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Every year some three million major operations are carried out in the UK. | 0:00:05 | 0:00:10 | |
The theatre doors are just here. | 0:00:11 | 0:00:13 | |
But few of us will know what really happens once we're put to sleep. | 0:00:13 | 0:00:17 | |
All right, all you've got to do now is think beautiful thoughts. | 0:00:17 | 0:00:20 | |
I don't think that patient can even comprehend what you're doing in theatre to them. | 0:00:20 | 0:00:24 | |
And that's what the plan is, that they don't know what they've been through. | 0:00:24 | 0:00:28 | |
This series goes behind the theatre doors at the Queen Elizabeth Hospital in Birmingham... | 0:00:28 | 0:00:33 | |
-Let's get cracking then. -Right, okey-dokes. | 0:00:33 | 0:00:36 | |
..where for the first time, cameras have been allowed to join some of | 0:00:36 | 0:00:40 | |
Britain's top surgeons during their most high-stakes operations. | 0:00:40 | 0:00:44 | |
-Shall we go for it? -We'll go for it. | 0:00:44 | 0:00:46 | |
Using new technology and pioneering skills, | 0:00:46 | 0:00:49 | |
they are treating conditions that used to kill. | 0:00:49 | 0:00:52 | |
We continue to push the boundaries, | 0:00:52 | 0:00:54 | |
continue to take the inoperable and make it operable. | 0:00:54 | 0:00:57 | |
This is surgery at its most experimental. | 0:00:57 | 0:01:00 | |
This is where I've got to get it right. | 0:01:00 | 0:01:02 | |
People didn't attempt this surgery a few years ago, | 0:01:02 | 0:01:04 | |
because it was just perceived as being too big, | 0:01:04 | 0:01:06 | |
too difficult and too scary. | 0:01:06 | 0:01:08 | |
But pushing the human body to its limits comes with great risk... | 0:01:08 | 0:01:12 | |
Keep it together, keep it together, keep it together. | 0:01:12 | 0:01:14 | |
..for the patients and the surgeons. | 0:01:14 | 0:01:17 | |
An operation will go wrong for a 30-second lapse of concentration. | 0:01:17 | 0:01:22 | |
It needs to work, because if it doesn't I'm going to cry. | 0:01:22 | 0:01:24 | |
Things worry you. You get very worried. | 0:01:24 | 0:01:26 | |
This is going completely the wrong direction. | 0:01:26 | 0:01:28 | |
The trick is to not appear to be worried. | 0:01:28 | 0:01:31 | |
They need to be top of their game every time. | 0:01:31 | 0:01:34 | |
People often characterise surgeons as bombastic and arrogant. | 0:01:34 | 0:01:37 | |
Babcock, please, long one, to me. Slap it in, sweetheart. | 0:01:37 | 0:01:40 | |
You've got to be dedicated to do it, you've got to love it. | 0:01:40 | 0:01:43 | |
Oh, my God! Jesus Christ. | 0:01:43 | 0:01:46 | |
You're only as good as your last result. | 0:01:46 | 0:01:48 | |
BLEEPED EXPLETIVE | 0:01:48 | 0:01:50 | |
This is what it takes to operate at the cutting-edge of medicine. | 0:01:50 | 0:01:54 | |
You have to be jolly careful that you don't bugger it up. | 0:01:54 | 0:01:57 | |
It's do or die, really. | 0:01:57 | 0:01:59 | |
The Queen Elizabeth Hospital in Birmingham | 0:02:08 | 0:02:11 | |
is one of the nation's largest surgical units. | 0:02:11 | 0:02:14 | |
Today, there will be more than 120 operations in its 42 theatres. | 0:02:16 | 0:02:21 | |
So, we are doing a left-hand nerve exploration, | 0:02:21 | 0:02:25 | |
plus repair. | 0:02:25 | 0:02:27 | |
Most are well-established procedures, | 0:02:27 | 0:02:30 | |
but some are clinical trials in which surgeons will use cutting-edge | 0:02:30 | 0:02:34 | |
techniques on humans for the very first time. | 0:02:34 | 0:02:38 | |
If we go through the waiting list, | 0:02:38 | 0:02:41 | |
at the moment we have got six active patients. | 0:02:41 | 0:02:44 | |
Surgeon Richard Laing is working on a trial targeting | 0:02:44 | 0:02:48 | |
one of the nation's biggest health crises - liver disease. | 0:02:48 | 0:02:52 | |
Because of a Western diet, | 0:02:54 | 0:02:56 | |
obesity is a huge problem, and is | 0:02:56 | 0:02:59 | |
one of the biggest increasing causes of liver disease. | 0:02:59 | 0:03:01 | |
Deaths from liver disease have soared by 40% in a decade. | 0:03:01 | 0:03:06 | |
And more and more patients are waiting for life-saving liver transplants. | 0:03:06 | 0:03:10 | |
-ON RADIO: -'OK, you're on four blues, on your way, four blues it is.' | 0:03:12 | 0:03:15 | |
OK. Thank you. | 0:03:15 | 0:03:16 | |
Today a donor liver is being rushed from London to the team in Birmingham. | 0:03:18 | 0:03:23 | |
This is where it will ask us to put in the data, | 0:03:26 | 0:03:28 | |
so that takes about ten minutes. | 0:03:28 | 0:03:30 | |
Surgeons will only use a liver that they believe is good enough quality | 0:03:30 | 0:03:34 | |
to safely transplant, | 0:03:34 | 0:03:36 | |
and so a number of livers every year are not used | 0:03:36 | 0:03:39 | |
because they're considered too high risk. | 0:03:39 | 0:03:41 | |
Each year, around 400 livers are judged unfit for use, | 0:03:41 | 0:03:46 | |
leaving patients on the waiting list. | 0:03:46 | 0:03:49 | |
Richard hopes to prove that many of the rejected livers are, in fact, | 0:03:49 | 0:03:53 | |
viable for transplant. | 0:03:53 | 0:03:55 | |
This trial has the potential to help so many patients on the list, | 0:03:55 | 0:03:58 | |
but it's a high-risk trial. | 0:03:58 | 0:04:00 | |
I mean, transplantation is risky as it is. | 0:04:00 | 0:04:04 | |
But to take livers that have been rejected by everybody | 0:04:05 | 0:04:08 | |
and to try and put them into patients, | 0:04:08 | 0:04:11 | |
it is nerve-racking. | 0:04:11 | 0:04:14 | |
The liver en route to Birmingham would normally be rejected, | 0:04:15 | 0:04:19 | |
as it has come from a middle-aged donor who died of a heart attack | 0:04:19 | 0:04:22 | |
away from hospital. | 0:04:22 | 0:04:24 | |
And all the time that it's not connected to a live human | 0:04:24 | 0:04:27 | |
body, the liver is deteriorating. | 0:04:27 | 0:04:31 | |
The clock is ticking and time is absolutely critical. | 0:04:31 | 0:04:33 | |
The liver is being starved of oxygen, | 0:04:36 | 0:04:38 | |
and for every minute that passes, | 0:04:38 | 0:04:41 | |
liver cells are dying, and the risks | 0:04:41 | 0:04:43 | |
of that liver not working, following transplantation, increase. | 0:04:43 | 0:04:46 | |
Arrow to arrow, it's colour-coded. | 0:04:48 | 0:04:50 | |
Nice and simple for surgeons like myself. | 0:04:50 | 0:04:52 | |
When it arrives, the donor liver will be connected to a machine at | 0:04:52 | 0:04:56 | |
the heart of the trial. | 0:04:56 | 0:04:58 | |
Through a process called perfusion, | 0:04:58 | 0:05:00 | |
it will restore the liver to its best possible functioning state, | 0:05:00 | 0:05:04 | |
giving the team a chance to assess whether it is healthy enough for a | 0:05:04 | 0:05:08 | |
successful transplant. | 0:05:08 | 0:05:10 | |
This machine tries to mimic the conditions that a liver would | 0:05:10 | 0:05:14 | |
experience inside the human body. | 0:05:14 | 0:05:16 | |
So, you give it blood, oxygen, nutrients, | 0:05:16 | 0:05:19 | |
all at the body's normal temperature. | 0:05:19 | 0:05:22 | |
When you give it those conditions, the liver starts to function. | 0:05:22 | 0:05:25 | |
And not only does it function, but there is also a degree of | 0:05:25 | 0:05:27 | |
reconditioning and the liver gets the opportunity | 0:05:27 | 0:05:30 | |
to start to repair itself. | 0:05:30 | 0:05:32 | |
And what this machine allows us to do is to take a liver that's deemed | 0:05:32 | 0:05:35 | |
unsuitable, and prove in fact that it will function | 0:05:35 | 0:05:38 | |
after it's transplanted. | 0:05:38 | 0:05:40 | |
If all goes well, the donor liver will be transplanted to Connie O'Driscoll. | 0:05:42 | 0:05:47 | |
Connie's lived in the UK for more than 30 years, | 0:05:47 | 0:05:50 | |
almost as long as she's been suffering from a rare liver condition. | 0:05:50 | 0:05:54 | |
This is like round three for me at the Queen Elizabeth. | 0:05:54 | 0:05:58 | |
First was a bleed-out that brought me here for emergency rescue surgery. | 0:05:58 | 0:06:04 | |
When that was finished they found I had liver cancer | 0:06:04 | 0:06:08 | |
and they saved me again. | 0:06:08 | 0:06:10 | |
Now it's time for a new liver, because the old one has | 0:06:10 | 0:06:14 | |
pretty much taken a beating. | 0:06:14 | 0:06:17 | |
The last two years there has been nothing but medical, medical, medical, medical. | 0:06:17 | 0:06:23 | |
It has just absolutely consumed my life. | 0:06:23 | 0:06:25 | |
For Connie, the chance to get a transplant quickly is outweighing | 0:06:28 | 0:06:32 | |
