godfather of surgery

Chapter 791 Stepping to the rhythm of heartbeat

All the experts were present. Doctors, graduate students and training doctors from Anzhen Hospital came one after another after finishing the matters at hand. Those who could squeeze out their spare time came one after another.

In fact, Anzhen Hospital often holds surgical demonstrations like this. As doctors, graduate students and training doctors in this hospital, logically they would not be so active, but today, these doctors were obviously very active.

The conference room was packed with people and there were not enough chairs. A lot of plastic stools were brought in, but it was not enough. Everyone stood in the back and watched.

Some people haven't had breakfast yet and are rushing to the conference room while eating breakfast; some people are rushing here hungry. They have surgery, so why not have breakfast?

These doctors all came to Yang Ping. The master who published 13 CNS articles is now demonstrating surgery, and it is the top surgery in cardiac surgery-coronary artery bypass grafting. This kind of opportunity is rare.

And because of the surgery being demonstrated today, several of the big guys in charge of the team had to take a break from surgery. Naturally, the members of the team also benefited from the surgery and took the opportunity to take a day off, so they had time to observe the surgery.

It is not an exaggeration to say that An Zhenxin Surgery is a great success.

Everyone is very curious about whether Master Yang Ping’s surgery is as powerful as his scientific research. What is the level of his surgery?

After all, scientific research can rely on talent, but surgery, no matter how talented you are, requires time and cases to hone.

Just like the math teacher has the opportunity to watch Qiu Chengtong do the college entrance examination mathematics questions. He is the "Emperor of Mathematics". Can he do the college entrance examination mathematics questions?
"The operation has begun!"

A graduate student gave a reminder.

The somewhat noisy conference room immediately fell silent, and everyone began to observe the operation.

But the picture on the screen was only taken by the camera in the corner of the operating room, not the camera on the operating light.

The operation has not really started yet. On the screen, Professor Zhong and Professor Chu's operations have begun to disinfect and spread drapes. Yang Ping's operation patient is still intubating the trachea. Obviously, there may be a small problem with the anesthesia, which delays some time.

The experts have come with a mission and must not relax. They will also conduct surgical evaluations on the three professors who participated in the selection.

"Dear experts, I am going to have an operation today, and Director Ming Jiantai will accompany you. Sorry, sorry!" Professor Xu called over the intercom system from the operating room.

Director Ming Jiantai stood up to greet everyone. Today he entertained everyone on behalf of Director Xu and was also the host of the observation meeting.

Director Ming Jiantai is also a student of Professor Xu. He is a top figure in cardiac surgery in the country and can be ranked among the top five in coronary artery bypass surgery.

"I don't know what the situation is like in the other two operating rooms. Our patient encountered a little difficulty in anesthesia, and the tracheal intubation was not very smooth-" Professor Xu sent another message in the operating room.

No wonder the two surgeries over there have been disinfected and spread, but there is no movement here.

The progress of the other two machines is about the same. Sterilization and draping, preoperative checks have been completed, and skin incision has begun, so the screen has been switched to the surgical area shot by the operating light camera.

On Yang Ping's side, the anesthesiologist is using a fiberoptic bronchoscope to perform tracheal intubation.

There are three screens for observation. The operations of three people can be performed at the same time. This saves time. Otherwise, everyone would have to sit until night for six operations. It is obviously impossible to sit from morning to night.

Finally, the anesthesia was successful, and Directors Yang Ping and Xu began to wash their hands.

The first operation performed by Yang Ping was on a patient who needed to build eight bridges.

An Zhen's doctor began to disinfect the sheets. Director Xu and Yang Ping washed their hands and entered the operating room to put on surgical gowns.

Yang Ping is the surgeon, the first assistant is Director Xu, and the other assistants are also An Zhen's two associate professors.

Everyone gets in position and adjusts the position of the operating light. At this time, the screen switches to the surgical field screen.

The reason why this case is difficult is that it is a complex coronary heart disease with diffuse lesions in the distal coronary arteries. Its coronary arteries are like a bunch of spider legs, very thin, and the arteries are atherosclerotic, which are hollow blood vessels that become Solid, there is no bridge to build.

This is the case of Academician Meng Lao - diffuse lesions appear at the distal end of the coronary arteries.

If this case is placed in other places, whether it is China or foreign countries, basically nothing can be done. There is no way to build a bridge, let alone build a few bridges.

The reason why Director Xu chose this case to do today is that, similar to Academician Meng, he wanted to warm up in advance.

I didn’t expect Yang Ping to do this case, so just do it. Anyway, he is on the stage and can take over at any time. Moreover, this case requires the use of the surgery created by Professor Xu himself - end-to-end anastomosis of graft vessels for diffuse coronary artery disease. This technology is essential to achieve arterialization of veins. Professor Xu’s new surgical technique has accumulated hundreds of surgeries.

