godfather of surgery

Chapter 608 Underwater Escape
Little Duke Gothenburg has been taken to the operating room, and Yang Ping is about to leave for the operating room.

All the bosses present woke up and remembered something extremely important.

Today's preoperative discussion, because it was a temporary meeting, and an important person was not present, but it seems that he has been out of contact every time he is on vacation, and there is no way to contact him.

That is the legendary Maninstein of Charité Hospital. Although half of the Nobel Prize winners in medicine and physiology in Germany are from Charité Medical School and Hospital, the Nobel Prize is not a rare thing, but this professor is indeed the best. , because of his arrogant personality and frequent achievements in many fields, he is very dazzling in Charité Hospital.

"As for Gothenburg's condition, Professor Maninstein once mentioned the classic phenomenon of exhaustion. I think Professor Yang needs to listen to it."

Professor Lloyd is not provocative, but as a member of the team, it is his duty to remind the other party.

Yang Ping's operation plan did not mention the phenomenon of excessive consumption from the beginning to the end, perhaps he did not know that there was such a fatal risk.

"Please hurry up, time is a little tight!"

August urged, because the little duke had already entered the operating room, and August wanted to take Yang Ping to the operating room.

Professor Lloyd cleared his throat: "The so-called overuse phenomenon means that Gothenburg's heart and large blood vessels are in a state of oppression for a long time, because the heart is oppressed, its contraction and relaxation are not sufficient, and the blood vessels are oppressed, resulting in the blood recovered by the heart. Insufficient, the output pressure is too high. If things go on like this, the heart is only suitable for this low-consumption state. Now the pressure is suddenly released, the heart is liberated, and it can contract and relax as much as it wants, and the withdrawn blood suddenly increases, and the output load increases. The poor reserve capacity is quickly exhausted in this high-consumption state, and the heart will experience fatigue arrest."

This legendary figure's prediction of the disease is much more profound than that of all the bosses here, because he can understand the disease from different angles as a whole.

His ability to bring up the phenomenon of excess consumption shows that he has grasped the key to this case, while others have not.

This is indeed the case, if Godenberg's heart is not decompressed, it is a dead end, and decompression is also a dead end.

Just like if you don't eat, you will starve to death, and if you eat, you will die of swelling.

That's it.

Yang Ping had considered this possibility a long time ago, so he designed a gradually expanding artificial thoracic prosthesis. This delicate prosthesis not only exists for skin expansion.

More importantly, in order to overcome the excessive consumption of the heart, the space created by the artificial thoracic prosthesis is not completed in one step, but is automatically expanded bit by bit, and the pressure on the heart is relieved bit by bit.

This gradually expanding space gives the heart an adaptation process.

And this process of decompression must be properly controlled, not too fast or too slow.

Exactly how fast and how slow, this can only be obtained by countless trial and error studies.

So Maninstein can raise questions, but cannot solve them, but Yang Ping can solve them.

"The thoracic prosthesis I designed can avoid over-consumption, and the impact of all over-consumption on the operation can be ignored." Yang Ping tried to make the problem as straightforward as possible.

Now the patient is lying on the operating table waiting for help, and there is no time for a more in-depth academic communication.

Lloyd looked at Professor William, and then at the others.

Can Professor Maninstein avoid the cycle of life and death predicted by him?

Even Maninstein himself didn't find a way to avoid it, could he?
"Do you want to contact Professor Maninstein again?"

Someone suggested.

Although Maninstein is not the main person in charge of the Little Duke's medical team, he is also an important staff member.

"No need!" August made a decision.

Why contact him at this time, the patient is already lying on the operating table, and with the support of his mentor, August also has the confidence to say no to this influential man.

August is the person in charge of the Little Duke's medical care. Since August said so, the matter will be changed and no one will mention it again.

It’s just that everyone is still a little uneasy. Although this young Chinese professor looks really good, but Maninstein is a Nobel Prize winner. Will the Chinese people solve the problems he mentioned so easily? ——
In the operating room, Marcus has arrived early.

He worked with the junior doctor and body therapist to position the little duke.

The little duke couldn't lie on his stomach or his back, so he could barely lie on his side.

Performing spinal orthopedic surgery in the lateral position is extremely difficult for doctors, especially for osteotomy, and there is no sense of spatial positioning.

Nobody does spinal correction surgery in the lateral position.

Besides, it is very difficult to perform laparoscopy and thoracoscopy in the lateral position.

After general anesthesia, with the help of a special position fixer, the little Duke was placed in a lateral position, and even the anesthesiologist frowned. For patients with such deformities, no matter the anterior or posterior approach, or the lateral approach, The operation will be extremely difficult. Anyway, it is a headache to look at, and it feels a bit overwhelming.