any nerves about receiving experimental treatment. | 0:06:32 | 0:06:35 | |
We are recruiting 6,500 plus new patients into trials per year. | 0:06:37 | 0:06:43 | |
Some of those are ground-breaking trials, and will potentially change | 0:06:43 | 0:06:48 | |
the way in which care is delivered. | 0:06:48 | 0:06:49 | |
Hilary Fanning is in charge of all clinical trial activity within the trust. | 0:06:50 | 0:06:55 | |
Trials are about bringing the possibility of better treatment | 0:06:55 | 0:07:00 | |
and, in some cases, hope to patients who may not otherwise | 0:07:00 | 0:07:05 | |
have hope, because of their particular condition. | 0:07:05 | 0:07:08 | |
Today's research is tomorrow's standard of care, | 0:07:09 | 0:07:13 | |
so undertaking clinical trials is a fundamental part | 0:07:13 | 0:07:17 | |
of the delivery of a high-quality clinical service in the NHS. | 0:07:17 | 0:07:22 | |
SIRENS | 0:07:22 | 0:07:25 | |
-ON RADIO: -'Hello, it's Claire.' -Hello, Claire. | 0:07:27 | 0:07:29 | |
-'Just to let you know, your ten-minute warning has gone in.' -OK, thank you. | 0:07:29 | 0:07:32 | |
The donor liver will soon arrive for the first stage of the trial. | 0:07:32 | 0:07:35 | |
So, we'll go and set up the medications. | 0:07:35 | 0:07:37 | |
There is an air of anticipation - | 0:07:39 | 0:07:41 | |
"Is it going to work, is it not going to work?" | 0:07:41 | 0:07:43 | |
"I think this one'll work." "This one's never going to work." | 0:07:43 | 0:07:46 | |
Then the liver arrives. | 0:07:49 | 0:07:51 | |
And we get the first sight. And it might look really good, | 0:07:57 | 0:08:00 | |
it might look really awful. | 0:08:00 | 0:08:02 | |
You know, there are some livers which we'll put on the machine that | 0:08:02 | 0:08:05 | |
just don't function. | 0:08:05 | 0:08:06 | |
So, is a bit fattier than we thought, isn't it? | 0:08:07 | 0:08:10 | |
It's not the best-looking liver. | 0:08:12 | 0:08:15 | |
There are features that would mean that you wouldn't necessarily want | 0:08:15 | 0:08:19 | |
to transplant this liver straightaway. | 0:08:19 | 0:08:21 | |
But this is what the trial is for. | 0:08:21 | 0:08:22 | |
We've just been putting all the cannulas in so we can connect it to | 0:08:24 | 0:08:26 | |
the device, and then over the course of the perfusion we'll start to see | 0:08:26 | 0:08:30 | |
various readouts that will indicate whether or not the | 0:08:30 | 0:08:33 | |
liver's functioning. | 0:08:33 | 0:08:34 | |
Richard needs to run a series of tests to find out if it's healthy enough to transplant. | 0:08:34 | 0:08:40 | |
The liver has four hours to prove itself. | 0:08:40 | 0:08:44 | |
The liver might not function at all. | 0:08:44 | 0:08:46 | |
Only time will tell. | 0:08:46 | 0:08:47 | |
As well as being risky, clinical trials are expensive. | 0:08:52 | 0:08:56 | |
Along with the funding comes intense scrutiny. | 0:08:56 | 0:08:59 | |
In terms of income associated with awarded grants, | 0:09:00 | 0:09:05 | |
can you remember where we are with that? | 0:09:05 | 0:09:07 | |
25 million across Birmingham Health Partnership. | 0:09:07 | 0:09:10 | |
Was that last financial year? | 0:09:10 | 0:09:11 | |
I think it does take a particular type of person | 0:09:12 | 0:09:18 | |
to undertake clinical trials. | 0:09:18 | 0:09:22 | |
They have to be really sure that what it is that they're trying to | 0:09:23 | 0:09:28 | |
achieve is the right thing, and they have to maintain their belief in | 0:09:28 | 0:09:31 | |
themselves and their ability to deliver that. | 0:09:31 | 0:09:34 | |
There is a huge amount | 0:09:36 | 0:09:38 | |
of professional satisfaction in being a pioneer. | 0:09:38 | 0:09:42 | |
That in itself pushes you to the point of accepting a degree of risk | 0:09:42 | 0:09:48 | |
associated with clinical trials. | 0:09:48 | 0:09:50 | |
As a surgeon you are really sticking your head above the parapet. | 0:09:51 | 0:09:55 | |
If you're involved in trials like this, most people know you're doing it. | 0:09:56 | 0:09:59 | |
It's hard to keep these things quiet. | 0:09:59 | 0:10:01 | |
And if it doesn't work, you're still going to have to face them. | 0:10:01 | 0:10:04 | |
But you take that chance. | 0:10:06 | 0:10:08 | |
Consultant surgeon Richard Irving | 0:10:08 | 0:10:11 | |
and Professor Philip Begg | 0:10:11 | 0:10:12 | |
have received over £1 million to fund their trial. | 0:10:12 | 0:10:15 | |
They hope it could one day help to transform the lives of thousands of | 0:10:15 | 0:10:19 | |
people in the UK who have profound hearing loss. | 0:10:19 | 0:10:24 | |
So, in relation to the access to Paul's middle ear, | 0:10:24 | 0:10:27 | |
the pinna will be rotated out of the way and that's all going to be out | 0:10:27 | 0:10:31 | |
of the operative field. | 0:10:31 | 0:10:33 | |
The team are trailing a world first. | 0:10:33 | 0:10:36 | |
They're going to surgically implant this tiny hearing aid microphone | 0:10:36 | 0:10:40 | |
inside the patient's skull. | 0:10:40 | 0:10:41 | |
Their goal is for it to be more discreet than today's external hearing aids | 0:10:42 | 0:10:47 | |
and, perhaps, improve on their sound quality. | 0:10:47 | 0:10:50 | |
The impetus behind this really comes from patients. | 0:10:50 | 0:10:52 | |
They get a huge amount of benefit from an external hearing aid, | 0:10:52 | 0:10:55 | |
but still there are some lifestyle restrictions that they have. | 0:10:55 | 0:11:00 | |
And they're wearing something on their ear and on the outside of | 0:11:01 | 0:11:05 | |
their head, so it's visible. | 0:11:05 | 0:11:07 | |
For many patients that is a big downside. | 0:11:07 | 0:11:10 | |
People don't like looking different. | 0:11:10 | 0:11:13 | |
At night typically, patients, they take their device off | 0:11:13 | 0:11:16 | |
and they go back into a world of silence. | 0:11:16 | 0:11:19 | |
They can't hear, for example, a smoke alarm, a baby crying, | 0:11:19 | 0:11:24 | |
and they would feel really cut off. | 0:11:24 | 0:11:26 | |
63-year-old caretaker Paul Heaney started to lose his hearing more | 0:11:28 | 0:11:33 | |
than 20 years ago. He currently wears a cochlear implant | 0:11:33 | 0:11:36 | |
with an external sound processor microphone behind his ear. | 0:11:36 | 0:11:41 | |
He will be one of the first six people to trial the new internal microphone. | 0:11:41 | 0:11:45 | |
When your hearing goes, you feel a bit isolated in society. | 0:11:45 | 0:11:50 | |
People sort of tend to avoid you in certain situations rather than | 0:11:50 | 0:11:53 | |
having to repeat themselves. | 0:11:53 | 0:11:55 | |
You feel a little bit left out. | 0:11:55 | 0:11:57 | |
Paul is almost totally deaf, because of deterioration in his inner ear. | 0:11:59 | 0:12:03 | |
Although the trial is focused on testing whether the new microphone | 0:12:05 | 0:12:09 | |
is safe, he hopes it will lead on to the invention of completely internal | 0:12:09 | 0:12:13 | |
hearing aids. | 0:12:13 | 0:12:15 | |
Eventually when it's finished, | 0:12:15 | 0:12:17 | |
we'll get rid of all the outside paraphernalia and just be straight | 0:12:17 | 0:12:22 | |
through the ear. | 0:12:22 | 0:12:24 | |
It's a little bit of a step in the dark for me at the moment, | 0:12:24 | 0:12:27 | |
but from what I've read up about it | 0:12:27 | 0:12:29 | |
it would definitely be an improvement to the current status. | 0:12:29 | 0:12:32 | |
With Paul, that's an incredible thing to ask someone, | 0:12:35 | 0:12:39 | |
a huge thing to ask someone, | 0:12:39 | 0:12:40 | |
to agree to undergo an operation that they don't have to have. | 0:12:40 | 0:12:43 | |
He has a genuine desire to help other people. | 0:12:45 | 0:12:48 | |
If this is successful, then he will be down as one of the patients | 0:12:48 | 0:12:54 | |
who helped with this revolution. | 0:12:54 | 0:12:56 | |
Paul's procedure will take place in Theatre 15. | 0:12:59 | 0:13:02 | |
Richard will perform the pioneering surgery while Philip and an audio | 0:13:03 | 0:13:07 | |
research team will test the new implant. | 0:13:07 | 0:13:10 | |
-OK. -What are we doing for Mr Heaney? | 0:13:13 | 0:13:17 | |
Working on his left ear, | 0:13:17 | 0:13:19 | |
placing a middle ear microphone and a pedestal through the skin. | 0:13:19 | 0:13:23 | |
-OK, blood lost? -Minimal. | 0:13:23 | 0:13:26 | |
-Duration of surgery? -Three-and-a-half. | 0:13:26 | 0:13:29 | |
Yeah, any specific equipment you need? | 0:13:29 | 0:13:32 | |
-Lots and it's all here. -OK. | 0:13:32 | 0:13:34 | |
