Saijô no Meii 16

Saijou no Meii – chapter 16
By phichan, to be used exclusively for Trinity Bakuma

Page 4

Title: The Difference in Size

Page 5

Sena: Geez, I was really worried about you Dr. Saijou!
Sfx: *punching*

Sena: Even if it’s for the sake of the patient, don’t ever do that again!
Sfx: *punching*
Mikoto: Sorry! Sorry!
Ayame: Hey, come on, Sena.

Ayame: I get how you feel, but I think you should forgive him already.
Sena: How can you say that?!

Sena: You hit him too, you know!
Ayame: True…but…
Sfx: *scratch*

Ayame: I actually held back.
Sena: Oops…
Sfx: *stinging pain*

Sena: Oh man…I really lost it…
Sfx: *cough*
Sena: A-anyway, it’s almost time for that important surgery.

Page 6

Sena: Time to refocus ourselves and do our best!
Sena: Yea~~!
Ayame: …well, I guess that was all an expression of her affection, but…

Ayame: Women are scary, Mikoto.
Sena: Yea~~!
Mikoto: …yeah.
Sfx: *stinging pain*

Sfx: *Bang*

Sfx: *a lot of people are there*

Page 7

Ayame: Wow.
Ayame: I’m surprised. Even the observation room is full.

Sena: Of course it is.

Sena: After all, this is the first NOTES procedure done through the stomach.
Mikoto: Hehe
Mikoto: Everyone really wants to learn.
Ayame: I don’t think so.

Ayame: There are some here for other reasons.
Brother: Well, if it isn’t Dr. Saijou.

Brother: I heard from the patient’s mother.

Brother: To think you tested on yourself in order find out how to safely pass through the stomach.

Brother: You are indeed the best of the best.

Brother: I was just speaking Chairman Taira up there.

Page 8

Brother: With a doctor of your caliber, we thought it would be okay to revive pediatric surgery.

Mikoto: What? Really?
Brother: Of course.

Brother: If this surgery is completed in a proper manner, the Chairman, Director and I will all support it.
Brother: We will be happy to revive pediatric surgery.

Brother: I am only here to observe, but…
Brother: The rest of you have an important task ahead of you, so give it your all!
Mikoto: I will.

Sena: Isn’t that great doctor? We just need to succeed in this surgery.
Ayame: Hold on, something isn’t right.

Page 9

Ayame: It’s true that my brother’s initial plan went to hell, and there’s not much he can do at this point, but…

Ayame: I doubt that that conniving man has given up.
Sena: You’re over thinking it, Dr. Ayame.

Sena: The more conniving a man is, the more likely he is to change character and take sides with the better man.

Sena: The Associate Director must have realized he couldn’t match up to Dr. Saijou and decided instead to take his side.
Ayame: I really wish I could be that idiotically optimistic.

Sena: Hm? Did you say something?
Sfx; *turn*
Ayame: Nope.

Ayame: I can only pray that you’re prediction is right.

Page 10

Brother: Now, everyone, are we all ready? This is the Associate Director of Heisei Central Hospital, Kiryuu Sadame.

Brother: Today, Dr. Saijou will attempt the first ever NOTES procedure through the stomach.

Brother: And since there are many young doctors at this hospital, most of you probably won’t know what will be going on.

Brother: Hence, I will provide simple commentary on during the surgery, so please don’t worry.
Ayame: Bah. He neglected to mention that earlier.
Sena: Does it really matter?

Sena: He probably wants to ask us for forgiveness by praising Dr. Saijou during the commentary

Sena: Depending on how well praises us, I might just forgive him.
Sfx: *Ahem
Ayame: How optimistic can you be?

Page 11

Ayame: I don’t care what you say. There’s no way he would go that far.

Ayame: I’m betting he’s figured out some critical flaw to this surgery that we haven’t realized yet.

Ayame: So I’m sure this commentary is…
Mikoto: It’s alright.

Mikoto: Even though it’s a world first, I’ve done it already on myself. There’s no flaw.

Mikoto: So it doesn’t matter what the Associate Director is thinking.

Ayame: …I hope so.

Page 12

Mikoto: Now then, we will begin the extirpation of the ovarian cyst using the NOTES technique.

Mikoto: Inserting the endoscope.

Mikoto: Passing through the esophagus.

Mikoto: Inserting air through the forceps.
*Inflating the stomach makes the surgery easier.

Mikoto: Ayame, I’m going to cut open the stomach.
Ayame: ‘kay.

Mikoto: Incision complete.
Sfx: *whirrrr*

Mikoto: Once we’re through the stomach wall, inflate the SAND balloon.
Ayame: Got it.

Page 13

Sfx: *inflate*

Sfx: *Whoa*
Brother: Amazing.

Brother: I imagine most of you already figured it out, but as soon as Dr. Saijou passed the endoscope through the stomach wall he inflated the balloons.
O – Like in the picture below, you attach a rubber tube called an S-tube, and then inflate two balloons to pinch the stomach wall.

Brother: In doing this, they have prevented any leakage of gastric juices, which could lead to peritonitis.

Brother: By the way, it seems that Dr. Saijou tested the safety of this technique on his own body.

Brother: Although cutting your stomach doesn’t cause too much pain, it still shows his tenacity towards the surgery.
Sena: See? He only wants to compliment him.
Ayame: You just keep thinking that.

