Medical Smart Revolution

Join us as we explore Medical Frontiers!

Here in the Tokyo metropolis is an operating room equipped with state-of-the-art digital technology, the only one of its kind in the world.

Located in Tokyo Women's Medical University Hospital, it opened in February 2019.

We'll make use of the latest technology to fill you in on the details.

Hello everyone. I never thought a time would come when I would be greeting you like this.

This is an avatar robot, and I'm operating it from my home.

As the pandemic continues, advanced information processing is powering what's called a "medical smart revolution" in Japan.

Today, we focus on a new technology that is connecting doctors and improving the quality of medical care.

This is the leader of the team that developed the operating room.

A neurosurgeon, Yoshihiro Muragaki.

Erica will interview Muragaki through her avatar robot.

Lovely to meet you! Dr. Muragaki, thank you so much for your time today.

Hello Erica.

Shall we begin?

Yes, please.

Please enter.

This is the view from Erica's robot.

Wow! This looks so futuristic!

This is the Hyper Smart Cyber Operating Theater, or Hyper SCOT.

Data from 20 types of medical devices necessary for surgery is synchronized in real time.

All of the equipment works in unison to function as one big medical device in this digital operating room.

Since it opened in 2019, over 140 brain surgeries have taken place here.

What is the big machine on the left?

Hitachi, I can't see exactly what it is.

This is an MRI scanner.

It helps us determine during surgery if
any part of a malignant tumor is remaining.

We have a biomonitoring device there
and a nerve monitor there.

This is the navigation screen.
It's like a car navigation system.

It shows what part of the brain
is being operated on using MRI images.

All devices are connected in the Hyper SCOT.

In conventional operating rooms, doctors must check various medical devices to understand their patients' conditions.

This takes time and effort.

But in the Hyper SCOT, all medical devices are linked, enabling real-time data synchronization.

This is the system's primary feature.

The synchronized data is displayed on a monitor called the strategy desk.

In the top left is a high-definition live stream of the surgical field taken with a video microscope.

There's also a monitor showing the patient's vital signs.

This is an MRI image taken during surgery.

The surgical navigation system shows the location the surgeon is touching in real time in pale green on MRI images, helping to advance the tumor removal procedure.

This monitors the patient's motor functions.

It enables surgeons to confirm whether the motor nerves are functioning properly, thus helping them to avoid damaging the nerves.

This is an instant cellular-level analysis of the malignancy of removed tissue.

The higher the percentage, the more malignant the tissue.

This helps the surgeon determine during a surgery how much of the tumor has been removed.

Because various data is gathered here, doctors can keep track of the patient's condition on a single monitor, making operations highly efficient.

This is recorded continuously, so we can go back
and see data from an earlier part of the surgery.

So basically, you can just look back, I mean, if it was, for example, three minutes ago, then you can look back the screen and look back the recording.

Yes. We can go back to
an hour earlier, for example.

We mark important parts of the surgery
so that we can return to them right away.

Another feature of the Hyper SCOT is that data on the strategy desk can be viewed from outside the operating room.

Until now, surgeons could only rely on their own judgment when checking patients' conditions and the location of tumors, and deciding how to proceed.

But the Hyper SCOT allows all of the data to be shared with doctors outside the operating room, enabling them to give surgeons objective analyses and advice.

Muragaki believes that the involvement of multiple doctors can improve the safety and accuracy of surgery.

Usually, surgeons rely on information
available only in the operating room.

They operate alone, and must serve as
both the director and player, so to speak.

But with the Hyper SCOT, all of the information
appears here, so I can act as the director.

There's less of a burden on the surgeon, and
we can offer support from outside the room.

In May 2021, this patient with an advanced brain tumor was scheduled to have surgery in the Hyper SCOT.

Most of the various tests show that the
tumor has recurred and is growing.

The patient's tumor was detected in 2004.

He had surgery twice at a different hospital, but it recurred.

The tumor was a type called a glioma.

Gliomas grow and infiltrate into normal brain tissue, making removal difficult.

Furthermore, this patient's glioma recurred in a deep area of the brain, and his doctor said additional surgeries were no longer possible.

This is what the Hyper SCOT looks like.

Muragaki's team decided that surgery would be possible if they used the Hyper SCOT.

We can take MRI scans and use the
navigation during the procedure.

We'll also use a new device that
can tell whether tissue is cancerous.

I feel better knowing it will be
a computer-assisted surgery.

I'm not sure if machines are
really better than surgeons.

But I think it will be safe.

We'll conduct your surgery in what we believe
is the world's best operating room.

The reason Muragaki decided to develop the Hyper SCOT was to help patients like this one with gliomas that are difficult to remove surgically.

