godfather of surgery

Chapter 383 Entering the restricted area
Professor Feng lay supine on the operating bed, and the roving nurse connected the indwelling needle of the left radial artery to maintain the venous access.

Professor Ma, the anesthetist of Magic Six, performed local anesthesia for puncture and catheterization of the right subclavian vein, connected to various monitors, and dynamically monitored electrocardiogram, heart rate, arterial blood pressure, central venous pressure, pulse, and blood oxygen saturation.

Professor Ma injected fentanyl 0.2 mg, propofol 100 mg, and rocuronium bromide 50 mg intravenously. After successful induction of anesthesia, a spring stent endotracheal tube was inserted and connected to an anesthesia machine for mechanical ventilation.

The breathing sounds of both lungs were clear and symmetrical during auscultation. Professor Ma adjusted the breathing parameters to maintain the end-tidal partial pressure of carbon dioxide at 35-45mmHg, inhaled isoflurane to maintain the end-tidal concentration at 1%, and planned to add vecuronium bromide 40mg every 2 minutes.

After the anesthesia was satisfactory, everyone worked together to change Professor Feng to the prone position. Various body position pads and restraint belts were in place, and Professor Feng's eyes were also fixed in the closed position with protective tape.

The head is fixed on the Mayfield frame. Yang Ping installs the frame himself, and checks every screw several times, especially the three skull nails, to ensure that they are installed at the largest diameter of the head. The board holds the head firmly.

If the installation was not done properly, the pointed vertebra would not enter enough bone, and the head would slip off during the operation, which would be fatal to Mr. Feng.

Not only should the head and neck be fixed firmly, but also the angle of the fixation should be optimal. After adjusting these, Yang Ping checked the defibrillator again.

Even the sandbags used for CPR in the prone position, Yang Ping personally inspected them. The sandbags are stuffed in the lower part of the sternum, so that when the heart is pressed, the lower part of the sternum is squeezed by the sandbag and sinks when the back is pressed, forming a squeeze on the heart and playing a role Same effect as supine compressions.

Sandbags should not squeeze the abdomen, but only in the lower part of the sternum. According to the principle of body position, sandbags cannot be placed in this position, which may easily cause pressure sores.

The somatosensory evoked potential and motor evoked potential monitoring equipment of the brainstem and spinal cord worked normally.

So after checking these details and repeatedly emphasizing some precautions, Yang Ping took everyone to brush their hands with satisfaction.

Sterilized sheets, preoperative check, anesthesiologist reported vital signs: heart rate 75 beats/min, respiration (mechanical ventilation) 20 beats/min, blood pressure 120/65mmHg, blood oxygen saturation (low flow oxygen inhalation) 100%.

Yang Ping wore protective glasses and started the operation with a laser knife with a sapphire tip in his hand.

The laser knife fiddled a few times in his hand, looking for the feel, and began to cut the skin.

Based on the principle of two-point positioning, Yang Ping chose to connect the upper cervical posterior approach with the median occipital transmembranous velar approach to form a combined approach.

There are fourteen safety zones in brainstem surgery, and six in the medulla oblongata. The median occipital transmembranous velar approach is one of the six.

The tumor involved the upper cervical spinal cord and medulla oblongata, which should have been done by the cooperation of spinal surgeons and neurosurgeons, but now Yang Ping had to do it alone.

Yang Ping's research on anatomy has far surpassed these rough safety zone concepts. In the brainstem area, he already has a mature and complex safety map in his mind. Even in the most dangerous areas, he knows how to smoothly implement crossing.

The skin is incised, the scalp clips are neatly clamped at the edges, and the laser scalpel is advanced layer by layer.

On the outer side of the external occipital prominence, drill two holes at the lower edge of the transverse sinus,
The skull of the hindbrain was uncovered in a well-covered manner, and the circular spinal canal of the upper cervical spine was fully opened from the rear side, revealing the entire rhombic fossa.

With this fine craniotomy, the skull can be covered back like a cover after surgery, and together with the closed cervical vertebrae, it can be firmly fixed with internal fixation plates and screws.

The spinal canal and cranial cavity are opened, and the pulsating dura mater appears in the field of vision, which wraps the upper cervical spinal cord and medulla oblongata.

The entire brainstem is no bigger than a thumb, the medulla oblongata is only a part of it, one-third the size of a thumb, and the upper cervical spinal cord is about the size of a finger.

