0:00:02 > 0:00:05This programme contains some strong language.
0:00:05 > 0:00:08Every year, some three million major operations
0:00:08 > 0:00:11are carried out in the UK.
0:00:11 > 0:00:12Theatre doors are just here.
0:00:13 > 0:00:17But few of us will know what really happens once we're put to sleep.
0:00:17 > 0:00:20All right, all you've got to do now is think beautiful thoughts.
0:00:20 > 0:00:23I don't think a patient can even comprehend what you're doing
0:00:23 > 0:00:26in theatre to them. And that's what the plan is,
0:00:26 > 0:00:28that they don't know what they've been through.
0:00:28 > 0:00:30This series goes behind the theatre doors
0:00:30 > 0:00:34of the Queen Elizabeth Hospital in Birmingham...
0:00:34 > 0:00:35Let's get cracking, then.
0:00:35 > 0:00:36Right, okey-dokes.
0:00:36 > 0:00:38..where, for the first time,
0:00:38 > 0:00:40cameras have been allowed to join
0:00:40 > 0:00:42some of Britain's top surgeons
0:00:42 > 0:00:45during their most high-stakes operations.
0:00:45 > 0:00:46- Shall we go for it?- We'll go for it.
0:00:46 > 0:00:49Using new technology and pioneering skills,
0:00:49 > 0:00:52they're treating conditions that used to kill.
0:00:52 > 0:00:54We continue to push the boundaries,
0:00:54 > 0:00:57continue to take the inoperable and make it operable.
0:00:57 > 0:01:00This is surgery at its most experimental.
0:01:00 > 0:01:02This is where I've got to get it right.
0:01:02 > 0:01:05People didn't attempt this surgery a few years ago cos it was just
0:01:05 > 0:01:08perceived as being too big, too difficult and too scary.
0:01:08 > 0:01:12But pushing the human body to its limits comes with great risk...
0:01:12 > 0:01:14Keep it together, keep it together, keep it together.
0:01:14 > 0:01:17..for the patients AND the surgeons.
0:01:17 > 0:01:22An operation will go wrong for a 30-second lapse of concentration.
0:01:22 > 0:01:24Please work, because if it doesn't, I'm going to cry.
0:01:24 > 0:01:26Things worry you. You get very worried.
0:01:26 > 0:01:28This is going in completely the wrong direction.
0:01:28 > 0:01:31The trick is to not appear to be worried.
0:01:31 > 0:01:34They need to be top of their game every time.
0:01:34 > 0:01:37People often characterise surgeons as bombastic and arrogant.
0:01:37 > 0:01:39Babcock, please, long one, to me.
0:01:39 > 0:01:41Slap it in, sweetheart.
0:01:41 > 0:01:43You got to be dedicated to it. You've got to love it.
0:01:43 > 0:01:46- Oh, my God!- Jesus Christ.
0:01:46 > 0:01:48You're only as good as your last result.
0:01:48 > 0:01:50- BLEEP- hell!
0:01:50 > 0:01:54This is what it takes to operate at the cutting edge of medicine.
0:01:54 > 0:01:57You have to be jolly careful that you don't bugger it up.
0:01:57 > 0:01:59It's do or die, really.
0:02:15 > 0:02:206am on Thursday. In Birmingham's Queen Elizabeth Hospital,
0:02:20 > 0:02:24the surgical department is preparing for 108 patients.
0:02:26 > 0:02:29Most operations will be straightforward, textbook cases.
0:02:31 > 0:02:34But sometimes, surgeons take on
0:02:34 > 0:02:36procedures so complex and unpredictable,
0:02:36 > 0:02:39they'll only know the extent of the challenge they face
0:02:39 > 0:02:41once they begin operating.
0:02:42 > 0:02:45Planning for the unexpected can be difficult,
0:02:45 > 0:02:47although it do spend a lot of time beforehand
0:02:47 > 0:02:50running through the CT scans again and again.
0:02:50 > 0:02:54However, the CT will only give us so much information and sometimes,
0:02:54 > 0:02:56we do have to think on our feet.
0:02:58 > 0:03:02Surgeons Professor David Gourevitch and consultant Sam Ford
0:03:02 > 0:03:05head up one of the only units in the country
0:03:05 > 0:03:08specialising in treating sarcomas -
0:03:08 > 0:03:12rare, cancerous tumours that can grow to huge sizes.
0:03:12 > 0:03:15Sarcomas can be very difficult to remove.
0:03:15 > 0:03:19They tend to grow behind all the major structures
0:03:19 > 0:03:20in the abdomen and pelvis.
0:03:20 > 0:03:22- There it is. - There it is, going across there.
0:03:22 > 0:03:24Yeah. So, it comes right around here?
0:03:24 > 0:03:27Yes. This is already something more aggressive.
0:03:27 > 0:03:30- It's quite a business. - It's going to be really treacherous.
0:03:30 > 0:03:34It's the sort of last bastion of big surgery.
0:03:34 > 0:03:36I think what makes it interesting
0:03:36 > 0:03:39is the fact that the unexpected is more common.
0:03:39 > 0:03:41That's what keeps us on our toes.
0:03:42 > 0:03:46Today's patient will be one of their most challenging surgeries to date.
0:03:48 > 0:03:52Five months ago, 71-year-old Jasmine Harkness
0:03:52 > 0:03:54noticed a swelling in her stomach.
0:03:54 > 0:03:58I'd been to my sister's and I felt sort of bloated.
0:03:58 > 0:04:00And I noticed I was getting thinner,
0:04:00 > 0:04:03as well, in the face.
0:04:03 > 0:04:06And I thought, there's something not quite right.
0:04:06 > 0:04:10Within just a few months, the growth has filled her entire abdomen,
0:04:10 > 0:04:13from her ribs down to her pelvis.
0:04:13 > 0:04:16I've had three scans
0:04:16 > 0:04:19and they showed a picture of it on the screen.
0:04:21 > 0:04:25I thought, how could one person have something like that?
0:04:25 > 0:04:26You know...
0:04:27 > 0:04:30You've seen the Alien films, have you?!
0:04:33 > 0:04:35The sarcoma is now so large,
0:04:35 > 0:04:37it's crushing her liver, kidneys and stomach,
0:04:37 > 0:04:40making even eating difficult.
0:04:40 > 0:04:44Left untreated, Jasmine will die within four weeks.
0:04:44 > 0:04:48You look at yourself in the mirror and you could see, you know,
0:04:48 > 0:04:51sort of your cheekbones and things like that.
0:04:51 > 0:04:54You wouldn't think over just a few months
0:04:54 > 0:04:56you'd lose such a lot of weight.
0:05:00 > 0:05:03The surgeons won't know if it's even possible to remove
0:05:03 > 0:05:05until they're in theatre.
0:05:05 > 0:05:08What do you think? Do you think it's a...a goer?
0:05:08 > 0:05:11There's not enough about it to...
0:05:12 > 0:05:15..to stop an operation.
0:05:15 > 0:05:18I think we're going to have to see how it goes.
0:05:18 > 0:05:19I think this is going to be very difficult.
0:05:22 > 0:05:25Jasmine appears extremely frail.
0:05:25 > 0:05:29However, she's frail because she's carrying around a very large tumour
0:05:29 > 0:05:31that's slowly consuming her.
0:05:31 > 0:05:34It represents a third of her body weight.
0:05:34 > 0:05:38Five years ago, we probably wouldn't have taken her case on.
0:05:38 > 0:05:39Lovely to see you again.
0:05:39 > 0:05:43- Good to see you. - How are you?- Not too bad.
0:05:43 > 0:05:45Have you got any questions about the operation?
0:05:45 > 0:05:47Well...
0:05:47 > 0:05:49- How long will it last? - It's difficult to say at the moment.
0:05:49 > 0:05:52Do you remember we were talking about this being
0:05:52 > 0:05:53quite a big operation?
0:05:53 > 0:05:55And it might just take a little bit of time
0:05:55 > 0:05:57for us to get the tumour out...
0:05:57 > 0:05:59- Yes.- ..in entirety.
0:06:00 > 0:06:04The decision to go ahead with the operation is not straightforward.
0:06:04 > 0:06:05At all.
0:06:06 > 0:06:09Jasmine understands that without surgery,
0:06:09 > 0:06:12she will certainly die.
0:06:12 > 0:06:15But there is a possibility that once the abdomen is open,
0:06:15 > 0:06:17we can't remove the tumour.
0:06:17 > 0:06:21We'll only know if it's actually possible once we're operating.
0:06:21 > 0:06:23It's a significant responsibility.
0:06:25 > 0:06:27Come on in, everybody.
0:06:29 > 0:06:32I'm obviously a bit apprehensive,
0:06:32 > 0:06:34cos it's a big operation.
0:06:36 > 0:06:38I've never had a big operation before.
0:06:42 > 0:06:45But it's either have it done,
0:06:45 > 0:06:47or that's it.
0:06:50 > 0:06:52- Right, let's go.- Righto.
0:06:56 > 0:06:59Because it's an operation with so many unknowns,
0:06:59 > 0:07:04Sam has called upon David to support him during this complicated surgery.
0:07:04 > 0:07:07I'm just the old man of the department, really.
0:07:07 > 0:07:11And as such, when there are difficult patients
0:07:11 > 0:07:13or cases to be done,
0:07:13 > 0:07:16I'm often asked to come and give a hand.
0:07:17 > 0:07:20There has to be a captain. He's the captain,
0:07:20 > 0:07:23and I will be his number two, his wingman.
0:07:24 > 0:07:27This is obviously an operation at one extreme
0:07:27 > 0:07:29because of the size of the tumour.
0:07:29 > 0:07:33So we are aware of the possibility of the unexpected.
0:07:35 > 0:07:38Guys, just until she's asleep, just keep the noise down.
0:07:38 > 0:07:40OK? Thanks.
0:07:40 > 0:07:42No problem.
