godfather of surgery

Chapter 401 Curved Drilling
With the help of Robert, Huang Jiacai went to investigate several American medical device companies.

Lao Cheng visited the New York Hospital for Special Surgery, and the hospital sent an administrator to accompany him. He conducted in-depth research on the hospital's culture, management and structure.

After confirming that Yang Ping was not affected by the accident, Robert arranged the operation according to the original plan, and the first operation was performed by little Andrew.

Robert had been planning this operation for two years, but he didn't do it because he was not sure.

If you are not sure, you can only wait, and there is no turning back after surgery. Once the surgery is broken, it is not only difficult to do revision surgery, but also the effect is poor.

So Robert has been researching, hoping to develop a new surgical method to solve the multi-ligament reconstruction of children's knee joint.

The existing surgical methods cannot even deal with simple anterior and posterior cruciate ligament reconstruction, let alone this multi-ligament reconstruction.

For two years, Robert racked his brains and failed to make a breakthrough. It was not until he met Yang Ping that there was hope for this matter.

Everyone is looking forward to how Yang Ping will perform this operation, and what level of mentor Robert is talking about.

The New York Hospital for Special Surgery has long been ranked at the top of the orthopedic department in the world. These doctors are used to the feeling of being the first and teaching others. In their careers as doctors, many doctors have never seen a hospital invite someone to perform an operation.

Now Robert invites a Chinese professor to perform the operation, and everyone is full of anticipation and curiosity.

Because of the existence of the epiphysis in children, the adult methods are helpless. Some people suggest surgery after adulthood, and some people design the method of extraskeletal suspension, but the method of extraskeletal suspension changes the anatomical center of the ligament, and the insertion point cannot Obtaining solid tendon-bone healing is a helpless choice.

In short, to operate like an adult, a bone tunnel must be opened. As long as the bone tunnel is opened, the epiphysis will be damaged. If the epiphysis is damaged, it will cause bone development deformity, and in severe cases, the epiphyseal plate will close and growth will stagnate.

Reconstruction of multiple ligaments of the knee joint is already very difficult for adults, but it is even more difficult for children.

In order to watch the operation, except for the doctor on duty in the ward, the doctors in the entire sports medicine department rested, and no other operations were scheduled on this day.

Many doctors from other departments also came. Professor Jung, who specializes in knee replacement, also took time to see Yang Ping's operation.

Because sports medicine and joint replacement come out of joint surgery, many hospitals are divided into different disciplines. A doctor can perform both knee replacement and knee arthroscopic surgery.

There is a reason why Professor Jung is so interested in Yang Ping’s arthroscopic surgery. There are two key techniques in knee replacement—osteotomy and soft tissue balance. Difficulty, not on a level at all.

Professor Jung wanted to see how this Chinese doctor, Robert's mentor, could adjust so many ligaments to a balanced state.

Engineers from OrthoPediatricS company also rushed over. They wanted to see how these instruments are used and how to complete the operation, especially the drill bit that can drill holes with curves.

The OrthoPediatricS company manufactured this drill according to Yang Ping's drawings, but they don't know how to use it and where to use it. After all, they are not doctors.

Andrew Jr. was at the first table, and Robert himself was his assistant, leading Barrell in positions and disinfecting the sheets.

Yang Ping brushed his hands, put on a space surgical gown and gloves, and entered the position of the chief surgeon.

The first assistant, the second assistant, and the equipment nurse have already been in place, and ten equipment boxes have been placed on the surrounding equipment tables, which is fully reflected here.

Yang Ping has visited the supply room of this hospital. It should be the most complex and advanced supply room in the world. It adopts factory-like and assembly-line management. There are more than 100 operations every day, and each operation has about ten instrument boxes. Some operations exceed ten. Some doctors have their own exclusive surgical instrument boxes because of their personal habits.

More than 1000 instrument boxes are cleaned, collected, inspected, repaired, replaced, sterilized, and packaged after surgery. The entire process is monitored and tracked using a dedicated computer system.

