|Professor Liem performs stem cell transplant surgery on a patient at Vinmec International Hospital. — Photo Courtesy of Vinmec International Hospital
by Thu Van
HA NOI (VNS) — The day has not yet broken when Dr Nguyen Thanh Liem wakes up.
It is barely 5am on a cold winter morning in January, but the director of the Vinmec International Hospital is ready, even eager, to get the day started.
He has a quick breakfast with a cup of coffee and heads off to his office.
Liem has a sense of anticipation tingling in his veins today. He has an important surgery to perform. It's not a complicated one, but it is set to make history of sorts.
After ten years of researching this method, he has the opportunity to apply it on a patient and, possibly, save a life. It is also the first case of its kind in Viet Nam.
At 7.30am, at Vinmec International Hospital, parents of S (they don't want their son named) kiss him goodbye before he is taken into the operation room.
S was born normal. But by the time he was a month old, his skin turned yellow and his stool colour abnormal. S was diagnosed with biliary atresia.
"If your child has biliary atresia, there is no biliary tract outside the liver or bile duct is damaged, making it impossible for bile to flow through it. The bile is trapped, builds up, and damages the liver," Liem explained.
Biliary atresia is a chronic, progressive liver problem, and fatal if left untreated, he added.
At one month and 20 days, S'd had a surgery called "Kasai" in which Liem took a loop of his intestine and attached it to the liver to drain the bile.
S was fine after the operation. However, 70 per cent of the children who undergo the Kasai operation will also have to undergo a liver transplant after a while.
Almost four years old now, S's health has started to get worse.
"He often wakes up at night because of discomfort, and rashes appear on his body regularly," his father said, adding that he and S's mother knew it was time their son needed further medical treatment – a liver transplant.
However, this would require a long waiting period because a living donor with a matching blood group is very difficult to find.
"Finding a solution to regenerate the liver during this time so that the child can have a healthy life is thus of crucial importance," said Liem.
Today, he will use S's own stem cells and inject them into the boy's liver. While the solution is not new, the method is. Liem will inject the stem cells through the child's hepatic artery.
It's 7.45am when Liem arrives at his office on the sixth floor of the hospital. He quickly changes his clothes and goes down to the operation theatre on the second floor. Other doctors and nurses are already there. He looks at S, who is already anaesthetized. The little boy looks fast asleep.
A small sensor has been threaded through his veins and connected to a monitor. Oscilloscope waveforms begin to show up. With each heartbeat, a speaker produces an audible peeping sound. The steady peep, peep isn't loud, but it dominates the operating room.
It's 8am. Liem holds a large-sized needle in his hand. He starts to insert the needle into S's pelvic bone. He stops when the needle goes in about one centimeter. As he slowly pulls the plunger of the syringe, a thick liquid, the bone marrow, is withdrawn.
He looks at the monitor screen. Everything is fine.
He repeats the process several times in the next hour. By 9am, he has collected about 60ml of liquid marrow. This liquid will be filtered with a specific procedure to collect stem cells.
"Stem cells are considered master cells of the body. Stem cells are biological cells found in all multicellular organisms, that can divide and differentiate into diverse range of specialized cell types. Thus they can regenerate damaged organs in the living body of a human being," Liem explained.
He said he hopes that the stem cells will help regenerate S's damaged liver.
As the collected liquid marrow is taken for stem cell filtering in another room, Dr Liem leaves the operating room and returns to his office.
The former director of the National Hospital of Pediatrics (NHP) always has his plate full and does not waste a minute.
"I retired from NHP this year, and now I will have more time for research and focus on the things I've always wanted to do," he said.
It's 11am when Liem's phone rings. The stem cells are ready. He goes down to the operating room again.
A doctor holds a toothpick-sized plastic tube and starts to thread it through the child's femoral artery. As he does this, he watches a monitoring screen where the path of the artery can be seen. Slowly, he pushes the tube from the femoral artery to the iliac artery.
Liem watches this closely.
The peep, peep sounds still dominate the room.
Half an hour later, the plastic tube finally reaches the hepatic artery and Liem steps forward.
He takes the syringe that contains the stem cells and slowly, ever so slowly, injects the liquid through the plastic tube, eyes constantly moving from the needle to the monitor screen.
The even peep, peep sounds are reassuring. They say the boy's body is still fine, that is tolerating the performance.
"Before, a stem cell transplant would require an open surgery, which means we would have to open the abdomen of the patient to inject the stem cells. But in the case of children with biliary atresia, they are often too small for such an operation. It's too much for their body," Liem explained later.
"I'd been thinking of a method that would do least harm to the body of a child with such a problem, and finally came up with this method. Injecting stem cells through hepatic artery requires least penetration into the body and its organs, and thus it minimizes the possible trauma from surgery."
"And the patient will, of course, recover more quickly," he said, laughing.
Liem also said the stem cell transplant will help S have a healthy life as he waits for a suitable organ donor, but that he is expecting greater benefits.
"If the stem cells can differentiate well enough, the liver may even regenerate properly and stay healthy for the rest of his life. He may not even need a liver transplant."
"And the patient will, of course, recover more quickly than in the case of an open surgery," he said, breaking into a laugh again.
Moment of truth
At 11.45am, the surgery ends. The boy is doing fine. He is taken to the post-surgery unit.
Liem thanks other doctors and nurses, then washes his hands and leaves the theatre.
He feels fine after the surgery. It is not the longest one he has done. Just three and a half hours. The longest one was 10 hours.
Meeting the boy's parents at the door of the operation room, he tells them the surgery went well.
The parents burst into tears.
It's midday. The sun is shining, and Liem is smiling. — VNS