Even under a microscope, it's difficult to
tell normal tissue apart from glioma tissue.

Removal was difficult in the past.

I wanted to be able to remove gliomas
completely without any aftereffects.

Gliomas of all types account for about one fourth of brain tumors in Japan.

Surgery that attempts to remove as much as possible can hurt the nerves and cause aftereffects.

But not removing enough will harm the patients' chances of survival.

Data compiled by the Japan Neurosurgical Society show that almost 40 percent of 587 patients with medium malignancy glioma survived five years after surgery.

In the year 2000, Muragaki set out on a journey to improve the accuracy of brain surgery by developing a new type of operating room.

This set a major project in motion, involving 11 medical equipment makers and five universities.

It began receiving a government grant in 2014.

Two decades after Muragaki began development, the Hyper SCOT opened.

How did you feel personally when you first gave instructions from the surgical strategy desk?

I was really moved.
I had worked really hard to make it happen.

When I saw it with my own eyes,
I felt it was the future of surgical medicine.

Muragaki's hospital has now done the most glioma surgeries among all institutions in Japan.

The 5-year survival rate for medium malignancy glioma patients stood at about 40 percent after surgery.

But it is 74 percent among Muragaki's patients, although based on different data.

The team has succeeded in removing tumors almost entirely.

Surgery has begun on the glioma patient.

Muragaki monitors the procedure and the patient's condition from the strategy desk in a different room.

When the patient has had surgery before, it's even more difficult to tell
whether tissue is normal or not.

Having navigation and MRI will benefit us.

Among the numerous medical devices, the most important is the MRI scanner, which provides cross-sectional images of the brain.

Normally during surgery, doctors rely on MRI images taken beforehand to confirm the location of the tumor.

But this presents a challenge when the tumor is in the brain.

Cerebrospinal fluid surrounding the brain acts as a cushion to protect it from impact.

The fluid leaks out when the skull is cut open in surgery.

This causes the brain to sink slightly, and the location of the tumor to change marginally.

In surgery using the hyper SCOT, the first step after cutting open the skull is to do an MRI scan.

This is an MRI image of the patient's brain taken before the surgery.

Deep in the right frontal lobe is a 3-centimeter-wide tumor.

This image was taken after the patient's skull was cut open.

The upper space has grown by about five millimeters, and the brain has sunk in the skull.

The tumor's position is lower, and its shape has changed slightly due to the softness of the brain.

Surgeons usually rely on their experience and instinct to estimate the difference.

But Muragaki's team can confirm the accurate location of the tumor thanks to the MRI.

MRI scans are done numerous times throughout the surgery in order to safely remove as much of the tumor as possible.

MRI scans are done when we think we've removed
most of the tumor or we've reached a tricky part.

At the end of the surgery, we do a
final scan to check for complications.

Usually, we do three to four MRI scans total,
or sometimes even five to six.

It's been three hours since the surgery began.

Only the lower part left now?

Only the back.
Can you see the navigation?

They're having difficulty distinguishing between the tumor and normal tissue.

It looks normal.

The colors of the tissue appear different when viewed directly compared with on the data screen.

Muragaki, who is in a different room, and the surgeon discuss whether the tissue should be removed.

We should probably take it out.

A surgeon who performs surgeries in the Hyper SCOT has noticed its benefits.

The doctor at the strategy desk has a
comprehensive view of the surgery and can notice things that may be
overlooked in the operating room.

The operating surgeon is too
focused on the surgical site.

It's a big advantage to have someone looking out
for residual tumor tissue and excessive cutting.

Eight hours after the surgery began, it is finally over.

The tumor is gone.

The patient has no aftereffects.

After radiation therapy, he is released from the hospital two months later.

What haven't you notice any issues at all？ The Hyper SCOT is great for brain tumor removal.

But I'd like to expand its use to other diseases
or to other fields of medicine.

Orthopedic surgeons are now using it
for bone tumors on a trial basis.

We also aim to introduce the system in
endovascular treatment, which uses catheters.

Muragaki and his team plan to further widen the application of the Hyper SCOT.

We will soon be able to assist surgeries
remotely, using the 5G network.

For example, I could support emergency surgeries
while on a trip to attend a conference.

All I'd need is a 5G terminal
connected to the strategy desk.

I could offer as much support
as if I were actually there.

We also plan to make the SCOT available
outside hospitals, at disaster scenes.

The "Mobile SCOT," installed in a truck, can rush to disaster sites.

It's being jointly developed with a major communications firm.

They aim to put it to practical use by 2025.

Emergency doctors have had to rely
only on their own knowledge.

But the system will connect them with
neurosurgeons at universities via 5G.

