep at night
00:38:11i have a tumour
00:38:18oh god it is scary isn't it
00:38:31so as you can see this is the ct which has been done recently
00:38:36and this is the upper part of the chest you can see the lungs and the heart is there
00:38:41the tumour is starting to appear there big lump there as we're going this is growing up
00:38:47this is over 20 centimetres plus
00:38:50you can see it is protruding through the skin here
00:38:54and it's forming like a mushroom type of you know growth there
00:38:59Anna has had this tumour for four months
00:39:02this area is now infected because it is not covered by skin
00:39:08and it's invading the ribs there
00:39:10this is the rib there this is another rib there
00:39:13and then the muscles in between the ribs all this is in the tumour is invading that
00:39:19and so the plan for the surgery is to try to get this big tumour out in a safe way
00:39:27and also at the same time including a negative margin as much as possible surgical margin around the tumour
00:39:36a surgical margin means that there is no cancer left behind
00:39:40this very rare tumour has a very high instance of recurrence coming back if we do not get a surgical
00:39:49margin
00:39:49the risks involves bleeding, surgical site infection, problems with infection in the chest
00:39:56we call it pneumonia that could end up by respiratory failure which means she cannot breathe
00:40:02she has a big battle ahead of her
00:40:05we are racing again it's time
00:40:08hi, good luck
00:40:10don't, what was that?
00:40:12good luck
00:40:14love you
00:40:15love you
00:40:16hi Jan
00:40:20I think she was really scared, she was really scared and that's why she's hid it
00:40:26I've been thinking, well, what did I miss?
00:40:29where was the point that I should have picked up on this and there wasn't?
00:40:33hello
00:40:34hello, Anna
00:40:36nice to meet you, my name is Hannah, I'm your big support worker, I'll be taking you down to surgery
00:40:41I'll be with you throughout the whole surgery
00:40:43so if you feel nervous or anything, you've got my hand to squeeze
00:40:48mum's really, really strong
00:40:51mum's trying to stay in the most positive frame of mind for her
00:40:55because I just think she needs people around her that are saying, it's going to be fine and we are
00:41:00going to get through there
00:41:02we'll get rid of that
00:41:13you don't have any questions, Hannah? I don't, no
00:41:16everything's clean for you? It's nice
00:41:18okay, and hopefully everything goes okay and that you behave yourselves
00:41:23I will behave yourself, I promise to God
00:41:28okay, let's see what they need to do so they'll come back, okay?
00:41:30okay
00:41:40hey
00:41:40morning, my name is Sam
00:41:43look out
00:41:45I've come to hold your hand
00:41:49relax your hand there, now let us do our magic
00:41:52okay, okay
00:41:53just have to do it
00:41:54okay
00:41:54happy for work, happy for life
00:41:56yeah, just going to fall into the night
00:41:58feel like
00:41:59I'm done
00:42:00the challenge is to make sure that we remove this tumour with a good safety margin
00:42:13and also try to avoid contamination of the surgical field
00:42:19it's a very complex operation
00:42:21she has a very high risk of bleeding, infection, a clot in her leg, which can travel to her lungs
00:42:28but if she doesn't have the surgery, we know there's only one outcome, which is basically the tumour growing
00:42:34and invading all her body and eventually losing her life
00:42:40we have to do the best as a multidisciplinary team for her
00:42:48so, blood pressure?
00:42:50yeah
00:42:50I'm happy
00:42:53this surgery is complex and high risk, so we need two surgeons
00:42:59my throthic colleague, Mr. Calcutt, will be removing the tumour and Anna's affected ribs
00:43:05and then we'll reconstruct Anna's chest wall after 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 because it has opened up
00:43:21and it is smelling and it is going to be infected
00:43:25the things which concern us is this is an infected mass
00:43:29so we have to make sure the surgical field remains sterile
00:43:34if not, the infection can spread to the surrounding tissues
00:43:38can I remove the dressing now, guys?
00:44:05you can see the fungating mass there
00:44:07you can see the fungating mass there
00:44:21it has grown to that size so rapidly that it has just opened up
00:44:27it is all that dead tissue which is contracted
00:44:33there's no breast tissue, all the breast has been replaced by the tumour itself
00:44:38now the tumour is exposed, we really have to work carefully
00:44:41so the infected mass doesn't contaminate any other parts of Anna's body
00:44:54hello, this is the main reception, how can I help?
00:45:03Let's face the bandage
00:45:24The retrieval team are preparing to take the heart off the perfusion machine, the OCS
00:45:29machine.
