
In a university hospital in Tokyo is a globally-unique operating room called the Hyper SCOT, equipped with the latest digital technology. Data from 20 medical devices are integrated in real time and shown on a monitor during surgery. It has been used for difficult brain tumor surgeries since opening 2 years ago. Doctors outside the operating room can see the monitor and give the surgeon advice, for a more accurate surgery. Separately, another university is using virtual reality to help students learn.
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Join us as we explore Medical Frontiers!
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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.
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Located in Tokyo Women's Medical University Hospital, it opened in February 2019.
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We'll make use of the latest technology to fill you in on the details.
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Hello everyone. I never thought a time would come when I would be greeting you like this.
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This is an avatar robot, and I'm operating it from my home.
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As the pandemic continues, advanced information processing is powering what's called a "medical smart revolution" in Japan.
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Today, we focus on a new technology that is connecting doctors and improving the quality of medical care.
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This is the leader of the team that developed the operating room.
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A neurosurgeon, Yoshihiro Muragaki.
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Erica will interview Muragaki through her avatar robot.
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Lovely to meet you! Dr. Muragaki, thank you so much for your time today.
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Hello Erica.
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Shall we begin?
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Yes, please.
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Please enter.
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This is the view from Erica's robot.
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Wow! This looks so futuristic!
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This is the Hyper Smart Cyber Operating Theater, or Hyper SCOT.
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Data from 20 types of medical devices necessary for surgery is synchronized in real time.
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All of the equipment works in unison to function as one big medical device in this digital operating room.
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Since it opened in 2019, over 140 brain surgeries have taken place here.
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What is the big machine on the left?
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Hitachi, I can't see exactly what it is.
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This is an MRI scanner.
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It helps us determine during surgery if
any part of a malignant tumor is remaining. -
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We have a biomonitoring device there
and a nerve monitor there. -
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This is the navigation screen.
It's like a car navigation system. -
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It shows what part of the brain
is being operated on using MRI images. -
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All devices are connected in the Hyper SCOT.
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In conventional operating rooms, doctors must check various medical devices to understand their patients' conditions.
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This takes time and effort.
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But in the Hyper SCOT, all medical devices are linked, enabling real-time data synchronization.
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This is the system's primary feature.
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The synchronized data is displayed on a monitor called the strategy desk.
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In the top left is a high-definition live stream of the surgical field taken with a video microscope.
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There's also a monitor showing the patient's vital signs.
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This is an MRI image taken during surgery.
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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.
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This monitors the patient's motor functions.
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It enables surgeons to confirm whether the motor nerves are functioning properly, thus helping them to avoid damaging the nerves.
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This is an instant cellular-level analysis of the malignancy of removed tissue.
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The higher the percentage, the more malignant the tissue.
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This helps the surgeon determine during a surgery how much of the tumor has been removed.
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Because various data is gathered here, doctors can keep track of the patient's condition on a single monitor, making operations highly efficient.
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This is recorded continuously, so we can go back
and see data from an earlier part of the surgery. -
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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.
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Yes. We can go back to
an hour earlier, for example. -
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We mark important parts of the surgery
so that we can return to them right away. -
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Another feature of the Hyper SCOT is that data on the strategy desk can be viewed from outside the operating room.
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Until now, surgeons could only rely on their own judgment when checking patients' conditions and the location of tumors, and deciding how to proceed.
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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.
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Muragaki believes that the involvement of multiple doctors can improve the safety and accuracy of surgery.
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Usually, surgeons rely on information
available only in the operating room. -
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They operate alone, and must serve as
both the director and player, so to speak. -
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But with the Hyper SCOT, all of the information
appears here, so I can act as the director. -
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There's less of a burden on the surgeon, and
we can offer support from outside the room. -
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In May 2021, this patient with an advanced brain tumor was scheduled to have surgery in the Hyper SCOT.
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Most of the various tests show that the
tumor has recurred and is growing. -
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The patient's tumor was detected in 2004.
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He had surgery twice at a different hospital, but it recurred.
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The tumor was a type called a glioma.
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Gliomas grow and infiltrate into normal brain tissue, making removal difficult.
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Furthermore, this patient's glioma recurred in a deep area of the brain, and his doctor said additional surgeries were no longer possible.
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This is what the Hyper SCOT looks like.
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Muragaki's team decided that surgery would be possible if they used the Hyper SCOT.
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We can take MRI scans and use the
navigation during the procedure. -
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We'll also use a new device that
can tell whether tissue is cancerous. -
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I feel better knowing it will be
a computer-assisted surgery. -
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I'm not sure if machines are
really better than surgeons. -
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But I think it will be safe.