0:07:42 > 0:07:44That's you, you're checked in.
0:07:44 > 0:07:45That's your boarding pass.
0:07:45 > 0:07:49Sue Sinclair is lead anaesthetist.
0:07:49 > 0:07:50You're going to start feeling
0:07:50 > 0:07:53- a little bit light-headed, darling, OK?- Yeah.
0:07:53 > 0:07:56All right? All you've got to do now is think beautiful thoughts.
0:07:56 > 0:07:59There's a lot of sort of traditional argy-bargy between surgeons
0:07:59 > 0:08:03and anaesthetists. Anaesthetists are very...well balanced.
0:08:03 > 0:08:04We've got chips on both shoulders
0:08:04 > 0:08:07because no-one thinks we're as important as the surgeons.
0:08:07 > 0:08:11Sue is the matriarch of the anaesthetic department.
0:08:11 > 0:08:13Without her, it'd be very difficult
0:08:13 > 0:08:15to undertake an operation of this size.
0:08:15 > 0:08:17Go on, you hold my hand. That's lovely.
0:08:17 > 0:08:19Can you open your eyes for us, Jasmine?
0:08:19 > 0:08:20There's a good girl.
0:08:20 > 0:08:21OK, we're in business.
0:08:22 > 0:08:25When you're anaesthetised, you're defenceless,
0:08:25 > 0:08:27you can't do anything for yourself.
0:08:27 > 0:08:29You can't even blink.
0:08:29 > 0:08:30You can't breathe.
0:08:30 > 0:08:33Our real job is keeping her alive.
0:08:34 > 0:08:37Now Jasmine is asleep, it will take another hour
0:08:37 > 0:08:39to prep her for surgery -
0:08:39 > 0:08:42five times longer than more straightforward procedures.
0:08:42 > 0:08:46Now, very, very gently, chaps.
0:08:47 > 0:08:50Sue and her team insert a seven-channelled catheter
0:08:50 > 0:08:52into Jasmine's jugular vein
0:08:52 > 0:08:55to monitor her vital signs.
0:08:55 > 0:08:56She's so fragile.
0:08:56 > 0:08:58Poor love.
0:08:59 > 0:09:02Mrs Harkness is a very frail girl.
0:09:02 > 0:09:05There are surgical risks to her and there are anaesthetic risks that she
0:09:05 > 0:09:09just, her circulation just will not withstand this scale of surgery.
0:09:09 > 0:09:12That's it. Beautiful.
0:09:12 > 0:09:17Some people would find that that was maybe a risk too big to take.
0:09:17 > 0:09:20But the alternative is that she will die.
0:09:20 > 0:09:24OK, guys, I think we're good to go, aren't we?
0:09:24 > 0:09:26- You bring her, I'll take the drugs? - Yeah.
0:09:27 > 0:09:30- You've still not seen her, have you? - Yeah, I've seen her.
0:09:30 > 0:09:33- Yeah.- Gosh, you've made us work for it.
0:09:33 > 0:09:3713 experienced clinicians are needed for Jasmine's operation.
0:09:39 > 0:09:43Sam and David lead another two surgeons.
0:09:44 > 0:09:48Sue leads a team of two anaesthetists and two assistants.
0:09:48 > 0:09:50And another five specialist nurses
0:09:50 > 0:09:53oversee the surgical equipment.
0:09:53 > 0:09:55I think we're ready to start. Are you ready to start?
0:09:55 > 0:09:57Is everybody we need in the room?
0:09:57 > 0:09:58- Yep.- Yes.
0:09:58 > 0:10:01- OK.- What are you doing for this lady today?
0:10:01 > 0:10:04We are going to excise this massive liposarcoma
0:10:04 > 0:10:07from her retro peritoneum on the right.
0:10:07 > 0:10:10Fantastic. Expected blood loss?
0:10:10 > 0:10:11Difficult to say.
0:10:11 > 0:10:13There will be some blood loss.
0:10:13 > 0:10:15- OK.- And she's cross-matched for ten units, I think.
0:10:15 > 0:10:17Are there any issues of concern?
0:10:17 > 0:10:21Plenty of surgical concerns, mainly due to size and access.
0:10:21 > 0:10:23Yeah. Expected duration of surgery?
0:10:23 > 0:10:24As long as it takes.
0:10:26 > 0:10:28- That's it. Time-out over.- Great.
0:10:28 > 0:10:31- Thanks very much.- Thank you.- Can we have the operating lights on?
0:10:31 > 0:10:32Light angle, please.
0:10:35 > 0:10:38- And we're ready to go?- Yeah. - Sue, are you OK to start?- Yeah.
0:10:38 > 0:10:40- Off you go, boys. Have a good one. - Geronimo.
0:10:44 > 0:10:46Despite weeks of planning,
0:10:46 > 0:10:49it's only now the team will see for themselves
0:10:49 > 0:10:51exactly what they're up against.
0:10:55 > 0:10:58So the tumour is just coming into view now.
0:10:58 > 0:11:02This large, white structure that trusty Gourevitch has his hand on.
0:11:06 > 0:11:07Can I have the scissors, please?
0:11:12 > 0:11:13Oh, my God!
0:11:15 > 0:11:17It's a big bastard.
0:11:17 > 0:11:21When we opened the abdomen for the first time, and we get first sight
0:11:21 > 0:11:24of the enemy and appreciate its sheer size,
0:11:24 > 0:11:26we always look at each other in amazement.
0:11:26 > 0:11:29Just to say, "What have we got ourselves into here?
0:11:29 > 0:11:31"And how are we going to get this out?"
0:11:31 > 0:11:33- Wow.- Shit.
0:11:42 > 0:11:44Right, let's open it. Let's open it out.
0:11:44 > 0:11:47Keep going, Max. We need all the space we can get here.
0:11:47 > 0:11:48Forceps, please.
0:11:50 > 0:11:52I tell you what, this tumour is bloody heavy.
0:11:52 > 0:11:55- THEY LAUGH - We've only just started!
0:11:55 > 0:11:57Have you not been to the gym recently?
0:11:57 > 0:12:00- I don't need to go to the gym!- Look at him, he's like a honed athlete.
0:12:00 > 0:12:02- Look!- I don't need to go to the bloody gym!
0:12:02 > 0:12:04Did you have your Weetabix this morning?
0:12:04 > 0:12:07I had three, yes. It doesn't seem to have helped. There we go.
0:12:07 > 0:12:09- Let's go wide, darling.- I know.
0:12:09 > 0:12:11Into the chest nicely.
0:12:11 > 0:12:15- This bit is going to be... - It's going to be an absolute pig.
0:12:15 > 0:12:18Jasmine's tumour needs to be removed completely intact
0:12:18 > 0:12:20if it's not to return.
0:12:20 > 0:12:22Difficult access here.
0:12:22 > 0:12:27Just a few cells left behind could cause the cancer to regrow.
0:12:27 > 0:12:29Bloody hell, it goes on for miles.
0:12:29 > 0:12:32Right, careful we don't puncture the tumour here.
0:12:32 > 0:12:36You're full of confidence and bravado before you start
0:12:36 > 0:12:39and you open the patient and you feel that slight
0:12:39 > 0:12:41uncomfortable feeling on the back of your neck.
0:12:41 > 0:12:44And your colleague looks at you and you look at him and you think,
0:12:44 > 0:12:46"Have we made a terrible mistake?"
0:12:54 > 0:12:57Most of the 36,000 operations
0:12:57 > 0:13:00performed each year at the Queen Elizabeth Hospital
0:13:00 > 0:13:01are straightforward.
0:13:01 > 0:13:03Like Sam and David,
0:13:03 > 0:13:07consultant urologist Rupesh Bhatt specialises in rare tumours
0:13:07 > 0:13:11that most surgeons wouldn't attempt to remove.
0:13:11 > 0:13:15I take on the things that other surgeons can't do,
0:13:15 > 0:13:17or won't do.
0:13:17 > 0:13:21The unpredictability of these big cases
0:13:21 > 0:13:23really makes me feel quite excited.
0:13:23 > 0:13:25How I'm going to rise to the challenge.
0:13:25 > 0:13:28There's also a bit of anxiety, as well,
0:13:28 > 0:13:30but you learn to control it.
0:13:32 > 0:13:3567-year-old grandfather of four Bob Moran
0:13:35 > 0:13:37has been told by his local hospital
0:13:37 > 0:13:39that his tumour is so advanced,
0:13:39 > 0:13:42there's nothing more they can do for him.
0:13:42 > 0:13:44Open the door, please.
0:13:46 > 0:13:49What do you say when a doctor just tells you that?
0:13:49 > 0:13:52I'd got a tumour. It's a bad one.
0:13:52 > 0:13:56And that's when my world sort of fell out, you know.
0:13:56 > 0:13:59I just... Bombshell hit me.
0:13:59 > 0:14:01You think...is this real?
0:14:01 > 0:14:02Am I dreaming this?
0:14:03 > 0:14:06Bob has a very rare form of cancer.
0:14:06 > 0:14:09His tumour has grown from his left kidney
0:14:09 > 0:14:12into the surrounding blood vessels
0:14:12 > 0:14:14and is making its way up a major vein
0:14:14 > 0:14:17called the inferior vena cava, or IVC.
0:14:18 > 0:14:22A piece could break off at any time and travel into Bob's heart,
0:14:22 > 0:14:24killing him in minutes.
0:14:24 > 0:14:27I'm happy for you to ask any questions as I go along.
0:14:27 > 0:14:29- OK.- So, recapping...
0:14:29 > 0:14:32Only a handful of surgeons in the UK are willing,
0:14:32 > 0:14:35or skilled enough to carry out this operation.
0:14:35 > 0:14:36- I think you know everyone here.- Yes.
0:14:36 > 0:14:38I'm Rupesh Bhatt, the surgeon.
0:14:38 > 0:14:42Surgery to remove a kidney cancer is already a challenge,
0:14:42 > 0:14:44but, in Bob's case,
0:14:44 > 0:14:46that's a whole different ball game.