Prepare two equipment nurses and two roving nurses, both of whom are senior nurses in their 40s.

The anesthetist is August's personal anesthetist.

The first assistant is played by August himself, and the second assistant is played by Marcus.

It can be said that August has prepared the strongest lineup of Harlacing to assist Yang Ping.

Music, Marcus remembered August's explanation.

Guzheng version of Gaoshan Liushui, which August specially brought from China. He put the disc into the CD player, adjusted it, and then told the itinerant nurse: When the surgeon completes the preoperative check, start playing music.

Munich Harlaching Orthopedic Hospital has a history of more than [-] years and is the world's leading orthopedic hospital.

At this point, they were up and running for the operation.

They never thought that the little duke would be on the operating table so soon.

August and Yang Ping, wearing sterile caps, masks, and blue hand-washing clothes, walked into the operating room. Yang Ping stood in front of the film reading light screen and read the film for the last time before the operation.

This is a habit. No matter how familiar with the case, Yang Ping must read the film for the last time in the operating room.

The operating room is very spacious, with several instrument tables spread out in an L shape, and there are many equipment and instruments such as ECMO and navigation equipment, so it doesn't look crowded.

The German nurses are tall and strong, and they can shuttle freely in the operating room.

August was by Yang Ping's side, but once he faced other people, he immediately regained his former majesty and gave orders to everyone in the operating room. This is his territory and he has absolute authority.

After the postures were arranged, everyone washed their hands and disinfected the sheets, and the operation began naturally.
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This operation was actually performed in the lateral position, which was unexpected to everyone.

But after thinking about it again, it seemed that there was no other suitable position except for the side-lying position, because the little duke's deformed body couldn't assume positions other than the side-lying position.

The conference room of the operating room was full of people, and a dozen or so bigwigs gathered in front of them. Their hearts were clouded and they felt suffocated.

How to carry out the operation on a body in lateral position and severe deformity?

Feeling uneasy, restless, and dull, as if there was no time and space for the surgery to unfold.

After the preoperative check, Yang Ping remembered the music of the mountains and rivers, and Yang Ping began the operation. He cut the skin, subcutaneous and fascia in the middle of the patient's lower back, and then used an electric knife to separate the muscles on both sides of the spinous process.

He was not in a hurry, and his first step was to do a posterior approach to insert pedicle screws.

Even with the aid of navigation, screw placement in this spiral spine is a high-risk undertaking.

Everyone thought it would be extremely difficult to implant screws in the lateral position, but Yang Ping was sitting on a stool, facing the back of the little duke, Marcus was doing nothing on the opposite side, and August was on the same side as Yang Ping. help.

The operative field is opened using an automatic retractor.

Even with a high-definition camera, it is a little unclear for this lateral position operation.

Anyway, Yang Ping kept repeating actions: opening the mouth and inserting the guide pin.

Dozens of guide pins were implanted before everyone realized it. Using the navigation equipment to see through, the position was very good, and then repeated the same operation: clearing the path and inserting screws.

In just ten minutes, dozens of screws were successfully implanted.

This set of equipment was designed by Yang Ping himself, and then contacted by Marcus for production.

After installing the screws, Yang Ping installed a temporary external fixator using the screws as connection points, locked each connecting joint, and then started the posterior osteotomy.

The ultrasonic bone knife started to work amidst the noise. Osteotomy was originally a high-risk job, but it was extremely easy in Yang Ping's hands.

The nature of the entire operation seemed to have changed, and the atmosphere at the scene changed from high tension to relaxation, because everyone felt as if they were doing a small operation, which was not so scary.

The main steps of the back road have been completed.

Now start the release of the anterior approach, the lateral position allows the anterior and posterior surgery to switch freely without changing the position.

The operation was too fast, and it was still a bit difficult for the two equipment nurses to keep up with the rhythm. Yang Ping and August moved to the other side.

After connecting the various lines of thoracoscopy and laparoscopy, Yang Ping asked the anesthesiologist to alternately collapse both lungs to make room for the operation because of the support of ECMO.

The lens of the thoracoscope is inserted into the chest cavity, and the narrow space inside has no place at all. The surroundings of the lens are filled with something, and there is no room for visual operation at all.

Yang Ping's separating forceps pushed the tissue away bit by bit, and slowly reached the front of the thoracic vertebrae. Yang Ping handed the separating forceps to August. His job was to hold the separating forceps and move the surrounding The tissue gets out of the way, creating a gap to complete the procedure.

This gap is really too forced.

Professor Lloyd watched the operation on the screen, and his scalp felt numb involuntarily, because this operation is like an underwater escape magic.

This magic trick is to firmly trap the human limbs, put them into an iron cage, and then sink the iron cage and the person to the bottom of the water.

