Robotic Surgery Pioneer: Watanabe Go – FRONTRUNNERS
[Music] at the leading edge of heart surgery advanced robots are used to facilitate complex procedures Dr Martnav is probably one of the pioneering individuals in the field of minimally invasive surgery and robotic surgery My doctor in this is perfect It’s unbelievable And she wanted to see my scar and everything Dr Watanabo is a globally respected pioneer of robot assisted heart surgery In 2014 he opened his own medical institute in Tokyo where he leads a team of 21 fellow doctors And for colleagues he has some strict demands Dr Watanabe’s heart surgeries see him operating a leading edge surgical robot from a booth in the corner of the theater Each intervention is a matter of life and death with zero room for error For heart surgery the norm is open heart procedures which involve cutting through the sternum to gain access to the chest cavity [Music] And while the wide aperture allows surgeons to quickly respond to sudden developments it also results in heavy bleeding and long recovery times A large incision lets you see everything but it also leaves a big scar And bones take time to heal like a fracture 8 weeks or more That whole time until the bone refuses it’s just pinned in place It takes around two months for the bone to heal fully and until then you have to really limit physical activity In contrast Watanab’s minimally invasive approach requires only three 1 cm holes between the patients ribs These provide the entry points for a scalpel forceps and camera leaving patients ready for discharge as little as a week after surgery The smaller each wound is the quicker the healing process It’s less painful too and with less bleeding But despite all these benefits it’s a very difficult technique In fact Watanabe conducts more robot assisted heart surgeries each year than any physician in the world A typical day sees him handle two operations including many patients from overseas Please show me the surgical scar One such patient is Jumabai Bakenov a college professor from Kazakhstan who underwent a procedure with Watanab 4 months ago Very nice very beautiful artificial ring And just a week later he was out of hospital and back at work Good data and echo cardiogram So no regard and good my doctor in this is perfect It’s unbelievable Yeah And then she wanted to I I told her that it’s Dainci in Japan in Vatana and she wanted to see my scar and everything Now I feel the result So result is good So I’m very happy and I’m thankful to Dr Watanab In Tinki Prefecture north of Tokyo we meet another patient scheduled for surgery with Watanab 65year-old Nishino Takuya Last year he was diagnosed by a local hospital with a heart condition named mitro valve regurgitation I developed a cough and I get so tired that I just can’t walk anywhere without stopping to rest That’s why I decided to get checked out In most cases mital valve regurgitation goes undiagnosed until it’s reached an advanced stage This was also the case for Nishino who was advised to undergo open heart surgery Thinking about the long recovery time and so on did make me uneasy Once a keen mountain climber Nishino worried that open heart surgery would leave him unable to ever return to his previous levels of physical activity It was then that he heard about Watanab’s minimally invasive approach and left an inquiry via the institute’s website In less than an hour I got a reply from Dr Watanabe himself I was astonished Here is the actual response from Watanabe In the absence of other heart issues there’s no need for open heart surgery If you can come here in person I will examine you myself And we were able to tag along for this initial consultation An echo cardiogram is used to check Nishino’s heart circulation Nishino’s condition involves incomplete closure of a heart valve enabling backflow of blood between chambers [Music] The main cause of mital valve regurgitation is tearing or stretching of the cordday tendin fibers that drive the expansion and contraction of the valve Watanab plans to use sutures to reinforce the loose fibers [Music] Watanabe’s Institute actually takes the rare step of disclosing historical figures on the number and type of procedures conducted including mortality data And while deaths are unfortunately a reality the 30-day post-operative mortality rate for non-emergency surgery stands at just 0.37% The reason for this low mortality is thorough preparation and planning [Music] Watanab’s team leaves no stone unturned in their efforts to identify any potential risks in advance [Applause] [Music] even seemingly unrelated symptoms require careful attention Perhaps I am a bit more neurotic than most other surgeons I have to have multiple safety nets constantly pondering all eventualities to make sure I have a plan B in case anything happens I’m not the kind of person who can just coast through things but perhaps that’s what brought me this far The day of Nishino’s operation arrives Every morning Watanabe has a key pre-surgery routine [Music] A firm handshake is Watanab’s way of checking if the patient has the strength to get through the op A short while later in the operating theater and Watanab’s colleagues are prepping for the robot assisted surgery When all is ready Watanab 2 heads inside [Music] He begins with another look at the mitro valve [Music] The first step is to clamp the aorta to cut off systemic circulation This stops the heart beating reducing the patient’s pulse to zero But prolonged clamping increases stress on the patient They have to work quickly Watanab begins with sutures around the fibers controlling the leaky valve [Music] He adjusts these to make sure the valve can close properly But when working with structures little more than half a millimeter in thickness the slightest mistake could necessitate full open heart surgery Patients place their trust in us as medical professionals I have to become one with the machine and do everything I can to heal them For most surgeons this sort of valve repair would take over 90 