Therefore, Professor Xu never thought of letting Yang Ping complete this case.

"In this case, diffuse lesions have appeared in the distal coronary arteries. Ordinary methods are simply not possible. It's better for me to do it." Director Xu proposed to exchange places with Yang Ping.

Yang Ping said calmly: "I know - block the blood flow of the cardiac vein and let it connect to the bridge blood vessel, so that the direction of the blood flow is reversed, and the oxygen-rich arterial blood flows through the capillaries to supply blood to the cardiomyocytes, because The walls of veins are thin, so we need to precisely control the blood flow into the graft vessels through surgery--"

Professor Xu was startled: "Have you done it?"

"Otherwise, how could I dare to stand on the stage? The operating room is serious and sacred. I understand! Professor Xu, how could I not master such a world-leading surgical technique? Let me give it a try." Yang Ping was confident.

Okay, try it, don't look away, Professor Xu will always keep an eye on it.

The circulating nurse was going to put on a head-mounted microscope for everyone, but Yang Ping said there was no need to wear a microscope:
"Prepare the thoracoscope and supporting equipment!"

Yang Ping turned around and looked at the audience. The thoracoscope was not ready yet.

"Do it with a thoracoscope?" The circulating nurse looked at Professor Xu in surprise to confirm whether it was true.

Professor Xu also looked confused: "Thoracoscopic examination?"

Ordinary coronary artery bypass grafting can be performed using a thoracoscope, but in this case, the grafted blood vessel needs to be anastomosed to the vein. The vein wall is thin and the heart beats violently. The arm of the thoracoscope instrument is very long and difficult to control, making it impossible to perform such delicate operations. One mistake and the blood vessel can be torn.

Besides, if you continuously jump to bypass the heart, you need to use a fixator to fix the heart. Otherwise, it will be very difficult to find a blood vessel to anastomose the blood vessel on the heart that is beating too much. With a thoracoscope, the fixator cannot be inserted, so it is impossible.

"Professor Yang? Use thoracoscopy?" Professor Xu couldn't believe it.

Yang Ping said firmly: "Yes, for thoracoscopic surgery, isn't the informed consent written on the surgery? I also told the patient."

The informed consent for the surgery was written on it, but that was just for careful consideration and all the surgical procedures were written down. "Get ready quickly, don't waste time." Yang Ping ordered the traveling nurse.

Professor Xu did not stop him, so the circulating nurse had no choice but to do as he was told. Professor Xu did not stop him because he was on the stage and wanted to see what Yang Ping did. After all, he was also the owner of CNS 13, so he should not act recklessly.

And just now Yang Ping said it himself - the operating room is serious and sacred.

The thoracoscope is ready, the various pipelines are connected, and the preoperative check is completed.

Yang Ping made a small hole in the patient's chest, inserted the lens and instruments, and the operation officially began.

The operation started with removing the internal mammary artery under the microscope. The movements of the instruments under the microscope were very fast. Doctors including Professor Xu had never seen such a fast thoracoscopic surgery. It was much faster than the thoracotomy performed by coronary artery bypass grafting experts. .

The internal mammary artery is extremely thin and brittle, with a diameter of only about 2 mm. It is necessary to prevent damage when removing the blood vessel. Therefore, even if the thoracotomy operation is generally slow, slowness can achieve stability and precision. This is determined by the limits of the human body.

However, in Yang Ping's eyes, blood vessels of two millimeters are considered large blood vessels. Replantation of a baby's severed finger is considered a small blood vessel.

Director Xu was frightened by the sudden and fast movement. He just wanted to remind Yang Ping to slow down - this was a heart surgery.

As a result, the internal mammary artery had been removed and handed over to Professor Xu.

Since the surgery was performed using a thoracoscope, the other two assistants helped hold the mirror, so Professor Xu had nothing to do.

Professor Xu placed the removed internal mammary artery on wet gauze and carefully inspected it. The quality was very, very high, and Professor Xu was relieved.

In the short time that Professor Xu was examining the internal mammary artery, a radial artery had been sent to Professor Xu. Because this patient was special and required a large number of bypass grafts, it was obviously not enough to take the internal mammary artery alone, and another one had to be taken. A blood vessel graft was used, such as the great saphenous vein, but the patient had severe varicose veins, so the radial artery was used.

After removing the graft, the next step is to cut the pericardium, find the target on the beating heart - the coronary artery and its branches, and then perform vascular anastomosis. In this case, the coronary artery has become atherosclerotic and is difficult to bridge, so we still need to find the target in the heart. vein.

The instruments under the microscope are like slender and flexible hands, which can quickly cut through the pericardium and find the target blood vessels.

Next is the most difficult operation - thoracoscopy to anastomose blood vessels on the beating heart.

It is very difficult to anastomose blood vessels on a constantly beating heart under the microscope because the heart is not fixed and the heart beats very hard. At this time, the blood vessels that need to be anastomosed also rise and fall with the heartbeat.