Everyone watched the magician complete the impossible escape with trepidation, and the feeling of suffocation, despair and excitement was exactly the same as now.

With such a deformed thorax, it is almost difficult to have gaps in the thoracic cavity to operate thoracoscopes and instruments.

But Yang Ping insisted on using a pair of separating forceps to create a space close to the gap, and another type of microscopic electric knife began to separate and release the soft group of the front side of the thoracic spine.

After release, a long microscopic ultrasonic bone knife was inserted through the sheath.

What is he doing?

Professor Lloyd, Professor William, and Professor Rimbaud stared wide-eyed at the same time. He wanted to use the ultrasonic osteotomy under the microscope to perform anterior osteotomy.

Could it be?He fixes the spine with a temporary external fixator, opens the posterior osteotomy, and performs the minimally invasive anterior osteotomy under the microscope. In this way, after the combined anterior and posterior osteotomy is completed, the external fixator is used to adjust the spine, and finally the nails are installed. The rod system is locked, the temporary external fixator is withdrawn, and the operation is complete!
Sure enough, the vertebral body was osteotomized from the front side with an ultrasonic osteotome under thoracoscopic surgery.

With the trembling of the ultrasonic bone knife, a wedge-shaped incision is made on the vertebral body, and then the excess bone cut out is bitten out.

The grumpy Professor Lloyd slapped his thigh with a palm. This is a genius, he can actually use the external fixator like this.

In this way, the osteotomy can be done safely without worrying about the stability of the spine, let alone the interference of the gravity of the spine itself on the osteotomy, which greatly simplifies the whole operation.

Moreover, he can use a thoracoscope in such a narrow space.

I am afraid that Constantine, who is a heart surgeon, is also ashamed of himself.

What's next?Amputated ribs!
Yes, he guessed right, this operation is really interesting, an almost impossible and suffocating operation, it seems so easy.

Ribs are stripped one by one, cut off and extracted, and then put into artificial ribs.

Twelve pairs, 24 ribs, except for a few centimeters used to fix the artificial ribs, all others were cut and taken out.

The technique is delicate and clear. After the periosteum of each rib is cut, it is completely stripped out, and the stripped ribs are smooth.

Artificial ribs are placed into the periosteum and then sutured.

When the titanium plate in the precordial area was replaced, August held the heart, because the patient was in a lateral position and there was nothing blocking the heart. It might roll out of the chest cavity due to gravity.

Every time a few ribs were amputated, several artificial ribs were placed until 24 ribs were completely replaced.

24 artificial ribs are connected with the remaining ribs at the front and rear, and then connected to each other by bridges to form a solid artificial thorax.

How dare you?The patient relies on ECMO to continue his life, and he dares to do this kind of operation.

All the bigwigs who watched the video watched the surgery on the screen and were all dumbfounded. The Chinese professor is very courageous, but he has superb surgical skills to realize this bold plan.

I am afraid no one here can do the thoracoscopic soft tissue release and osteotomy just now.

After the surgery on the thoracic spine and thoracic cage is completed, Yang Ping will focus on the surgery on the lumbar spine next, using laparoscopy to perform endoscopic release and osteotomy just like the thoracic spine.

In this way, the joint osteotomy is completed, and the prosthesis replacement of the thorax is also completed. The operation is done here, and the bleeding is not much. Except for the inevitable bleeding of the osteotomy cancellous bone, the other bleeding is very little.

When everything was ready, Yang Ping brought August to the back surgery area.

He carefully adjusted the external fixator and rearranged the truncated vertebrae. He stared at the screen of the somatosensory evoked potential monitor while adjusting the external fixator with extreme care.

Slowly, little by little, the spine is adjusted.

"Excellent!"

Yang Ping began to install the fixation rod, then locked it, and removed the temporary external fixator for the spine.

This is not over yet.

Yang Ping turned to the front side of the patient again, and began to insert the thoracoscope and laparoscope, and made a small incision of [-] cm in the chest and abdomen. Screw in the locking screw.

For each anterior osteotomy, a clavicle compression plate is placed under the microscope, so that the new bone surface of the osteotomy fits tightly together, which not only has the effect of hemostasis, but also prevents future fusion.

Tighten a little screw on this side, Yang Ping turned to the back side again, tightened the nut of the fixing rod, and repeated back and forth between the front and back sides of the patient. The system is all tightened, and each osteotomy is tightly sutured together.

The anterior and posterior joint fixation makes the spine very firm.

"perspective!"

The navigation device fluoroscopy can reconstruct the image of the spine in three dimensions, which is very satisfactory.

Professor Lloyd felt like watching an underwater escape magic trick. This Chinese professor really managed to escape!

(End of this chapter)