godfather of surgery

In the operating room, Yang Ping told the two instrument nurses how to cooperate: one specially prepares the instruments for the next step, and puts the instruments needed for the next step at the highest priority. What instruments are needed for the next step, Yang Ping will notify her in advance to prepare, and she must Listen attentively.

Another nurse is responsible for delivering the equipment, getting the needed equipment from the priority location and delivering it as quickly as possible.

In this way, two people can work together to speed up the process.

When everything was ready, Yang Ping began to enter the skull through the operating window of the eye socket and used the safety window to separate the tumor.

The circular laser knife and the pointed laser knife have different ability levels. One is suitable for coagulation of blood vessels, and the other is suitable for cutting. They play their greatest role in Yang Ping's hands. When the circular knife in the left hand does not turn on the energy, the cold mode is used as the right laser knife. The auxiliary instrument is used for peeling. It is like the tip of a pair of tweezers, which can pull, block and separate, while the knife head on the right hand always carries energy for sharp separation.

When a small artery is exposed, the knife head on the right hand cuts the artery, and the knife head on the left hand comes up instantly with energy to coagulate the severed blood vessel, first the proximal end, then the distal end, and the sequence is so perfect. The operation is very delicate.

At this speed, the small arteries have no time to bleed and are blocked by the hemostatic function of the laser knife.

The back of Johanathan's neck began to sweat. He was so skilled, so precise, so stable. How many surgeries did it take to achieve such a level?

Even if Johannesson's current surgeries were increased tenfold, he still wouldn't be able to reach this level.

Johannessen continuously drips ice salt water into the surgical area to reduce the thermal damage of the laser knife. Although the thermal damage of this contact laser knife is very small, it still exists. Constant use of ice salt water during the operation can eliminate the thermal damage and can also Constrict the arteries and provide a certain degree of hemostasis.

However, the dripping of ice salt water needs to be done intermittently, otherwise it will easily affect the operation of the main knife.

"Continue, don't stop using the ice salt water."

Yang Ping ordered Johannason, his tone was always calm.

Johannessen had no choice but to follow the order and continue to maintain the influence of ice salt water on the surgical area without interruption. Even so, it did not affect Yang Ping's operation at all, and his operation seemed to be able to operate without any interference.

Yang Ping seems to be familiar with the boundaries of tumors. His operations are always performed in the gap between the tumor and the brain tissue. In fact, this gap only exists in theory and is difficult to find in practice.

Johannesson had been watching the operation intently. He didn't understand why Yang Ping was so clear about the boundaries of the tumor.

For any tumor surgery, if the doctor can clearly understand the boundaries of the tumor during the operation, the safety and effectiveness of the surgery will increase exponentially. In most cases, not to mention the fact that doctors cannot find the exact boundaries of malignant tumors at all, some benign tumors It is not clear during the operation where the boundary is.

Soon, the tumor was taken out, and Yang Ping threw the tumor into the curved plate. He knew that now, no blood was seen in either the surgical area or the surface of the tumor. This was a tumor with rich blood vessels.

Yang Ping waited for about 5 minutes. There was no bleeding in the surgical area. There was no need to stop the bleeding again. The surgical area was directly flushed with ice-cold saline. The cavity left by the original location of the tumor was clean.

"Replant your eyeballs!" Yang Ping didn't plan to take a break.

The two ophthalmology equipment nurses who were on standby immediately washed their hands and came to the stage. The ophthalmologist had learned his lesson and without much hesitation, he directly prepared two equipment nurses. In order to be prepared, he called two companions to act as a reserve team in case there were not enough assistants. , need to increase manpower, and the reserve team can come on stage at any time. It seems that the ophthalmologist has obviously contracted speed phobia.

The assistant was replaced by Johannessen, an ophthalmologist--Klaus, an outstanding doctor graduated from Harvard. His specialist training was completed at the Bascom Palmer Eye Institute. He is studying eye transplantation and has done a lot of animal experiments. The results were both surprising and disappointing.

The mice's eyeballs were removed and then replanted. After allowing the mice to recover for a period of time, the mice's pupils were able to reflect light, indicating that at least some of the new nerve axons after the replantation had grown to the visual center of the brain.

This is an exciting result, even if a small number of nerves grow to the brain's visual center, making things theoretically possible.

