Saijô no Meii 11

This is not to be used by anyone outside of Trinity BAKumA without my permission.

Page 1
If he is as skilled as he seems
Then I will have to change my strategy

Page 2
Mikoto: Anterior right bile duct branch severed.
Mikoto: Ayame, tie up the cut vessel.
Ayame: I'm on it.
Sadame(thought): Although the liver removal process was perfect...It's still too soon to judge his abilities.
Sadame(thought): To make this operation a success, there are still two points remaining.

Page 3
One is that no matter how much the liver is cut, no blood or bile would come out-

To begin with, because the liver contains many blood vessels and bile ducts, if it is cut, ligation procedure is necessary...

In the ice water, even if the blood vessels or bile ducts are cut, no liquid would come out, so it is hard to tell where ligation needs to be done.

The problems lie especially with the bile duct...

Because bile, in addition to being transparent, does not clot like blood...

If forgetting to tie even one bile duct,

After the operation, the transparent fluid would continue to overflow from the liver, and the damage becomes irreparable.

Page 4
The second point is the infiltration of the tumor inside the hepatic vein-

The tumor is not only inside the liver, but also in a part of the hepatic vein.
Diagram: Tumor(right), Hepatic vein(left)

The hepatic vein, unlike other trivial blood vessels, can't just be cut and thrown away.
Diagram: Tumor infiltration, Removal, Replace, (middle)Other blood vessel, (bottom)Reconstruct the blood vessel like this

2cm of the infiltrated section must be cut and replaced with vessels from elsewhere in the body, but...

No other vessel that can be safely cut in the body has the same thickness!

How will he solve this problem? I can probably tell how good he from this.
Mikoto: Oh yeah, Sena-san.

Page 5
Mikoto: I need 5 centimeters of the patient's iliac vein...
Mikoto: Can you do it?
Maria: O, of course!
Maria: I may not look it, but I'm very good at severing blood vessels!
Mikoto: Ok, thanks.
Sadame(thought): Iliac vein...?
Sadame(thought): It's true that taking the iliac vein will not harm the body in any way...
Sadame(thought): However, at the patient's age, the hepatic vein is about 8mm thick, and the iliac vein is 4mm thick...
Diagram: Hepatic vein, Iliac vein
Sadame(thought): I think it's too thin to replace the hepatic vein...

Page 6
Mikoto: Ayame, start injecting IC fluid*! *TL's Note: Not sure what that is.
Mikoto: Check the bile duct!
Ayame: Gotcha.
Sadame(thought): Ah...
Sadame(thought): He solves the first problem by injecting the liver with colored liquid.
Diagram: No leaks (success), Leakage (failure), O The IC liquid is blue. One can tell if there are any cuts left untied by checking to see if there are any leaks.
Sadame(thought): However, checking for leaks from the bile ducts would be...
Ayame: Ok Mikoto, there are no leaks.
Sadame(thought): No way! Is the tumor removal already finished!?
Ayame: All of the bile ducts and blood vessels have been tied.

Page 7
Ayame: We now just have to reconstruct the hepatic vein.
Mikoto: Yeah!
Sadame(thought): I can't believe it...
Sadame(thought): They are really done with the tumor removal...!
Mikoto: Alright, let's start the reconstruction right away.
Mikoto: Sena-san, were you able to extract the iliac vein?
Maria: Y, yes!
Maria: How is it?
Mikoto: Yes, you are very good at this!
Maria: I'm glad!

Page 8
Mikoto: The thing about severing blood vessels is that even though you are supposed to not think about it and just insert the scalpel, it is a very difficult thing to do...
Mikoto: Sena-san has a very good sense for it.
Maria: Really!?
Maria(thought): Could it be, this is the first time that I am useful!?
Maria: ...But, when I think about it, isn't its thickness very different from the hepatic vein?
Mikoto: That's right.
Mikoto: We will cut it open, spread it into a 5 millimeter by 1.2 millimeter rectangle, and then roll it up horizontally...
Diagram: Thin vessel -> Cut open -> Rectangle -> Roll it up *Calculate with Pi as 3. 4mm of blood vessel cut open would be 4mm x 3(Pi) = 1.2cm
Mikoto: See, you can change the thickness to anything you want.
Maria: I see-
Sadame(thought): However...
Sadame(thought): We need about 2cm of the hepatic vein. Even though the thickness is right, the length is not enough this time...
Diagram: Required vein, Mikoto's vein