-Happy? -OK, microscope on, thanks. | 0:13:34 | 0:13:36 | |
I'll just give this a clean. | 0:13:36 | 0:13:38 | |
Richard will have to insert a hearing aid microphone smaller than | 0:13:39 | 0:13:43 | |
a matchstick right inside Paul's head. | 0:13:43 | 0:13:47 | |
And then connect it to the tiny bones in his middle ear. | 0:13:47 | 0:13:50 | |
To implant the device he'll need to drill out a minute channel | 0:13:51 | 0:13:55 | |
through solid bone, | 0:13:55 | 0:13:58 | |
navigating between two important nerves. | 0:13:58 | 0:14:01 | |
One that controls facial movement, | 0:14:01 | 0:14:03 | |
and another connected to the sense of taste. | 0:14:03 | 0:14:06 | |
It is a surgical challenge to work in that area of the body. | 0:14:10 | 0:14:14 | |
So, you have to be incredibly careful. | 0:14:14 | 0:14:18 | |
OK, if you've got the razor... | 0:14:18 | 0:14:20 | |
I need to take this to the table, Richard, at some point. | 0:14:23 | 0:14:27 | |
Yeah, let me just clean out his ear and then I'll put the probe in. | 0:14:27 | 0:14:30 | |
Richard is one of the most talented surgeons I've ever met. | 0:14:32 | 0:14:37 | |
Suction can be on, please. | 0:14:37 | 0:14:39 | |
We've got a very unique relationship. | 0:14:39 | 0:14:42 | |
We are two people who you might expect to have quite big egos. | 0:14:42 | 0:14:45 | |
We kind of leave our egos at the door. | 0:14:45 | 0:14:47 | |
And we work really, really well together. | 0:14:47 | 0:14:51 | |
It is a relationship that's based on respect. | 0:14:51 | 0:14:54 | |
-Ready? -It is ready to go in, yeah. | 0:14:54 | 0:14:57 | |
So, this probe goes in the external ear. | 0:14:57 | 0:14:59 | |
Before Richard begins, he tapes a small speaker inside Paul's ear. | 0:15:01 | 0:15:05 | |
This will play test sounds, so the microphone can be checked by sound | 0:15:06 | 0:15:10 | |
engineer Rob Morse once it's implanted. | 0:15:10 | 0:15:14 | |
So, we are putting a sound into the ear to make sure that's our levels right. | 0:15:14 | 0:15:19 | |
-Happy? Let's start, yeah. -Right. | 0:15:19 | 0:15:21 | |
Just going to start the incision | 0:15:21 | 0:15:24 | |
working my way through the | 0:15:24 | 0:15:26 | |
scalp and the soft tissues. | 0:15:26 | 0:15:29 | |
I'll just get enough exposure and then I'll start. | 0:15:29 | 0:15:32 | |
Make my access route through the skull. | 0:15:32 | 0:15:34 | |
OK, right, great, let's have the drill, thanks. | 0:15:36 | 0:15:38 | |
So, I now make a passageway through the bone, working | 0:15:41 | 0:15:46 | |
in an area behind the ear canal. | 0:15:46 | 0:15:51 | |
First Richard has to drill a channel into Paul's skull, | 0:15:52 | 0:15:55 | |
less than a centimetre from the membrane that protects his brain. | 0:15:55 | 0:15:59 | |
When you first do this, you're incredibly nervous. | 0:15:59 | 0:16:02 | |
You're incredibly slow. | 0:16:02 | 0:16:04 | |
There is a risk that the membranes could be breached, | 0:16:04 | 0:16:08 | |
and of infection that could spread inside the skull. | 0:16:08 | 0:16:12 | |
These are incredibly rare, but they're things | 0:16:12 | 0:16:15 | |
that go through your mind. | 0:16:15 | 0:16:17 | |
Can I have the microscope, as well? Thanks. | 0:16:17 | 0:16:21 | |
I often compare it to how NASA prepares astronauts, | 0:16:21 | 0:16:25 | |
where they'll spend maybe 20 years preparing for a flight | 0:16:25 | 0:16:29 | |
that takes ten, 20, 30 days. | 0:16:29 | 0:16:32 | |
And it's the same with this, with the surgery. | 0:16:32 | 0:16:35 | |
We spent a year planning for every possible disaster that could happen. | 0:16:35 | 0:16:40 | |
Have you got a one cutter, thanks? | 0:16:40 | 0:16:41 | |
-One cutter. -And a smaller sucker. | 0:16:41 | 0:16:43 | |
As you become more and more comfortable, | 0:16:44 | 0:16:46 | |
somehow you're able to switch off in this surreal world. | 0:16:46 | 0:16:52 | |
I am conductor of that orchestra while I'm operating, | 0:16:52 | 0:16:56 | |
and I determine what is happening in that environment. | 0:16:56 | 0:16:59 | |
I have now got a much smaller tip and I'm making a small passageway | 0:16:59 | 0:17:04 | |
into the back of the middle ear, | 0:17:04 | 0:17:06 | |
running between the facial nerve, | 0:17:06 | 0:17:09 | |
that's the nerve that moves the face | 0:17:09 | 0:17:12 | |
and the nerve that supplies taste. | 0:17:12 | 0:17:15 | |
Two structures that I would very much like to avoid. | 0:17:15 | 0:17:18 | |
We are doing a surgical procedure on what is arguably one of the most | 0:17:19 | 0:17:24 | |
delicate parts of the human body | 0:17:24 | 0:17:26 | |
in the skull. | 0:17:26 | 0:17:28 | |
So, within a tiny area, a couple of centimetres across, | 0:17:30 | 0:17:34 | |
I have all of those anatomical structures to deal with, | 0:17:34 | 0:17:38 | |
and what I am doing is taking a high-speed drill | 0:17:38 | 0:17:40 | |
and making my way through. | 0:17:40 | 0:17:43 | |
Clearly if things do not go to plan, | 0:17:44 | 0:17:47 | |
that could have a huge impact on that patient's quality of life. | 0:17:47 | 0:17:50 | |
In Theatre 5, Richard Laing has been monitoring a donor liver | 0:17:56 | 0:18:00 | |
he wants to use in the transplant trial for the last two hours. | 0:18:00 | 0:18:04 | |
The organ's being kept alive by the perfusion machine, | 0:18:07 | 0:18:11 | |
supplying it with blood, nutrients and oxygen. | 0:18:11 | 0:18:15 | |
I'm going to take a biopsy in here. | 0:18:15 | 0:18:18 | |
Only specific tests will determine if the liver is now good enough for | 0:18:18 | 0:18:22 | |
transplant. | 0:18:22 | 0:18:24 | |
We'll look for various readouts that will indicate whether or not the liver is functioning. | 0:18:24 | 0:18:27 | |
It shouldn't be too much longer before we can make a decision on | 0:18:27 | 0:18:30 | |
whether or not it's transplantable. | 0:18:30 | 0:18:32 | |
One of the liver's main jobs is to turn lactate, | 0:18:33 | 0:18:37 | |
an acid produced by muscular activity, into glucose. | 0:18:37 | 0:18:41 | |
A lactate reading of 2.5 or lower | 0:18:42 | 0:18:44 | |
indicates the liver is functioning well enough for transplant. | 0:18:44 | 0:18:48 | |
-It's 2.6. -Oh, fantastic. -Nearly there. | 0:18:50 | 0:18:53 | |
Nearly there. | 0:18:53 | 0:18:55 | |
The liver is very close to coming into criteria. | 0:18:55 | 0:18:59 | |
We're just waiting on this last result. | 0:18:59 | 0:19:01 | |
Before the lactate was 2.6. | 0:19:05 | 0:19:07 | |
It's now down to 2.1. | 0:19:07 | 0:19:08 | |
Textbook liver function. | 0:19:08 | 0:19:10 | |
The liver's met the criteria, which is fantastic, | 0:19:10 | 0:19:14 | |
but this is just the start. | 0:19:14 | 0:19:16 | |
The question now is will that liver continue to function | 0:19:16 | 0:19:19 | |
after it's transplanted? | 0:19:19 | 0:19:21 | |
Hello, Mrs O'Driscoll, how are you? | 0:19:28 | 0:19:31 | |
Nice to see you. Lovely to see you again. | 0:19:31 | 0:19:34 | |
I didn't think we'd be seeing each other so soon. | 0:19:34 | 0:19:36 | |
I know, it has been soon, hasn't it? | 0:19:36 | 0:19:38 | |
Good thing I had my suitcase packed. | 0:19:38 | 0:19:39 | |
HE CHUCKLES | 0:19:39 | 0:19:41 | |
This liver was offered to us yesterday. | 0:19:41 | 0:19:43 | |
We were able to put it on the machine. | 0:19:43 | 0:19:45 | |
-And it performed very well. -Excellent. | 0:19:45 | 0:19:48 | |
Mr Perera doesn't see any reason why we shouldn't use the | 0:19:48 | 0:19:51 | |
liver. He will be making his way... | 0:19:51 | 0:19:53 | |
-Is he the surgeon? -He's the surgeon who will be doing the operation. | 0:19:53 | 0:19:55 | |
Very, very experienced. | 0:19:55 | 0:19:57 | |
-Oh, good. -You're in safe hands. | 0:19:57 | 0:19:59 | |
I feel in safe hands. | 0:19:59 | 0:20:00 | |
-OK, well, it's good to see you again, OK? -Thank you. -And we'll see you soon. | 0:20:00 | 0:20:04 | |
-All right? -Bye. | 0:20:04 | 0:20:05 | |
By signing up for the trial, | 0:20:05 | 0:20:08 | |
Connie will get the transplant she needs fast. | 0:20:08 | 0:20:11 | |
But everyone is conscious of the price she could pay. | 0:20:12 | 0:20:15 | |
With any clinical trial, there is a degree of risk. | 0:20:16 | 0:20:18 | |
But the stakes are huge with this trial. | 0:20:18 | 0:20:21 | |
If we can't do what we're setting out to do, | 0:20:21 | 0:20:23 | |
which is show whether or not a liver's going to function after it's | 0:20:23 | 0:20:26 | |
transplanted, for us as clinicians it's really disappointing. | 0:20:26 | 0:20:29 | |
But for the patients, that could be devastating. | 0:20:29 | 0:20:33 | |