0:14:46 > 0:14:50The tumour is untreatable by chemo or radiotherapy.
0:14:50 > 0:14:54Two surgical teams will need to remove Bob's left kidney
0:14:54 > 0:14:58and the rest of the tumour that has grown within his IVC.
0:14:59 > 0:15:04The only way they can do this is to stop Bob's heart,
0:15:04 > 0:15:05then drain his blood,
0:15:05 > 0:15:07slice open the vein,
0:15:07 > 0:15:09remove the tumour
0:15:09 > 0:15:11and restart his heart.
0:15:11 > 0:15:16I would do about six of these cases a year.
0:15:16 > 0:15:18That's very rare.
0:15:18 > 0:15:21By the time the patient is coming to see me,
0:15:21 > 0:15:25they really are at the Last Chance Saloon.
0:15:26 > 0:15:27OK, let's go.
0:15:27 > 0:15:30- Everyone is ready for you downstairs.- Right, then, OK.
0:15:30 > 0:15:32So we'll crack on with things.
0:15:32 > 0:15:34- Thank you.- OK.- That's all I want.
0:15:34 > 0:15:35Good. I'll see you down there.
0:15:36 > 0:15:40Urologically, I'm at the edge of what I can do.
0:15:40 > 0:15:44The anaesthetists are doing the same.
0:15:44 > 0:15:47What makes this procedure unique
0:15:47 > 0:15:51is that we are really at the edge of what we can do as surgeons.
0:15:55 > 0:15:57There is no alternative.
0:15:57 > 0:16:00That's the end of it for me.
0:16:00 > 0:16:02The end of everything.
0:16:02 > 0:16:04- They can't start without you.- No.
0:16:05 > 0:16:08So this is the only chance that I've got.
0:16:10 > 0:16:12You put your hand out, you take it.
0:16:14 > 0:16:16One, two, three.
0:16:22 > 0:16:25- OK, let's go.- Thank you.
0:16:26 > 0:16:29It's estimated the operation will take seven hours.
0:16:31 > 0:16:35Rupesh will work with urologist colleague Richard Viney.
0:16:35 > 0:16:37Can you give us a little twirl?
0:16:37 > 0:16:38Thank you very much.
0:16:38 > 0:16:42Cheers. Right, let the magic begin.
0:16:42 > 0:16:44I always enjoy working with Rupesh,
0:16:44 > 0:16:46particularly when it comes to the big cases.
0:16:46 > 0:16:49Because they're few and far between and because they're complex,
0:16:49 > 0:16:51we tend to try and do them together.
0:16:51 > 0:16:54I think it gives the best expertise for the patient
0:16:54 > 0:16:57and he's also very easy to make fun of, which is great!
0:16:57 > 0:16:59Table up a bit, please.
0:17:00 > 0:17:02Oh, I love these.
0:17:02 > 0:17:03- These are like a treat.- Thank you.
0:17:03 > 0:17:05Oh!
0:17:05 > 0:17:08Most surgeons undertaking this kind of surgery
0:17:08 > 0:17:10are slight adrenaline junkies.
0:17:10 > 0:17:12There is an immense sense of build-up
0:17:12 > 0:17:14when you're undertaking this kind of work
0:17:14 > 0:17:17and you'll often see a lot of dark humour.
0:17:17 > 0:17:19This is like what I have to do to my wife
0:17:19 > 0:17:23when she's having her fake tan applied.
0:17:23 > 0:17:27See? Look! I mean, that looks like a week in St Tropez, doesn't it?
0:17:27 > 0:17:30But inside, everyone's heart's pumping away.
0:17:30 > 0:17:32There you go. Done.
0:17:32 > 0:17:35And everyone's sort of very much at the edge.
0:17:35 > 0:17:37- Thank you very much.- Cheers. OK.
0:17:37 > 0:17:39Let's get cracking, then, yeah?
0:17:39 > 0:17:41The challenge for Rupesh
0:17:41 > 0:17:44is the sheer unpredictability of the tumour's growth.
0:17:44 > 0:17:47OK, knife, then, please.
0:17:47 > 0:17:51Until he stops Bob's heart and opens the IVC vein,
0:17:51 > 0:17:54he won't know whether the tumour is loose...
0:17:54 > 0:17:56Watch your fingers, mate.
0:17:56 > 0:17:58..or worst-case scenario,
0:17:58 > 0:18:02stuck to its lining and much more complicated to remove.
0:18:02 > 0:18:05A surgeon has to have strong self-belief.
0:18:06 > 0:18:09Bit of lint on that, please.
0:18:09 > 0:18:12You're operating on somebody who's got a beating heart...
0:18:12 > 0:18:15..and you're opening up their biggest vein.
0:18:17 > 0:18:20It's a very complicated, very stressful operation.
0:18:26 > 0:18:28By 11:30am,
0:18:28 > 0:18:3128 patients are already out of theatre.
0:18:34 > 0:18:36Oh, my God.
0:18:36 > 0:18:37Nice cup of tea or coffee.
0:18:37 > 0:18:40Oh, please. I need big one!
0:18:40 > 0:18:44They've had surgery to repair damaged nerves and stop nosebleeds.
0:18:46 > 0:18:48In Theatre 15, surgeons are only beginning
0:18:48 > 0:18:51to remove Jasmine's tumour.
0:18:52 > 0:18:56What's this down here? Is that peritoneum or tumour?
0:18:56 > 0:18:59It's grown so large, it's displaced much of her anatomy.
0:18:59 > 0:19:03- There.- We think the other ureter is going to be in here somewhere.
0:19:03 > 0:19:06Sam and David won't be able to remove it
0:19:06 > 0:19:08until they establish exactly
0:19:08 > 0:19:10which organs and vessels are where.
0:19:10 > 0:19:12It's probably there, isn't it?
0:19:12 > 0:19:14Let's just work out where we are...
0:19:14 > 0:19:16Cos everything is on its side, isn't it?
0:19:16 > 0:19:19- Shall we take this gall bladder out of the way?- Yeah.
0:19:19 > 0:19:22- Where's her kidney? - Kidney is going to be...
0:19:22 > 0:19:23..in your hand somewhere.
0:19:23 > 0:19:25Oh, fuck. OK.
0:19:25 > 0:19:27- Are you serious?- Well, it's in the tumour, isn't it?
0:19:27 > 0:19:29We would have seen it by now.
0:19:30 > 0:19:32The tumour has grown so much,
0:19:32 > 0:19:35it now extends all the way from Jasmine's diaphragm
0:19:35 > 0:19:37to her pelvis.
0:19:37 > 0:19:39Her liver, intestines, and stomach
0:19:39 > 0:19:41have all been pushed aside,
0:19:41 > 0:19:43and the tumour has swallowed up one of her kidneys.
0:19:45 > 0:19:47How are you going? How are you getting on, boys?
0:19:47 > 0:19:49Just as you said that, we found something.
0:19:49 > 0:19:51It's "spot the organ", isn't it?
0:19:53 > 0:19:55- Jeez, this thing's heavy.- I know,
0:19:55 > 0:19:58it's just the sheer weight of it is...
0:19:58 > 0:20:00As Sam and David navigate through
0:20:00 > 0:20:03Jasmine's radically altered anatomy,
0:20:03 > 0:20:06Sue is constantly monitoring her vital signs,
0:20:06 > 0:20:08from blood pressure and heart rate
0:20:08 > 0:20:11to kidney function and oxygen levels.
0:20:11 > 0:20:13Sue's imperative.
0:20:13 > 0:20:16During the operation, there's potential for massive blood loss.
0:20:16 > 0:20:20There's potential for big swings in the blood pressure from us moving
0:20:20 > 0:20:22the tumour around, so she knows what
0:20:22 > 0:20:25we're going to do so that she can be a step ahead of us.
0:20:25 > 0:20:27There's a small vessel coming out.
0:20:27 > 0:20:29Can you see that?
0:20:29 > 0:20:31Simon, can you come in, please?
0:20:31 > 0:20:33Sue, if you want us to back off, just let us know.
0:20:33 > 0:20:37Um, I've got no return at the moment, guys.
0:20:37 > 0:20:38OK, do what you need to do. We'll just back off.
0:20:38 > 0:20:41Just 20 minutes into the operation,
0:20:41 > 0:20:43Jasmine's blood pressure suddenly drops.
0:20:43 > 0:20:45Her heart rate's the same. 120.
0:20:48 > 0:20:51Very little blood is pumping around her body,
0:20:51 > 0:20:53restricting oxygen to her organs.
0:20:53 > 0:20:56We're not losing any blood. We've got no blood down here.
0:20:56 > 0:20:58Are we tensioning the chest, maybe?
0:20:58 > 0:21:00Couldn't...just take it this way...?
0:21:00 > 0:21:01..OK on the vent...
0:21:03 > 0:21:05No problem with the chest.
0:21:05 > 0:21:08Sue suspects it's the weight of the tumour that's the problem.
0:21:12 > 0:21:14As they roll it around in the abdomen,
0:21:14 > 0:21:17it will press on the major blood vessels,
0:21:17 > 0:21:19going to and from the heart,
0:21:19 > 0:21:23which means that we will have instability with the circulation.
0:21:23 > 0:21:25Quite significant instability.
0:21:25 > 0:21:27- Have you got it there?- Got it.
0:21:29 > 0:21:31It's coming out now. Hold on.
0:21:31 > 0:21:34As they move the tumour again, the blood pressure returns.
0:21:34 > 0:21:37- Hm.- OK.- Very strange. Don't like that.
0:21:37 > 0:21:40I don't think it takes a lot of obstruction.
0:21:41 > 0:21:44It must have been compressing a major blood vessel.
0:21:45 > 0:21:49The trouble is, those blood vessels aren't where they should be.
0:21:49 > 0:21:51Sam and David must now find them.