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We'll conduct your surgery in what we believe
is the world's best operating room. -
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The reason Muragaki decided to develop the Hyper SCOT was to help patients like this one with gliomas that are difficult to remove surgically.
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Even under a microscope, it's difficult to
tell normal tissue apart from glioma tissue. -
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Removal was difficult in the past.
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I wanted to be able to remove gliomas
completely without any aftereffects. -
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Gliomas of all types account for about one fourth of brain tumors in Japan.
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Surgery that attempts to remove as much as possible can hurt the nerves and cause aftereffects.
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But not removing enough will harm the patients' chances of survival.
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Data compiled by the Japan Neurosurgical Society show that almost 40 percent of 587 patients with medium malignancy glioma survived five years after surgery.
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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.
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This set a major project in motion, involving 11 medical equipment makers and five universities.
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It began receiving a government grant in 2014.
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Two decades after Muragaki began development, the Hyper SCOT opened.
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How did you feel personally when you first gave instructions from the surgical strategy desk?
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I was really moved.
I had worked really hard to make it happen. -
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When I saw it with my own eyes,
I felt it was the future of surgical medicine. -
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Muragaki's hospital has now done the most glioma surgeries among all institutions in Japan.
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The 5-year survival rate for medium malignancy glioma patients stood at about 40 percent after surgery.
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But it is 74 percent among Muragaki's patients, although based on different data.
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The team has succeeded in removing tumors almost entirely.
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Surgery has begun on the glioma patient.
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Muragaki monitors the procedure and the patient's condition from the strategy desk in a different room.
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When the patient has had surgery before, it's even more difficult to tell
whether tissue is normal or not. -
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Having navigation and MRI will benefit us.
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Among the numerous medical devices, the most important is the MRI scanner, which provides cross-sectional images of the brain.
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Normally during surgery, doctors rely on MRI images taken beforehand to confirm the location of the tumor.
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But this presents a challenge when the tumor is in the brain.
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Cerebrospinal fluid surrounding the brain acts as a cushion to protect it from impact.
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The fluid leaks out when the skull is cut open in surgery.
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This causes the brain to sink slightly, and the location of the tumor to change marginally.
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In surgery using the hyper SCOT, the first step after cutting open the skull is to do an MRI scan.
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This is an MRI image of the patient's brain taken before the surgery.
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Deep in the right frontal lobe is a 3-centimeter-wide tumor.
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This image was taken after the patient's skull was cut open.
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The upper space has grown by about five millimeters, and the brain has sunk in the skull.
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The tumor's position is lower, and its shape has changed slightly due to the softness of the brain.
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Surgeons usually rely on their experience and instinct to estimate the difference.
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But Muragaki's team can confirm the accurate location of the tumor thanks to the MRI.
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MRI scans are done numerous times throughout the surgery in order to safely remove as much of the tumor as possible.
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MRI scans are done when we think we've removed
most of the tumor or we've reached a tricky part. -
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At the end of the surgery, we do a
final scan to check for complications. -
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Usually, we do three to four MRI scans total,
or sometimes even five to six. -
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It's been three hours since the surgery began.
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Only the lower part left now?
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Only the back.
Can you see the navigation? -
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They're having difficulty distinguishing between the tumor and normal tissue.
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It looks normal.
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The colors of the tissue appear different when viewed directly compared with on the data screen.
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Muragaki, who is in a different room, and the surgeon discuss whether the tissue should be removed.
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We should probably take it out.
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A surgeon who performs surgeries in the Hyper SCOT has noticed its benefits.
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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. -
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The operating surgeon is too
focused on the surgical site. -
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It's a big advantage to have someone looking out
for residual tumor tissue and excessive cutting. -
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Eight hours after the surgery began, it is finally over.
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The tumor is gone.
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The patient has no aftereffects.
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After radiation therapy, he is released from the hospital two months later.
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What haven't you notice any issues at all? The Hyper SCOT is great for brain tumor removal.
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But I'd like to expand its use to other diseases
or to other fields of medicine. -
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Orthopedic surgeons are now using it
for bone tumors on a trial basis. -
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We also aim to introduce the system in
endovascular treatment, which uses catheters. -
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Muragaki and his team plan to further widen the application of the Hyper SCOT.
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We will soon be able to assist surgeries
remotely, using the 5G network. -
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For example, I could support emergency surgeries
while on a trip to attend a conference. -
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All I'd need is a 5G terminal
connected to the strategy desk. -
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I could offer as much support
as if I were actually there. -
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We also plan to make the SCOT available
outside hospitals, at disaster scenes. -
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The "Mobile SCOT," installed in a truck, can rush to disaster sites.
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It's being jointly developed with a major communications firm.
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They aim to put it to practical use by 2025.