Worst case scenario, they can die. | 0:20:33 | 0:20:35 | |
In theatre, Connie's life will be in the hands of transplant surgeon | 0:20:40 | 0:20:43 | |
Thamara Perera. | 0:20:43 | 0:20:45 | |
In the last seven years he's performed hundreds of transplants. | 0:20:46 | 0:20:50 | |
Transplant surgery, it's not a very popular field, | 0:20:51 | 0:20:54 | |
because it has quite a lot of hard work that you need to put in, | 0:20:54 | 0:20:58 | |
but someone has to do it. | 0:20:58 | 0:20:59 | |
There are so many patients out there | 0:21:00 | 0:21:02 | |
waiting on the transplant waiting list, so you don't want to stop. | 0:21:02 | 0:21:06 | |
You just need to keep going. | 0:21:06 | 0:21:08 | |
I can see the transformation, which I like, you know? | 0:21:08 | 0:21:11 | |
You really feel that you have done something to the patient and the | 0:21:11 | 0:21:16 | |
patient has got a new life. | 0:21:16 | 0:21:17 | |
That is what makes this job worthwhile. | 0:21:18 | 0:21:21 | |
There comes a point where you've done every bit of planning, | 0:21:29 | 0:21:32 | |
every bit of preparation... | 0:21:32 | 0:21:34 | |
You've just got to take that leap of faith and go to the next stage, | 0:21:36 | 0:21:39 | |
and just hope that it works. | 0:21:39 | 0:21:40 | |
Patient's name and procedure. | 0:21:40 | 0:21:43 | |
We've got Connie O'Driscoll on the table for liver transplant. | 0:21:43 | 0:21:46 | |
OK, expected blood loss. | 0:21:46 | 0:21:48 | |
Unpredictable, could be loads depending on the situation. | 0:21:48 | 0:21:51 | |
Thamara is a machine. | 0:21:52 | 0:21:55 | |
He is so dedicated to becoming the best in the world, | 0:21:55 | 0:21:58 | |
I've no doubt about it. He's so driven. | 0:21:58 | 0:22:01 | |
He fights for every single patient, to get them a transplant. | 0:22:01 | 0:22:05 | |
If I needed a liver transplant, Thamara would be definitely at that table. | 0:22:05 | 0:22:09 | |
Can I get the temperature down on theatres, please? | 0:22:09 | 0:22:12 | |
The main surgical challenge is to connect Connie's new liver | 0:22:14 | 0:22:18 | |
as quickly as possible. | 0:22:18 | 0:22:20 | |
First, Thamara must carefully divide and detach the major arteries and | 0:22:22 | 0:22:26 | |
veins connected to Connie's diseased liver. | 0:22:26 | 0:22:30 | |
These need to be securely clamped so Connie doesn't bleed out. | 0:22:31 | 0:22:34 | |
He'll then have to work fast to put the donor liver in position and | 0:22:36 | 0:22:40 | |
connect it to Connie's blood vessels and bile duct. | 0:22:40 | 0:22:43 | |
The time is critical, | 0:22:45 | 0:22:47 | |
because each and every second where the liver is out of the machine, | 0:22:47 | 0:22:51 | |
it undergoes a degree of damage, | 0:22:51 | 0:22:54 | |
which could lead to failure and emergency re-transplant. | 0:22:54 | 0:22:58 | |
In Theatre 15, Richard Irving and Philip Begg | 0:23:05 | 0:23:08 | |
are two-and-a-half hours into surgery to plant a new | 0:23:08 | 0:23:12 | |
kind of hearing aid microphone inside their patient's skull. | 0:23:12 | 0:23:15 | |
So far Richard has managed to work around Paul's delicate facial nerves | 0:23:17 | 0:23:22 | |
as he drills towards the middle ear. | 0:23:22 | 0:23:25 | |
Now he needs to drill even deeper to reach the tiniest bones in the body, | 0:23:25 | 0:23:30 | |
which transmit sound to the inner ear. | 0:23:30 | 0:23:33 | |
Slower, more careful progress in this area. | 0:23:34 | 0:23:37 | |
Exposing the bits of the middle ear that I want to get access to. | 0:23:37 | 0:23:41 | |
The ambition is for this new technology | 0:23:45 | 0:23:47 | |
to improve on the broad range of sound | 0:23:47 | 0:23:50 | |
that gets picked up by external microphones. | 0:23:50 | 0:23:53 | |
Instead, it is designed to produce | 0:23:53 | 0:23:55 | |
much more directional sound, by | 0:23:55 | 0:23:58 | |
picking up the vibrations from the tiny incus bone in the middle ear. | 0:23:58 | 0:24:02 | |
OK. | 0:24:02 | 0:24:04 | |
So, straight ahead of me is the incus bone, | 0:24:04 | 0:24:07 | |
and this is where we are going to attach our microphone. | 0:24:07 | 0:24:10 | |
Drill, thanks. | 0:24:12 | 0:24:13 | |
Next Richard has to drill a hole into the fragile incus | 0:24:14 | 0:24:18 | |
which is scarcely three millimetres wide. | 0:24:18 | 0:24:20 | |
There is not a large number of us that do this, | 0:24:24 | 0:24:26 | |
and it does require fine dexterity | 0:24:26 | 0:24:30 | |
and a lot of confidence in what you're doing. | 0:24:30 | 0:24:33 | |
It takes time, it takes expertise, | 0:24:33 | 0:24:35 | |
so the skill that Richard demonstrates in bucketfuls | 0:24:35 | 0:24:39 | |
gives us a safe place to implant. | 0:24:39 | 0:24:43 | |
OK, that looks a nice depth. | 0:24:46 | 0:24:48 | |
Thanks. So there is the little hole on the incus bone. | 0:24:48 | 0:24:52 | |
OK, have you just got the fixation piece there for me? | 0:24:54 | 0:24:57 | |
Fixation device. | 0:24:57 | 0:24:58 | |
Needle to me, please. | 0:25:06 | 0:25:08 | |
What I want is that hole in my incus | 0:25:11 | 0:25:14 | |
to be pretty much in the centre of that disc. | 0:25:14 | 0:25:16 | |
Which is there. | 0:25:18 | 0:25:19 | |
Which it is. That looks pretty good, doesn't it, yeah. | 0:25:19 | 0:25:23 | |
So I can fixate here, yes? | 0:25:23 | 0:25:25 | |
-Yes. -Right. -Shall we get the implant? | 0:25:25 | 0:25:28 | |
Richard now has to insert the tip of the microphone | 0:25:31 | 0:25:34 | |
into the tiny hole he's drilled in the incus. | 0:25:34 | 0:25:37 | |
It has to be implanted with just the right amount of pressure. | 0:25:41 | 0:25:46 | |
Too much, or too little, and the microphone won't work. | 0:25:46 | 0:25:50 | |
The recess is 0.6 of a millimetre across | 0:25:50 | 0:25:53 | |
and about a millimetre deep. | 0:25:53 | 0:25:55 | |
Come on. | 0:25:55 | 0:25:58 | |
That is the key challenge as to whether this thing works - | 0:25:58 | 0:26:00 | |
can you get this coupled precisely to the bones of hearing? | 0:26:00 | 0:26:04 | |
-I'll straighten this. -Yes, it can be straight. | 0:26:06 | 0:26:10 | |
I have to try and gauge really, just using the senses in my hand the | 0:26:12 | 0:26:17 | |
tension between that bone and the microphone. | 0:26:17 | 0:26:20 | |
We really do not want anything to go wrong. | 0:26:24 | 0:26:27 | |
Yeah. Good job. | 0:26:30 | 0:26:31 | |
Green screen over, thanks. | 0:26:34 | 0:26:35 | |
OK. Shall we connect up, yeah? | 0:26:38 | 0:26:40 | |
The implant is in place. | 0:26:42 | 0:26:44 | |
Now Phil and the audio team need to play sounds through the speaker in | 0:26:45 | 0:26:48 | |
Paul's ear, to check the microphone picks them up. | 0:26:48 | 0:26:51 | |
You should start hearing it now. | 0:26:53 | 0:26:54 | |
-There's nothing. -Nothing. | 0:26:59 | 0:27:01 | |
Just trying advancing it slightly. | 0:27:04 | 0:27:06 | |
See if that's any better. | 0:27:08 | 0:27:10 | |
No, it's still low. | 0:27:10 | 0:27:11 | |
You're not picking up any sound in theatre either. | 0:27:13 | 0:27:15 | |
Yeah, it's too quiet. | 0:27:17 | 0:27:19 | |
Unless they can get the implanted microphone working, | 0:27:19 | 0:27:23 | |
the operation won't have any benefit for Paul. | 0:27:23 | 0:27:26 | |
This has developed over a number of years. | 0:27:27 | 0:27:30 | |
The responsibility for it does sit on my shoulders as the chief | 0:27:30 | 0:27:33 | |
investigator. That's something I have to manage and is something | 0:27:33 | 0:27:37 | |
that I am accountable for. | 0:27:37 | 0:27:39 | |
Clinical trials wouldn't be possible if there weren't the patients who | 0:27:48 | 0:27:52 | |
were brave enough to take part, | 0:27:52 | 0:27:54 | |
and put their own health on the line in a lot of cases, | 0:27:54 | 0:27:57 | |
and their lives on the line. | 0:27:57 | 0:28:00 | |
We have a duty to really look after these patients as much as possible, | 0:28:00 | 0:28:04 | |
and make it as safe as possible and really try and get them through it. | 0:28:04 | 0:28:07 | |
In the transplant trial in Theatre 3, | 0:28:09 | 0:28:12 | |
Thamara Perera is about to remove Connie's diseased liver, and replace | 0:28:12 | 0:28:17 | |
it with a donor organ that's been revived and rehabilitated. | 0:28:17 | 0:28:21 | |
We'll have to start, thank you. | 0:28:21 | 0:28:24 | |
Just starting. | 0:28:24 | 0:28:26 | |
The surgery itself is extremely complicated, | 0:28:27 | 0:28:31 | |
and you have an organ that is diseased, | 0:28:31 | 0:28:34 | |
but also is receiving two litres of blood a minute, | 0:28:34 | 0:28:37 | |