What the blood vessel anastomosis pursues is stability, which means that the blood vessels should not move and the movements of the hands should remain stable. This is in conflict with the beating of the heart, and this contradiction is doubled under the microscope.

Therefore, the hands or instruments of the surgeon cannot move at this time, but must move with the rhythm of blood vessel movement and maintain dynamic stability during movement. Only in this way can the blood vessels be anastomosed well. Once the dynamic stability is not maintained, the blood vessels will be torn. Broken, or the fit is not neat and does not meet the requirements.

Start the first stitch, the second stitch, the third stitch -——
The instrument under the microscope is still so fast and silky smooth, the needle tip almost follows the rhythm of the heartbeat, moving with the moving blood vessels, and truly remains relatively still with the blood vessels.

In this relative stillness, blood vessels were anastomosed one after another. Both the needle pitch and the margin were perfect, and each needle was placed in place at one time without any trial needle movements, let alone repeated or ineffective operations.

Professor Xu simply put his hands on the protective bag on his chest and stood aside to look at the display screen of the thoracoscope.

I have been doing coronary artery bypass grafting for 20 years, and today I have opened my eyes to the fact that coronary artery bypass grafting can still be done, and the doctor's needle tip can actually complete the operation by stepping on the patient's heartbeat.

The shock brought by the surgery was much stronger for Professor Xu than the 13 papers.

Because coronary artery bypass grafting is Professor Xu’s strength, he is the number one in Asia. There is a world outside the world, and there are people outside the world. Director Xu truly feels the connotation of this sentence.

Professor Xu wondered why Yang Ping's movements under the microscope were so fast, and how he was able to step on the patient's heartbeat and keep the needle tip and heartbeat relatively still.

Professor Xu himself admitted that if he accumulated more surgeries, he would be able to handle this kind of case with a thoracoscope, but he would never be able to do it so quickly and smoothly.

How many surgeries does it take to hone this?
But Yang Ping is so young, how can he accumulate a large number of surgeries.

Is this talent?
It seems that the talent gap is difficult to shorten with hard work.

Professor Xu stood motionless in front of the screen, immersed in this genius operation.
-
At this time, the conference room was already in a commotion, because everyone was crowded with each other, and those at the back wanted to squeeze in to the front, so the meeting was a bit chaotic.

The eight blood vessels were anastomosed under thoracoscopic surgery, and the arteries were venous. The operation was performed on a beating heart, and the movements were so fast and smooth.

Again, this shock is stronger than the 13 papers.

This is a face-to-face shock, just like watching a war movie. No matter how much sensory stimulation real 3D brings to the audience, how can it be as strong as the shock brought by the bloody scenes of real battlefields?

Professor Xin Weicong breathed out. He had just seen Yang Ping move so fast and was still worried about something happening. His heartbeat was so fast that it reached his throat. Now that the operation was almost over, he breathed a sigh of relief.

He said "No problem!", which is no problem!
Yang Ping's operation ended quickly, and he immediately received the next patient in another operating room, also using a thoracoscope.

After Yang Ping's second surgery, Professor Zhong and Professor Chu were still anastomosing blood vessels.

Professor Xin was thinking that it was not a matter of preparing the surgeon, but whether the surgeon of the old academician's surgery should be directly handed over to Yang Ping.

"I'm not a cardiac surgeon. What level do you think Professor Yang is at?"

Professor Zhou Min is a physician by training and doesn’t know much about surgery. He just watched this thing for fun. But from the bursts of cheers from everyone in the venue just now, Director Zhou knew that this surgery must be awesome. How awesome is it? He didn’t know. .

Professor Xin said bluntly: "The level is higher than Professor Xu——"

"His aortic dissection surgery skills are better than yours, and his coronary artery bypass surgery skills are better than Professor Xu's? Aren't you the best in the world? Isn't Mr. Xu the best in Asia? Why are you two No. [-]s now--"

Zhou Minren was excited for a moment and found that what he said was inappropriate, so he did not say the last two words "Xie Cai".

"Our number one ranking is true, but that's because we didn't meet Professor Yang. Professor Yang is the number one in the surgical specialty, the number one in specialty killing."

Professor Xin said it confidently without any embarrassment.

PS: Regarding coronary artery bypass surgery, Professor Gu Chengxiong from Anzhen Hospital is the No. 1 in Asia!The new technology of "end-to-end anastomosis of graft vessels for diffuse coronary artery disease" pioneered by Professor Gu has been used in many patients with complex coronary heart disease and is the world's leading technology.This "Gu's" surgery has also been included in the European monograph "ARTERY BYPASS" on cardiovascular surgery for learning by cardiac surgeons around the world.

Also: Some details in the first few chapters were not handled properly and have been slightly modified. Thank you everyone!
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