godfather of surgery

Chapter 299

Before the operation, Yang Ping had to have a brief communication with Guo Jingyao, and Dr. Huang and Dr. Lin were by the bedside.

In Yang Ping's eyes, Guo Jingyao was just one of his many patients.

The doctor must go to the operating table clearly, and it is better for the patient to go to the operating table clearly. This is the purpose of communication.

Even with a net worth of hundreds of billions, he is no different from ordinary people on the operating table. His body is still composed anatomically and functions according to physiology.

Books written by the ancients often described that celebrities were born with abnormalities. Either their arms were as long as their knees, or their ears were so large as to hang down their shoulders. From a medical point of view, this should be regarded as a deformity.

Like ordinary patients, Guo Jingyao longs for his legs to regain consciousness and strength, and longs to stand up without relying on a wheelchair.

He asked many questions about the details of the operation, some of which were naive and even ridiculous, but Yang Ping still patiently explained that he didn't want his patients to go to the operating table with anxiety.

At nine o'clock the next morning, Guo Jingyao's operation officially began.

The operation was arranged in a [-]-level laminar flow hybrid operating room, which is convenient for postoperative DSA angiography to confirm whether the fistula is really closed.

Chinese doctor Tian Tuan recharged his batteries and was full of energy. Under the leadership of Dr. Huang, he entered the operating room.

Dr. Huang and Dr. Lin accompanied Yang Ping to help open the door, get slippers and clothes.

Not only Zhang Lin's hairstyle is new, but also his clothes, belts and shoes are all new, and the clothes also have a faint machine smell from new fabrics.

This operation requires access to the spinal canal, and anastomosis of blood vessels in the spinal canal may be performed. In order to reduce the probability of infection, unrelated personnel are prohibited from entering.

Except Dr. Huang, Dr. Lin, and the anesthesiologists and nurses assisting Tiantuan, other personnel are not allowed to enter the operation. If you want to watch the operation, you can only watch it through video in the viewing area of ​​the operating room.

Among those banned from entering were August and Milton.

Yang Ping is the chief surgeon, and he has absolute power to make some regulations. The purpose of these regulations is only one: to make the operation as perfect as possible!
Guo Jingyao was lying on the operating table, his body trembling a little, and his heart rate also accelerated, reaching 105 beats per minute.

"Don't be nervous!" the fat man comforted him.

His voice was also a little trembling: "I'm not nervous, but I just can't control it."

not nervous?The body doesn't lie, the fat man pushed the sedative through the vein and started the induction before anesthesia.

Under the action of the sedative, Guo Jingyao's body stopped shaking, and his heart rate also fell back to the normal range: 87 beats per minute.

The endotracheal intubation was successful and the anesthesia machine was connected. The Zeus anesthesia machine uniquely realized the integrated integration of the information processing engine system and the vital signs monitoring system.

The patient ingests the anesthetic through breathing, sends the anesthetic into the alveoli through the circuit system, enters the blood from the alveoli, and then flows along the blood in the blood vessel. The anesthetic diffuses to all parts of the body, shielding the perception of the central nervous system, and achieving purpose of general anesthesia.

Guo Jingyao's spontaneous breathing was temporarily suppressed by the anesthetic, and his breathing was handed over to the anesthesia machine to take over.

The fat man made a handsome gesture of ok: "Successful anesthesia!"

Dr. Lin was in the audience, and Dr. Huang was on the stage. For this kind of surgery, the performers cannot all be foreign doctors with temporary licenses, but doctors with normal licenses must stand on the stage.

The intervening doctor Zhou performed puncture and catheterization on one side of Guo Jingyao's femoral artery in the lateral position, and reserved it for postoperative DSA.

After the catheterization of the femoral artery is completed, the patient changes from the lateral position to the prone position, and lies on the prone frame dedicated to spinal surgery.

Zhou Can, the itinerant nurse, protected the bony protrusions with cushions; the abdomen was suspended in the air to avoid the congestion of the spinal venous plexus caused by extrusion; the eyes were fixed and protected with glue in the closed position; the urinary catheter was checked and the genitals were not compressed.

When every detail is perfect, the whole composed of details will be perfect.

Hand-washing and disinfection sheets, 3M disposable sterile sheets, are covered one by one, only the part of the operation is exposed.

Song Zimo connected the sterile handle to the shadowless lamp, and used the sterile handle to adjust the height and angle of the shadowless lamp to the best.

"Pause check before starting the operation!"

Everyone immediately concentrated and stopped all actions in their hands.

"Surgical patient Guo Jingyao, male, 60 years old, hospital number—"

"correct---"

The doctors and nurses who participated in the operation said in unison that if there is any objection, it must be raised on the spot. This is both a right and an obligation.

"Surgical site?"

"thoracic!"

"Surgical approach?"

"Posterior thoracic laminectomy fenestration spinal dural arteriovenous fistula!"

"Estimated amount of bleeding?"

"Within 50ml!"

"Surgical focus?"

"Successfully implement arteriovenous fistula formation without damaging the spinal cord and nerve roots!"

"Anesthesia focus?"

"The vital signs of the patient were stable during the operation."

"Do you have any questions about this operation?"

"no!"

"No doubt, please start the operation now."

The roving nurse closed the medical records and checked them before the surgery could officially begin.

"Anesthesiologist, please report the patient's vital signs."

"Heart rate 82 beats/min, respiration 20 beats/min, blood pressure 132/84mmHg, ear temperature 36.6 degrees Celsius——"

"Very good! I'm going to operate now, Knife!—"

Preoperative suspension and checking is a serious task, and there is no reason to be sloppy. This is the final determination of the surgical patient, surgical site, and surgical method.