00:45:31Go for it.
00:45:32Take it off the rig.
00:45:47It's important to implant the heart as quickly as we can because at the moment the heart
00:45:53is not getting a blood supply to it.
00:45:56We know that the longer the heart is out of the body, the worse the outcome.
00:46:03And the risk of the patient dying.
00:46:06We want the heart to get the oxygen and the blood and its normal nutrients back to it
00:46:10as quickly as possible.
00:46:12So we just need now to trim things to the right length so we can sew it in.
00:46:16Hold on.
00:46:18Very careful there.
00:46:21OK.
00:46:22Rains.
00:46:22Rains at the back.
00:46:24So one, two, this is three and four.
00:46:30That's right.
00:46:31Can I have a swab please?
00:46:33Water on the blues please?
00:46:43The donor heart is put in place so we're just starting to sew the heart in.
00:46:48We're doing the left atrium and that's what takes all the blood back from the lungs.
00:46:54And then we'll eventually go into the left ventricle, the main pumping chamber of the heart.
00:47:02Right up on your suckers.
00:47:05So we're just joining the inferior vena cava.
00:47:09Force up please.
00:47:11From the artery.
00:47:14So now we've joined all the bits of the heart up and in a moment we're going to let the
00:47:20blood flow back into the heart.
00:47:22So we gradually reduce the flow of blood from the heart lung machine and start to return the blood back
00:47:31to the body.
00:47:33So that's the point at which we see whether the heart starts to beat or not.
00:47:39OK, um, gently run some warm blood into the roof.
00:47:42Gently running some warm blood.
00:47:44Blood only.
00:47:54Gently.
00:47:55That's gross.
00:47:58Still running warm blood, yeah.
00:47:59How much did you give him?
00:48:00About 600.
00:48:07My fear is if the new heart doesn't restart, that 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.
00:48:38I can see it moving.
00:48:40It's slowly starting to contract.
00:48:45PVI at 60, please.
00:48:45And the heart is just gradually starting to be a little bit stronger.
00:48:48Which is a good start.
00:48:59We're completely off the heart lung machine.
00:49:02And Matt's new heart is doing all the work.
00:49:05So at the moment we're just taking out the pipes which are in the heart for the bypass and then
00:49:13close the chest.
00:49:21The heart function is reasonable, but he's needing quite a lot of drugs to keep his blood pressure up.
00:49:36Matt can go back to intensive care unit.
00:49:40Matt can go back to intensive care unit.
00:49:41We're not quite out of the woods yet, so we'll continue observing very closely.
00:49:46But now Matt's got a chance of a new life.
00:50:11I need a bowl with the betadine and the hack towels and the stapler.
00:50:15We are basically trying to isolate the tumour which is infected and opened up to air so that we can
00:50:26work around it and keeping our field of surgery as clean as possible.
00:50:37We need to ensure the infection doesn't spread to other parts of Anna's body.
00:50:49Okay, good, well done.
00:50:54So the next test will be, we will try to remove the whole mass along with the rib cage to
00:51:03which it is attached.
00:51:06It is crucial that we do not leave any tumour cells behind.
00:51:11It is an aggressive tumour that will grow back and Anna's life will be in danger.
00:51:19We are trying to just go around the tumour, try to separate it from the normal area.
00:51:27We will just try to keep it at least about a couple of centimetres all around.
00:51:32So we will like to have as clear a margin as possible.
00:51:39You can see the blood vessels which are supplying the tumour there.
00:51:44There is another big blood vessel there.
00:51:46There is lots of big blood vessels supplying the tumour.
00:51:49Because this tumour needs blood to survive.
00:51:55This tumour is like a parasite feeding on Anna's body.
00:52:00And to remove it, we have to cut through these vessels.
00:52:02But we must be careful so that we don't cause a major bleed, which can actually be deadly.
00:52:09Can we have the ligature for Mr. Calcutt?
00:52:14So we are just going to secure this blood vessel.
00:52:18At the moment, I think we are just trying to control the bleeding.
00:52:23Give me ligature, ligature.
00:52:28Yeah, that's perfect.
00:52:35You can see now it's starting to peel off a little bit from the chest wall.
00:52:43Yeah, but you can see the ribs are there.
00:52:46So we were down to the ribs and the chest wall muscle.
00:52:51We are just about to take the whole tumour out, along with the two ribs.
00:52:58So this is all coming out as one big mass.
00:53:04There it is.
00:53:28So we have just taken two ribs, so we have taken them out, along with the tumour.
