近畿大学医学部・病院50周年史
Survey or Interview坂口 元一

心臓血管外科はハード。
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やりがいを感じてもらいたい

Cardiovascular surgery is demanding.
That’s why we help young surgeons discover their purpose.
SAKAGUCHI Genichi

Chief Professor of Department of Cardiovascular Surgery

Making use of experiences such as ‘studying abroad in Australia’ and ‘revitalizing cardiovascular surgery,’ he regards Kindai University Faculty of Medicine as the place for the culmination of his efforts in fostering others.

In 2019, shortly after SAKAGUCHI Genichi assumed his position as Chief Professor, Department of Cardiovascular Surgery at Kindai University Faculty of Medicine, he was called upon by then-Dean, MATSUMURA Itaru.
“Mister SAKAGUCHI, you were not chosen for your academic record,” MATSUMURA told him.
The implication was clear: it was not the quantity or quality of his papers that had secured him the role, but rather his clinical experience and surgical skill. MATSUMURA continued, “I want you to steadily increase the number of cases you handle.” At that moment, TOHDA Yuji, who was serving as Hospital Director, interjected, promising that he would provide as much support as possible to make that happen.
SAKAGUCHI came to understand why he had been chosen—because of his high surgical case volume. Yet, at the same time, he realized that fulfilling this mission would require more than individual effort. To truly expand case volume, he would need to confront and rethink the very system of cardiovascular surgery in Japan.
For in Japan, skilled cardiovascular surgeons are few in number. The work is grueling: long hours and relentless physical demands. “If you type ‘cardiac surgeon’ into an internet search bar,” he notes, “the predictive text immediately offers the word ‘overwork.’”
Another problem is tied to a chronic weakness of Japan’s healthcare system: its extreme decentralization. Because medical facilities are spread thinly across regions, each hospital handles only a small number of cases.
In cardiovascular surgery, as in all surgical fields, technical mastery comes only through accumulated experience. But with case numbers limited at each hospital, young surgeons have few opportunities to serve as lead operators. Instead, they spend long years in supporting roles, unable to build the practical experience they need.
What came to SAKAGUCHI’s mind was his experience in his mid-thirties studying at the Austin Health Center of the University of Melbourne in Australia.
But before that, it is worth looking back on how SAKAGUCHI first came to walk the path of a cardiovascular surgeon.

In Australia, even while performing eight times as many surgeries, it did not feel like overwork.

SAKAGUCHI Genichi was born in 1965 in Himeji City, Hyogo Prefecture, into a long line of physicians—his great-grandfather, grandfather, and father had all been doctors.
“I used to hate it when my friends teased me, saying, ‘You’ll become a doctor too, won’t you?’ So for the longest time I planned to go into engineering. But then my younger brother—who had been with me from kindergarten through high school—said he was going to medical school. I thought, if my younger brother is going into medicine, maybe it would be strange for me to go into engineering. So at the very last moment, I decided to apply to medical school,” he recalls.
At the Faculty of Medicine at Kyoto University, SAKAGUCHI joined the competitive alpine ski team, staying at ski resorts nearly three months each year. But by his fourth year, the demands of clinical training forced him to step away from skiing.
“At Kyoto University, those who chose internal medicine studied so intensely. I knew I couldn’t match that, so I had already decided on a surgical path.”
It was around this time that he was given the chance to observe a heart surgery performed by Professor BAN Toshihiko, then head of cardiovascular surgery at Kyoto University Faculty of Medicine.
“It was an operation where they actually stopped the heart. Four doctors worked together, along with three or four clinical engineers. Watching it, I thought, this is incredible. I want to try this myself.”
The ancient Greek philosopher Aristotle once warned, “Only the heart, where the gods reside, must not be harmed.” Among all the organs, the heart is the most essential for sustaining life, and heart surgery is the most demanding of all operations.
SAKAGUCHI knew well the grueling demands of cardiac surgery. “Even back then, I knew it was brutal work… but somehow, that made it seem cool to me,” he says with a smile.
“In the field, interns were at the very bottom. We had to prepare the IV drips, develop the X-rays—everything. During surgeries, we’d be the second or third assistant, then be responsible for post-operative management. Staying at the hospital for three days straight was nothing unusual. We slept in stacked bunk beds right there.”
He shrugs it off, saying it felt like an extension of the ski club training camps he had known in his student club days—tough, but strangely fun.
From Kyoto University Hospital, he moved to Osaka Red Cross Hospital, and in 1998, he made his way to the Austin Health Medical Center in Melbourne, Australia. The goal was simple: to gain as much hands-on surgical experience as possible.
“In Japan, a typical facility performed about a hundred heart surgeries per year. At the Austin Medical Center back then, the number was eight hundred.”
The way of working was also utterly unlike anything SAKAGUCHI had known.
“At 6:30 in the morning, everyone gathered at the hospital. After making the rounds, surgeries began just past 7 o’clock. Three operations were performed in a single day, and usually, everything was finished by about 2:30 in the afternoon. By three or four o’clock, we could head home and spend time with our families.”
In Australia, SAKAGUCHI came to realize the crucial importance of system building.
“In Australia, heart surgeons who can operate independently are called consultants. Across the entire country, there are only about thirty to forty of them.”
Each consultant leads a surgical team composed of assisting doctors. SAKAGUCHI, too, served as one of those assistants. The atmosphere inside the operating room was also entirely different.
“In Japan, it wasn’t unusual for the lead surgeon to shout at everyone during an operation. There were operations where nurses ended up in tears. But in Australia, everything proceeded calmly, almost conversationally, with people even making small talk as they worked.”
And yet, the techniques were astonishingly precise and fast.
“A surgery that took about six hours in Japan would be completed in three. Because the time the heart was stopped was shorter, the recovery after reconnection was faster. The tempo was incredible.”
Postoperative care was also completely systematized. Responsibilities were clearly divided among staff, and no one expected doctors to stay overnight. The experience in Australia would become a lasting touchstone for SAKAGUCHI’s career from then on.
After returning to Japan, he went on to work at the National Hospital Organization Kyoto Medical Center, Kurashiki Central Hospital, Shizuoka General Hospital, and Kokura Memorial Hospital.
Among the many hospitals where he worked, the one that left the deepest impression on SAKAGUCHI was Shizuoka General Hospital. There, he was entrusted with the daunting task of revitalizing its cardiovascular surgery department, which at the time handled only a small number of heart operations.
“In our lives, more than 90 percent of our waking hours are devoted to heart surgery. If surgery feels like drudgery, you can’t keep doing it. So, the operations must be done as efficiently as possible. And young doctors, too, must be given their share of cases.”
While ensuring patient safety, SAKAGUCHI deliberately created opportunities for younger surgeons to operate. If they could not feel the sense of fulfillment that came with the work, he believed they would never last in such a demanding field.
Today, Shizuoka General Hospital is recognized as one of the busiest cardiovascular surgery centers in Japan—a testament to the success of the system he helped build.

