godfather of surgery

Chapter 778: This is how pineapples are cut
With everyone watching, Yang Ping began to operate on the pigs. Song Zimo and Xu Zhiliang served as assistants. The ultrasound department sent a doctor to control the color Doppler ultrasound machine. The surgery needed to be performed under the supervision of esophageal color Doppler ultrasound.

Traditional surgery requires thoracotomy. You need to use an electric saw to make a longitudinal incision of at least 15 to 20 centimeters from the sternum, then open the chest cavity, cut through the thick aorta, and enter the left ventricle from the aorta.During the operation, the heart needs to be stopped and extracorporeal circulation must be used.

Yang Ping's new surgery does not require such drastic measures. It only needs to make a small opening of 5 cm in the intercostal space of the left chest, use this small opening to enter the chest cavity, and then make a small opening at the apex of the heart through puncture and insert an electric rotary knife.

Basically, other cavity structures in the human body can be operated on using endoscopes, but not the heart. The heart is filled with blood, and the endoscope can see nothing except a patch of red in the blood.

In order to allow the rotary cutter to enter the left ventricle to be operated under "visual" conditions, esophageal color ultrasound is required. Its probe enters from the mouth and enters the esophagus, so that the heart can be observed behind the heart.

Because it is closer to the heart and there is no bone obstruction, the image will be clearer than a transthoracic color Doppler ultrasound. The chest wall is farther from the heart and separated by ribs, so the natural image is relatively poor.

When instruments are inserted from the apex of the heart, there are almost no operational dead ends for either the ventricular septum or the left ventricle. "Freedom of vision" and "freedom of operation" are very important for surgical operations.

The electric rotary cutter is already in place and started to start. It is the same as the power planing instrument used in arthroscopic surgery and can be operated by a handle, which is very convenient.

The thick interventricular septum was adsorbed by the knife head, and the rotary cutting blade was used to cut it. Professor Cao, Director Xin, and Director Xiang, who were engaged in cardiac surgery, were watching the operation intently, looking at the tricks, while many other students were surrounding them. What you see is ten pigs, what you see is the excitement.

It is very important not to leave any bubbles or debris when cutting. The cardiovascular system is a closed pipeline system. Debris or a large number of bubbles generated in the heart will become traveling emboli. The emboli will travel from the left ventricle into the main body as the blood circulates. arteries, and then enters the systemic circulation, which is the general circulation.

Arteries become thinner and thinner, and finally connect to capillaries, and then to veins.

As the emboli continue to travel with the blood flow, there will always be an artery in a place that is smaller than the diameter of the emboli. At this time, the emboli will block the blood vessels, causing ischemia in the areas supplied by the blood vessels. These places will lose blood irrigation, and soon It will cause infarction.

If a vital organ is blocked, it is very dangerous, such as acute cerebral infarction.

Everyone was concentrating on watching the operation and did not notice the hospital leaders wandering around the operating room, and no one went to say hello.

Even if someone sees it, they pretend not to see it, for fear that saying hello will affect the progress of the operation.

Dean Xia, Director Han and Director Zhao watched the operation together and asked Huang Jiahui in a low voice about the new equipment.

Then stop and watch carefully for a while like everyone else.

Their arrival was to convey their support to Yang Ping. As for what the operation would do, they didn't care at all. Anyway, Yang Ping could do whatever he wanted, whether he was playing with pigs or cows.

After being in the operating room for a long time, it became boring. The leaders went to see the experimental pigs again, asked the seller's guarantee team for some details about the experimental pigs, and even tried to catch a pig in the Baoding pen for fun.

"Can your pig bark?" Dean Xia asked the breeder.

The breeder smiled and said: "There is no pig that doesn't bark."

"I'm talking about whether you, a pig, will scream so loudly that people around you can hear it, disturbing the rest of the people nearby."

The breeder thought about it and said, "Normally not, but it is inevitable. After all, they are pigs, and people sometimes get angry and lose their temper. Moreover, pigs are kept in strict confinement since they were young, and then they are raised for experiments. Some pigs She will be in a bad mood and become depressed, and she will scream a few times to express her dissatisfaction with life."

After hearing this, Dean Xia thought about it. If this place was to be transformed into a surgical laboratory, some experimental pigs would be brought in frequently in the future, so the renovation and decoration of the laboratory was very important.

"In the future, we need to pay more attention to the decoration and sound insulation of the surgical laboratory. If these pigs start barking, it will interfere with the patients' rest."

Dean Xia gave some advice.