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Emergency doctors have had to rely
only on their own knowledge. -
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But the system will connect them with
neurosurgeons at universities via 5G. -
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I want to make high-level medical treatment
available even in areas with few hospitals. -
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What are you personally hoping to achieve regarding SCOT going forward into the future?
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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. -
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I also want to make full use of digital data
that accumulates in the Hyper SCOT. -
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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. -
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Surgeons could then choose the best one,
based on past exchanges with the patient. -
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That's my next goal.
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Dr. Muragaki, thank you so much for your precious time today.
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It's been such a pleasure having you on the show. Thank you.
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Thank you.
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The medical smart revolution is also happening in the classroom.
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In 2020, this university began offering classes supported by a virtual reality technology named OPEcloud VR.
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Students put on special goggles to immerse themselves in virtual experiences.
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They are watching a scene from an emergency room.
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It was taken with a 360-degree camera.
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When they move their heads, the perspective changes.
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1, 2, 3.
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Doctors have begun trying to resuscitate a patient with no vital signs.
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Wearing the goggles, students can, in a virtual sense, step into real-life situations like this anytime, anywhere.
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Hand-written notes appear at important parts of the procedure.
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What did they do?
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They first turned on the monitor
to check the heartbeat. Then what? -
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They found a vein for IV insertion.
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Right. And then?
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They did tracheal intubation.
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Secure air passage and give artificial respiration
while constantly compressing the chest. -
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What medicine do you use?
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Adrenaline.
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Yes. It's important to administer
adrenaline or epinephrine. -
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Emergency medicine specialist Shoji Yokobori gives VR-supported classes.
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The university developed the system with a tech company for research purposes.
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Before the coronavirus pandemic, we had
in-person classes and simulations. -
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But now, it's difficult to hold large
classes or to have patient simulations. -
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Students can't have the kind of
clinical training they had before. -
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I believe VR-supported classes allows students
to experience real-life situations. -
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They usually undergo over 2400 hours of clinical training before graduation.
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But the pandemic has made it impossible for them to enter clinical settings.
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This is why Yokobori introduced VR into his classes.
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Imagine you're in the emergency room and
insert the tube into the patient's trachea. -
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VR enables students to visualize themselves treating an emergency patient in actual settings.
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Find the glottis and insert the tube.
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What's most noteworthy about VR is that it can provide the user with highly-immersive experiences.
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Students see through the doctor's perspective, and they are prompted to take action.
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With VR, it's better than actually being on site.
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I can see what's going on from a
closer distance and better angle. -
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As a student, when you're at the scene,
you end up watching the action from a distance. -
23m 19s
VR helps you see up close and at varying angles
the kind of work the different people are doing. -
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I think it's very beneficial.
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Dr. Yokobori, thank you so much for your time today, and it's a pleasure to have you on the program.
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Thank you for giving us like this great opportunity.
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We had the goggles delivered to Erica.
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She tried them on to see what it was like.
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Look around you. You'll feel as if
you're actually in the hospital. -
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Yeah. I feel like I'm floating in the room.
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It will seem as if you're standing by the doctor.
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I can completely see you're compressing the chest now.
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But, its clarity is amazing!
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Wow. That's wild! That's amazing!
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Yokobori began these virtual reality lessons because of the pandemic, but he realized their unexpected advantages.
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In conventional classes,
students sometimes lacked focus. -
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For effective learning, we needed something
that appealed to their senses. -
24m 59s
VR has a strong impact,
so it helps them to learn better. -
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They also remember much more.
It's like it's imprinted on their brains. -
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I think it's a very effective teaching tool.
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What would be the perfect scenario for training?
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Would it be just for VR, or would it be a combination of a conventional past VR?
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Once students view a procedure with VR,
they should recreate it on a patient simulator. -
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After the students watch the emergency treatment, they commit it to memory by practicing on simulators.
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It's important for them to reenact it themselves,
then review the scene on VR once again. -
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This will help to improve their skills.
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What about other any disadvantages then though to do, for example, virtual reality training?
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It cannot simulate touch or smell.
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I think this is what we need to work on.
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So you're adding the smell to the virtual reality?
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Yes, hopefully in the near future.
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This will expand the possibilities
of medical training. -
26m 44s
What is your goal in terms of OPEcloud VR?
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An issue facing Japan's healthcare system is that
doctors are concentrated in urban areas. -
26m 59s
This is partly due to the fewer
educational opportunities in rural areas. -
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Also, young doctors in these areas have
less chances to get critical experiences. -
27m 10s
VR would give all doctors equal opportunities,
no matter where they live. -
27m 16s
This would improve not just Japan's
medical system, but also the world's. -
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Thank you so much for your time today, and it's pleasure having you on the program.
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My pleasure too. Thank you so much.
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Japan is a leader in medical smart technology.
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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.