I did the world's first brain surgery in a bear,

in the rainforest, using a mattress pump in an emergency

to complete the operation.

I've anesthetized hundreds of seals,

many of which have tried to commit suicide under anesthesia.

And I did the world's first keyhole appendix removal

in a sick, wild orangutan.

I'm Romain Pizzi and I'm a wildlife veterinarian.

[Presenter] And Romain has given us unique access

to terabytes worth of his own self-shot footage.

Here we'll be covering three different surgeries.

Not only were we having to perform

the first brain surgery in a bear,

but it was also in a jungle, in a very undeveloped country,

and having to fit everything we could possibly need

in two suitcases.

Champa was a rescued moon bear in Laos

that was confiscated as a tiny cub.

Now she had quite a swollen head

but she was behaving normally when she was tiny.

[Presenter] But as she got older,

rescue workers started to suspect

there was something wrong with her brain.

She stopped being able to see,

she started to have a lot of mucus draining from her nose

and she moved very, very slowly,

and that's when they contacted me.

[Presenter] Romain thought Champa

might have hydrocephalus,

a condition where fluid builds up inside the skull,

crushing the brain.

Now there's no MRI in the whole country

when we had this case,

so we had to figure out a different way to do this.

[Presenter] So 9,000 kilometers away in Scotland,

Romain had to get creative.

I've got a bear skull and actually took x-rays of it

so I could plan where would be the closest place

that I would be able to access her brain.

So I poured some latex on the inside

and made a mold of what the shape of the brain is

and then planned on the computer

how I would approach the brain

if this was water on the brain hydrocephalus.

Probably the biggest challenge of the whole endeavor

is flying to the other side of the world to do brain surgery

without knowing if you've actually got the diagnosis right.

[Presenter] His first step was an anesthetizing Champa,

and even that can have catastrophic results.

Too high a dose could be fatal for Champa,

too little could be fatal for Romain.

I have had a bear wake up on me

on one occasion when I was operating

and I wasn't finished yet,

and it started to shrug itself on the table.

And that can be quite a scary incidence

when you have 150 kilogram, really quite dangerous animal

waking up and you're not finished suturing.

Now Laos is obviously a very underdeveloped country

with limited facilities even for human healthcare.

We're not going to be able to get a vein

and put a little catheter in,

as you could do in a pet or a human patient.

We need to dart our patient.

So the safest place to dart a bear is in the hind muscles,

so the back leg, in the top of the leg.

Basically it's bum.

[Presenter] With Champa darted and asleep

Romain drilled a tiny hole into her skull,

and the diagnosis was correct, hydrocephalus.

Hydrocephalus is a common condition in human children

and easily treated

by draining the excess fluid down to the abdomen

using a tube.

The body then absorbs the fluid.

But, obviously, a bear's not like a child

and will climb trees and rub itself, and has sharp claws.

[Presenter] Sharp claws that could rip the tube out.

Catastrophically the brain could either collapse on itself

or the shunt could actually block.

So we buried this little shunt

just behind the base of the ear

so it wouldn't be able to get its claws there.

We could make a very big incision and put the tube in,

but then the bear would risk opening this

so we want to do everything by keyhole surgery.

Keyhole surgery is where we use

specialized, very thin instruments

so that we only end up with tiny surgical wounds,

and we use a special surgical telescope

to be able to see inside the body while we do it.

Now the anatomy of a bear skull is really different.

Bears have a big sinus on the top of their head,

that's a big air-filled space.

So where you'd put your tube in an infant

wouldn't work in a bear

because it would disappear into the sinus

on top of their head,

and so we actually had to drill a little hole

much further back.

[Presenter] With the whole drilled

and the shunt run down to Champas abdomen,

the team were on the home stretch,

until the electricity went out.

So we borrowed a mattress pump

and what we did is ran that in very short bursts

just to put room air into the abdomen,

just to give us enough space

to do the last bit of the operation,

which we did very quickly, just to make sure

that we don't put too much pressure on the abdomen.

This is an ingenious retractor

which is only five millimeters,

and we can stick down the little tubes

that can go safely in the abdomen.

And then by turning the handle,

it will turn into the surgical equivalent

of a keyhole surgery hand.

[Presenter] The surgery took six hours.

The next morning, Romain went down to Champas den.

After years of pain and eyesight problems,

Champa woke up and started to look at Romain and the team

in the eyes.

The surgery was a success.

Every year, all over Europe,

many orphaned grey and harbour seal pups

need rescuing and hand-rearing,

and then they're returned to the world.

Now, one of the most common problems

that I see, as a surgeon,

is actually seals with a ruptured eye.

Now, I've anesthetized hundreds of seals

but they're still a really challenging patient

because they actually

try to commit suicide under anesthesia,

which is a bit nerve-racking and quite frustrating.

Because seals live in water,

we describe them as having something called a dive reflex.

If you hold your breath for a prolonged period of time

you'll feel that you need to take a breath.

You cannot make yourself unconscious by holding your breath.