and you have to be able to get that liver out quickly, | 0:28:37 | 0:28:40 | |
and you have to be able to put the new one in. | 0:28:40 | 0:28:42 | |
Argon, please. | 0:28:42 | 0:28:44 | |
Using an electrosurgical pencil, Thamara needs to carefully separate | 0:28:44 | 0:28:48 | |
Connie's liver from the surrounding tissue in her abdomen. | 0:28:48 | 0:28:52 | |
As surgical lead, he must stay aware of everything that happens in theatre. | 0:28:52 | 0:28:57 | |
There are three zones in a surgeon's focus. | 0:28:58 | 0:29:01 | |
The immediate focus is there, | 0:29:01 | 0:29:03 | |
the structures, what I'm going to do. | 0:29:03 | 0:29:05 | |
At the same time I have a peripheral focus, | 0:29:07 | 0:29:09 | |
the team are on me, what are they doing? | 0:29:09 | 0:29:12 | |
Is the scrub nurse ready with the next instrument? | 0:29:12 | 0:29:16 | |
The third zone, it's the environment, | 0:29:21 | 0:29:23 | |
the theatre environment. | 0:29:23 | 0:29:25 | |
Are you OK? | 0:29:25 | 0:29:27 | |
Without the three zones, you cannot perform a good operation. | 0:29:27 | 0:29:32 | |
Left hepatic artery is going. | 0:29:35 | 0:29:37 | |
The liver is attached to major blood vessels, | 0:29:37 | 0:29:40 | |
including the arteries supplying blood from the heart and the portal | 0:29:40 | 0:29:44 | |
vein which carries blood to the liver from the stomach and intestines. | 0:29:44 | 0:29:48 | |
These all need to be disconnected with immense care. | 0:29:50 | 0:29:53 | |
They will need to be used again, when attaching the donor liver. | 0:29:53 | 0:29:57 | |
There are two sources of blood supply into the liver, | 0:29:57 | 0:30:00 | |
these are the portal vein and the hepatic artery. | 0:30:00 | 0:30:03 | |
But this is not for people who are chicken-hearted. | 0:30:07 | 0:30:09 | |
This lay is a bit...awkward, isn't it? | 0:30:11 | 0:30:14 | |
Until Connie's vessels get joined up to the new liver, | 0:30:15 | 0:30:19 | |
they need to be clamped to prevent dangerous blood loss. | 0:30:19 | 0:30:22 | |
If you don't get it right, the bad outcomes happen | 0:30:22 | 0:30:26 | |
in front of your eyes. | 0:30:26 | 0:30:27 | |
15 minutes. | 0:30:29 | 0:30:30 | |
Yeah, fine, I'll be ready. | 0:30:30 | 0:30:32 | |
Thamara is close to removing Connie's liver, | 0:30:35 | 0:30:38 | |
so it's time to get the donor organ ready. | 0:30:38 | 0:30:41 | |
John, are you OK for me to take the portal vein? | 0:30:41 | 0:30:43 | |
-Yes. -Thank you. | 0:30:43 | 0:30:45 | |
Portal vein is clamped. | 0:30:45 | 0:30:47 | |
It's going to be flushed in a second. | 0:30:55 | 0:30:57 | |
Disconnect the liver, we are ready. | 0:30:57 | 0:30:59 | |
Disconnect the liver, right, OK. | 0:31:01 | 0:31:04 | |
We'll work our way through taking it off now. | 0:31:04 | 0:31:06 | |
Connie's liver has been removed. | 0:31:08 | 0:31:10 | |
And with the donor organ coming off the machine's | 0:31:13 | 0:31:16 | |
oxygen and blood supply, the team must move fast. | 0:31:16 | 0:31:20 | |
The timing is important, | 0:31:20 | 0:31:21 | |
because I do not want too much time spent | 0:31:21 | 0:31:25 | |
between it coming out the machine and reconnection of blood supply. | 0:31:25 | 0:31:29 | |
It has to be 20 minutes. | 0:31:29 | 0:31:31 | |
-And then it is connected. -It will be two minutes, OK? | 0:31:31 | 0:31:34 | |
Once that liver is removed from the machine, the clock is ticking. | 0:31:35 | 0:31:39 | |
It is deteriorating, the cells are dying. | 0:31:41 | 0:31:43 | |
I'm coming. | 0:31:43 | 0:31:45 | |
Now the donor liver is in Theatre 3, | 0:31:47 | 0:31:50 | |
Thamara has just 13 minutes to connect it to Connie's blood vessels. | 0:31:50 | 0:31:54 | |
He will start with the large portal vein, | 0:31:56 | 0:31:58 | |
which delivers 75% of the liver's blood supply. | 0:31:58 | 0:32:01 | |
Clamp on the cable, please. | 0:32:03 | 0:32:04 | |
It is one of the most complex operations. | 0:32:12 | 0:32:15 | |
There has to be a mental design in your head. | 0:32:15 | 0:32:18 | |
How am I going to put these two structures together? | 0:32:18 | 0:32:22 | |
Scissors, please. | 0:32:22 | 0:32:23 | |
You need to know what I am going to do now, | 0:32:24 | 0:32:26 | |
my next suture is going to be there. | 0:32:26 | 0:32:29 | |
Add the following suture is going to be there. | 0:32:29 | 0:32:31 | |
Hold this, please. With my hand, please. | 0:32:31 | 0:32:33 | |
OK, that's finished. | 0:32:33 | 0:32:34 | |
Cut the bottom two needles, please. | 0:32:34 | 0:32:37 | |
Big spoon clamp, please. Pick-ups to me. | 0:32:37 | 0:32:40 | |
Starting the portal vein. | 0:32:40 | 0:32:41 | |
The portal vein is a thin, fine structure, | 0:32:42 | 0:32:45 | |
susceptible to tear during the operation. | 0:32:45 | 0:32:49 | |
The integrity of these vessels are important for the survival | 0:32:51 | 0:32:55 | |
of the liver. | 0:32:55 | 0:32:57 | |
You cannot take hours and hours doing these two joints. | 0:32:57 | 0:33:00 | |
Do you see what I am doing? | 0:33:03 | 0:33:05 | |
Holding the cut edge and stretching it. | 0:33:05 | 0:33:07 | |
Imagine a line parallel to that edge. | 0:33:07 | 0:33:11 | |
Five minutes. | 0:33:14 | 0:33:16 | |
Four o'clock. | 0:33:24 | 0:33:26 | |
Eight o'clock. | 0:33:28 | 0:33:30 | |
Scissors ready, please. | 0:33:33 | 0:33:35 | |
Turn one minute. | 0:33:35 | 0:33:36 | |
It is an enormous responsibility to operate on a patient, | 0:33:36 | 0:33:40 | |
so you need to have courage and you need to have expertise. | 0:33:40 | 0:33:44 | |
Portal vein is finished. Hold this, please. | 0:33:44 | 0:33:46 | |
You need to take the clamps off, | 0:33:49 | 0:33:51 | |
let the blood flow through the liver into the patient. | 0:33:51 | 0:33:55 | |
With blood now flowing through the donor organ, | 0:33:55 | 0:33:58 | |
Connie's body could have an adverse reaction to such a major procedure. | 0:33:58 | 0:34:02 | |
This is the period the patient can become really unstable. | 0:34:02 | 0:34:06 | |
Sometimes the changes are powerful enough to stop the heart. | 0:34:07 | 0:34:12 | |
OK, that clamp's off. | 0:34:15 | 0:34:17 | |
In Theatre 15, | 0:34:29 | 0:34:31 | |
the hearing aid trial team have been working for five hours. | 0:34:31 | 0:34:34 | |
But the operation has been at a standstill for the last 45 minutes. | 0:34:36 | 0:34:40 | |
Are we getting something? | 0:34:44 | 0:34:46 | |
It is not good, though. | 0:34:46 | 0:34:49 | |
The miniature microphone implanted in Paul's middle ear still isn't | 0:34:49 | 0:34:53 | |
picking up any sound. | 0:34:53 | 0:34:55 | |
We can't really proceed with that. | 0:34:55 | 0:34:57 | |
It is one of those episodes in your surgical career | 0:34:58 | 0:35:04 | |
where you emotionally go from somewhere up here | 0:35:04 | 0:35:08 | |
to the bottom, and instantly you think, | 0:35:08 | 0:35:12 | |
"I've done something wrong. What have I done?" | 0:35:12 | 0:35:15 | |
OK, well, we will have a look at that and see. | 0:35:18 | 0:35:20 | |
-Did it? -I think so. | 0:35:21 | 0:35:23 | |
I think you're right. | 0:35:23 | 0:35:25 | |
I think it's the mic. | 0:35:25 | 0:35:27 | |
If the microphone HAS been damaged, | 0:35:29 | 0:35:31 | |
they will need to extract it and repeat the operation with a new one. | 0:35:31 | 0:35:35 | |
No real change. I have done all of the surgical sounds | 0:35:35 | 0:35:37 | |
-and your voice and all of that. -There was nothing? | 0:35:37 | 0:35:40 | |
There was nothing. No. | 0:35:40 | 0:35:41 | |
We are checking the channels as well, just in case. | 0:35:41 | 0:35:44 | |
Doing a surgical procedure that has never been done before, | 0:35:46 | 0:35:49 | |
it doesn't always go to plan. | 0:35:49 | 0:35:51 | |
And sometimes you can't explain why it doesn't go to plan. | 0:35:51 | 0:35:56 | |
That is part of the life as a surgeon. | 0:35:56 | 0:35:59 | |
But you take that risk. | 0:35:59 | 0:36:00 | |
Before unscrewing, can we just check that probe first? | 0:36:00 | 0:36:03 | |
Yeah. | 0:36:03 | 0:36:05 | |
Next they decide to check if there is any fault with the speaker they | 0:36:05 | 0:36:08 | |
are using for the test. | 0:36:08 | 0:36:10 | |
It is taped inside Paul's ear. | 0:36:10 | 0:36:12 | |
Is that better now? | 0:36:12 | 0:36:14 | |
Oh, my God! | 0:36:14 | 0:36:15 | |
What? Good. | 0:36:15 | 0:36:17 | |
I can hear everyone. | 0:36:17 | 0:36:18 | |
-The probe slipped off. -Ah. | 0:36:19 | 0:36:21 | |
That is... I can hear myself... | 0:36:21 | 0:36:23 | |
That is perfect. | 0:36:23 | 0:36:25 | |