During Yang Ping's visit, he found that they were very serious about the inspection of the equipment. Each equipment had to go through the inspection of the standard procedure, and the damaged ones were picked out immediately, and new replacement equipment were added on the spot, which was very efficient.

Some hospitals have equipment that is not in stock and need to be replenished by the manufacturer. They are also registered and replenished as soon as possible, and the departments will be notified in advance.

Yang Ping looked over all the instruments used in the surgery, especially those designed by himself, and made sure that there was nothing missing before Yang Ping officially opened the stage.

The glass protection that hangs slowly from the ceiling surrounds the surrounding area and isolates the operating table from the surrounding area, ensuring the safety of the operating area to the greatest extent.

Check before operation, open the mouth, insert the probe, and start the inspection of various anatomical structures in the knee joint.

The probe moves freely in the child's knee joint, always in the gap, and does not collide with the cartilage.

Every time the position of the knee joint is changed, there is no need to wait. The movement of the probe is almost synchronized with the change of the position of the knee joint, and the two cooperate perfectly.

Stryker's latest naked-view 3D arthroscopic device is very easy to use, and the image presented on the screen is a clear 3D instead of a two-dimensional plane.

Those who should be palpated with a probe should be carefully palpated; those who should stop and observe carefully should not be handled roughly; those who should lift up the meniscus should never omit the steps.

The time that should not be wasted, not a second was wasted, the proficiency of the operation has entered a state of enjoyment.

In the teaching room of the operating room, everyone watches the video. The entire arthroscopic surgery is completed under the camera. The surgeon also watches the real-time video to complete the operation, so the field of view of the surgeon is the same as that of the audience.

The atmosphere is delicate, fast but not impatient, elegant but not frivolous, which has made the operation artistically appealing.

Professor Jung, an amateur music lover, has a professional violin performance. He not only has the ability to judge the operation rationally, but also has the ability to judge emotionally.

Surgery can form emotional charm, which means that rationality has reached the extreme, and harmony and rhythm are produced invisibly. This level must be a master among masters, and it is definitely not something ordinary people can achieve.

Professor Jung lamented that from the operation of this Chinese man, he could see a kind of temperament --- broad, deep, simple, and sensitive, which was not derived from logical reasoning, but from perceptual imagination.

The examination of the knee joint has been completed, and the next step, the reconstruction of the anterior cruciate ligament, has begun. There are several ligaments that need to be reconstructed in this operation.

The equipment nurse was a bit overwhelmed and couldn't keep up with the rhythm. Robert had tutored her many times in the operation steps, and she was mentally prepared, but she still couldn't keep up.

Maybe the speed of the operation was beyond her imagination. The sister-in-law started to feel a little nervous. Robert comforted her: "Don't worry, Dr. Yang will stop and wait for you."

Robert was worried that she would collapse, Barrell supported her legs, and Robert helped deliver the equipment from the side, and the scene was stabilized.

To prepare the tunnel opening, according to Robert, Dr. Yang will use the sagittal curve to drill the hole, bypassing the epiphysis. Everyone is eager to see how Yang Ping performs the curve tunneling in this step.

"Curve drilling does not require a guide pin. At present, we can only drill with bare hands. In the future, we can use computer software to navigate. There are three drilling methods: sagittal plane curve drilling, coronal plane curve drilling, and horizontal plane curve drilling. Sagittal plane curve drilling. In order to avoid damage to the posterior nerve and blood vessels, a small incision needs to be made on the front of the knee for the second curve, and reverse drilling is performed from the front to the back; horizontal curve drilling, postoperative stress will be concentrated on the epiphyseal line Below, it is easy to cause epiphyseal traction stress concentration, severe cases cause epiphyseal separation; coronal drilling is the safest, most convenient, and the best effect, and can avoid the shortcomings of the previous two drilling methods.

Yang Ping explained while doing, Robert thought too simple, he thought that Yang Ping would drill the sagittal curve, and the way he guessed was exactly the one that Yang Ping eliminated first.

The coronal plane is the imaginary plane that divides a person into front and back halves; the sagittal plane is the plane that divides a person into left and right halves; the horizontal plane is the plane that divides a person into upper and lower halves.