I want to make high-level medical treatment
available even in areas with few hospitals.

What are you personally hoping to achieve regarding SCOT going forward into the future?

I want every hospital to have a SCOT
so that the best possible teams can be assembled for surgery,
wherever in the world it takes place.

I also want to make full use of digital data
that accumulates in the Hyper SCOT.

The AI could offer surgical options based on
the data and indicate possible outcomes for each, such as survival rates and
the possibilities of complications.

Surgeons could then choose the best one,
based on past exchanges with the patient.

That's my next goal.

Dr. Muragaki, thank you so much for your precious time today.

It's been such a pleasure having you on the show. Thank you.

Thank you.

The medical smart revolution is also happening in the classroom.

In 2020, this university began offering classes supported by a virtual reality technology named OPEcloud VR.

Students put on special goggles to immerse themselves in virtual experiences.

They are watching a scene from an emergency room.

It was taken with a 360-degree camera.

When they move their heads, the perspective changes.

1, 2, 3.

Doctors have begun trying to resuscitate a patient with no vital signs.

Wearing the goggles, students can, in a virtual sense, step into real-life situations like this anytime, anywhere.

Hand-written notes appear at important parts of the procedure.

What did they do?

They first turned on the monitor
to check the heartbeat. Then what?

They found a vein for IV insertion.

Right. And then?

They did tracheal intubation.

Secure air passage and give artificial respiration
while constantly compressing the chest.

What medicine do you use?

Adrenaline.

Yes. It's important to administer
adrenaline or epinephrine.

Emergency medicine specialist Shoji Yokobori gives VR-supported classes.

The university developed the system with a tech company for research purposes.

Before the coronavirus pandemic, we had
in-person classes and simulations.

But now, it's difficult to hold large
classes or to have patient simulations.

Students can't have the kind of
clinical training they had before.

I believe VR-supported classes allows students
to experience real-life situations.

They usually undergo over 2400 hours of clinical training before graduation.

But the pandemic has made it impossible for them to enter clinical settings.

This is why Yokobori introduced VR into his classes.

Imagine you're in the emergency room and
insert the tube into the patient's trachea.

VR enables students to visualize themselves treating an emergency patient in actual settings.

Find the glottis and insert the tube.

What's most noteworthy about VR is that it can provide the user with highly-immersive experiences.

Students see through the doctor's perspective, and they are prompted to take action.

With VR, it's better than actually being on site.

I can see what's going on from a
closer distance and better angle.

As a student, when you're at the scene,
you end up watching the action from a distance.

VR helps you see up close and at varying angles
the kind of work the different people are doing.

I think it's very beneficial.

Dr. Yokobori, thank you so much for your time today, and it's a pleasure to have you on the program.

Thank you for giving us like this great opportunity.

We had the goggles delivered to Erica.

She tried them on to see what it was like.

Look around you. You'll feel as if
you're actually in the hospital.

Yeah. I feel like I'm floating in the room.

It will seem as if you're standing by the doctor.

I can completely see you're compressing the chest now.

But, its clarity is amazing!

Wow. That's wild! That's amazing!

Yokobori began these virtual reality lessons because of the pandemic, but he realized their unexpected advantages.

In conventional classes,
students sometimes lacked focus.

For effective learning, we needed something
that appealed to their senses.

VR has a strong impact,
so it helps them to learn better.

They also remember much more.
It's like it's imprinted on their brains.

I think it's a very effective teaching tool.

What would be the perfect scenario for training?

Would it be just for VR, or would it be a combination of a conventional past VR?

Once students view a procedure with VR,
they should recreate it on a patient simulator.

After the students watch the emergency treatment, they commit it to memory by practicing on simulators.

It's important for them to reenact it themselves,
then review the scene on VR once again.

This will help to improve their skills.

What about other any disadvantages then though to do, for example, virtual reality training?

It cannot simulate touch or smell.

I think this is what we need to work on.

So you're adding the smell to the virtual reality?

Yes, hopefully in the near future.

This will expand the possibilities
of medical training.

What is your goal in terms of OPEcloud VR?

An issue facing Japan's healthcare system is that
doctors are concentrated in urban areas.

This is partly due to the fewer
educational opportunities in rural areas.

Also, young doctors in these areas have
less chances to get critical experiences.

VR would give all doctors equal opportunities,
no matter where they live.

This would improve not just Japan's
medical system, but also the world's.

Thank you so much for your time today, and it's pleasure having you on the program.

My pleasure too. Thank you so much.

Japan is a leader in medical smart technology.

And due to the coronavirus pandemic, these innovations have been rapidly accelerated, which will ultimately result in many advances in areas of medicine, education, and also patient's care.