The speaker had come loose, so no sound was reaching the microphone. | 0:36:25 | 0:36:29 | |
There is always a solution. | 0:36:29 | 0:36:32 | |
It is about working the problem, | 0:36:32 | 0:36:35 | |
using the Apollo 13 mission statement, | 0:36:35 | 0:36:38 | |
"Failure is not an option." | 0:36:38 | 0:36:39 | |
It is just, you know, your seven o'clock beer becomes a nine | 0:36:41 | 0:36:43 | |
o'clock beer. That's the only difference in life. | 0:36:43 | 0:36:46 | |
OK, anything else we need to do, or can I close up? | 0:36:48 | 0:36:50 | |
-OK. -Yeah. | 0:36:50 | 0:36:51 | |
-Time to close, yeah? -OK. | 0:36:51 | 0:36:53 | |
Table up in the air a little bit, please. | 0:36:53 | 0:36:55 | |
-VOICEOVER: -If this is successful, it will be hugely satisfying. | 0:36:57 | 0:37:00 | |
To think that a significant advance in science has been attributed to | 0:37:00 | 0:37:06 | |
something that you have actually done, and that is huge. | 0:37:06 | 0:37:09 | |
OK. Everything is nearly finished. | 0:37:09 | 0:37:12 | |
Just putting a dressing on your head. | 0:37:12 | 0:37:15 | |
-Should be good, shouldn't it, really, with those results? -Yeah. | 0:37:15 | 0:37:18 | |
Although the microphone is functioning, | 0:37:18 | 0:37:20 | |
the team will not know whether it is helping Paul until he has recovered | 0:37:20 | 0:37:24 | |
from surgery, and it gets switched on for testing. | 0:37:24 | 0:37:27 | |
If we are successful, it is a game changer, | 0:37:27 | 0:37:31 | |
and potentially will be life-changing for tens of thousands | 0:37:31 | 0:37:35 | |
of people across the globe. | 0:37:35 | 0:37:38 | |
Throughout the hospital, | 0:37:58 | 0:37:59 | |
tools and treatments that have emerged from clinical trials are | 0:37:59 | 0:38:03 | |
revolutionising everyday health care. | 0:38:03 | 0:38:05 | |
Now, then, how is your elbow? | 0:38:05 | 0:38:07 | |
I think it looks good. | 0:38:07 | 0:38:09 | |
Lieutenant Colonel Professor Steven Jeffery is a consultant plastic | 0:38:09 | 0:38:14 | |
surgeon who specialises in treating burns. | 0:38:14 | 0:38:16 | |
Many burns patients like David Walsh struggle with recurring wound | 0:38:17 | 0:38:21 | |
-infections. -The flap's fine. | 0:38:21 | 0:38:24 | |
Yeah, that looks very good, but... | 0:38:24 | 0:38:27 | |
Having a large number of bacteria present in your wound | 0:38:27 | 0:38:29 | |
is not good for your wound, | 0:38:29 | 0:38:31 | |
so that tells you you have got to do something about it. | 0:38:31 | 0:38:34 | |
Steven is using a new device that has recently been through successful | 0:38:34 | 0:38:39 | |
clinical trials. | 0:38:39 | 0:38:40 | |
It detects bacteria much faster than traditional methods. | 0:38:40 | 0:38:44 | |
Previously, if you suspected a lot of bacteria to be present and maybe | 0:38:45 | 0:38:50 | |
infection, you would take a swab, microbiology swab, | 0:38:50 | 0:38:53 | |
and you'd send that off to the lab and you'd wait three or four days | 0:38:53 | 0:38:56 | |
and you'd get the result back. | 0:38:56 | 0:38:58 | |
We will take a look using this camera, the MolecuLight camera. | 0:38:58 | 0:39:02 | |
-Yeah. -What it does is, it shows you bacteria. | 0:39:02 | 0:39:06 | |
OK, so we are going to have to darken in the room | 0:39:06 | 0:39:08 | |
for this to work. | 0:39:08 | 0:39:10 | |
Illuminating the skin with a specific wavelength of light | 0:39:10 | 0:39:14 | |
makes bacteria fluoresce under the MolecuLight screen. | 0:39:14 | 0:39:18 | |
Most bacteria will shine red. | 0:39:18 | 0:39:20 | |
There's another type of molecule which will fluoresce | 0:39:20 | 0:39:23 | |
a kind of greeny blue, and that's found in pseudomonas, | 0:39:23 | 0:39:27 | |
which is something that is particularly troubling to us in the | 0:39:27 | 0:39:31 | |
burns world. | 0:39:31 | 0:39:32 | |
You see that there, the lightened bits? Are they the infected bits? | 0:39:32 | 0:39:35 | |
-Yeah, they are. -I knew it, I bloody knew it. -Yeah. | 0:39:35 | 0:39:39 | |
With faster, more accurate diagnosis, treatment can be more effective. | 0:39:39 | 0:39:43 | |
You have got pseudomonas in that... | 0:39:43 | 0:39:46 | |
-Definitely? -Yeah. | 0:39:46 | 0:39:47 | |
But it is OK, now we know what it is, we can treat it. | 0:39:47 | 0:39:49 | |
I don't think the inventor had fully appreciated how big this was | 0:39:51 | 0:39:55 | |
going to be, and how important it is to see bacteria in real time. | 0:39:55 | 0:40:00 | |
That has never been possible before. | 0:40:00 | 0:40:02 | |
Trials targeting Britain's most widespread and deadly health problems have | 0:40:09 | 0:40:13 | |
the potential to save thousands of lives. | 0:40:13 | 0:40:16 | |
Urology surgeon Prashant Patel is looking for new ways of tackling a | 0:40:17 | 0:40:22 | |
disease that will strike one in eight men in their lifetime - | 0:40:22 | 0:40:26 | |
prostate cancer. | 0:40:26 | 0:40:28 | |
Cancer in the UK at the moment is an epidemic. | 0:40:28 | 0:40:32 | |
Prostate cancer is now the most leading cause of cancer diagnosis | 0:40:32 | 0:40:36 | |
in UK men. | 0:40:36 | 0:40:37 | |
10,000 patients are also dying from prostate cancer every year. | 0:40:37 | 0:40:41 | |
Prashant's team are working with the University of Birmingham to trial an | 0:40:41 | 0:40:45 | |
ambitious technique that could supersede today's treatment options. | 0:40:45 | 0:40:50 | |
Chemotherapy and radiotherapy, whilst effective, | 0:40:50 | 0:40:53 | |
it causes a significant amount of collateral damage. | 0:40:53 | 0:40:56 | |
The idea of doing the trial is to go for the punching - | 0:40:56 | 0:41:01 | |
see whether we can cure and control the cancer, | 0:41:01 | 0:41:04 | |
but at the same time minimise the side-effects. | 0:41:04 | 0:41:06 | |
The trial will involve injecting a patient with a genetically modified | 0:41:08 | 0:41:12 | |
virus, triggering a process which should attack and destroy the cancer | 0:41:12 | 0:41:17 | |
cells. Only 11 patients have signed up to try it out so far. | 0:41:17 | 0:41:22 | |
79-year-old William Yates is a grandfather of five. | 0:41:28 | 0:41:33 | |
He will be Prashant's 12th subject. | 0:41:33 | 0:41:34 | |
-Good morning, Mr Yates. -Good morning. -Morning. -Good morning. | 0:41:36 | 0:41:40 | |
-How are you? -I am very good. -Good. | 0:41:40 | 0:41:43 | |
-All set? -Yes, thank you. -Excellent. | 0:41:43 | 0:41:45 | |
You have met Sian and Fiona already. | 0:41:45 | 0:41:46 | |
-Yes. I have met the Angels. -Excellent. So you know what is happening today? | 0:41:46 | 0:41:49 | |
-Yes. -So we are going ahead with the prostate cancer gene therapy trial. | 0:41:49 | 0:41:53 | |
Yes. | 0:41:53 | 0:41:55 | |
The stakes for conducting any particular clinical trial | 0:41:55 | 0:41:58 | |
are extremely high. | 0:41:58 | 0:41:59 | |
All things we do in medicine is associated with risks. | 0:41:59 | 0:42:03 | |
And there are known risks and there are the unknowns. | 0:42:03 | 0:42:07 | |
When it comes to clinical trials, | 0:42:07 | 0:42:09 | |
it is the unknowns which we are trying to explore. | 0:42:09 | 0:42:12 | |
But that is the way medicine evolves. | 0:42:12 | 0:42:15 | |
And just to recap, we are doing this | 0:42:15 | 0:42:18 | |
because you have had prostate cancer diagnosis, | 0:42:18 | 0:42:21 | |
a few years ago you had radiotherapy | 0:42:21 | 0:42:23 | |
-and now there is some biochemical failure. -Yes, yes. | 0:42:23 | 0:42:27 | |
William is taking part in this trial as his prostate cancer has returned | 0:42:27 | 0:42:31 | |
after eight years in remission. | 0:42:31 | 0:42:34 | |
He is keen to get involved with testing the innovative treatment, | 0:42:34 | 0:42:37 | |
despite its lack of a proven track record. | 0:42:37 | 0:42:40 | |
-So we have got this opportunity to treat you with gene therapy. -Yeah. | 0:42:40 | 0:42:44 | |
I was quite proud to be a guinea pig, to be quite honest. | 0:42:46 | 0:42:49 | |
And if that can wipe it out in years to come, I think | 0:42:49 | 0:42:52 | |
I have done my little bit, so I am quite happy about that. | 0:42:52 | 0:42:56 | |
-Are we ready to rock and roll? -Yes. -OK, great. | 0:42:56 | 0:42:59 | |
Right, we will get you changed and I will be seeing you in theatre in a | 0:42:59 | 0:43:03 | |
-few minutes. -OK. -OK? Right. We shall see you in a bit. | 0:43:03 | 0:43:07 | |
OK, good morning, all. William Yates, gene therapy trial. | 0:43:14 | 0:43:18 | |
Intraprostatic injection. | 0:43:18 | 0:43:20 | |
So everyone's eyes should be covered. | 0:43:20 | 0:43:22 | |
