Working in University Hospital in Tokyo

As soon as I begin working in Tokyo, my life style changes completely as well other Japanese who had lived in Vienna.

I am working from 7 PM to 10PM around weekday and also daytime weekend. Since it may be usual situation in Tokyo, I can understand it regardless of what I want to do. But you must suppose what I have to do from morning till night, everyday, even in not a high volume center on the base of international standard.

The answer should be that a young surgeon must work as ICU care staff postoperatively and medical secretary, as well as surgeon. If anything, his/her work may be occupied mostly as like secretary including making medical record on hospital chart, department chart, filling in domestic society format, and writing letters to insurance company and so on.

Moreover Japanese traditional custom, which is that young workers had better to work longer time than their boss who are likely to want to stay their office long time without having hobby, prevent from improvement of working conditions. Therefore we have operation only 3 days a week, but pretty busy everyday.

I used to play my son all weekend in Vienna, but it becomes rear. Using Sunday afternoon I took my son to zoo and aqua museum in Tokyo for a month finally.

Ueno Zoo is well known as one of biggest one in Japan. He enjoyed looking at panda and elephant. I bought a year pass in spite of whether I can come here often.



Next weekend I took him to a nice aqua museum in the Kasai Rinkai Park, my favorite.


You can see a group of tunas wandering in a huge doughnut shape glass tank. I believe it shall be fabulous beyond imagination.


He also likes it very much.

They were short time with him in the meantime of working but I refreshed a little bit.
It is starting busy weekday again as usual.

Christmas Market in Vienna

It is quite interesting for me the Christmas Market in Vienna where people come to buy something Christmas goods or just to look and drink cups of hot alcohol with fruit flavor even in snowing and cold day.

In this season coming Christmas, you can see lots of temporary construction stores in streets in Vienna, which are the Christmas Market. Of course normal permanent stores sell Christmas goods but people seem to be like it pretty much.

The Christmas Market may be more attractive than normal stores because of availability all kind of Christmas goods at a place, something special atmosphere of temporary construction with bright lights that are charming people, and also opening on Sunday when all moral stores are closed in Vienna.


I went to the Market in Herengasse with my family.
Even in snowing weather, people were drinking and eating on air without umbrella. I think you can hardly see such people in Japan where it is thought that you should be inside if you have something to bit in winter or rainy day.



The last winter I came to the Christmas Market several times, but all I remember is that too cold to find out anything interesting. I recognized changes in my mind that I pretty enjoyed the Markets this season in spite of being much colder than the last winter.

Fortunately my son learns to ride a pony in a Market’s attraction. This photo shows second times of his pony ride with his strong desire.

(He can ride a pony completely alone.)

Eventually I like it very much. I think, however, that if you would meet such fantastic Christmas Markets in Japan, they may not be attractive as like here, probably because they are based on the culture and spiritual climate of Austria, different from Japan where normal store are opening 24h or eager to lead the latest fashion.

The Christmas Market represents entertainments in winter of Vienna on the basis of favorite of the citizens.

Heart Transplantation

Since an operation which I had been supposed to assist was postponed due to heart transplantation, I was looking at it.

The ischemic time of the donor heart began from several minutes before 9, and the recipient operation was started half past 9. The sternum was re-opened carefully to avoid any bleeding, and severe enlargement heart was exposed by Prof A, except for the lateral wall due to strong adhesion of the previous Dor procedure.

After getting information from the donor team of arriving here within 20 min, he start started excising the recipient heart. At the same time of finishing all maneuvers in the recipient, donor team doctors including Dr. X were coming with the heart. A talented young surgeon, Dr. X performed transplantation within 40 min perfectly. The ischemic time was 230 min.

Of course the shorter cardiac ischemic time is the better outcome. In order to obtain the shorter ischemic time, teamwork is quite important. The other concern, it should be shorter operation and cardiopulmonary bypass time as possible in the recipient to reduce surgical trauma. In regarding this operation, as the donor was in foreign country besides bad weather, it needs longer time for transportation. In spite of these issues, transplantation was achieved less than 4 hours ischemic time as usual, without vain waiting time in the recipient procedure.