0:21:52 > 0:21:55We're heading up into tiger country here, aren't we?
0:21:55 > 0:21:57We sometimes use the phrase "tiger country"
0:21:57 > 0:22:00and that really refers to the
0:22:00 > 0:22:03frighteningly large and thin-walled blood vessels.
0:22:03 > 0:22:06I just want to know where this effing IVC is.
0:22:06 > 0:22:09Particular tiger country is around the IVC,
0:22:09 > 0:22:11the inferior vena cava,
0:22:11 > 0:22:12which is a very large vein
0:22:12 > 0:22:15that takes blood back from the legs back up to the heart.
0:22:15 > 0:22:17Normally, it looks blue.
0:22:19 > 0:22:23We should have seen the bastard by now, shouldn't we?
0:22:23 > 0:22:26- You know, I think it's going to be in here.- I think it's that, is it?
0:22:29 > 0:22:30- Is that it?- I don't know.
0:22:30 > 0:22:33- I'm not convinced yet.- I know. I'm not convinced, either.
0:22:34 > 0:22:36There's the cava. Look, there.
0:22:36 > 0:22:38There. Got you. Just there.
0:22:38 > 0:22:40Yeah, it's blue all right, isn't it?
0:22:43 > 0:22:46- I'm happy now we've got a glimpse of big blue, there.- Yeah.
0:22:46 > 0:22:49I'm not so happy that it's going to be...
0:22:49 > 0:22:50an absolute devil.
0:22:50 > 0:22:53The full length of the IVC vein
0:22:53 > 0:22:55is stuck to the tumour.
0:22:55 > 0:22:56To save Jasmine,
0:22:56 > 0:22:58they'll need to detach it meticulously
0:22:58 > 0:23:02without penetrating either the tumour or the vein.
0:23:02 > 0:23:05You can actually see the blood flow, streaming through it.
0:23:05 > 0:23:07It's transparent. It's so thin.
0:23:07 > 0:23:09So it just tears like tissue paper.
0:23:10 > 0:23:12That's the perfect thing.
0:23:12 > 0:23:13Get on top of the cava, isn't it?
0:23:13 > 0:23:17They bleed out very rapidly and much more scarily, probably,
0:23:17 > 0:23:20than any other blood vessel in the body.
0:23:20 > 0:23:23Can we move the light over here, please? Get the light.
0:23:24 > 0:23:26Just wait for it to come in. I can't see shit.
0:23:26 > 0:23:28- It needs to come around a bit more. - Can that come round?
0:23:28 > 0:23:30Absolutely dead still now, James. I know you're not moving,
0:23:30 > 0:23:32but it's just a couple of millimetres
0:23:32 > 0:23:34and the tip of the diatherm is into the cava.
0:23:37 > 0:23:39James, keep still, for Christ's sake.
0:23:46 > 0:23:50You have to be jolly careful that you don't bugger it up, really,
0:23:50 > 0:23:52and that's why you need to operate with a colleague
0:23:52 > 0:23:54on the other side of the table.
0:23:54 > 0:23:57So when I get a bit nervous and uncertain,
0:23:57 > 0:23:59Sam takes over and vice versa.
0:24:00 > 0:24:02Yeah, it's not very nice up here.
0:24:03 > 0:24:04The diathermy, please.
0:24:06 > 0:24:09Professor Gourevitch can be a bit of a handful.
0:24:09 > 0:24:10He's very forthright.
0:24:10 > 0:24:13Quite noisy and opinionated at times,
0:24:13 > 0:24:16but one of the biggest things that he's taught me is that
0:24:16 > 0:24:19you just have to get on with it
0:24:19 > 0:24:21and believe that things will work out.
0:24:24 > 0:24:27This is clearly monumental scale surgery.
0:24:28 > 0:24:30She is one of the few patients
0:24:30 > 0:24:33that you would counsel may die on the table.
0:24:42 > 0:24:45Underneath the operating theatres in the basement
0:24:45 > 0:24:49lies the Molecular Pathology Department.
0:24:50 > 0:24:54All tumours removed from surgery end up down here for investigation.
0:24:56 > 0:24:59The team are expert in analysing cancer cells
0:24:59 > 0:25:01in unprecedented detail.
0:25:02 > 0:25:07Molecular pathology has really been a game changer in certain cancers.
0:25:07 > 0:25:10It means that now, we're able to transform what were otherwise
0:25:10 > 0:25:12potentially untreatable cancers
0:25:12 > 0:25:15into ones that we can control and essentially treat
0:25:15 > 0:25:17like chronic diseases.
0:25:17 > 0:25:21One of the latest innovations in molecular pathology
0:25:21 > 0:25:23is the use of robots.
0:25:23 > 0:25:27So in the past, pathology was very, very labour intensive
0:25:27 > 0:25:31and with labour-intensive procedures done by humans,
0:25:31 > 0:25:33you're increasingly adding in the risk of say,
0:25:33 > 0:25:35for example, contamination,
0:25:35 > 0:25:38which can have really severe effects for patient samples.
0:25:39 > 0:25:43More accurate diagnosis makes for more effective treatment...
0:25:45 > 0:25:47..so the team have also started to use fluorescent dyes
0:25:47 > 0:25:52to detect specific genes in the DNA of tumour samples.
0:25:52 > 0:25:56Each of these blue dots is a cell
0:25:56 > 0:25:57and within those cells,
0:25:57 > 0:26:00you've got green dots and you've got red dots.
0:26:00 > 0:26:03Now normally, you should expect to have two copies of the green
0:26:03 > 0:26:06and two copies of the red, but what you can see here is
0:26:06 > 0:26:08that we've got huge numbers
0:26:08 > 0:26:13of these red dots and that supports a diagnosis of liposarcoma.
0:26:13 > 0:26:15In the past, a lot of these cases
0:26:15 > 0:26:20would just have been diagnosed as being undifferentiated sarcomas
0:26:20 > 0:26:22and those patients would generally just have received
0:26:22 > 0:26:24quite aggressive chemotherapy,
0:26:24 > 0:26:27which brings with it lots and lots of side effects.
0:26:27 > 0:26:30Now, we can pick and choose which patients
0:26:30 > 0:26:32need to have that aggressive chemotherapy
0:26:32 > 0:26:36and which patients could potentially have lighter, more tolerable
0:26:36 > 0:26:38chemotherapy with the same effect.
0:26:39 > 0:26:42Overall, that means that for patients,
0:26:42 > 0:26:44they have an expectation of how
0:26:44 > 0:26:47likely they are to do well or poorly,
0:26:47 > 0:26:51which means that, on a very human level, they can plan their lives.
0:26:59 > 0:27:02Clean swabs like that, please.
0:27:02 > 0:27:04Are you happy with the place?
0:27:04 > 0:27:07- Can it go there?- Mate, you can go wherever you want.
0:27:07 > 0:27:09- You're the boss.- Perfect, thank you.
0:27:09 > 0:27:13In Bob's operation, Rupesh has made a start on the tumour.
0:27:13 > 0:27:15The only way to remove it from the main vein
0:27:15 > 0:27:18will be to stop Bob's heart
0:27:18 > 0:27:22but first, they must remove his kidney, where the cancer started.
0:27:22 > 0:27:24Cut along the dotted line.
0:27:26 > 0:27:28Rupesh and Richard must carefully
0:27:28 > 0:27:32disconnect the many veins and arteries supplying the kidney.
0:27:32 > 0:27:34Ligaclip, please.
0:27:34 > 0:27:36- There you go, my friend. - Thank you, sir.
0:27:36 > 0:27:39This is, so far, quite nice.
0:27:39 > 0:27:41- Shh!- I know, exactly!
0:27:41 > 0:27:44You had to jinx it. You HAD to jinx it!
0:27:45 > 0:27:46I'm always worried about bleeding.
0:27:46 > 0:27:48It's a real threat.
0:27:48 > 0:27:52You need to make sure that every single little blood vessel
0:27:52 > 0:27:54is completely tied off.
0:27:54 > 0:27:56And the liga, please. And the ligaclip.
0:27:58 > 0:28:03Because next step is that Bob is going to be given medications
0:28:03 > 0:28:05to completely thin his blood...
0:28:06 > 0:28:09..so his clotting will not work,
0:28:09 > 0:28:11so if there's a little tiny hole,
0:28:11 > 0:28:12even if it's a millimetre,
0:28:12 > 0:28:15it'll keep bleeding until all the blood is gone.
0:28:19 > 0:28:21Hold on, hold on, hold on, hold on.
0:28:21 > 0:28:23I think I've just caused some bleeding there.
0:28:23 > 0:28:25Sucker, sucker. Where's the sucker?
0:28:25 > 0:28:26Can we have a suction on?
0:28:29 > 0:28:31There it is.
0:28:31 > 0:28:33Naughty little artery.
0:28:34 > 0:28:38It takes Rupesh and Richard two and a half hours of painstaking work
0:28:38 > 0:28:42to seal the blood vessels before they can free the tumour.
0:28:44 > 0:28:45It's coming, it's coming.
0:28:45 > 0:28:47It's coming. There we go.
0:28:47 > 0:28:49- It's come.- It's there.- Done.
0:28:49 > 0:28:51- Ta-dah.- OK? Done.
0:28:51 > 0:28:55The only remaining part of the tumour is inside the IVC,
0:28:55 > 0:28:58the vein leading straight into Bob's heart.
0:28:58 > 0:29:01Good, OK.
0:29:01 > 0:29:03To remove the tumour within it,
0:29:03 > 0:29:06they need the IVC vein to be completely empty of blood.
0:29:08 > 0:29:12This means that all the blood in Bob's body needs to be drained.
0:29:15 > 0:29:17So now would be a good time
0:29:17 > 0:29:20to get Mr Rooney to start opening the chest.
0:29:21 > 0:29:23Consultant cardiothoracic surgeon
0:29:23 > 0:29:27Stephen Rooney and his team will join Rupesh and Richard
0:29:27 > 0:29:30with this, the riskiest stage of the operation.