This is a risky trial, because it is the first time | 0:43:24 | 0:43:27 | |
this kind of genetically modified virus has been used on humans. | 0:43:27 | 0:43:32 | |
All experimental treatments must be proven safe before they can progress | 0:43:32 | 0:43:37 | |
to wider trials. | 0:43:37 | 0:43:38 | |
We are the only people who are conducting these trials. | 0:43:38 | 0:43:42 | |
We are dealing with biologically modified viruses. | 0:43:42 | 0:43:45 | |
They do not normally exist. | 0:43:45 | 0:43:47 | |
Here is our gene therapy pharmacist. | 0:43:47 | 0:43:49 | |
We have got all six syringes ready. | 0:43:49 | 0:43:52 | |
We hope that when this virus enters into the body, it will attack | 0:43:52 | 0:43:55 | |
the cancer cells, | 0:43:55 | 0:43:57 | |
and in addition will also provoke the immunity of the patient to fight | 0:43:57 | 0:44:04 | |
against the cancer without causing significant side-effects. | 0:44:04 | 0:44:07 | |
The treatment has two stages. | 0:44:08 | 0:44:11 | |
First, the genetically modified sample of the common cold virus will | 0:44:11 | 0:44:14 | |
be injected directly into the prostate. | 0:44:14 | 0:44:17 | |
The virus is altered so it won't spread, | 0:44:19 | 0:44:21 | |
and so it changes the biochemistry of the cancer cells. | 0:44:21 | 0:44:26 | |
Next, after 48 hours, a drug is given to the patient. | 0:44:26 | 0:44:31 | |
When this drug comes into contact with the cancer cells affected by | 0:44:31 | 0:44:34 | |
the virus, it will start to kill them off. | 0:44:34 | 0:44:37 | |
We have got the ultrasound scan set up of the prostate, | 0:44:38 | 0:44:41 | |
and the grid is on there, as you can see. | 0:44:41 | 0:44:44 | |
Prash needs to inject the live virus with great precision | 0:44:44 | 0:44:48 | |
into the six cancer sites in William's prostate, | 0:44:48 | 0:44:51 | |
showing up as the darker areas on the ultrasound. | 0:44:51 | 0:44:54 | |
To keep William comfortable and completely still, | 0:44:56 | 0:44:59 | |
he is under general anaesthetic. | 0:44:59 | 0:45:00 | |
There are risks associated with these kind of trials. | 0:45:01 | 0:45:05 | |
With live biological agents like viruses, | 0:45:05 | 0:45:07 | |
we keep a very close eye on the patient's side-effects. | 0:45:07 | 0:45:11 | |
Ready when you are. | 0:45:13 | 0:45:14 | |
The worst-case scenario is virus related inflammatory reaction. | 0:45:14 | 0:45:20 | |
It just doesn't give you a flu-like illness but a very severe | 0:45:20 | 0:45:24 | |
inflammatory illness. In that case we are in problem. | 0:45:24 | 0:45:27 | |
But as with all trials like this, they won't know how William's body | 0:45:28 | 0:45:32 | |
will react until he has received the virus injections. | 0:45:32 | 0:45:35 | |
Right, OK, we are ready to start. | 0:45:37 | 0:45:38 | |
-Final needles. -Final needle. | 0:45:39 | 0:45:41 | |
In Theatre 3, the transplant trial team have rushed to get Connie's | 0:45:48 | 0:45:52 | |
new liver into position, and started connecting it to her blood supply. | 0:45:52 | 0:45:56 | |
-Happy? -Yeah. | 0:45:58 | 0:45:59 | |
Now surgeon Thamara Perera is moving on to the most delicate stage - | 0:45:59 | 0:46:04 | |
plumbing in the network of hepatic arteries which help to supply the | 0:46:04 | 0:46:08 | |
liver with oxygenated blood. | 0:46:08 | 0:46:10 | |
In those very fine sutures, you need to slow down, focus. | 0:46:10 | 0:46:14 | |
You need to make it the best possible way so that it will not | 0:46:14 | 0:46:20 | |
make any clots or damage into the blood vessel. | 0:46:20 | 0:46:23 | |
If a clot develops in the hepatic artery, that is going to | 0:46:23 | 0:46:28 | |
damage the liver. | 0:46:28 | 0:46:30 | |
Can I get this artery... | 0:46:30 | 0:46:32 | |
If you rupture a blood vessel, | 0:46:33 | 0:46:35 | |
the amount of bleeding is enough to kill a patient within 30 seconds. | 0:46:35 | 0:46:40 | |
One of the arteries is proving difficult. | 0:46:44 | 0:46:47 | |
One of my teachers told me, when I first became a surgeon, | 0:47:07 | 0:47:11 | |
he said, "God has given you power. It is a privilege. | 0:47:11 | 0:47:16 | |
"Please make sure every patient goes home safe." | 0:47:16 | 0:47:19 | |
With all the blood vessels attached, Thamara has got one last task - | 0:47:21 | 0:47:26 | |
reconnecting the bile duct which supplies the digestive system with | 0:47:26 | 0:47:30 | |
the fluid we need to digest fats. | 0:47:30 | 0:47:32 | |
That looks all right. | 0:47:35 | 0:47:37 | |
-We are happy to close, then? -Yeah. | 0:47:40 | 0:47:42 | |
-Looking very great. -Good. | 0:47:42 | 0:47:45 | |
Once you know everything has gone OK, it is a big relief, | 0:47:45 | 0:47:50 | |
so that is probably the time to take a proper deep breath. | 0:47:50 | 0:47:54 | |
OK. Thank you. Thank you, everybody. Thank you. Thank you. | 0:47:54 | 0:47:56 | |
Could we have staples, please? | 0:47:58 | 0:48:01 | |
Calmly and nicely. | 0:48:01 | 0:48:03 | |
The operation is complete in time. | 0:48:03 | 0:48:06 | |
Lactate on the machine was 1.2, glucose was... | 0:48:06 | 0:48:09 | |
Now they must wait to see if Connie's new liver continues to perform. | 0:48:09 | 0:48:14 | |
The liver's functioned as we would have hoped. | 0:48:15 | 0:48:17 | |
But, you know, this is a trial. | 0:48:18 | 0:48:20 | |
Connie has got a long road ahead of her. | 0:48:22 | 0:48:24 | |
And there are no certainties. | 0:48:24 | 0:48:25 | |
We will just keep our fingers crossed that she does well. | 0:48:26 | 0:48:29 | |
In Theatre 28, prostate cancer patient William Yates | 0:48:43 | 0:48:46 | |
is about to be injected with a genetically modified virus. | 0:48:46 | 0:48:51 | |
As you can see, whilst I am moving the needle, it is in that area. | 0:48:51 | 0:48:55 | |
OK. | 0:48:55 | 0:48:56 | |
For neurologist Prash to test his new gene therapy technique, | 0:48:57 | 0:49:02 | |
he needs to deliver it to the site of the cancer | 0:49:02 | 0:49:04 | |
with pinpoint accuracy. | 0:49:04 | 0:49:06 | |
Prior to the procedure, | 0:49:06 | 0:49:08 | |
we would have done all our prior mapping of the prostate, | 0:49:08 | 0:49:10 | |
as to where the cancer is. | 0:49:10 | 0:49:12 | |
But we use the grid to accurately place the virus within the cancer. | 0:49:14 | 0:49:18 | |
OK, now, as soon as the virus goes in, | 0:49:18 | 0:49:22 | |
you can see there, you see? | 0:49:22 | 0:49:24 | |
You've got a very nice distribution. | 0:49:24 | 0:49:26 | |
Second injection going in. | 0:49:30 | 0:49:31 | |
And the co-ordinate for this is... | 0:49:31 | 0:49:33 | |
..b2.5. | 0:49:33 | 0:49:36 | |
-That will be going at the same depth? -Same depth, five. | 0:49:36 | 0:49:39 | |
Yeah, that is perfect placement there. | 0:49:42 | 0:49:44 | |
So it is e3, please. | 0:49:44 | 0:49:46 | |
OK, I am happy with that. | 0:49:48 | 0:49:50 | |
As soon as the virus goes in, I have got a very good coverage. | 0:49:50 | 0:49:54 | |
How is he behaving on the top end? | 0:49:54 | 0:49:57 | |
No problems? | 0:49:57 | 0:49:59 | |
OK. The right side is all done. | 0:49:59 | 0:50:01 | |
As you can see, it is all blanched out white. | 0:50:01 | 0:50:04 | |
OK. Injections are done. | 0:50:05 | 0:50:07 | |
Everything gone on schedule, which is good. | 0:50:07 | 0:50:10 | |
Exactly as planned. | 0:50:10 | 0:50:12 | |
OK. Over and out. | 0:50:12 | 0:50:14 | |
-Thank you. -Thank you. | 0:50:14 | 0:50:16 | |
During the next few hours, the virus should start to trigger | 0:50:16 | 0:50:20 | |
changes in the cancer cells in William's prostate. | 0:50:20 | 0:50:23 | |
So this is your infusion. | 0:50:30 | 0:50:32 | |
This will work with the treatment that you had. | 0:50:32 | 0:50:34 | |
-Is that the killer? -Yeah, this one... -This is the... | 0:50:36 | 0:50:38 | |
It is? Oh, good. | 0:50:38 | 0:50:40 | |
The drug William is getting will only become a tumour killer when it | 0:50:41 | 0:50:45 | |
reaches any cancer cells affected by the virus. | 0:50:45 | 0:50:48 | |
Unlike chemotherapy, it won't damage the healthy cells in his body. | 0:50:48 | 0:50:53 | |
-And how long does this one take? -Five minutes. -Five minutes. | 0:50:53 | 0:50:56 | |
-Five minutes? Is that all? -Yeah. | 0:50:56 | 0:50:58 | |
All done. | 0:50:59 | 0:51:01 | |
So it is a battlefield inside my body now, then? | 0:51:02 | 0:51:05 | |
-Yeah. -Good. | 0:51:05 | 0:51:07 | |
If this works, I shall feel marvellous. | 0:51:09 | 0:51:11 | |
And if it helps to help other people, | 0:51:13 | 0:51:17 | |
then at least I have done something useful in my life. | 0:51:17 | 0:51:20 | |