As soon as you're gonna lose consciousness,

you will actually, your brain will make you take a breath.

Now that doesn't work with seals

because if you're diving under water

and you feel like you're building up carbon dioxide

or running low on oxygen,

the worst thing you can do is take a breath

'cause you'll drown.

So they have a whole range of different adaptations

that their body uses to try and get around this.

It slows their heart down and it changes the blood flow

through different blood vessels.

It'll dilate the blood vessels to the heart

and the brain and the kidneys, those vital organs,

but it will constrict blood vessels

to either non-vital organs.

Now the problem is, under anesthesia it can be difficult

to recognize and understand what's happening,

and the seal might go into these dive reflexes

and as we try and wake it up

and it runs a little bit low on oxygen

and a bit high on carbon oxide,

it actually slows its heart down and circulates worse,

and it dies.

And so these are things that we have to be very aware of

with how we anesthetize seals

and how we monitor them during anesthesia.

The simplest solution to preventing this whole dive reflex

is to actually breathe really well for our seals.

And all we need to do

is regularly squeeze the Ambu bag that we're using

to give oxygen and anesthetic gases to our patient

regularly throughout the anesthesia,

and that will prevent any of these reflexes from happening.

[Presenter] With the seal safely sedated,

Romain must remove the ruptured eye.

Once you take the eyeball out, what could happen

is their skin can heal down into the socket

and it'll end up with a little cavity.

Now that could accumulate little sea creatures

and all sorts of debris

if that animal goes back to the wild,

and we can't let that happen.

So to solve that, once we've taken the eyeball out

and before we close the skin,

we make a mesh of stitches across that orbit

so that when the skin starts to sink down,

it hits that mesh.

Now I can use the thermal camera

to judge how the eye's healing

and to tell if there's any infection,

because the blubber heals very differently.

So this is what my eye would look like.

Now you'll actually see

that my glasses will reflect infrared from the light,

but a seals eye can look quite different

especially if there's an injury around the eye,

or the eye has been partly punctured.

It'll radiate a lot less heat

because it's actually a smaller structure.

But I also have to be really careful

on how I suture this closed

so that it's watertight very soon

and the seal can go back into water

a day or two after its operation.

So Myria was a very specific case.

She'd been confiscated from a farmer

because she'd been raiding his fruit trees

and he put her in a wooden crate

and kept her like that for two years.

So she'd gone to one of the rescue centers

and she was doing really well

when she suddenly got very severely ill,

so they rushed her into the clinic and took some x-rays

and this is when they saw the nail.

This was a large metal nail

and no one could figure out where it was.

It looked like it might be just up her bottom

and she was going to poo it out, but the nail never passed,

and that's when I got involved.

Now, orangutans have quite a long appendix,

a lot longer than ours, and little heavy things like stones

and, in this case, the nail, will typically get lodged there

and they can cause a problem and appendicitis

and either puncture their appendix

or the appendix can rupture.

So now we know what the problem is, but our challenge is

how to do surgery so it doesn't turn into a disaster

because orangutans are probably the most intelligent

of all the great apes.

And that's really interesting,

although we may be more closely related to chimpanzees,

chimpanzees learn in a group

whereas orangutans learn on their own.

And so the youngsters will spend much longer with their mom

learning all the life skills

and they have a very problem-solving way

of thinking about the world.

But when I do surgery,

or anyone else does something like it

and they've got a little bit of discomfort,

their first inclination is to open any wound

and try and explore that.

Now that can be an absolute disaster

if you open up the abdomen

because if they open the wound and play with the intestines,

that will be fatal,

and that's why keyhole surgery is so vital in orangutans.

To make the tiny incisions that we are going

to stick our keyhole surgery instruments through

really taxes one's eyesight,

and that's why I use magnifying loops

to have a look at what I'm doing.

And that just allows me to see and keep sterile

without having my face right against the orangutan,

the tiny area that I'm working in.

[Presenter] Orangutan's appendix surgery

is the same as human appendix surgery,

but Romain has to use even smaller incisions.

In Myria's case, an orangutan, because she's so clever

and we were worried she'd open those holes,

I used even smaller instruments.

So these are even just three millimeters in diameter,

barely larger than a microchip needle,

and those tiny holes don't even really need stitches

and there's no chance that she'd be able to open them

or even poke a grass blade inside

to interfere with the operation after I'm finished.

Now, Myria had a really good outcome.

She were recover really quickly,

she almost didn't notice she'd had surgery

because those wounds were so tiny.

She was eating an hour after she woke up.

A couple of months later

when they were preparing to get her ready

to go back to the wild,

they actually managed to foster a small baby onto her,

and she was great and she took this little baby

and looked after it and started to teach her things

and when they released Myria back to the forest

she took the baby with her.

And they've been monitoring her the last few years

and it's almost five years now

that she and her now quite large infant that she's adopted

are doing really well.

So that is something really deeply satisfying

that the operation

actually resulted in such a happy outcome.