00:53:35This is the tumour there, this is the breast area, and this is the muscles of the chest,
00:53:40and these are the ribs.
00:53:44I'm confident that we have removed the whole tumour, but our worry is that on an anesthesia
00:53:49scan, they looked that there was a shadow on her lung, and we need to make sure and to
00:53:54check if the tumour has spread deeper into her chest or not.
00:54:02So that's the heart.
00:54:07At the moment, we have collapsed the right lung, so she is at the moment being ventilated
00:54:14only on one lung, which is the left one.
00:54:23When the lung is collapsed, as you see, you can basically feel the lung.
00:54:31If there is any shadow or any nodules, you will feel it against your fingers.
00:54:36We are just going to feel it.
00:54:43Is it there?
00:54:58I'm just walking out.
00:55:13I know my lovely operation's all over, you're just waking up, take some nice big breaths
00:55:18for me, oh there we are, nice big breaths for me, nice big breaths in and out, of course
00:55:26mate, of course, it's all over, you have to get nice and wide, still worried, obviously
00:55:39we haven't formally tested our vision, only a fool would be complacent now, well, well
00:55:59Liz, it's so good to see you awake, honestly, it wasn't an easy operation, there was quite
00:56:06a lot of bleeding, but we got it all out, thank you David, not at all, not at all, it's
00:56:12absolutely great, now, what I want to do quickly is just look at your eyes, can you cover one
00:56:17of your eyes, it doesn't matter which, okay, cover it properly, so, if you keep looking
00:56:23at my nose here, keep looking at my nose, can you see my finger there, lovely, you stay still,
00:56:30can you see my finger there, look at my nose, look at my nose, can you see my finger there,
00:56:35just, yeah, there, brilliant, now put that hand down, lovely, can you see my finger there,
00:56:42keep looking at my nose, can you see my finger there, just, yeah, that's really good, it seems
00:56:48you've got a full field of vision, your job is just to rest over the weekend now, I'm very
00:56:54glad how things turned out, thank you David, it's a great relief, yeah, not at all, you take
00:57:01care of yourself now.
00:57:35We are just going to feel it, I have completely looked at and I can't feel any module, so thankfully
00:57:49the tumour hasn't infiltrated into her lungs.
00:57:54And what we have left is a gaping hole in Anna's chest.
00:57:59In this hole, the organs are exposed, the heart, the lungs, all these are vital structures
00:58:07that no human being can live without them, so we need to protect them.
00:58:11If we don't reconstruct this properly, then Anna wouldn't be able to breathe and she would
00:58:17be at risk of a life-threatening infection like sepsis.
00:58:20Okay, let's have the mesh.
00:58:22This is basically a biological mesh, which with various materials they have used to process
00:58:30it, because otherwise your body will react to it.
00:58:35So that's the mesh, which we are going to use to fill the defect.
00:58:49These are the sutures I'm going to use to secure that mesh.
00:58:55So it's all completed, so the defect is gone.
00:59:05Now we're going to start thinking about closure.
00:59:11Before the tumour was removed, I detached the skin and the muscle flap from Anna's back,
00:59:17which I stored in her body.
00:59:19It's still connected to its original blood supply and I will now use it to complete the
00:59:24chest wall reconstruction.
00:59:29Okay, now can we have the alice, two alices?
00:59:36And this is the flap that's been fished there.
00:59:41Okay, so we're just checking if we can close this.
00:59:45This is the maximum amount of skin that we could have taken from the back, but if it's
00:59:50not big enough, we may need to do an entirely new skin graft.
00:59:55Give me the stapler.
00:59:57All right, look, it's going to stay right there.
00:59:59See?
01:00:05It's a measure of flow.
01:00:08Okay.
01:00:09I don't think we require a skin graft.
01:00:13This is a flap which is sitting nicely, hopefully, in this position.
01:00:19We need to test the original blood supply to the flap to check if it's still flowing or
01:00:24not, because if it's not, the tissue could die.
01:00:35What is the so-called
01:00:37protocol?
01:00:37Okay.
01:00:48I'll see you next week.
01:00:48I'm going to take it.
01:00:50I'll see you next week.
01:00:51I can see you next week.
01:00:53I'm running around the window.
01:00:54I'm gonna try.
01:00:54It's gonna be done.
01:00:55You can already be done.
01:00:56I'm looking at a sort of bomb.
01:00:56I'm looking at a lot of people.
01:00:57I'm gonna check the blood vessels. Can we have a Doppler? Basically it's like an
01:01:02instrument that we use to measure the flow of the blood. I need to hear the
01:01:09steady pulse which means the blood is flowing into the blood vessel.