minutes But not for Dr Watanab After just 46 minutes he gives the order to unclamp Nishino’s aorta A before and after comparison demonstrates the lack of leakage back through the valve 5 hours later and word arrives that Nishino has come round from his anesthetic All right All right [Music] just 2 days after the operation and Nishino’s already walking with assistance The longer a patient is bedbound the longer recovery takes Blood loss is another factor and how soon they start eating We call it the fast track If they’re up on their feet early they’ll live longer too [Music] It’s lunchtime But with the next operation coming up there’s little time to rest In America they have these like tea trolleys for the surgical staff Whenever you feel like it you can just go over and grab what you want from these jars and just eat it right there like a buffet That’s great when you’re so busy [Music] Ever since graduating from med school at the age of 25 Watanab’s mission has been to reduce strain on patients I just found myself thinking why the need for such big incisions From my first year at college I wondered why we had to go in through the middle of their chest At 30 he went on secondment to a leading cardiovascular hospital in Germany honing his craft by participating in some 700 operations per year And once back in Japan he placed his focus on minimally invasive techniques In 1999 he successfully used an endoscope to complete a coronary bypass without stopping the patient’s heart But medical associations still frowned at such practices which they saw as risky I was seen as abnormal for pursuing new approaches An oddball But around the world people are constantly testing out new ideas and it’s our role to take those and build upon them to drive further progress Despite the doubters Watanabe continued his pursuit of minimally invasive techniques [Music] And in the course of his research he discovered that a US team had developed a surgical robot that enabled keyhole surgeries via remote control [Music] It was a revelation capable of such intricate procedures I had to have one At the time the device was primarily used in gastrointestinal surgery but in 2005 Watanabe used it for the first of many hot procedures in Japan In 2018 Japan extended health insurance coverage to selected robot assisted heart surgeries putting minimally invasive treatment within reach of the general public But Watanab’s efforts are driven by the memory of one patient in particular He had advanced valvular heart disease but he was just 17 still just a child I told him I’d operate when he was stronger but his condition never improved It just kept getting worse and in the end I couldn’t operate Ultimately the boy was transferred to Osaka for a heart transplant That’s when he asked me “Sensei aren’t you going to operate?” In the end we transferred him And the very next day he passed in Osaka It was just such a shock He’d come to us for an operation nobody else could do placing all his trust in us So when he asked why I wouldn’t operate I just felt so powerless I resolved that next time a child came to me with the same condition I had to operate no matter what You have to do every procedure in the knowledge that this could be your patient’s last chance [Music] Back in Toigi Prefecture it’s now 2 months since Nishino Takuya’s operation Fore foreign foreign today Watanabe welcomes another new patient 82-year-old year-old Hamaguchi Kaio [Music] Last year at a routine checkup she was told that a long-standing heart issue had deteriorated Hamaguchi’s condition is known as aortic stenosis an affliction of the valve that carries blood out of the heart Calcification prevents the valve from opening properly causing reduced circulation and even backflow It’s a condition that is becoming more common as Japan’s population ages The solution is a valve transplant but yet again Hamaguchi’s local clinic proposed open heart surgery Having heard from daughter Yoko about the benefits of keyhole surgery Hamaguchi decided to have the procedure done at Watanab’s Institute But operating on the thinner arteries of seniors presents both a challenge and a serious risk Watanab and his team discuss the correct approach Everything up to the removal of the calcified aortic valve will be done with robotic assistance But after the insertion of the new sutureus prosthetic valve they decide to stitch the aorta back up by hand Hamaguchi’s surgery gets underway Watanabe creates an access point between the aorta and the pulmonary artery However [Music] Hamaguchi’s fragile blood vessels seem to have ruptured [Music] [Music] Watanab acts quickly to clear the blood from the target area [Music] But these are nervy moments Watanab cuts out the calcified valve Concentration is vital as leaving even a fragment behind could result in complications including a stroke Watanab affixes a number of guide sutures along which to slide the prosthetic valve into place The robotic part of the procedure complete They insert the new valve and restitch the aorta by hand But they’re already running behind schedule down to the wire The goal is to minimize strain on the patient Today was a tough one Everyone’s trying hard and doing a good job but sometimes you still need to hurry things up That’s surgery for you But even after such a tough operation Hamaguchi is ready for home just nine days later [Music] So what is it that continues to motivate Dr Wata Nabago as a frontr runner in the field of minimally invasive surgery the smaller the wound the less blood lost and the sooner people can return to their daily lives even to work That’s why this approach is important because patients have a life to live after their heart has been repaired So our role is to keep on aiming for even gentler surgical approaches that place even less strain on the patient That’s our job
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A leading heart surgeon uses robot-assisted techniques to perform less invasive procedures that result in quicker recovery times for patients.