Saijô no Meii 22

*******For use in Trinity BAKumA scanlations ONLY*******

p123:

Sakamoto: Without making any excuses, with honest eyes...

Sakamoto: Prepared to accompany Kazuma right down to the depths of hell,

this is the kind of doctor that I trust!

p124:

Sadame: Pffft...

Sakamoto: What's so funny?

Sadame: Oh, excuse me.

Sadame: I'm not making fun of you.

Sadame: In fact, I absolutely agree with what you just said.

Sakamoto: Eh?

Sadame: To be absolutely honest...

Sadame: If I myself were to become sick, I'd want him to be the surgeon.

Sakamoto: Huh?
[What the hell is this guy saying...?]

p125:

Sadame: What are you so surprised about?

Sadame: Taking like/dislike out of the equation, there's no mistaking

that he is a top-class surgeon.

Sadame: It's the same in this operation.

Sadame: Dr. Sakamoto, have you caught onto what Saijou is trying to do to

Kazuma?

Sakamoto: Uh, no...

Sakamoto: I still don't get it...

Sadame: Well since I think I get it now, why don't I tell you.

Sadame: Just now, my brother Ayame said that the greater omentum is

firmly adhered to the small bowel....

[From p115 (Chapter 21)
Ayame: It's no good, Mikoto!

Ayame: It looks like the greater omentum (the mesentery hanging down from

the stomach and the transverse colon) is too extensively adhered to the

small intestine!

[L to R: mesentery, small intestine, greater omentum, large intestine,

stomach, Diagram of adhesion]

p126:

Sadame: ...and also, Saijou said that the adhesion was mainly on the

opposite side to the mesentery...

[From p118 (Chapter 21)]
[Saijou: Since the adhesions on the small bowel opposite the mesentery

are so extensive, I'll split it transversely instead of down the middle!]
[L to R: Circle: Transverse cut, X: Cutting through the middle]

Sadame: So just to recap, putting it all together...
The greater omentum, connected to the stomach, is basically stuck to the

small intestine.

Sakamoto: Obviously.
[Diagram 1(top right): same as on previous page]
[Diagram 2(main diagram): From top to bottom, Liver, gall bladder,

stomach, Greater omentum (Large letters+hiragana in the middle), large

bowel (right hand side), small bowel (lower left)]

Sakamoto: That's why he cut transversely, obviously.

Sakamoto: That way they can separate the adhesions as little as possible

and still get away with it.

Sadame: Exactly.

[Diagram: ]
[Top 4, L to R: Greater Omentum, Adhesion, Small intestine, Colon]
[Left side: Transverse Cut, On either side of curved arrows: Reflect,

Reflect]
[Right Side: Midline cut, in between arrows: separate]
[Box label: To cut through the middle as shown on the right, all

adhensions need to be removed first. To cut transversely, however, only

partial removal of adhesions is required.]

p127:

Sadame: However, as you were saying, dividing transversely would result

in the part of the small intestine, separate now from its mesentery, from

undergoing ischemic death...
[Refer prev. Chapter, p118]

Sadame: Do you know why he says it'll be alright?

Sakamoto: Show off.
Just shut up and tell me.

Sadame: The answer is simple.

Sadame: It's because blood vessels have grown in from the greater omentum

through the adhesions.

Sakamoto: !

Sadame: Normally, the formation of adhesions by themselves wouldn't

result in angiogenesis (formation of blood vessels), but if the adhesions

are so extensive that removal is difficult, then that's a different

story...

Sadame: In that case, angiogenesis can occur.

Sadame: That man, most probably...

p128:

Sadame: He's already seen that this adhesion isn't like most adhesions,

he's seen the new blood vessels coming in from the greater omentum.
[Diagram: Upper left: Greater Omentum, Bottom left: Normal adhesion

(transparent), Right: Adhesions with penetrating vessels, Bottom right:

Small intestine]

Sakamoto: But how... that's...

Sadame: Well, if you think of all the other things this man's been doing

up till now, it's probably not that surprising.

Sadame: Operations using adhesions in this way have been done before...

Sadame: even though there are only a few cases in the whole world of it

being done in humans.

Sakamoto: ......

Sadame: Oh.

Sadame: I didn't notice till just now...

Sadame: What's really amazing is that there.
[What he's wearing on his head]

Sakamoto: ?

p129:

Sakamoto: The surgical loupe... what about it?

Sadame: Remember, he's doing a bowel extension on a 9 year old child.

Sadame: If he didn't need to visualize very fine vessels, why would he be

wearing a loupe?

Sakamoto: !!

Sadame: Actually it's rather odd that Ayame, as first assistant, is not

wearing a loupe in the first place.

Sadame: Normally, since both the surgeon and the assistant should be

viewing the same operating field, unless there's a special reason,

there's no reason for the surgeon to be using the loupe.

Sakamoto: So, you mean that Saijou...

Sadame: Exactly. He foresaw the adhesions forming in this way, and that

he would need to confirm the presence of those vessels himself, right

from the start...

p130:

Sadame: Even with the current medical technology, it is impossible to

vizualize the extent of adhesions before opening up the abdomen...

meaning that he was already anticipating these eventualities.

Sakamoto: What... what a freak...

Sadame: How fortunate...

Sadame: ...for Kazuma, to have met with such a talented surgeon.

Sakamoto: .....

Saijou: OK, let's wash out the abdominal cavity.

Ayame: Yessir.