01:01:30Yeah, it's good news. The flow in the blood vessel is good. We are looking good.
01:01:39We're looking good. We're now closing the skin. It seems that someone up there is
01:01:43taking care of us.
01:01:47It wasn't quite as planned today. I'm pleased with Ana. She's behaved herself as
01:01:55she promised before the surgery. I think she's going to be quite very emotional
01:02:00when she wakes up and sees that this has gone.
01:02:09It's gone. It's all gone. You did behave yourself. You did, yes.
01:02:18But you feel lighter.
01:02:24I'm not sure you'll get your Chinese tonight, but hopefully you'll get it tomorrow.
01:02:37Hoping that the flap continues to work and Ana recovers with her chest wall functions.
01:02:46We will be monitoring the flap. We will be monitoring her vital signs. Anything can happen at any point.
01:03:04Hello. Hi, Matt. Hi. How are you?
01:03:06Oh, very well, thank you, yeah. Good. Yeah, thanks to you.
01:03:09Good to see you. And you, yeah. Good to see you. So, just over two weeks now.
01:03:13Yep. How are you feeling? I'm feeling pretty good, all things considered. Good.
01:03:17Yeah, building up my strength back up. And when you're back on the bike?
01:03:21Uh, well, how long is a piece of string? Let's see. But not just yet, but yeah, I'd like to.
01:03:28You were fit beforehand. Yeah, that's it.
01:03:29And so those are all good things for you. Yeah, no.
01:03:32It's getting you back to that. Yeah, that's it. That's it.
01:03:35And we'll hold you to getting you back on the bike.
01:03:38It's amazing. Thank you. It's not enough, really. But it's incredible.
01:03:41So, yeah, I feel very blessed. So, thank you. Good. Cheers, Matt. Thanks very much.
01:03:48Great to speak to you. Thank you.
01:03:57I think life after this, Matt, will be different. I think you'll have a different outlook on life
01:04:01and you'll want to grasp life with both hands.
01:04:06It's given me an appreciation as well for what medical science can do as well,
01:04:09because here I am, you know, with a new chance ahead, a second chance.
01:04:15And, you know, I've already got some big plans. And, yeah, just looking forward to it.
01:04:35Hello. Hello. How are you?
01:04:37How are you? How are you doing?
01:04:40You know, I feel so much better today.
01:04:43I think I would like to just check quickly what's happening.
01:04:48I'm just going to open this. That looks absolutely fine.
01:04:55Listen, you're going to be free like an eagle now, all right?
01:04:59I want to back my Chinese.
01:05:01Yeah. So, all this is out of the way now.
01:05:06Thank you so much. God bless.
01:05:09Take care of yourself. Take care of yourself.
01:05:11Thank you. Take care.
01:05:11Keep on bathing. Keep on bathing.
01:05:14Thank you, young men.
01:05:16Oh, I wish I'm younger. I'm getting older now.
01:05:18I wish I could see you.
01:05:22Anna's doing really great. I'm really pleased to remove the dressings today.
01:05:26And the ones looks perfectly fine. There's no signs of any infection.
01:05:31She's going to be able to go back to her normal daily activities, normal social life.
01:05:40And I believe that this has dramatically improved her quality of life.
01:05:45And she can gain back the control on her life again.
01:05:52I'll probably think it for the rest of my life now, how did they get rid of that?
01:05:58It was like a miracle.
01:06:02And it was a miracle they've done on me.
01:06:18If I got a significant bleed, there is a chance of death, stroke and blindness.
01:06:28He's a big monster.
01:06:30I didn't think it was going to be this bad. It's a nightmare.
01:06:38Not only can the patient bleed to death, if it's injured, it can cause stroke.
01:06:46New Surgeons, A Matter of Life or Death is back next Wednesday at 9.
01:06:51If you or someone you know has been affected by any of the issues raised in this program,
01:06:55please go to channel5.com slash helplines for information and support.
01:07:00New tomorrow at 9, Ben Fogel's headed to a remote spot in Uganda,
01:07:03where Alison's lived off-grid for 30 years in New Lives in the Wild.
01:07:08Next, new Ambulance Code Red.
01:07:10I've been squared.
01:07:11I'll see you again.
01:07:12Bye.
01:07:12Mary Polder
01:07:12Bye.
01:07:12Now I see you.
01:07:12If you're ready to go, questions.
01:07:13I'll see you again.
01:07:13Bye.
01:07:13You
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