Kindai University Faculty of Medicine is the culmination of my lifelong efforts in nurturing the next generation.

Let us return to the period after SAKAGUCHI became professor and chair of cardiovascular surgery at Kindai University Faculty of Medicine.
Achieving his mission of increasing surgical case numbers meant overcoming one significant obstacle: at that time, the university had no full professor heading its Department of Cardiology.
Cardiovascular surgery and cardiology are two sides of the same coin. Many patients first visit cardiology for evaluation before being referred for cardiovascular surgery.
“First, I went door-to-door, visiting local clinics that listed cardiology as a specialty. I asked them directly: if you see patients with heart problems, please refer them to our cardiovascular surgery department at Kindai,” he recalls. “I visited more than a hundred clinics.”
At the same time, he was asked to recruit a strong cardiology leader to join Kindai University.
“Cardiology, including procedures like TAVI, is now being driven by the younger generation. I went looking for such a young physician,” he explained.
TAVI—Transcatheter Aortic Valve Implantation— involves threading a catheter through the groin and delivering a folded artificial valve to the aortic valve, pushing open the stiffened native valve. It is a procedure that lies on the border between surgery and internal medicine, and SAKAGUCHI himself had been involved in its clinical trials.
“In some hospitals, I’ve heard that surgery and internal medicine end up fighting over who treats the same heart condition. But what truly matters is saving the patient’s life. What’s essential is that the ‘heart team’—cardiovascular surgery and cardiology—functions together as one,” SAKAGUCHI emphasizes.
In his mind, SAKAGUCHI was drawing on his experience at Kokura Memorial Hospital, where he had worked immediately before coming to Kindai.
“At Kokura, we performed between 300 and 400 TAVI procedures a year. And when our cardiovascular surgery outpatient clinic got overwhelmed, the cardiologists stepped in to help us.”
SAKAGUCHI asked a former junior colleague from Kokura Memorial Hospital’s cardiology department to recommend a strong physician who could help him build such a team at Kindai. The name that came back was NAKAZAWA Gaku, then an associate professor of cardiology at Tokai University School of Medicine, who was quickly gaining recognition among SAKAGUCHI’s colleagues in cardiovascular surgery in the Kanto region.
Though he had never met NAKAZAWA before, SAKAGUCHI sent him an email—and arranged to meet. His first impression was decisive: “He was courteous and had great energy. I immediately felt he was someone I could build an ideal heart team with.”
One year after SAKAGUCHI’s arrival, in 2020, NAKAZAWA became Chief Professor of Cardiology.
The heart team at Kindai University Hospital, led by SAKAGUCHI and NAKAZAWA, set its sights on a clear mission: to respond to every “Heart Call.”
The “Heart Call” is the hospital’s emergency call system, activated when a patient suddenly suffers cardiac arrest, respiratory arrest, or other life-threatening changes. Whether the call comes from within the hospital or from an incoming emergency transfer, the commitment is to accept all patients, without exception.
“We do not turn away patients in need. That,” SAKAGUCHI emphasizes, “is the most important principle for our heart team of cardiovascular surgeons and cardiologists.”
For SAKAGUCHI, Kindai University is also the culmination of his long-held mission to train the next generation.
“There are no surgeries anymore that only ‘star players’ with extraordinary technical skill can perform,” he declared.
When asked what kind of person makes a good cardiovascular surgeon, SAKAGUCHI pauses to consider:
“Even if you’re technically skilled, if you can’t function in a team, it’s difficult. What we need are people who are light on their feet, and can communicate well.”
Still, he does not pretend the work is easy. To younger doctors, he offers this encouragement: “You don’t have to think of it as something you’ll do for your entire life. But while you’re young, it’s worthwhile to place yourself in a demanding field like cardiovascular surgery, where you can accumulate invaluable experience. If you have even a little interest, I hope you’ll give it a try.”