I really admire surgical teamwork including 2 coordinators, 3 anestheologies, 2 professor surgeons, and large number of co-medicals including transport supporters. Especially Dr. X did absolutely good job from taking the heart to transplanting with his highly skill and tough spirit under strictly limited time.

I hope this patient will make it without any complications.

心臓外科 卒後教育 留学...

I have been afraid that you have not had a proper education system especially regarding surgical training for young cardiac surgeons.

Although I had been aware of it since I used to work in a certain Japanese University hospital, unfortunately I am meeting similar situation necessarily. In sprite of that a Japanese doctor is supposed to be coming and joining our team, which was obvious from several months ago, my professor did not have any concrete plan of clinical practice and experimental study for him. After a young doctor emerged he tried to manage somehow to make new post graduate education program or to change it, but it is still pretty obscure seemed only a sort of pretending.

When I came here I also did not have any concrete plan and routine works, but I have been getting lots of opportunity to do or assist in cardiac operations thanks to kind a couple of professors. I have to admit sometimes to tolerate unwilling circumstances with my patient. Accidentally no other clinical fellow has stayed for long term in our department, in other words a couple of fellow had worked or has been working for short duration or with other specialty, leading me to have moderate amount of opportunities to join cardiac operations.

Situation becomes pretty changed, due to one additional young surgeon joining our team from the last March and above mentioned one coming.

Professor told me recently that we had to revolute training system, so I would get more. If it were true, it would be very good revolution at least for doctors coming from oversees, but I can not help something feeling reluctant.

Is it so easy to change?
I can not help caring of straggle to get it in my future also, because people notion is basically not so easy to change that a revolution of university hospital system is also seemed quite hardship.

It might be similar situation surrounding Japanese young surgeons in University hospitals, but still someone becomes something one with his clever or/and maintaining good relationship with their boss. Maybe you have to learn not only clinical practice but your personality, mentality, and most provably how to belave.

ウィーン医科大学心臓胸部外科 （AKH, University Hospital of MUV）

****心臓外科留学で想うこと****

It is difference between ordinary Japanese Universities and the Medical University of Vienna (MUV), although I do not know everything of Japanese Universities, that every surgeons have own research programs about clinical and experimental topics.



Even in medical students in Vienna participant research works under the direction of some professors. Some smart medical students have several research programs and if they are lucky, some of them can possess certain paper as a first author.




Moreover physicians and surgeons seem to be talented; I think they are something one who are in leading position in their medical fields. I also recognize importance of English ability. I feel every doctors seem to be native speaker, and large number of medical students also have English educated background.

I can't help thinking that it is necessary to make out English well if you will role important position in international medical field with no doubt.

Ross operation

Performing a Ross procedure, one of operations for aortic valve disease, is relatively rare in Japan, but it is one of standard valve operations in AKH, where has tremendous valver cases and is relatively easily available allograft/homograft.

A Professor has enough amounts of operation to accomplish stable excellent operative results, and achieved having high quality surgical technique. I think that is why Ross should be one of standard operations which can be terminated within 3 hours skin to skin without blood loss.

I really realize several issues including homograft availability, are pretty different of those of Japan allowing to be possible it.

the pedicle SV graft

Harvesting a pedicel saphenous vein (SV) seems slightly technical higher procedure due to cutting many branches compared conventional method.

The fascia and the saphenous nerve also should be removed with a pedicel vein graft. It seems to be more and less intensive method for lower extremity on the basis of physiological circulation, but the long term outcome with graft patency has been already proven.

I think the essential concept of it focus on non-touch technique during harvest; needless to say never infuse water. In other wards, you should take the SV very gently same as you harvest the LITA.

Apparently this case was second one in Vienna. You have to wait to see the result at least several years to confirm usefulness of this method.