Coronal curve drilling, this curve will be shaped in the coronal plane.

Start coronal curve drilling, and the soft drill bit can change direction arbitrarily for directional drilling.

"If you are not skilled, you must use C-arm machine fluoroscopy monitoring, or use navigation equipment to help prevent damage to the epiphysis."

Of course, Yang Ping does not need such complicated assistive technology, he can drill holes with his bare hands, and he is too familiar with anatomy.

Yang Ping's explanation of Robert's words was just a reminder: Don't imitate dangerous scenes.

The drill starts from the lateral wall of the femoral intercondylar fossa, the anatomical center of the anterior fork ligament, toward the lateral side. Without such a steerable drill, the curved tunnel cannot be drilled anyway.

Along the safety zone below the epiphysis, the drill bit is drilled out of the lateral femoral condyle along a preset curve, and then the soft protective sheath can be turned to prevent the soft tissue from being twisted by the drill bit in the next step.

Under the protection of the sheath, the drill bit turns and crosses the epiphyseal line. Just above the exit, there is another safe zone, and the drill bit drills in. This is the direction opposite to the previous one, from the outside to the inside, just halfway through, without drilling through.

This operation is hidden in the bone tissue and cannot be seen on the screen. In order to confirm that the tunnel did not damage the epiphysis, Yang Ping decided to perform a C-arm fluoroscopy.

The glass protective cover was raised, everyone avoided, and the operator of the C-arm machine performed a perspective.

The drill bit is still in the tunnel, and the metal shadow is the direction of the tunnel. Above and below the epiphyseal line, the two curved metal shadows are very beautiful, and the epiphyseal plate is not damaged.

Curve drilling, beautiful curve drilling!Professor Jung was amazed.

Soft drills are often used in orthopedics, especially for drilling in narrow spaces. In some dead angles of operation, hard straight drill rods will be pinned and cannot be drilled, just like bullets have shooting dead ends.

Therefore, soft drills are widely used. Because the drill pipe is flexible, the soft drill can apply stress to change the direction of the drill bit to complete drilling at almost any angle.

But that just can determine arbitrary drilling point, can't control the route to the tunnel that drilling passes through.

Now this Chinese doctor has designed this set of instruments, which can skillfully drill holes in any path.

No wonder Robert worshiped him as a teacher and secretly went to China to study, the Chinese are so smart.

This doctor is not only highly skilled in surgery, but also advanced in concept.

In the same way, the tibial tunnel is completed with a segmental drilling of the curve in the coronal plane.

The tendon is implanted in the bone tunnel, and the two ends of the tendon are embedded in the bone tunnel. Instead of using the commonly used micro flip plate suspension fixation, it is a novel built-in anchor.

The anterior cruciate ligament, posterior cruciate ligament, medial posterior structure, medial lateral structure, and many ligaments are drilled with curves and fixed with built-in anchors, making children's surgery as mature as adults.

The combination of new equipment and superb surgical technology makes this world's top surgery simple and direct.

Moreover, the new device strictly complies with the relevant regulations of the FDA, avoiding the trouble of approval.

"How did Robert know this Chinese doctor?" Jung felt itchy.

An attending doctor in the sports medicine department next to him shook his head: "I don't know."

"Does Dr. Yang only focus on sports medicine?" Professor Jung asked.

"I heard no, he is good at spine, joints, trauma, and sports medicine!" the attending doctor replied.

Professor Jung was very dissatisfied. This guy Robert had found such a good teacher, but he never mentioned it to him.

Petty, despicable, selfish, narrow-minded!
Professor Jung was indignant, and he went over all the words he could think of in his heart. Afterwards, he wanted to settle the score with Robert and settle the score properly.

Why, there is such a mentor who has never disclosed any information.

If you only focus on sports medicine and arthroscopic surgery, it is understandable that this instructor is also good at joint replacement!

The last time he went out for a week, he actually vaguely said that he was going to China to attend an academic meeting.

The dishonest man, the dishonest man!
"The next one is ready to start." Someone reminded Professor Jung.

The second operation is in another operating room, ready to begin.

(End of this chapter)