godfather of surgery

Chapter 737: Still under the microscope?

Dr. Wen spat out a series of no's, but Song Zimo couldn't get in the middle of the conversation.

Even Xu Zhiliang seemed extremely impatient. He turned around and asked Robert to point the phone at him.

"You - your - damn - just - in one sentence - the success rate - is - high - high?"

Hearing this Xu's language, Zhang Lin's back was sweating. Zhang Lin and Xu Zhiliang are Xu Zhiliang's junior doctor. They have to face this kind of communication almost every day. Zhang Lin not only did not dare to refute, but also listened respectfully and seriously without missing a word.

A Wen Ruzheng voice came from the phone: "Fei - Fei - very high, almost the same as ordinary - ordinary frozen slices."

Damn it, Xu Zhiliang was so angry that he dared to repeat himself.

"Tell him that if something goes wrong, he won't even be allowed to wear underwear during this streaking run." Yang Ping said towards the phone.

Inside Wen Ruzheng's stammering voice stopped immediately, and after a while he whispered, "Professor Yang is here?"

"Yes!" Yang Ping answered himself.

"Hurry up and send the specimen down. Don't worry, the technology is mature. I am a gentle and upright gentleman, no -" Dr. Wen said in a serious tone.

Robert cut off his phone call in time. Everyone in the operating room wanted to laugh, but out of respect for Xu Zhiliang, everyone held back their laughter.

"Li Guodong, please send the specimens to the pathology department in person. Don't come back right away. Wait for the results before coming back." Yang Ping named Li Guodong to be responsible for the specimens.

The bone fragments were put into a sterile specimen bag. Li Guodong wore gloves and carefully labeled the specimen bag, took it in his hand, left the operating room, and rushed to the pathology department.

After the bones were sent away, August suddenly discovered something. Yang Ping's rongeur went in, seemingly easily, but he actually bit off the bone around the cyst, and finally completely removed the cyst and The surrounding bone.

How did he do that?
How could it be possible to completely remove the cyst with a pair of rongeurs, without any intraoperative imaging assistance, such as a C-arm X-ray machine or CT scan monitoring?

If this is a malignant tumor, then this surgical operation is undoubtedly a truly tumor-free technology and can be said to be perfect for complete resection.

August walked around a few times outside the yellow forbidden line on the operating table, and then stopped near the instrument table. He wanted to see what was so special about the long-handled, thin rongeur, and he even doubted it. There may be some intelligent detection equipment on it.

Although he was at a certain distance, August could still see the rongeur clearly. It was an ordinary rongeur with a long handle and a thin handle. Apart from being particularly suitable for operation under the microscope, he could not see the rongeur clearly. Out of anything special.

How did Professor Yang completely remove the bone cyst, without injuring the cyst wall, and without allowing the cyst fluid to flow out.

Although the operation seemed uneventful, August racked his brains to figure out the reason behind it, but he couldn't figure it out.

Most of the transoral anterior surgery has been completed, and the remaining steps are to fill the artificial atlas with bone. The artificial atlas in the middle part of the internal fixator includes the anterior arch, posterior arch, and two lateral masses, which try to simulate the Mechanical structure of normal atlas.

The internal fixator spans the atlas and fixes the head and neck based on the headrest and axis. This fixation is temporary. Ultimately, it is hoped that the filled bone can heal together with the skull base and axis, that is, the head and neck can be boned. sexual welding.

Bone welding is the "fusion" of spinal surgery, which is one of the basic goals of spine surgery.

The underlying logic of spinal surgery is also the basic goal: decompression, stabilization, and orthopedics. All operations will be carried out around these three goals.

Remove the hematoma, remove the crushed atlas, this is decompression, relieve the existing or potential compression of the spinal cord.

Implanting an internal fixator is to reshape the stability of the spine. This stability is temporary and ultimately requires bone-to-bone healing to create permanent stability.

To restore the dislocated atlanto-occipital joint and atlantoaxial joint to the correct position and maintain the normal anatomical observation of the head and neck is orthopedics.