Director Han feels that there must be dedicated people for environmental disinfection here. Pigs are animals and have certain special characteristics.

"Although the pigs will not stay for a long time in the future, humans and animals will still live together, and the environmental disinfection treatment is special. Does the Animal Department of Nandu Medical University have experience in this area?"

"Yes, we have a complete set of methods and systems to ensure strict hygiene in laboratories involving animals." The experimenter answered immediately.

He saw that these were leaders, so he took the opportunity to promote them, hoping to win business.

Director Zhao followed: "Compared with ordinary pigs, these experimental pigs have stricter requirements for epidemic prevention, and they are raised with great care. After the experiment, can they be handed over to the canteen for recycling?"

"Private slaughtering is illegal. We can recycle it. You can just leave it to us." the veterinarian replied.

Several hospital leaders stood at the door of the room where the experimental pigs were kept, and started a serious discussion around the pig issue.
-
The operation is still going on here. Looking at the image on the color ultrasound monitor screen, Director Xin touched his chin. This operation is really interesting.

No matter what happens after the operation, at least the ventricular septum is being thinned now. This cutting method is not only effective, but also precise and minimally invasive.

What makes Director Xin very puzzled is why Yang Ping's operation is so skillful. It is not like the new techniques and new instruments used for the first time.

According to common sense, if a new operation is performed for the first time, it must be done carefully, slowly, and step by step. However, this is not the case at all for Yang Ping. His operation is very skillful.

Director Xin came closer and glanced at the electrosurgical rotary cutter in Yang Ping's hand. How could this be a recently innovative product? This mature instrument has gone from the idea, to drawings, to multiple trial productions and improvements. , it takes three or four years to get a mature product.

This new surgery must be the result of several years of hard work and is by no means a short-term achievement, Director Xin concluded.

It is much more convenient to enter the left ventricle from the apex of the heart to remove the hypertrophied interventricular septum than from the aorta. One is a roundabout side attack, and the other is a frontal attack. If it is a war, the former will achieve unexpected results, but surgery is another matter. Frontal attack The attack is more straightforward than a roundabout attack.

Being straightforward allows for more freedom in terms of vision and space. "Freedom of vision" and "freedom of operation" are the basis of surgery.

A good idea. The more Director Xin thought about it, the more wonderful it became. But he didn’t know what would happen after the operation and whether embolism would occur due to debris.

After cutting out almost 20G of myocardial tissue, Yang Ping stopped the operation and said:

"Too much cutting will cause conduction block, but today is an experiment. In order to show the effect of the rotary knife, I will cut a little more. If conduction block occurs, we will install a pacemaker." Yang Ping told the audience in advance Get vaccinated, especially Professors Cao Zhenshan and Xin Weicong.

Because it was the first operation, Yang Ping needed to demonstrate the huge power of the electric rotary scalpel, so he cut out a full 50G of myocardium from the interventricular septum and left ventricle. Normal operations do not require cutting out so much myocardial tissue, and the experimental pig's The heart is normal, not hypertrophic, so after removing so much myocardium, Pig No. [-] did develop conduction block.

In order to obtain more experimental data, Yang Ping did not give up on the experimental pig and installed a permanent pacemaker on the pig to maintain the normal beating of the pig's heart.

The first operation was completed. According to the normal surgical procedure, Yang Ping sutured the small puncture hole at the apex of the heart, and then sutured the 5 cm small incision on the chest. Pig No. [-] left the operating room with a ventilator and entered the temporary observation room.Pig No. [-] was anesthetized by the seller's team and moved to the operating table.

Someone has already started chatting with Huang Jiahui in the audience to understand the structure, principle and operation method of the instrument. Director Xin also noted that this little girl wanted to see this rotary knife after finishing the operation.

Professor Xin came a little closer to the operating table. He asked the instrument nurse to show him the cut out myocardium. He wanted to see what the cut out myocardium looked like?
Zhou Can gently clamped the myocardium with a vascular clamp and lifted it up to show Professor Xin.

This piece of myocardium is a whole piece and slightly curled. If the blade is sharp enough, this method will theoretically not produce debris.

Professor Xin has always been worried about the interference of metal instruments on esophageal color ultrasound. Now it seems that there is no problem. The color ultrasound image has no artifacts caused by metal and is very clear.

The operation is very fast. Due to the improvement of surgical techniques and innovation of tools, the operation has become relatively simple. Compared with thoracotomy, it is much simpler. As long as the myocardium is not cut too thin or penetrated, there will basically be no problems.