OK, that one is all done. | 0:51:20 | 0:51:23 | |
It is often the case with medical trials we have to wait and watch, | 0:51:25 | 0:51:29 | |
and in William's case that will be very much applicable. | 0:51:29 | 0:51:32 | |
We just keep our fingers crossed, hold the nerve, | 0:51:33 | 0:51:36 | |
and see whether he has withstood treatment without any significant | 0:51:36 | 0:51:40 | |
side-effects. | 0:51:40 | 0:51:42 | |
And from William's perspective, | 0:51:42 | 0:51:44 | |
whether the treatment has had any effect on his cancer. | 0:51:44 | 0:51:46 | |
For every successful clinical trial, | 0:51:54 | 0:51:57 | |
there are countless others that end in failure, or doubt. | 0:51:57 | 0:52:01 | |
And with a failed trial, it is not just the clinicians who are affected. | 0:52:01 | 0:52:05 | |
It just might not work, | 0:52:05 | 0:52:07 | |
and we would all be very disappointed after all this effort. | 0:52:07 | 0:52:10 | |
Particularly the patient. | 0:52:10 | 0:52:11 | |
They would be hugely disappointed if they have gone through this | 0:52:11 | 0:52:15 | |
and it doesn't work. | 0:52:15 | 0:52:16 | |
Paul is about to find out if the implanted microphone has helped his hearing. | 0:52:18 | 0:52:22 | |
Having recovered from the operation, | 0:52:22 | 0:52:25 | |
today he is having it switched on for the first time. | 0:52:25 | 0:52:29 | |
OK, so I just need to make a few changes on your existing processor. | 0:52:29 | 0:52:34 | |
He is still wearing his old external microphone. | 0:52:34 | 0:52:38 | |
But now they are going to switch that off and turn on the new implanted microphone instead. | 0:52:38 | 0:52:42 | |
-I will start speaking to you, Paul... -Right. | 0:52:44 | 0:52:46 | |
You are listening to me now through the middle ear microphone. | 0:52:46 | 0:52:49 | |
-Right. -So how does my voice sound compared to your normal microphone? | 0:52:49 | 0:52:53 | |
-More clarity. -More clarity? | 0:52:53 | 0:52:55 | |
-Yeah. -Excellent. That's great. | 0:52:55 | 0:52:58 | |
I haven't heard with this much clarity for the last 20 years. | 0:52:58 | 0:53:02 | |
The general background noise is completely gone. | 0:53:02 | 0:53:05 | |
Much more volume and more clarity. | 0:53:05 | 0:53:08 | |
You're all set. | 0:53:08 | 0:53:09 | |
It definitely gives me a lot of hope to be a bit more social. | 0:53:09 | 0:53:11 | |
It is a fantastic device. | 0:53:11 | 0:53:13 | |
-Good luck with it, Paul. -Yes, it has been quite an adventure. | 0:53:13 | 0:53:17 | |
If this really works, and the early evidence is very encouraging, | 0:53:18 | 0:53:24 | |
then in years to come, there could be surgeons all around the world | 0:53:24 | 0:53:28 | |
putting this technology and benefiting tens of thousands of patients. | 0:53:28 | 0:53:32 | |
And that's really the buzz of a project like this. | 0:53:33 | 0:53:37 | |
That, to me, is probably about the most exciting thing you can do | 0:53:37 | 0:53:40 | |
as a surgeon. | 0:53:40 | 0:53:41 | |
-Morning, William. -Good morning. | 0:53:44 | 0:53:46 | |
-How are you? -I'm fine, thanks. -Good, good. | 0:53:46 | 0:53:49 | |
It has been two weeks since William received experimental gene | 0:53:49 | 0:53:52 | |
therapy, in the hope it will stop the spread of his prostate cancer. | 0:53:52 | 0:53:56 | |
Right, so have a seat. | 0:53:56 | 0:53:58 | |
He has had no bad reaction to the live virus - | 0:53:58 | 0:54:01 | |
a crucial factor in this initial trial. | 0:54:01 | 0:54:04 | |
Your blood results are available, | 0:54:05 | 0:54:07 | |
so let's have a look at them and see how you are. | 0:54:07 | 0:54:09 | |
Something which you will be very keen to know is the PSA. | 0:54:09 | 0:54:12 | |
PSA is a protein produced by the prostate, | 0:54:14 | 0:54:16 | |
and is used as an indicator | 0:54:16 | 0:54:19 | |
for cancer. A reduction would mean William's treatment is working. | 0:54:19 | 0:54:23 | |
Recently your PSA was on a sharp rise. | 0:54:23 | 0:54:26 | |
-A very steep rise. -Yeah. | 0:54:26 | 0:54:28 | |
And when we did the injection, your PSA has dropped down... | 0:54:28 | 0:54:31 | |
-Oh, good. -Your results so far have been quite reassuring. | 0:54:31 | 0:54:35 | |
-Yeah. -I don't think you should open a bottle of champagne as yet. | 0:54:35 | 0:54:39 | |
The most important thing is what the trends are and how it is | 0:54:39 | 0:54:42 | |
-over a course of time. -Yeah, yeah. | 0:54:42 | 0:54:44 | |
William will need to return for regular PSA testing over the months ahead. | 0:54:44 | 0:54:50 | |
-Oh, that's lovely to hear, anyway, yeah. -OK? -Yeah. -That's great. | 0:54:50 | 0:54:52 | |
-I will see you in a week's time. -Thank you. -Any problems give us a bell. -OK. | 0:54:52 | 0:54:55 | |
-Take care. -Thank you. -Bye-bye. | 0:54:55 | 0:54:57 | |
Although William's results are promising, this is just the start. | 0:54:59 | 0:55:03 | |
The current trial is aimed at proving the treatment is safe from dangerous side-effects. | 0:55:03 | 0:55:08 | |
Next, the team will need to run a phase two trial to assess | 0:55:08 | 0:55:12 | |
just how effective it is against the cancer. | 0:55:12 | 0:55:15 | |
It is an extremely long process for something that starts off | 0:55:16 | 0:55:20 | |
from a bench side to enter into clinical practice. | 0:55:20 | 0:55:23 | |
You may not even find that light at the end of the tunnel, | 0:55:23 | 0:55:28 | |
but that doesn't stop me from exploring. | 0:55:28 | 0:55:31 | |
The ultimate goal for Thamara Perera, is to increase the number | 0:55:34 | 0:55:38 | |
of donor livers available for patients who will die without them. | 0:55:38 | 0:55:42 | |
Today he is checking up on Connie after her transplant. | 0:55:42 | 0:55:45 | |
-Good morning. -Good morning, Connie. How are you? | 0:55:45 | 0:55:47 | |
Just what I like to see, those smiley faces. | 0:55:47 | 0:55:50 | |
-How are you feeling? -I am feeling wonderful, | 0:55:50 | 0:55:52 | |
and excited and ready to go home. | 0:55:52 | 0:55:55 | |
-That is good. -I couldn't be more happy. | 0:55:55 | 0:55:57 | |
Without that machine, I would not have received this liver. | 0:55:57 | 0:56:01 | |
I'm looking forward to a future. | 0:56:01 | 0:56:03 | |
I think those two words right there, "a future," says it all. | 0:56:03 | 0:56:08 | |
Good. We will see you in the clinic next Monday, then. | 0:56:08 | 0:56:11 | |
Thank you. Thank you, thank you. | 0:56:11 | 0:56:12 | |
Good, you're welcome. See you Monday. | 0:56:12 | 0:56:14 | |
Well, she has done remarkably well, actually. | 0:56:16 | 0:56:18 | |
Perfectly normal liver functions. | 0:56:18 | 0:56:20 | |
She is up and about. | 0:56:20 | 0:56:22 | |
And she is a happy woman today. | 0:56:22 | 0:56:23 | |
OK. Right... | 0:56:23 | 0:56:26 | |
It is a privilege to be in this era. | 0:56:26 | 0:56:30 | |
People are excited, transplantation practice is changing. | 0:56:30 | 0:56:34 | |
-Is this my chariot? -Yes. | 0:56:34 | 0:56:36 | |
Come ten years, transplantation of organs on machines | 0:56:36 | 0:56:40 | |
is probably going to be the gold standard. | 0:56:40 | 0:56:43 | |
Bye, and take care. | 0:56:44 | 0:56:46 | |
I think when you start out doing research, | 0:56:46 | 0:56:48 | |
you can only really hope to be part of something like this. | 0:56:48 | 0:56:51 | |
To see someone who enrols in the trial and receives one of these livers, | 0:56:51 | 0:56:55 | |
and then you see them in the follow-up clinic a month later, | 0:56:55 | 0:56:58 | |
they've changed dramatically. | 0:56:58 | 0:57:00 | |
Feels great to be minutes away from fresh air. | 0:57:00 | 0:57:03 | |
Oh, I'm just, I'm just... | 0:57:03 | 0:57:05 | |
To make a difference to people, it is absolutely a fantastic feeling. | 0:57:06 | 0:57:10 | |
Oh, God... | 0:57:10 | 0:57:12 | |
You can't really ask much more than that. | 0:57:15 | 0:57:17 | |
There are now more patients involved in clinical trials in the NHS than | 0:57:19 | 0:57:24 | |
ever before. And like the medical pioneers who came before them, | 0:57:24 | 0:57:28 | |
the surgeons at the Queen Elizabeth will keep daring to attempt | 0:57:28 | 0:57:31 | |
tomorrow's procedures in their theatres today. | 0:57:31 | 0:57:35 | |
Wherever you have expertise, and whatever area you're working in, | 0:57:35 | 0:57:39 | |
you look at what you've got and you think, can we make it any better? | 0:57:39 | 0:57:42 | |
Whether or not it does actually push the envelope, time will tell, but | 0:57:44 | 0:57:49 | |
we're determined and we'll keep pushing it. | 0:57:49 | 0:57:51 |