0:29:30 > 0:29:33So have you got any more dissection to do?
0:29:33 > 0:29:36No, no. We're done. The kidney's through the mesenteric window,
0:29:36 > 0:29:37ready to lift out, basically.
0:29:37 > 0:29:40Sweet. Enjoyed yourself so far?
0:29:40 > 0:29:43It's been awesome. It's just a pity you have to put up with Rupesh,
0:29:43 > 0:29:45but, you know, what can you do?
0:29:45 > 0:29:47- Right, then.- Starting the chest.
0:29:49 > 0:29:52The first step is cutting open Bob's rib cage
0:29:52 > 0:29:53to access his heart.
0:29:53 > 0:29:55There we go.
0:29:56 > 0:29:58SAW BUZZES
0:30:03 > 0:30:04Lamps back on.
0:30:04 > 0:30:06The saw can go.
0:30:06 > 0:30:08When you're looking over their shoulder
0:30:08 > 0:30:11when they've got the chest open, you just see the heart sat there...
0:30:11 > 0:30:12Quite an extraordinary thing.
0:30:14 > 0:30:16It is life right there.
0:30:17 > 0:30:19Can I have...
0:30:19 > 0:30:21..15 blade,
0:30:21 > 0:30:23a pair of forceps
0:30:23 > 0:30:25and aortic cannula.
0:30:25 > 0:30:26Here we go.
0:30:27 > 0:30:29With the chest now open,
0:30:29 > 0:30:33Stephen starts by inserting two cannulas directly into the heart.
0:30:34 > 0:30:37The process involves making an incision in a beating heart,
0:30:37 > 0:30:41which to an onlooker is kind of a very, very weird thing to watch.
0:30:41 > 0:30:43See someone actually stabbing someone's heart with a knife,
0:30:43 > 0:30:46but it's what the cardiothoracic surgeons do.
0:30:46 > 0:30:47OK...
0:30:47 > 0:30:49- Yeah?- Do you want to go on to the pump, please?
0:30:49 > 0:30:50Thank you. Going on bypass.
0:30:55 > 0:30:56That's on bypass.
0:30:56 > 0:30:58And start to cool, please.
0:30:58 > 0:31:00- I have started to cool, thanks. - Excellent.
0:31:00 > 0:31:03For Bob to survive having his heart stopped,
0:31:03 > 0:31:06and his body entirely drained of blood,
0:31:06 > 0:31:08they first need to gradually cool
0:31:08 > 0:31:10his temperature from 37 degrees
0:31:10 > 0:31:12down to just 18.
0:31:13 > 0:31:16Cooling to 18 degrees.
0:31:16 > 0:31:18At normal body temperature,
0:31:18 > 0:31:19without blood flow,
0:31:19 > 0:31:21Bob's organs would fail in minutes.
0:31:23 > 0:31:24But the cold will protect him
0:31:24 > 0:31:27by putting him into a kind of hibernation,
0:31:27 > 0:31:32offering a few precious minutes for Rupesh to open the IVC vein.
0:31:32 > 0:31:34It's mainly for his brain.
0:31:34 > 0:31:38When it's cooler, the cells aren't requiring as much oxygen.
0:31:38 > 0:31:40They go to sleep, essentially.
0:31:40 > 0:31:42So we've just got to cool now.
0:31:42 > 0:31:44Very cool.
0:31:44 > 0:31:46To bring his temperature down,
0:31:46 > 0:31:50Bob's blood leaves his heart via the cannula into the bypass machine,
0:31:50 > 0:31:54where it's gradually cooled and then returned to his body.
0:31:54 > 0:31:56This cooling was discovered accidentally.
0:31:56 > 0:32:01There's a famous medic who fell through into a frozen river
0:32:01 > 0:32:05and they fished her out a long time afterwards.
0:32:05 > 0:32:09Even though she was technically dead as far as the heart was concerned,
0:32:09 > 0:32:13they still carried on and on and on and what they found was,
0:32:13 > 0:32:16as she re-warmed, she came back to life again.
0:32:21 > 0:32:24As the cooled blood returns to Bob's body,
0:32:24 > 0:32:26it shuts down his organs
0:32:26 > 0:32:28and slowly stops his heart.
0:32:30 > 0:32:33To see it stop, it's very odd.
0:32:35 > 0:32:37It's an incredible notion.
0:32:38 > 0:32:41It's a bit like suspended animation.
0:32:43 > 0:32:45I'm a scientist and yet there is
0:32:45 > 0:32:49something special about this state that patients are in.
0:32:50 > 0:32:53With no pulse or blood pressure of his own,
0:32:53 > 0:32:56Bob is now, to all intents and purposes, dead.
0:32:57 > 0:33:00The surgical team have just 30 minutes
0:33:00 > 0:33:02to remove the remaining tumour.
0:33:02 > 0:33:05I'm not going to get sort of religious about it.
0:33:07 > 0:33:09But it's quite awe-inspiring.
0:33:09 > 0:33:12He is literally on the edge of life and death.
0:33:16 > 0:33:18In theatres around the unit,
0:33:18 > 0:33:21surgeons make progress through their daily lists.
0:33:21 > 0:33:23Ligaments are tightened,
0:33:23 > 0:33:27heart valves replaced, a pancreas transplanted.
0:33:27 > 0:33:30Babcock, please. Long one to me, please.
0:33:30 > 0:33:31Slap it in, sweetheart.
0:33:31 > 0:33:32In Theatre 15,
0:33:32 > 0:33:34the sarcoma team are slowly removing
0:33:34 > 0:33:37Jasmine's tumour along with a margin
0:33:37 > 0:33:39of healthy tissue around it.
0:33:39 > 0:33:40OK, that's it. Good.
0:33:40 > 0:33:42Ooh! That's good.
0:33:42 > 0:33:44- OK, that's enough.- Well done.
0:33:49 > 0:33:51We're trying to concentrate on the operation,
0:33:51 > 0:33:53- you're thinking about alcohol! - Well, you know,
0:33:53 > 0:33:54have to think of the future, haven't you?
0:33:54 > 0:33:56LAUGHTER
0:33:56 > 0:33:58- Do you think you're nearly there, then?- No!
0:34:00 > 0:34:02James, you OK? Do you want a rest?
0:34:04 > 0:34:05OK. James, have a rest.
0:34:10 > 0:34:13- Could you make it any more difficult?!- Exactly!
0:34:13 > 0:34:15An operation to remove a sarcoma
0:34:15 > 0:34:18can be prolonged and we need points in the operation
0:34:18 > 0:34:20where we can release the tension.
0:34:20 > 0:34:23We quite often poke fun at each other, have a bit of banter.
0:34:23 > 0:34:25Stop slacking. Get on with it!
0:34:25 > 0:34:27We're just having a breather!
0:34:27 > 0:34:29Sue, can you put the table up a little bit?
0:34:29 > 0:34:31Again? What, more?
0:34:31 > 0:34:33- In your own time, darling. Don't worry.- God's sake, man!
0:34:33 > 0:34:34We saw you sneaking off.
0:34:34 > 0:34:37Well, you're certainly making it LOOK tricky, aren't you?
0:34:37 > 0:34:39- Up in the air?- Thank you, Sue.
0:34:39 > 0:34:41Sorry to disturb your chit-chat over there!
0:34:41 > 0:34:44All right, we've got to get this bloody kidney, haven't we?
0:34:45 > 0:34:47We've had a bit of cowboy action.
0:34:47 > 0:34:50The cancer is thought to have originated
0:34:50 > 0:34:52in the fat around Jasmine's right kidney,
0:34:52 > 0:34:56which is now buried so deep in the tumour, it can't be saved.
0:34:57 > 0:35:00- Are you going to take the kidney? - Yeah, the kidney's definitely out,
0:35:00 > 0:35:03- yeah.- It's got to come out. - No, that's fine.
0:35:05 > 0:35:08In order for Jasmine to survive this disease,
0:35:08 > 0:35:11the tumour has to be taken out intact.
0:35:11 > 0:35:14The tumour contains a kidney, so that kidney's going.
0:35:15 > 0:35:18It's an important consideration, though,
0:35:18 > 0:35:20because on a healthy person with two kidneys,
0:35:20 > 0:35:23there is still a risk of them going into renal failure.
0:35:24 > 0:35:26It is very possible that Jasmine's
0:35:26 > 0:35:28remaining kidney can't cope,
0:35:28 > 0:35:30so she's between a rock and a hard place.
0:35:30 > 0:35:33- Ready?- Yeah.
0:35:33 > 0:35:34- Shall I pull?- Yeah.
0:35:35 > 0:35:38Normally, to remove a kidney,
0:35:38 > 0:35:42the surgeons would simply cut the main artery leading directly to it.
0:35:42 > 0:35:44I'm just worried the anatomy's so distorted here.
0:35:46 > 0:35:50The trouble is, Jasmine's kidney is so deep inside the tumour,
0:35:50 > 0:35:53they can't see which artery leads to it.
0:35:53 > 0:35:55OK, what have we got here? Behind here?
0:35:55 > 0:35:57That's the renal vein, isn't it?
0:35:57 > 0:35:59The surgeons have in their mind
0:35:59 > 0:36:01a road map of how the anatomy should look
0:36:01 > 0:36:03and when anatomy is so distorted
0:36:03 > 0:36:06by the sheer size of the tumour,
0:36:06 > 0:36:09you have to be very careful not to make assumptions.
0:36:09 > 0:36:12- Yeah? Are you happy?- I don't mind, it's your operation.
0:36:12 > 0:36:14You bloody well picked it up,
0:36:14 > 0:36:17so shall we think about it a little bit? Cos it is big, isn't it?
0:36:17 > 0:36:19We've taken one back already and we are upside down.
0:36:19 > 0:36:21Let's have a look, let's have a look.
0:36:21 > 0:36:23Stop, stop, stop.