Page 14

Sena: Eehhh~~?!
Mikoto: Next, send more air into the abdomen and head down.

Sfx: *whirr*
Mikoto: Okay. Now approaching the ovary.

Mikoto: I see the ovarian cyst.

Brother: We have finally reached the ovarian cyst.

Brother: Now we reach the problem of suctioning out the inside of the cyst.

Brother: The hole made in the stomach is about 2 cm, but the ovarian cyst at the very least is 8 cm in diameter, even after removing the healthy ovarian shell.

Proper way to sever.
8 cm

 cyst

Actual ovary.

O – Like in the diagram above, the ovarian cyst is normally gouged out from the actual ovary.

Page 15

Brother: So, if you don’t first suction out the inside of the cyst,

The shriveled cyst can be First suction out the inside of the cyst
pulled through the hole <-- Shriveled <-- Suction before cutting it out of the ovary.

The cyst is too large Removing the cyst without
to pass through the hole <-- X <-- Extraction first suctioning out the contents.



Brother: the cyst will be too large to pull through the stomach wall even after removing it from the ovary.

Brother: However, even if you were to stick a needle into the cyst for suction,

Brother: Some of the contents are guaranteed to spill out as soon as you stick it in.

Brother: I am sure you are all fully aware that spilling the contents of a cyst into the body has the risk of spreading it somewhere else.

Brother: Though I am sure that Dr. Saijou would never do something so dangerous…

Ayame: Oh crap!

Page 16

Ayame: I see. So this is what my brother was after!
Sena: What do you mean?

Ayame: Like my brother said, when you extract a cyst using the NOTES technique, you have to first drain the inside of the cyst or else it won’t fit back through the hole.

Ayame: But if you do that, a good amount of tumor cells will definitely spill out into the body
Ayame: Planting themselves around the peritoneum, leading to tumors.

Ayame: Of course, it’s not 100% that the spillage will lead to tumors,

Ayame: So there are doctors who don’t think twice about sticking the needle in during a laparoscopy, despite the risks.

Ayame: So we’re pretty screwed if they attack us on those risks we’re taking.
Sena: R-really?!

Page 17

Sena: So the Associate Director plans to criticize us in front of all these people on the risks we’re taking?
Ayame: Exactly.
Mikoto: Removed the cyst from the ovary.

Mikoto: Okay, now we’re taking the cyst to the stomach without breaking it.
Ayame: Hey, wait!

Mikoto: You can’t just remove the cyst like that, no matter what my brother says!

Ayame: If we don’t drain the cyst first, it’ll be too big to fit through the hole!
Mikoto: Why?

Ayame: What do you mean, why…

Ayame: Don’t tell me he can’t whether the 8 cm cyst is larger than the 2 cm hole?!

Mikoto: Removing the balloons.

Page 18

Mikoto: We’re gonna push the cyst through the stomach.
Ayame: Seriously?!

Brother: Oh may, what’s going on here?

Brother: They’re trying to pull the 8 cm cyst through the 2 cm hole.

Stomach )) Cyst
As seen from the side.

Brother: The cyst is fully swollen with the fluids inside, so it should be impossible to squeeze it through.
Brother: Hmph. You don’t know when to give up, do you?

Brother: Are you getting desperate because of the dangers I pointed out?

Brother: No matter how hard you try, you won’t be able to fit a large thing through a small hole unless you can use magic.
Brother: What does Dr. Saijou plan to do?

Brother: Due to the size of the cyst, i…

Page 19

Brother: Iiiiiiiiii?!

Doctor: Iiiiiii?
Doctor: What’s an iiiiiiiii?

Brother: Oh, excuse me.

Brother: Un…unbelievable.

Brother: The 8 cm cyst is passing through the 2 cm hole.
Brother: Am I seeing things?

Brother: Is this man really a wizard?!
Brother: No…of course not…

Doctor: Um…Associate Director?

Page 20

Doctor: We have no idea what’s going on.
Doctor: Could you please explain it to us?
Doctor: It’d be really helpful.
Brother: Yes…of course…

Brother: Not good!

Brother: I can’t explain it to them since I have no idea what’s going on.

Brother: I won’t like it, but I guess I’ll praise him some more to buy some time.

Brother: Even though it’s a surgery that’s never been done before, Dr. Saijou already devised a special technique for it!
Brother: But if I don’t start explaining it soon…

Brother: I’ll just be praising him for the rest of the surgery.
Brother: Dr. Saijou’s demeanor itself…

Brother: Shows what a great doctor he is…
SFX: *whisper whisper*
Doctor: Hey, maybe he doesn’t know what’s going on himself.
Doctor: Maybe…

Page 21

Brother: Damnit. This is so humiliating.

Mikoto: Okay. Ovarian cyst has been extracted.
Brother: You’ll pay for this, Saijou Mikoto…

Brother: I’ll get you back for this for sure.
Sfx: *shake with anger*
Brother: A-anyway, to all the young doctors…
Sfx: *whisper whisper*
Mikoto: Surgery complete!

Brother: Let us take after Dr. Saijou and carry the future of Japan’s medicine…
Sena: See? He just wanted to compliment him.
Ayame: Yeah, whatever.