A surgical patient needs to be checked three times before entering the operating room from the ward for surgery, once when picking up the patient in the ward, once before entering the operating room for anesthesia, and once again before the surgeon performs surgery.

The tireless check will minimize the mistakes of wrong patients, wrong parts and wrong operations.

On the screen in the viewing area, during the preoperative check, August, Milton, and Kobayashi also stood upright, respectful, as if they were there.

This sense of ritual can always remind the surgeon to remain in awe of surgery and life.

The yellow line on the floor next to the operating table is a prohibition line. Those who observe the operation must be outside the yellow line.

If it crosses the yellow line, it is easy to cause contamination to the operation. Once it is contaminated, there is a risk of infection. Infection is a disastrous consequence for any operation, especially for orthopedics, which is simply devastating.

In the wild era of surgery, there was no disinfection, no anesthesia, no hemostasis and blood transfusion. In this era of three no operations, even a simple amputation has a mortality rate of 50.00%, death from pain, death from bleeding, and death from infection.

It is hard to imagine that at that time, after amputation, in order to stop the bleeding, some doctors pressed the bloody limbs into boiling water or boiling oil, and the patients often passed out from the pain.

At that time, it was a lucky thing to be able to survive after the operation, and whether to survive depended on which side of the coin tossed.

After solving the three major techniques of disinfection, hemostasis and blood transfusion, and anesthesia, surgery officially entered the modern age.

The only on-site observer, Dr. Lin Mingyuan, consciously stood outside the yellow line.

The noise from the air handler and air conditioning system, and the "breathing" sound of the anesthesia machine have become the background sound of the operating room, and everyone has long been used to it.

Yang Ping was wearing a surgical gown, a sterile cap and a mask, and his exposed eyes were also protected by goggles. Song Zimo stood opposite, and Zhang Linxiaowu stood next to the two.

A knife in the palm of your hand is like a pet that has been kept for many years, possessing spirituality.

A ten-centimeter longitudinal incision was made, cutting through the skin, and the deep fascia was incised with an electric knife. The bright red bleeding points were eliminated by double-click electrocoagulation at the initial stage.

Subperiosteal dissection is performed along one side of the spinous process, which reduces bleeding.

The paravertebral muscles are peeled off on the spinous process and lamina, close to the bone surface.

The snow-white gauze was pinched in Song Zimo's hand, ready to be used at any time to stop the bleeding, but it never came in handy.

The less surgical bleeding, the less interference to the patient's physiological functions, and the better the surgical level of the surgeon.

Several cameras on the shadowless lamp shoot the operation area from different angles and transmit the images to the screen.

There is no superfluous movement, each step is extremely concise.

In less than 3 minutes, the operator revealed the lamina without blood, the automatic retractor was put in, and the operation space was revealed.

The surgery appeared to be very easy and the movements were extremely precise. This kind of surgery had already entered another realm.

"Can you do this? After entering the lamina, without gauze?" August asked.

Milton shook his head: "I can't do it, and neither can you."

"Does he have magic that can temporarily stop the patient's blood flow?" August always had some weird ideas.

"Remember, your identity is a doctor." Milton reminded.

"Doctors are derived from wizards."

"Why don't you say it's a barber?"

"The first doctors in Europe were served by barbers. The red, white and blue signs at the entrance of the barber shop originally represented blood, white cloths for wiping blood, and veins."

"The window has been opened on the lamina. Doesn't he need to use some anatomical landmarks or imaging methods to locate it?"

"If the route is very familiar, why do you need to navigate?"

"Pick-up windows, that's my specialty."

Uncovering the window requires an excellent technique. The window is opened from the lamina, and the size of the outer surface and the inner surface of the lamina are different.The principle is the same as that of the manhole cover, the outer opening is large and the inner opening is small. After the operation in this way, the cover can be reset, and it fits just right without sinking.

In doing so, the back of the vertebra is protected, there is no bone defect, and the stability of the spine is better.

The lid was lifted and the dural sac was revealed.

In the middle of the spine is a hollow bony canal, which hides the spinal cord. Like the brain, the spinal cord is the nerve center of the human body, but the brain is the high-level center and the spinal cord is the low-level center.

The spinal cord is similar to silken tofu, very delicate, and it is covered with several layers of capsules, the outermost layer of which is the dura mater, and this operation must be performed outside the dura mater.

"The fistula has been found, it's just under the window." Milton looked at the screen.

"With such precise positioning, he is at least five years ahead of us." August sighed.

"No, there is no one else here, just us, we can be bolder, it doesn't matter ten years." Milton is very serious.

"My God, the blood vessels are really domineering in front of the arteriovenous fistula, and it can't be retracted, damn it."

"Only a little gap can be exposed. It is very difficult to complete the operation in the gap."

Under the microscope, two thin rubber strips gently retract the blood vessel a little bit, exposing the gap for operation.

The surgical target lay quietly under the window. It was treacherous and cunning, escaped round after round of case analysis, and finally fell into Yang Ping's hands.

"It would be great if there was a surgical robot for microsurgery. Only with fine robotic arm terminal instruments and 360-degree movement directions can we handle this kind of surgery."

"Could it be that Dr. Yang's wrist and fingers can move 360 ​​degrees?"

"Look carefully."

"I'm looking!"

　Today is a sad day. Academician Yuan Longping and Wu Mengchao have passed away. We mourn in silence!Grandpa Yuan, Grandpa Wu, have a good journey!
　　
　
(End of this chapter)