Page 9
Maria: But now the iliac vein is not long enough...
Mikoto: Right, that's why I asked you to get 5 centimeters.
Mikoto: 8 millimeters of hepatic vein requires about 2.4 centimeters because 8mm x 3(Pi) = 2.4. If we had 5 centimeters, we can make two of them.
Mikoto: If we overlap them we can also adjust the length. (smaller font)If it's too long we can always cut some off)
Sadame(thought): Woah, doubling the blood vessel!!
Mikoto: Just remember to not line up the sewlines.
Maria: I see!
Diagram: Good example, bad example, O Just like in the good example, it's best to make the sewlines face opposite sides. If it is done like in the bad example, blood is more likely to leak from the cross that is formed.
Sadame(thought): I have never heard of this technique...
Sadame(thought): This way, there is no problem in either the length or the thickness...!!
Sadame(thought): It's regrettable...but this boy has genuine skills...no,

Page 10
Sadame(thought): He is the best of the best!
Mikoto: Ok! Let's return the liver back into the body!
Mikoto: The liver will be outside of the ice water so everyone please hurry!
Everyone: Understood!
Box: Several days later
Woman: Thank you very much.
Mikoto: It's nothing...
Man: We really can't thank you enough...

Page 11
Boy: Thank you doctor!
Mikoto: Hope you get to go home soon!
Mikoto: The day you get discharged from this hospital, I will give you a Spiderman figure.
Boy: Yay, really?
Ayame: ...Hm? Is that the patient from the other day with his parents?
Maria: Yes.
Maria: Wow, even I'm moved by their deep gratitude <3
Ayame: I see...
Maria: You don't want to say hello?
Maria: They would surely be really thankful if they learn that you were the first assistant.
Ayame: It's ok.
Ayame: Unlike you and Mikoto, I'm not good at showing a smiling face in front of others.

Page 12
Ayame: Isn't it good to not get in their way?
Maria: Wha~~t? but-
Ayame: You two are just really good people.
Ayame: If I really became the unworthy doctor like my brother says, what should I do then?
Sadame(background): Even though he is my brother, he has done something-
Ayame(background): Shut up!!
Mikoto: That won't happen.
Ayame: Mikoto...
Mikoto: Both this time and during emergencies before, you helped out even when the operations had high risks.
Ayame(background): Ok! Let's do it.
Ayame(background, upper left): Mikoto, go contact the patient and prepare for the operation.
Ayame(background, right): Mikoto, if it's ok, I would also like to help out.
Ayame(background): Isn't it better to have more people?
Mikoto(background): Yes, thanks!
Mikoto: People like that can't be be bad doctors can they?
Ayame: Fu, I don't know about that.

Page 13
Ayame: Maybe I'm the kind of freak who enjoys those high-risk challenges.
Ayame: Actually, when I was overseas, without the hospital's permission, I did such an operation and killed a patient...The hospital was in big trouble.
Ayame: Because I had the patient's permission, I escaped only with revoked license...
Ayame: I guess what my brother said wasn't necessarily a lie after all.

Page 14
Mikoto: It must have been a difficult operation, carrying it out without permission.
Mikoto: ...You wanted to save his life no matter what, didn't you...
Ayame: ...Mikoto...

Page 15
Mikoto: No matter how good a doctor is, there are patients that he can't save.
Mikoto: However, even knowing that, never giving up...
Mikoto: Knowing the patient's feelings...especially...
Ayame: ...I guess...
Ayame(thought): If Mikoto had been there that time...

Page 16
Ayame(thought): They maybe I...
Mikoto: Ayame...
Ayame: Ok, that's enough about me.
Ayame: Rather, my brother is the main problem.
Ayame: He was awfully quiet in the operation room...

Page 17
Ayame: That's because he was surprised by your skill he couldn't do anything.
Ayame: From now on, even suppose that the Pediatrics is brought back, he will still constantly apply pressure to you two.
Maria: Wh...
Maria: Why is he going so far to...
Ayame: Don't you think it's strange?
Ayame: You already know he interferes because Pediatrics bring in no profit and it's easy to make mistakes. However...
Background: Unlike the director, the vice-director is very strict about the running of the hospital.
Background: Sena, being a Pediatrician is hard and you won't earn much.
Background: I knew my brother was trying to get in your way.
Ayame: He is only the vice-director, and not the owner of this hospital.

Page 18
Ayame: Even when the children's surgical department is going in the red, or when there are incidents, unless the hospital is going bankrupt, his salary won't change that much.
Maria: I guess it's true when you put it that way.
Mikoto: ...
Ayame: In other words...
Ayame: The things he said, like there's not enough profit or too many incidents, are not the real reasons...
Ayame: This hospital has some hidden agenda.