It also connects various intricate blood vessels and nerves, such as vertebral arteries, cranial nerves, and spinal nerves.

Now the operation needs to perform complex and precise incision, separation and hemostasis in this finger-sized space. There must be no mistakes, and a small mistake will cause the death of the patient.

Because the tumor only involves the medulla oblongata and upper cervical spinal cord, all approaches need not be used.

Yang Ping holds a laser scalpel in his right hand and a gun-shaped bipolar coagulation forceps with a light source in his left.

With the utmost proficiency in dissection, all obstacles to the surgical target are removed.

The entire posterior portion of the upper cervical cord and brainstem was safely brought into view from the scalp, with hardly any hemorrhage seen.

The accuracy of the gun-shaped double-click electrocoagulation tweezers is astonishing. Before every bleeding point appears red, it will be resolved in advance by double-click electrocoagulation. The hemostasis action is completed once, and the action will never be repeated.

"microscope!"

A Carl Zeiss neurosurgery microscope is pushed to the operating area.

Yang Ping changed the gloves, adjusted the focal length and the interpupillary distance by himself, and then changed to new sterile gloves until he was satisfied.

With the subtle light of the laser knife, the Y-shape cuts the dura mater and opens it.

The middle hole of the fourth ventricle is open, and the outside is choroidal tissue, cerebellar tonsil, and posterior inferior cerebellar artery.

Gentle neural pullers pull the cerebellar tonsils and posterior inferior cerebellar arteries laterally.

The choroidal tissue and inferior medullary velum are separated, exposing the entire rhomboid fossa.

At this point, the dorsal region of the brainstem exposed by the transmembranous velar approach appeared in the field of vision, and the safe operating area near the facial hillock was placed in the field of view.

The whole reveal was actually completed within a few minutes, and the movement was smooth, steady and brisk.

The chief surgeon didn't want to waste time on revealing this step.

The things of Wen Rentao and Zeng Ran were only revealed by pulling hooks.

The whole process was performed without blood, and the suction device in Wen Rentao's hand didn't play a big role, appearing very lazy.

"It's too fast, a truly bloodless operation, really beautiful!" Johannesson sighed, worthy of the 80.00% success rate.

The surgery had just completed the revealing process, and Johannesson had already been impressed by the superb surgical technique, clean and clear surgical field of view, and extremely skilled dissection.

The so-called layman watches the fun, and the expert watches the way. As the world's top neurosurgery expert, he has a deeper understanding than others.

However, it was hard for him to believe that this was an orthopedic surgeon performing an operation.

"It's like he knows every possible bleeding point in advance. This is the first time I have seen this bloodless operation." As a tumor surgeon, Griffin is particularly sensitive to hemostasis.

Woodhead has never looked away. As a spinal surgeon, his scope of surgery often extends to the medulla oblongata. In the United States, spinal surgery is not a branch of orthopedics, but considered a branch of neurosurgery.

At this time, he admired this bold and open exposure very much, and at the same time, he found it difficult to replicate this unboxing technique that is very particular about bone treatment.

"I'm afraid it's hard to replicate this kind of fineness?" Woodhead was both envious and helpless.

He was thinking about what kind of surgical training Yang Ping received in order to acquire such fine and proficient anatomical knowledge and surgical ability.

View under the microscope, laser knife, gun-shaped double-click electrocoagulation tweezers, with light source attractor in the operation field.

The previous exposure is just a foreshadowing, and the subsequent surgery is the real step.

This scalpel moves the life center without error.

"Guys, focus," Johannesson reminded.

All three of them sat upright, focused, and began to watch the video of the surgical field under the microscope.

The entire meeting room was so silent that the breathing of the neighbors could be heard.

"Doctor anesthesiologist, I am going to cut the upper cervical spinal cord and medulla oblongata, start to separate the tumor, and pay close attention to the vital signs."

"The defibrillator starts to prepare. Remember, once ventricular fibrillation occurs, the anesthesiologist will report immediately, and the defibrillator must complete the defibrillation within five seconds."

Yang Ping reminded everyone, but the danger is not coming so soon, it is very necessary to let them enter the state in advance.

The laser knife begins to cut along the posterior median groove of the medulla, which is one of the safe areas of the medulla.

The knife line is straight, just like a ruler.

　Today, I can only publish one chapter of the surgical preparations, and the main part of the surgery will be released at once tomorrow, and it still needs to be polished to make it look good.

　　
　
(End of this chapter)