Sadame: Oh look, it looks like the operation is drawing to an end.

Sadame: Well, it looks like it's time for me to go now...

p131:

[Please stay tuned for the upcoming antics of the Associate Director]

Sakamoto: Wait, just hang on a sec!

Sakamoto: I mean, just what the hell are you, anyway?

Sakamoto: You realize what a genius Saijou is, yet why do you try to get

in his way?

Sadame: Kukuku... well, I'll ask you.

Sadame: Who the hell would try to tear down someone they don't even

recognize?

Sakamoto: !

Sadame: When one understands that they don't have a chance against one's

opponent, they have 2 options...

Sadame: You can train and train, in the hopes of surpassing them...

Sadame: Or to try and pull them off their pedestal!

Sakamoto: Hmph.

p132:

Sakamoto: So let me guess, you're the latter, huh?

Sadame: ...I won't say that you've hit the nail on the head...

Sadame: People are weak... I'm not the only one who believes this...

Sadame: ...especially those who do not have that man's resolve.

Sakamoto: ?

Sadame: Well, whatever. [SNAP!]

Sadame: If you're still thinking of sticking with him, I hope you're

prepared to face the consequences.

Sakamoto: .....

p133:

[A few days later-]
[Pediatric Surgery]

Internist: Hmmm, it seems that Kazuma is doing well since the operation.

Internist: I'll wait a little longer, then I'll start getting him to eat

normally again.

Internist: Especially since his small bowel needs a workout in

preparation for Dr. Saijou's next, novel procedure.

Sakamoto: Hey, hey! Don't think you can say things like that then overdo

it!

p134:

Sakamoto: Kazuma isn't a pig like you, you know.

Internist: Hey, I know, I know!
[HAHAHAHAHAHA]

Sakamoto: .....
[Hahaha]

Sakamoto: Thank you, Saijou. I don't know how to thank you...

Saijou: No, no, please don't mention it. [Oh]

Saijou: You needn't thank me.

Sakamoto: Oh yeah, I get it.

Sakamoto: Rather than my thanks, you'd rather me work hard for pediatric

surgery, right?

Sakamoto: I don't know when I'll get sent off somewhere else (TL note:

e.g., rural posting. There is an implicit negative connotation. ), but

wherever I go, that won't change a thing!

p135:

Sakamoto: I'll give it my best from now on, believe me!

Saijou: Dr. Sakamoto...

Internist: Oh yeah, Dr. Saijou, there's something I want to ask you.

Internist: It's regarding the novel surgical procedure...
[BAM]

Internist: Uh, what are you doing?

Sena: I musn't tell anyone, so it's better that I don't hear about it!

Internist: Huh???

Sena: ~~~~

Ayame: You idiot.

p136:

Ayame: The first operation was a success, so it's okay to talk about the

second one.

Sena: Oh, is that so.

[Teehee]
Ayame: I'm sorry, Dr. Itou. She's a bit stupid.
[Please ignore her]

Itou: Oh... right.

[Diagram: (Top to bottom) This operation, Planned operation]
Itou: Since we ran into some unexpected adhesions, the small intestine

didn't end up looking like as planned...

Itou: Will this affect the next operation in any way?

Saijou: No, not at all.

Saijou: My new procedure involves cutting the small bowel in a zig-zag

fashion, it really doesn't matter whether it's curved or straight...
[TL note: This procedure is actually called 'Serial Transverse

Enteroplasty', developed by Heung-Bae Kim's team at Harvard Medical

School (J Pediatr Surg 2003, 38(3):425).]

Itou: Is that so.

Sena: Zi...Zig-zag?

Saijou: That's right.

p137:

Saijou: For example, let's say that this is the bowel.

Saijou: I just make cuts like so...

Saijou: And here we go.

Saijou: I'm not sure exactly how many times, but now it's many times

longer!

Sena: Oh, I see!

Sena: That's amazing! So this is the new procedure!

Sakamoto: Yes, that's right.

p138:

Sakamoto: I was really surprised too, the first time I heard it- but the

small bowel does get fatter after a while, so it's fine to cut it this

thin.

Sakamoto: Cutting with the GIA stapler, you don't even have to suture the

cut ends, so it's much safer.
[GIA Stapler (See Chapter 2) can cut and simultaneously seal the cut end

automatically.]

Sakamoto: It's such a brilliant idea, it's only natural to think that

he's no match for...
[Sadame: When one understands that they don't have a chance against one's

opponent, they have 2 options...]

Sakamoto: .....

Sena: ?

Sena: Did you say something?

Sakamoto: Well, to be honest, I...

p139:

Ayame: I see, so my brother actually...

Sakamoto: Yeah.

Sakamoto: Maybe he was just trying to provoke me, I don't know...

Sakamoto: but I got the impression that there are many others who don't

think good of Saijou.

Saijou: Hey Ayame, why do people hate me?

Ayame: It's because you're stupid as well.

[Sena: You and I are alike, doctor(heart)]

Ayame: I'm joking.

Ayame: Okay, seriously though, we really need to take this seriously.

p140:

Ayame: Tales of the medical world in Japan have been told through

countless novels and TV shows... that's just how political it is.

Ayame: Let's face it, even if you were to become a professor, medical

faculty get paid less than those doctors who run their own practice, and

it's not like they have a whole lot of power, either.

Ayame: So, why do they fight each other...

Ayame: Do you understand why, Mikoto?

Saijou: .....