0:36:24 > 0:36:28They need to decide between two very similar-looking blood vessels.
0:36:29 > 0:36:31One supplies the kidney,
0:36:31 > 0:36:35the other is called the superior mesenteric artery,
0:36:35 > 0:36:36or SMA,
0:36:36 > 0:36:39and supplies blood to the whole of Jasmine's bowel.
0:36:39 > 0:36:42James, suck this stuff out here.
0:36:42 > 0:36:43And here, and here.
0:36:43 > 0:36:45The superior mesenteric artery
0:36:45 > 0:36:47comes off the aorta,
0:36:47 > 0:36:50almost at the same point as the right renal artery.
0:36:50 > 0:36:53They literally come off within a millimetre of each other.
0:36:53 > 0:36:55This is a very, very dangerous part of anatomy.
0:36:55 > 0:36:59- Is that the vein?- It must be the vein.- Shall I just be brave?
0:36:59 > 0:37:00No. Don't be. Don't be brave.
0:37:01 > 0:37:03If we were to divide the SMA,
0:37:03 > 0:37:06mistaking it for the renal artery,
0:37:06 > 0:37:10then Mrs Harkness would lose all the blood supply to her small bowel
0:37:10 > 0:37:13and that would be a fatal mistake.
0:37:13 > 0:37:16- Yeah.- SMA?- Yeah.- SMA is in my hand.
0:37:16 > 0:37:18Can we stop here for a moment, please, chaps?
0:37:18 > 0:37:21- We've just got to be certain. - SMA is here.
0:37:21 > 0:37:23- Have you got it? - Put your hand around here.
0:37:25 > 0:37:27Yes, SMA is in my hand.
0:37:27 > 0:37:30- Sure?- Yeah. Are you sure?- Well, I think so, because this is going
0:37:30 > 0:37:31in completely the wrong direction
0:37:31 > 0:37:35and going into the tumour, but if we do take it, we're up shit creek.
0:37:35 > 0:37:36Yeah. Put a bulldog on it.
0:37:36 > 0:37:39- OK. Can I have a vascular bulldog, please?- Yes, OK.
0:37:41 > 0:37:43Long one. Thank you.
0:37:43 > 0:37:45They clamp one of the arteries.
0:37:46 > 0:37:49If the small bowel drains of blood,
0:37:49 > 0:37:52they will know they've got the wrong one.
0:37:52 > 0:37:55- What's her blood pressure?- Enough.
0:37:55 > 0:37:57Let's just talk our way through this again.
0:37:57 > 0:37:59I've got my finger around what I think is the SMA.
0:37:59 > 0:38:01- It's pumping.- It is pumping nicely.
0:38:01 > 0:38:03At some points in a sarcoma operation,
0:38:03 > 0:38:06we have to be absolutely certain
0:38:06 > 0:38:09that we know which artery it is we're about to divide -
0:38:09 > 0:38:11a little bit like bomb disposal.
0:38:11 > 0:38:14If we were to divide the wrong artery,
0:38:14 > 0:38:16then it can have catastrophic consequences for the patient.
0:38:16 > 0:38:21We are absolutely and utterly committed, once we divide that.
0:38:21 > 0:38:23- There's no going back.- OK. So, we're happy?- Yeah.
0:38:23 > 0:38:26- You sure?- Yeah.- Yeah. OK.
0:38:31 > 0:38:33The deed is done.
0:38:33 > 0:38:35With the kidney disconnected,
0:38:35 > 0:38:38they've cleared a major hurdle.
0:38:38 > 0:38:40But unless they can get the tumour out intact,
0:38:40 > 0:38:43they won't know if they've done enough to save Jasmine.
0:38:50 > 0:38:52The theatre has ten units of blood ready
0:38:52 > 0:38:54in case Jasmine has a major bleed.
0:38:56 > 0:39:01Surgeons at the QE are reliant on a steady stream of blood arriving from
0:39:01 > 0:39:05the NHS Blood and Transplant Centre just half a mile away.
0:39:06 > 0:39:10State-of-the-art surgery requires the blood bank to supply
0:39:10 > 0:39:14all the components of blood in immaculate condition.
0:39:14 > 0:39:17Red cells are used for volume replacement during operations.
0:39:17 > 0:39:21They're also used for people whose red cells are not correct,
0:39:21 > 0:39:22like leukaemics.
0:39:23 > 0:39:27Frozen plasma contains the main proteins.
0:39:27 > 0:39:30So they can be used again for volume replacement
0:39:30 > 0:39:33or to replace specific proteins, like clotting factors.
0:39:34 > 0:39:37These are where we store platelets,
0:39:37 > 0:39:39which is a special clotting cell.
0:39:41 > 0:39:44They have to be kept again in temperature-controlled conditions.
0:39:44 > 0:39:47They're also kept agitated. This is to prevent them settling.
0:39:47 > 0:39:50If they settle, they could start to aggregate,
0:39:50 > 0:39:53and once they've aggregated, they can't be used for a patient.
0:39:57 > 0:40:01The red blood cell units are kept alive in a solution of sugars and
0:40:01 > 0:40:05metabolites and have a short shelf life of just over a month.
0:40:09 > 0:40:12A highly sophisticated tracking system
0:40:12 > 0:40:15follows each unit of blood all the way from the donor
0:40:15 > 0:40:18to the patient who receives it.
0:40:21 > 0:40:25In Bob's operation, they're five hours into surgery.
0:40:25 > 0:40:27- We happy?- Yes.
0:40:27 > 0:40:31- OK.- Can you turn the pump off and drain the patient, please?- OK.
0:40:31 > 0:40:33Draining the patient.
0:40:34 > 0:40:40His heart has been stopped and all the blood drained from his body.
0:40:40 > 0:40:42And can someone start the clock, please?
0:40:42 > 0:40:43I have got the clock on here.
0:40:43 > 0:40:46The team has just 30 minutes
0:40:46 > 0:40:49to remove the tumour from the biggest vein in Bob's body
0:40:49 > 0:40:52and then bring him back to life.
0:40:52 > 0:40:55You are under extreme time pressure.
0:40:55 > 0:40:58You've got about half an hour
0:40:58 > 0:41:02before you start causing damage to some of the vital organs -
0:41:02 > 0:41:04brain, heart, etc.
0:41:11 > 0:41:14Then the risk of stroke.
0:41:14 > 0:41:16The risk of cognitive damage increases.
0:41:18 > 0:41:20So this is very high-risk surgery.
0:41:23 > 0:41:25All the banter stops. Everybody focuses.
0:41:25 > 0:41:29Everyone is very much aware of how close to the wind we're sailing
0:41:29 > 0:41:31in that particular instance.
0:41:35 > 0:41:37I try to find out as much as I can
0:41:37 > 0:41:41about what I am expecting before I go into the operation.
0:41:41 > 0:41:45But there are always going to be some unknowns.
0:41:45 > 0:41:47One of the unknowns which really can stress me out
0:41:47 > 0:41:50and will certainly keep me awake
0:41:50 > 0:41:54is what the tumour within the IVC is like.
0:41:57 > 0:42:00OK, I need a blade, as well, please.
0:42:00 > 0:42:03Rupesh must now slice into the IVC,
0:42:03 > 0:42:05the largest vein in the body.
0:42:05 > 0:42:09It's the most critical moment in the operation.
0:42:11 > 0:42:14When you make the first cut with the knife, it's pretty scary.
0:42:17 > 0:42:20It's absolutely going against your training.
0:42:22 > 0:42:26You think you've got it under control, but it's big stuff,
0:42:26 > 0:42:27it's frightening stuff
0:42:27 > 0:42:31and it takes quite a while to sort of overcome that
0:42:31 > 0:42:33and you realise that you need to be the master of that
0:42:33 > 0:42:34as opposed to the other way around.
0:42:34 > 0:42:37- Sucker up.- Up on sucker.
0:42:39 > 0:42:42Despite all their planning, it's only now with the IVC open,
0:42:42 > 0:42:46that they'll discover if they can remove the tumour
0:42:46 > 0:42:47before their 30 minutes is up.
0:42:49 > 0:42:50You're never quite sure whether the tumour
0:42:50 > 0:42:52is going to be stuck to the lining of the cava
0:42:52 > 0:42:55and whether you're having to scrape it off,
0:42:55 > 0:42:58or whether it's going to lift out, literally, like a long tongue.
0:42:59 > 0:43:01The worst-case scenario is where
0:43:01 > 0:43:04the tumour is still attached to the vein
0:43:04 > 0:43:07and you could leave little elements behind, so you don't want do that.
0:43:07 > 0:43:10Think of porridge which is dried out,
0:43:10 > 0:43:11stuck to the bowl,
0:43:11 > 0:43:14and you're sort of peeling that away.
0:43:14 > 0:43:16You are free.
0:43:16 > 0:43:19I think I will get my finger in, OK.
0:43:20 > 0:43:23Each surgeon places a finger inside the vein -
0:43:23 > 0:43:26one from the top, one from the bottom
0:43:26 > 0:43:29and gradually release Bob's tumour.
0:43:31 > 0:43:33It's... It's free. Ready?
0:43:33 > 0:43:36- So that's my finger in. - I can feel you.- Fine.
0:43:36 > 0:43:38I'm taking it out now.
0:43:39 > 0:43:41There we go, it's out.
0:43:41 > 0:43:43- OK.- OK, there is the tumour.
0:43:43 > 0:43:46Got it? Keep it together, keep it together.
0:43:46 > 0:43:48Lovely. OK.
0:43:49 > 0:43:52Not a nice specimen, this one.
0:43:52 > 0:43:54The kidney and tumour are out.
0:43:54 > 0:43:57Remarkably, it has only taken four minutes.
0:43:57 > 0:44:02Now the two surgical teams have just 20 minutes to repair the IVC,
0:44:02 > 0:44:05the hole that's been made in the heart's atrium,
0:44:05 > 0:44:07and restore Bob's pulse.