When otologists studied electronic cochlear implants in the past, they believed that thousands of electrodes were needed to stimulate thousands of nerves to produce qualified hearing. However, later practice proved that only 16 electrodes were needed to stimulate the auditory nerve to help patients restore hearing.

Then, patients with this hemispheric brain can use half of their brain to complete all brain functions of normal people.

Many facts tell Klaus: Even when the input data is relatively lacking or the signal is weak, the brain can try its best to use this information to complete the mission.

Therefore, as long as a certain amount of optic nerve can grow to the visual center, the purpose of restoring vision can be achieved in theory.

The eye has more than 100 million retinal ganglion cells that make up the retinal layer of the eyeball. Each optic ganglion cell has a nerve fiber called an axon connected to the brain.

However, when they are all cut off, no one knows how many connections need to be restored to be qualified.

In order to restore as many connections as possible, microscopic anastomosis technology becomes key until there are no new medical breakthroughs.

Although this patient did not cut off the optic nerve, but only cut off the blood vessels, the anastomosis of the eye artery and vein also tested the operating skills under the microscope. He wanted to see what real eyeball reimplantation was like.

Klaus cheered up: "Shall we get started?"

Johannessen did not ask if he needed an elbow support again. The blood vessels were anastomosed under a microscope with a long-handled instrument, and it was absolutely impossible to perform the operation while suspended in the air. So there was no need to remind Yang Ping that he would definitely choose an elbow support.

But once again it surprised Johannesson and also surprised Klaus.

Yang Ping did not speak. In the small window, he began to anastomose the eye arteries and veins with his arms hanging in the air. His arms were more stable than the Da Vinci mechanical arm, without any shaking or trembling.

With the help of his assistant's eyepiece, Klaus could clearly see that the tip of the instrument was undergoing the most skilled micro-manipulation under his field of vision.

Whether it is an anastomosis of the ophthalmic artery or ophthalmic vein, there is no difficulty. Each needle is not only in place once, but always maintains a rhythm, and the needle spacing and margins are uniform.It looks as precise as a machine, but also presents the artistic touch of hand stitching.

This is not a person, but a super humanoid surgical machine, this is Klaus's evaluation of Yang Ping.

Johannesson has been staring at the second assistant's eyepiece. This is the first time that he and Yang Ping are operating on the same stage, and he has watched Yang Ping's surgery at such a close distance.

The mentor's skill was like a god, which naturally gave him an inexplicable sense of admiration and awe in his heart. No wonder Robert was willing to follow his mentor, working hard in front of him and behind the horse.

No wonder they go to great lengths to learn Chinese just to be able to stay with their instructors and communicate face to face with them.

Soon, the ophthalmic artery and accompanying vein were connected, several muscles were anastomotic, and the eyeball returned to its original position.

"Is it over?" Klaus asked.It seems that not long ago I said "Shall we get started?" and now I asked "Is it over?"

Yang Ping nodded and carefully placed the equipment in the bending plate.

"Papaverine is routinely used to prevent arteriolar spasm after surgery, and smoking is absolutely prohibited. There are no other special requirements. Just follow the routine after arteriolar anastomosis."

Johannesson took Yang Ping's words to heart.

The two equipment nurses, whether because of high nervousness or other reasons, felt relieved the moment the operation was completed.

Johannesson personally completed the dressing and finishing work. When he lifted the sterile drape, he did not forget to tell the anesthesiologist: "Everything goes well, please give him anesthesia and resuscitation?"

Resuscitation from anesthesia?

The anesthesiologist stood there, his face flushed.

"Any questions?"

Johannessen felt something was wrong and turned to look at the screen of the monitoring equipment. His blood pressure, respiration, and blood oxygen saturation were all normal. He gave a false alarm, thinking there was something wrong with the patient's vital signs.

The anesthesiologist shrugged awkwardly: "He - I'm afraid it will take at least three hours to wake up -"

What a mistake!

The anesthesiologist didn't know how to explain it, because he didn't know when Yang Ping's operation would end, so he adopted the "intermittent administration and intraoperative addition" model, giving a certain dose first, and then adding additional anesthesia according to the progress of the operation. Retreat and be flexible with your time.

The anesthesiologist at Mayo thought this was a seamless method. He calculated the first dose according to the time it would take for Mayo's usual brain tumor surgery, which was already very conservative.