The process is getting faster and faster. The support team sets up a preparation room in another room and anesthetizes the pigs in advance. After the operation is completed here, the pigs there are immediately sent over. This is almost an assembly line operation. The operation is completed in about five hours.

When it was over, Professor Xin had forgotten his status as an "observer". What else was there to observe in this kind of surgery? What he was thinking about now was how to get a rotary cutter back, and he wanted to try it himself.

"How about it?"

Professor Cao asked Director Xin beside him, but when he turned around, he found that his student had disappeared. When he looked again, Director Xin was already asking Yang Ping for a rotary scalpel, saying that he also wanted to try this surgery.

It seems that Sanbo Hospital can provide him with general surgery. This young man is really capable. Not everyone in 13 CNS has this ability.

13 articles, let alone outstanding young people, they will be promoted to academicians soon. I really don’t understand why young people today are so good.

"How about it?"

Professor Zhang Zongshun asked Professor Cao.

Professor Cao was pestering Huang Jiahui at this time and listened to Jiahui's introduction to the principles and usage of the equipment.

The principle is very simple, similar to cutting a pineapple core, but using such a simple principle to make a precise power instrument requires a lot of effort.

Everyone went to see the post-operative pigs again. Fatty Liang’s guidance on drug dosage control was very good. Three pigs had their tracheal intubations removed and were walking around in the temporary pig pen as if nothing was wrong.
-
Experiments are still being conducted on pigs here, so Xinmei's surgery will naturally have to wait.

But we can’t tell patients and their families: Wait a minute. Our new technology will operate on pigs first. If the pigs are alive and well after the operation, we will then use it on you.

Therefore, in order to avoid some misunderstandings, Li Guodong did not tell Teng Xinmei and his father about the pig experiment for the time being.

Teng Shaokui was worried. The girl next to him who was admitted to the hospital the day after his daughter had already had her surgery, but Xinmei's surgery had not yet been done.

Alas -, if the money is not in place, how can we schedule the surgery?

Even a fool understands this: after the operation, who will pay for it and run away?
At this time, Teng Shaokui was already very anxious and anxious. Fortunately, he finally found out Boss Li's latest phone number. He found an opportunity to sneak out and call Boss Li's number.

After a few rings, the other party answered the phone, and the voice sounded like it was indeed Boss Li.

“Boss Li—I’m Da Kui, Da Kui!”

The other party probably didn't expect Teng Shaokui to call him. He thought for a long time before saying, "Oh, Dakui, where are you now?"

"I'm not staying in my hometown, and you are still building a highway in Guizhou?"

"No, I'm in the provincial capital now and have been here for more than a year."

"provincial capital?"

Actually being in the same city, Teng Shaokui rekindled his hope and felt very excited.

"I - I am also in the provincial capital now." Teng Shaokui said excitedly.

"Are you there too? Where are you?"

"Sanbo Hospital!"

"Sanbo Hospital? There doesn't seem to be any construction work there."

"Indescribable!"

"I'm busy now. I'll go to Sanbo Hospital to see you in the afternoon. Wait for my call. Your big brother is also in the provincial capital." The other party laughed a few times and then hung up the phone.

Teng Shaokui didn't dare to mention borrowing money for the time being. He hadn't seen him for many years, so he opened his mouth to borrow money for fear of scaring others.

Although he had previously been obsessed with borrowing money from Boss Li, and after putting in so much effort to finally contact him, Teng Shaokui hesitated. It was very difficult to ask for a loan.

But if you don’t speak, who will you turn to?

After asking around a lot of relatives, the most they could raise was [-], which was the amount they had agreed to verbally.

Needless to say, my wife didn't need to say anything. After she revealed the matter, Zeng Cuiling scolded her directly.

Zeng Cuiling scolded Teng Shaokui for being careless. Did he spend 10 yuan on surgery because of water in his head? Xinmei is not doing well now. She will soon graduate from junior high school and go out to work. Or let your future husband or in-laws pay for it.

Teng Shaokui had no choice but to turn off the phone. He was now alone and helpless.

PS: The prototype of the new surgical procedure in this case is the transapical myocardial resection performed by Professor Wei Xiang, Director of the Cardiac Surgery Department of Tongji Hospital Affiliated to Huazhong University of Science and Technology. This surgical procedure and supporting equipment are completely independent innovations of Professor Wei and are world-leading technologies. After observing Professor Wei's surgery, many European and American cardiac surgeons sighed - this kind of surgery can actually be done, it is much more advanced than them.Salute to Professor Wei Xiang!

(End of this chapter)