0:44:07 > 0:44:09Good, OK.
0:44:09 > 0:44:12- OK.- Thank you very much. - You're welcome.
0:44:12 > 0:44:14It's what's known as SLF,
0:44:14 > 0:44:17which is "stitch like..."
0:44:17 > 0:44:18I won't finish it.
0:44:19 > 0:44:22He will close the heart, I will close the big vein.
0:44:22 > 0:44:25Can I have a heavy tie, please?
0:44:26 > 0:44:29Stephen has finished repairing the hole he made in the heart
0:44:29 > 0:44:31to access the tumour.
0:44:31 > 0:44:33How're you doing?
0:44:33 > 0:44:35- Yeah...- Halfway there.
0:44:35 > 0:44:37You guys have just got to chill out a bit, you know.
0:44:37 > 0:44:39You're going to end up in an early grave!
0:44:41 > 0:44:44Can I get round to slowly start to fill the patient?
0:44:44 > 0:44:45Yes, you can, please.
0:44:45 > 0:44:48OK, do you want to start filling the patient?
0:44:48 > 0:44:51- Yeah. I can do, yeah.- So now we're putting his blood back in.
0:44:51 > 0:44:54Stephen begins restoring Bob's circulation
0:44:54 > 0:44:56to check there are no leaks.
0:44:57 > 0:44:59Let's have a look... OK.
0:44:59 > 0:45:01- Yeah.- Crack on.- Yeah.
0:45:01 > 0:45:04Can we turn the timer off, please, Lee?
0:45:04 > 0:45:0513 minutes was arrest time.
0:45:05 > 0:45:09- How much?- 13.- One three? - One three, yeah.
0:45:09 > 0:45:11In just under 15 minutes,
0:45:11 > 0:45:13the team have removed the tumour
0:45:13 > 0:45:15and repaired the incisions.
0:45:15 > 0:45:16- Perfect.- Filled up.
0:45:16 > 0:45:18The cava's filling up nicely there.
0:45:18 > 0:45:20Start a gentle rewarm, please.
0:45:20 > 0:45:22Yeah, can we take the ice off the head, please?
0:45:22 > 0:45:27The bypass machine returns gently warmed blood to Bob's body.
0:45:27 > 0:45:30His heart is already starting to respond.
0:45:40 > 0:45:42As the blood goes back into the patient,
0:45:42 > 0:45:45and the patient's heart starts beating again,
0:45:45 > 0:45:49well... THAT is a magnificent feeling.
0:45:49 > 0:45:53You're really elated, you know at that stage that
0:45:53 > 0:45:56the major obstacles, the major pitfalls, are behind you
0:45:56 > 0:45:59and that you know that you're probably
0:45:59 > 0:46:01starting to look at a success story.
0:46:01 > 0:46:03Coming back online?
0:46:03 > 0:46:04- Yeah.- Hello...
0:46:06 > 0:46:08INDISTINCT
0:46:08 > 0:46:10But I suspect he'll come back into...
0:46:10 > 0:46:13Spontaneously come back into an organised rhythm.
0:46:15 > 0:46:16Why don't I just tear it off?
0:46:16 > 0:46:18Only if you lay your hands on it.
0:46:20 > 0:46:22- Say the word.- Thanks.
0:46:22 > 0:46:23- Just get the pump off.- Thank you.
0:46:23 > 0:46:24And shoot.
0:46:27 > 0:46:30Stephen shocks the heart to re-establish a normal rhythm.
0:46:32 > 0:46:34Despite a period of deep freeze,
0:46:34 > 0:46:38Bob is once more displaying all the vital signs of life.
0:46:38 > 0:46:40- Yes.- So, are you happy for us to come off?
0:46:40 > 0:46:42I am, gases are good.
0:46:42 > 0:46:45And you've not got bleeding going on in the abdomen?
0:46:45 > 0:46:48- I'll have a look at it.- OK. OK, can we get the lungs on, please?
0:46:50 > 0:46:52Bob is slowly removed from the bypass machine,
0:46:52 > 0:46:56and his heart and lungs take over again.
0:46:56 > 0:46:57That's quarter flow.
0:46:58 > 0:47:00All right, that looks comfortable.
0:47:00 > 0:47:02- Do you want to clamp there, please? - Thank you.
0:47:02 > 0:47:05Clamping venous. Venous is clamped.
0:47:05 > 0:47:08That's off bypass, 100 left in the pump.
0:47:09 > 0:47:11- Venous pipes out.- Thank you.
0:47:11 > 0:47:13So we're off bypass.
0:47:13 > 0:47:14Pump is empty.
0:47:14 > 0:47:16Pump is now off.
0:47:16 > 0:47:18Are we going to start closing down this end?
0:47:18 > 0:47:22- I'm happy.- Yeah, everyone good? - Yeah.
0:47:22 > 0:47:27After eight hours, Bob's operation is coming to an end.
0:47:27 > 0:47:29When surgeries like Bob's go well,
0:47:29 > 0:47:32immediately at the end of surgery,
0:47:32 > 0:47:35you know, you've had eight, 12 hours
0:47:35 > 0:47:37of severe concentration,
0:47:37 > 0:47:41you're quite drained. I tend to be quite euphoric after that.
0:47:42 > 0:47:45It's just an incredible operation though, isn't it? I love it.
0:47:46 > 0:47:49If you think about it, it's quite surreal.
0:47:49 > 0:47:51You know, this is a patient
0:47:51 > 0:47:54where...they've been frozen...
0:47:55 > 0:47:59..where normally that wouldn't be, um, survivable.
0:47:59 > 0:48:04And the fact that the Bob before an operation will be the same as,
0:48:04 > 0:48:07hopefully, will be the same as the Bob after
0:48:07 > 0:48:08as far as brain function,
0:48:08 > 0:48:10how he deals with his family,
0:48:10 > 0:48:12how the family know what Bob is,
0:48:12 > 0:48:14it's incredible that you can do that.
0:48:19 > 0:48:24Across the department, the end of an operation brings relief.
0:48:24 > 0:48:29I'm just savouring my Hendrick's gin and tonic with cucumber
0:48:29 > 0:48:34and a good Fever-Tree tonic water!
0:48:34 > 0:48:37I'd just kill a pint of anything!
0:48:37 > 0:48:39A pint of that would be fine!
0:48:42 > 0:48:44In Theatre 15,
0:48:44 > 0:48:48Sam and David are nearing the crunch point of the sarcoma operation.
0:48:48 > 0:48:49Oh, God.
0:48:49 > 0:48:52Let's get this bastard out.
0:48:52 > 0:48:54They've almost detached Jasmine's tumour,
0:48:54 > 0:48:56and are preparing to remove it.
0:48:56 > 0:48:59See, I'm worried here we're going to go right through her back,
0:48:59 > 0:49:01and then onto the operating table.
0:49:01 > 0:49:02She's so slim, and we're taking
0:49:02 > 0:49:05a muscle at the back to cover the tumour.
0:49:05 > 0:49:09If the tumour was breached, then...all is lost.
0:49:09 > 0:49:12These types of tumours have a real potential for seeding,
0:49:12 > 0:49:15even one or two cells have the potential
0:49:15 > 0:49:18to survive and cause tumour recurrence.
0:49:18 > 0:49:22So, we need to remove the tumour in its entirety.
0:49:22 > 0:49:25And remove it with a healthy cuff of tissue.
0:49:25 > 0:49:26Cutter's not quick enough, is it?
0:49:26 > 0:49:28- No.- Right, be careful of this,
0:49:28 > 0:49:31- all sorts of stuff here stuck on the back of this lung here.- Yeah.
0:49:31 > 0:49:33As it becomes released,
0:49:33 > 0:49:36and you've almost fully mobilised it,
0:49:36 > 0:49:38there's a danger that the sheer weight of it
0:49:38 > 0:49:42just tends to sort of tear itself out of the abdomen.
0:49:43 > 0:49:45Just be careful now. It's OK, we can see, we've got the dome
0:49:45 > 0:49:48of the diaphragm... Hm. This lung's stuck to it.
0:49:48 > 0:49:49OK, let me see, let me see.
0:49:51 > 0:49:53Oh, we're right into the chest here.
0:49:53 > 0:49:54Jesus Christ.
0:49:54 > 0:49:57- Now, let's just take it steady now. - Yeah, exactly,
0:49:57 > 0:49:58we're about to lose it here.
0:50:00 > 0:50:03In every operation, there is a sort of "bugger it" factor.
0:50:03 > 0:50:07Which is, just before you finish removing the tumour,
0:50:07 > 0:50:09you're getting a little bit cross and a little bit tired,
0:50:09 > 0:50:12cos you been going for some hours now
0:50:12 > 0:50:14and you know it's going to come out.
0:50:14 > 0:50:17And you get to this stage of, "Bugger this, it's coming out!"
0:50:17 > 0:50:19And that's when you make a mistake.
0:50:21 > 0:50:22Take your time now.
0:50:26 > 0:50:28- Trolley for her? - Trolley behind, please.
0:50:28 > 0:50:31- Trolley behind.- Big swab, please.
0:50:33 > 0:50:35Can we just get this off?
0:50:35 > 0:50:37Get the bloody tumour out.
0:50:37 > 0:50:39So, you've got the cava. You have the cava there.
0:50:39 > 0:50:42I've got the cava on my side. OK, where's the aorta?
0:50:42 > 0:50:43The aorta is...
0:50:43 > 0:50:45- Not a million miles away. - Not a million miles away.
0:50:45 > 0:50:47- My finger's on the aorta.- OK.
0:50:47 > 0:50:48Fuck.
0:50:48 > 0:50:52- There's a hole there, there's a big hole in something.- Sucker, please.
0:50:52 > 0:50:53There's a bleed,
0:50:53 > 0:50:57but until they take out the tumour, they can't see where it is.
0:50:57 > 0:50:59Just take it, just bloody take it.