In the eyes of those young regular trainees and graduate students, the current surgeries seemed to be ordinary and nothing thrilling, but in August's eyes, he understood how difficult some surgeries were, especially the complete removal of the cyst, which required a lot of work. The surgical technique is very high.Yang Ping stopped the operation and waited for Dr. Wen's frozen pathology results.

The current diagnosis of "bone cyst" is only imaging diagnosis. Ultimately, whether it is a "bone cyst" or another tumor requires pathological examination to determine its nature.

If the pathological examination is benign, the bone tissue of the atlas excluding the cyst can be used as a bone block for bone grafting; if the pathological examination is malignant, the bone tissue of the atlas must be discarded, and Yang Ping needs to find another "supplier". For example, removing part of the ribs or ilium.

"I've never heard that bone tissue can be frozen sectioned. Can this guy do it?" Zhang Lin was a little skeptical.

Song Zimo believed in Dr. Wen very much: "This person has a bit of a weird temper and is pedantic, but his skills are incredible. He is definitely sure of what he says."

"To make pathological sections of bone tissue or calcified tissue, you must first decalcify and then remove acid. Not to mention the subsequent steps, the acid removal alone takes at least 24 hours. He can get the results in half an hour?" Zhang Lin muttered.

"Without diamonds, he wouldn't dare take this porcelain job." Robert took over.

August thought for a while and said: "His washing and deacidification method should be a new method. We are also trying frozen sections of bone tissue, using 0.5% sodium hydroxide to deacidify, and the deacidification can be completed in a few minutes. I guess he Should have mastered this method."

In surgical oncology in Europe and the United States, the person responsible for viewing frozen pathology slides during surgery is the surgeon, not the pathologist.

For example, when August undergoes spinal tumor surgery, after the tumor is removed on the operating table, if frozen sections need to be sent, the pathology room is near the operating room, and some are even next door. After the assistant prepares the frozen sections, August takes off the section. After taking off the surgical gown, go to the pathology room to see the frozen sections. After confirming the pathological diagnosis, wash your hands and dress again, get on the operating table, and continue the operation.

In Europe and the United States, learning to read pathological slides is a basic skill that surgeons who perform tumor operations must master.

Sure enough, less than half an hour later, the phone rang in the operating room. It was Dr. Wen. His tone was serious and serious, without the previous ridicule. Dr. Wen reported the pathology results in detail orally, and then the electronic and paper reports were immediately followed. can be seen.

For Yang Ping's convenience, Dr. Wen took photos of the microscopic pictures of the pathological sections and uploaded them to the computer, so that Yang Ping could also see the frozen section pictures in the operating room.

On the high-definition electronic screen in the operating room, pictures of frozen pathological sections were displayed. Yang Ping took a closer look and found that the frozen sections of bone tissue were very clear, and the results were consistent with Dr. Wen's report.

This is a true bone cyst and is benign, not malignant.

Then the atlas bone can be used as waste, so there is no need to remove the ribs or ilium for bone grafting. Zhang Lin and Xiao Wu began to process the removed part of the atlas. They trimmed the large pieces of bone into columnar blocks and then embedded them in the mesh. During the internal fixation, the internal fixation is implanted between the skull base and the axis vertebral body, and fixed with screws. The bone block inside is in close contact with the skull base bone and the axis vertebral body below, like a pillar supporting it. The base of the skull and the front of the cervical spine, and this column is the main load-bearing column.

In this way, the anterior surgery is considered to be over.

Yang Ping started the posterior approach surgery. Because of the sitting position, the area above the shoulders was completely exposed on the operating table. There was no need to change positions during the posterior approach surgery, which made the surgery easier and safer.

Performing posterior surgery in the sitting position requires extensive experience. There will be a lot of inconvenience for the doctor in the sitting position.

The backrest was adjusted to nearly ninety degrees and posterior surgery began.

"In the seated position, it is very difficult to reveal the posterior path——"

August began to struggle.

"Help connect a set of transforaminal scopes and a set of arthroscopes!" Yang Ping asked Zhou Can, the traveling nurse in the audience.

"Or microscopic surgery? How is it possible?"

August thought to himself that he couldn't think of any use of foraminoscope and arthroscopy in this kind of open surgery.

(End of this chapter)