Because this operation is much more difficult than ordinary brain tumors, and there is eyeball removal in the front and eyeball transplantation in the back, no matter how fast the Chinese doctors are, they are still under control.

"What's going on?" Johannessen couldn't figure out what the anesthesiologist meant.

The anesthesiologist blushed and said, "Sorry, my first dose is calculated as four hours, and you can complete the operation in one hour -"

Johannesson finally understood why the anesthesiologist seemed so embarrassed. He used humor to resolve the embarrassment: "Consider these three hours a free gift from Mayo. You are a generous person."

"Yes, sir, I think so. I will keep an eye on him in the post-anesthesia monitoring and treatment room." the anesthesiologist said.
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The video also shows the last moment of the operation, when the eyeball has been completely reset.

Mingo, the muscular man who was always talkative and the king of micro-manipulation, became taciturn. Each step of the surgery just now was fast, smooth and rhythmic, without any ineffective or repetitive movements.

The cooperation of the two laser knives is definitely at the top level in the micro-manipulation world. The two instruments are perfect at capturing timing, mastering the time difference, and switching and combining different functions.

In fact, a rough surgeon will not have these delicate concepts at all, not even the basic concepts of "invalid actions" and "repeated actions".

Just like boxing, throwing a few random punches with enough strength is also boxing; and although the world boxing champion seems to be throwing a few straight hooks, there is not only strength and speed, but also rich skills, how to move and how to attack. , how to defend, how to grasp the fighter opportunities, etc., the technology is very delicate.

Because most doctors do not pursue improvement in surgical skills like Mingo, but are satisfied with "being able to do it". As the number of surgical cases accumulates, "being able to do it" becomes "proficient". During this evolution, Few people take the initiative to study the art of surgery.

This kind of evolution, from novice to experienced, is a kind of passive improvement, not active improvement.

But Mayo neurosurgeons are different. They divide all surgeries into large steps and small steps. Personalized surgeries can also be combined using these steps, and each step is composed of many surgical actions. In this way, all surgeries are actually just a few. Composition of surgical actions.

Most surgeries can be handled according to standard procedures, with no steps missed or redundant steps added. When the number of procedures has been accumulated to a certain extent, the surgeon will not make invalid or redundant movements, thus saving surgical time and keeping the quality of the surgery under control.

Once you are very proficient in the steps and movements of the entire operation, you can pursue so-called micro-operation. Especially in neurosurgery, where most operations are completed under a microscope, micro-operation is very important.

Make the movements under the microscope delicate and scientific to further improve the quality of surgery. Some people will finish the same operation with blood, while others will finish it cleanly. The level is reflected in the micro-operation technology.

Seeing such a clean operation, a group of proud Mayo men felt ashamed. They had never seen such a "stomatological" operation, and there was no bleeding from beginning to end.

Probably, this is the legendary bloodless surgery.

The king of micromanipulation, the muscular man Minge, was stunned in his seat. He had just seen what real micromanipulation was, whether it was the removal of tumors or the anastomosis of blood vessels. It was simply a god-like operation. This level of micromanipulation was something he had never experienced before. Try hard, but never achieve it.

The white-haired man Theodore understood the mentality of the muscular man Mingo at this time. He said: "You are the king of micro manipulation, but he is the god of micro manipulation. No wonder he is Johanneson's mentor. He is Chinese. He is really omnipotent. .”

"Yeah, they seem to be able to accomplish anything."

"Such a big country, so many people, including many very smart people."

"No wonder he could hang his arms in the air during the previous operation under the microscope, and his elbows were only supported in the second half of the operation." Mingo didn't need to think anymore, the subsequent operations must be completed with both elbows supported.

The scene of the operation under the mirror began to replay the video of the eye transplant, but a small window next to the video also began to play the video.

This small window has not been opened just now, and now it is only played as a supplement. This video is not under the microscope, but shot by the camera on the operating light above his head. He can see the entire upper body of the operating member.

"His arms have been hanging in the air?" The white-haired Theodore exclaimed.

Mingo's eyes widened and he looked at the picture on the video. There must be a mistake. The video in the small window and the big picture must not be synchronized.

How is it possible to complete this operation with both arms hanging in the air?