0:51:00 > 0:51:03Let's go. Go, go, go.
0:51:03 > 0:51:05Oh, got it! Got it, don't worry. Got it.
0:51:05 > 0:51:07Jesus Christ!
0:51:07 > 0:51:11- I've got it, don't worry, I've got it.- Big ones, please.
0:51:15 > 0:51:16Phew!
0:51:17 > 0:51:19Although the tumour's out,
0:51:19 > 0:51:22they can't relax until they stem the bleed.
0:51:22 > 0:51:23Open the packs up, please.
0:51:25 > 0:51:26Come on. Suction.
0:51:26 > 0:51:29It's OK, we don't need it. It's packing. Just packing.
0:51:29 > 0:51:31- Thank you.- Thank you.
0:51:31 > 0:51:33Open it up!
0:51:38 > 0:51:40OK, right, let's all relax for a moment.
0:51:43 > 0:51:44It's taken seven hours,
0:51:44 > 0:51:46but it's finally done.
0:51:46 > 0:51:48All right?
0:51:50 > 0:51:52Lifting the tumour out is fantastic.
0:51:52 > 0:51:56It's a combination of relief...
0:51:56 > 0:51:58..and elation.
0:51:58 > 0:51:59Well done, well done!
0:51:59 > 0:52:01- Thank you, thanks!- Well done.
0:52:02 > 0:52:04I think it's officially plus size.
0:52:05 > 0:52:09That is absolutely enormous!
0:52:09 > 0:52:12- Pretty much 60...- 70.
0:52:12 > 0:52:15She's going to feel very, very different when she wakes up.
0:52:15 > 0:52:17She'll have to buy a new wardrobe.
0:52:17 > 0:52:20How on earth she'd been able to carry that around
0:52:20 > 0:52:22for months is anybody's guess.
0:52:26 > 0:52:27I think I get first guess.
0:52:29 > 0:52:31Get out of it. 18!
0:52:31 > 0:52:3318. Small, small, small, small.
0:52:33 > 0:52:35Prof, write Prof next.
0:52:35 > 0:52:3615.
0:52:38 > 0:52:39- Damien?- 22.
0:52:39 > 0:52:40During the operation,
0:52:40 > 0:52:43the atmosphere in a theatre can become quite tense
0:52:43 > 0:52:44and challenging at times.
0:52:44 > 0:52:47And in order to lift our spirits somewhat,
0:52:47 > 0:52:50we like to run a sweepstake and guess the weight of the tumour.
0:52:50 > 0:52:52I never seem to win,
0:52:52 > 0:52:55even though I've actually had the tumour in my arms beforehand.
0:52:55 > 0:52:58Go on, don't keep us in suspenders.
0:52:58 > 0:52:5919 and a half.
0:52:59 > 0:53:02- James it is, then! - Well done, James.
0:53:02 > 0:53:04So you get to buy the first round at the Plough, that's great!
0:53:05 > 0:53:07Quite a case.
0:53:07 > 0:53:09That's why we come here, isn't it?
0:53:10 > 0:53:12We're done, we're about to close.
0:53:14 > 0:53:16We're going to zip this one nicely up.
0:53:18 > 0:53:20- Hell of a tummy tuck.- Mm-hm.- Yes.
0:53:20 > 0:53:23Oh, she'll be light on her feet now, like a spring chicken.
0:53:27 > 0:53:31Despite all their worries, it seems the operation has been a success.
0:53:31 > 0:53:33It's been a long day.
0:53:35 > 0:53:37We're in the speciality because we enjoy it.
0:53:37 > 0:53:39We enjoy the surgery, we enjoy each other's company,
0:53:39 > 0:53:43and we enjoy the whole spirit of the theatre and the spirit of adventure
0:53:43 > 0:53:45that this sort of surgery brings.
0:53:47 > 0:53:48Good job.
0:53:48 > 0:53:51- Yeah, great. Thanks very much. - I haven't done anything.
0:53:52 > 0:53:53I'm only here for you.
0:53:53 > 0:53:56This is an exceptional case.
0:53:56 > 0:53:59And so, it comes as no surprise
0:53:59 > 0:54:04that we would wish to pit our wits against the tumour,
0:54:04 > 0:54:05and have it out and take it out.
0:54:07 > 0:54:08That's what drives us really.
0:54:08 > 0:54:09Sheer arrogance!
0:54:13 > 0:54:14Look at you tuckered up, lovely.
0:54:17 > 0:54:19All right, lovely, we're going over.
0:54:21 > 0:54:22Let's go.
0:54:24 > 0:54:27When I got home, having operated on Mrs Harkness,
0:54:27 > 0:54:30I was putting my son to bed and he likes me to carry him up the stairs.
0:54:30 > 0:54:34And I lifted him up and I thought, "Gosh, he's a heavy boy.
0:54:34 > 0:54:37"I'll just put him on the scales to see how heavy he actually is."
0:54:37 > 0:54:40And, oddly enough, he weighed exactly 20kg.
0:54:40 > 0:54:42So Mrs Harkness's tumour,
0:54:42 > 0:54:44weighs the same amount as a five-year-old boy.
0:54:51 > 0:54:54Two days after his operation,
0:54:54 > 0:54:57Bob is recovering in intensive care.
0:54:58 > 0:55:00It was my Cup Final, this one.
0:55:00 > 0:55:05And I thought to myself, "I've seen big players in the Cup Finals
0:55:05 > 0:55:08"dragged down, you know - they haven't performed."
0:55:09 > 0:55:12I've won my cup final, definitely.
0:55:14 > 0:55:16OK, how are you doing, Mr Moran?
0:55:16 > 0:55:17You're making pretty good progress.
0:55:17 > 0:55:19Yeah, it's going very well indeed.
0:55:19 > 0:55:22We'll keep a pretty close eye on you.
0:55:22 > 0:55:24I can only thank you.
0:55:24 > 0:55:28Can't do no more. You've made me a very happy man.
0:55:28 > 0:55:29And my family.
0:55:30 > 0:55:33I just can't thank you enough.
0:55:33 > 0:55:36I believed you from the first day I met you
0:55:36 > 0:55:38and I said I'd try and be a good patient.
0:55:41 > 0:55:43I'm all right now...
0:55:44 > 0:55:45Just so...
0:55:46 > 0:55:48I'm not upset, I'm thrilled.
0:55:50 > 0:55:52Just emotion, that's all.
0:55:52 > 0:55:55Yeah, I know. That's always going to happen.
0:55:55 > 0:55:58Where we are in 2017 with the NHS,
0:55:58 > 0:56:00the complaints come thick and fast,
0:56:00 > 0:56:02so it's quite nice to hear that.
0:56:04 > 0:56:09Nowadays, people generally expect treatment.
0:56:09 > 0:56:13OK, whether that's surgery or surgery with other things,
0:56:13 > 0:56:19and they're more demanding as far as what they expect from surgery.
0:56:19 > 0:56:21It's only human nature.
0:56:22 > 0:56:26But it does put a lot of pressure onto surgeons, and surgical teams,
0:56:26 > 0:56:29to keep pushing the boundary and to keep...
0:56:30 > 0:56:32..getting good results.
0:56:37 > 0:56:39Back in hospital,
0:56:39 > 0:56:41Jasmine is starting to recover
0:56:41 > 0:56:44and is adjusting to life without her tumour.
0:56:44 > 0:56:47I feel much better now than I did.
0:56:47 > 0:56:49And it's nice to be on the mend.
0:56:49 > 0:56:52It's nice, it's like a miracle, really,
0:56:52 > 0:56:54that you've got a second chance.
0:56:54 > 0:56:57- Knock, knock. Hello, Jasmine!- Hello!
0:56:57 > 0:56:59I feel as if I could float.
0:56:59 > 0:57:02It's like a cloud, you know,
0:57:02 > 0:57:06somebody's taken the worry out of you, out of your mind and you can
0:57:06 > 0:57:08just float on air.
0:57:08 > 0:57:10That's the feeling you get.
0:57:10 > 0:57:11OK, how was that?
0:57:11 > 0:57:14- Fine.- Yeah? So these ones are a little bit steep.
0:57:14 > 0:57:16I quite often ask my junior doctors
0:57:16 > 0:57:19what the most important gland in the body is
0:57:19 > 0:57:23and they say the pancreas, or the thyroid, or something like that.
0:57:23 > 0:57:25And actually the most important gland in the body
0:57:25 > 0:57:27is the up-for-it gland, "Are you up for it?"
0:57:28 > 0:57:30If that's working well,
0:57:30 > 0:57:34you can do things to people that you wouldn't be able to do to a patient
0:57:34 > 0:57:36who was struggling with motivation.
0:57:37 > 0:57:39I thought she put up an extraordinary effort
0:57:39 > 0:57:43- to get through that sort of surgery.- I feel all right.
0:57:43 > 0:57:46- Yeah? Do you want to turn around and we'll have a look...?- Yes.
0:57:46 > 0:57:49I mean as recently as, certainly ten years ago,
0:57:49 > 0:57:51it would be very unlikely that someone
0:57:51 > 0:57:55in her reduced condition with this massive tumour
0:57:55 > 0:57:58and poor physiological reserve would be offered
0:57:58 > 0:57:59this sort of surgery.
0:58:04 > 0:58:06What's changed in recent years?
0:58:07 > 0:58:09We just got a bit braver, I think.
0:58:14 > 0:58:18Next time...surgeons put experimental techniques to the test.
0:58:18 > 0:58:22Gene therapy trial. Everyone's eyes should be covered.
0:58:22 > 0:58:26I'm taking a high-speed drill and making my way inside the skull.
0:58:26 > 0:58:27There are huge risks...
0:58:27 > 0:58:29The liver might not function at all.
0:58:29 > 0:58:30..and rewards.
0:58:30 > 0:58:33If this works, I shall feel marvellous.
0:58:33 > 0:58:36Today's research is tomorrow's standard of care.