godfather of surgery

The liver is very close to the pancreas, so pancreatic tumors have many ways to invade it. Nowadays, liver metastases are particularly complicated. They actually grow around the portal arteries and veins and various ducts.

If you want to remove the tumor, you must cut off the blood vessels and then reconstruct the blood vessels. Of course, this tricky tumor cannot be removed in the body, so there is such a surgical procedure as ex vivo resection.

Now Yang Ping regards the liver and the tumor as a whole, and does not want to separate them. The separation of the tumor is left to outside the body. What Yang Ping needs to do now is to separate the whole "organ + tumor" from the surrounding normal tissue. Come.

But even so, it is not that easy, because the tumor eventually wraps around the blood vessels and crawls towards the inferior vena cava.

Sharp knives are the best sharp separation tools. Compared with the various "knives" now available, such as laser knives, ultrasonic knives, and water jets, the power of sharp knives remains undiminished in the hands of experts, and it is the easiest weapon to obtain. Any hospital has it.

Now the anatomy of the liver and tumor on the video can no longer be described, and I have no idea what they are.

Yang Ping and his assistants have put on fluorescent navigation glasses. Through these glasses, tumors stained with indocyanine green emit a faint green fluorescence, while normal tissues do not emit this light. Therefore, the tumor tissue may be affected by the tumor. The invaded tissue and the surrounding normal tissue are divided into two obvious camps. The sharp knife wanders between the two camps. In order to ensure the completeness of the resection, it must cross the dividing line and remove part of the surrounding normal tissue.

Resection first and reconstruction later is a helpless choice for surgery. Once important structures are violated, they will be mercilessly removed and then reconstructed afterwards.

Today's sharp knives are wandering in dangerous areas: the blood outflow outlet of the liver - this is the "intersection" where three hepatic veins merge into the inferior vena cava. All blood that has been "detoxified" by the liver must come out from here. Return to the inferior vena cava.

These blood vessels have been severely violated, so they cannot be preserved. Of course, before the entire surgical target is taken out of the body, Yang Ping temporarily retains their existence to ensure that the blood circulation of the liver continues normally.

If the entire surgical target is taken out of the body, the blood vessels here will be cut off at a normal location, and then the blood vessels and the tumor will be cut out together. After the tumor is removed outside the body, these blood vessels must be rebuilt with transplanted blood vessels.

Director Shi's heart is under tremendous pressure. If it weren't for those seven organs, if there was only this one organ, and only the liver and tumor seen so far, it would actually be a very large operation.

This operation is called isolated liver resection + autologous liver transplantation.

Liver transplantation usually refers to allogeneic liver transplantation. The liver transplanted is someone else's liver. Now the transplant is your own liver. It seems that transplanting your own liver should be easy.

On the contrary, autologous liver transplantation is much more difficult than conventional allogeneic liver transplantation, and is called the Mount Everest of hepatobiliary surgery.

There are two difficulties in autologous liver transplantation. First, after the patient's liver is taken out, the patient will have a liver-free period. During this period of time when the patient has no liver, the surgical team must ensure that he lives well.

Secondly, after the liver is taken out and put back after careful repair, it must be ensured that the liver is repaired flawlessly. Once the liver is repaired and damaged, the patient lying on the operating table will definitely not be saved.

Allogeneic liver transplantation is different. Someone else's liver is used. The patient has his own liver. When preparing the allogeneic liver, the patient has a liver. Although this liver is not good, it is better than nothing. In case something goes wrong with the allogeneic liver. It cannot be implanted, and the patient has no major problems for the time being.

Both cases are equivalent to changing the CPU on a running computer.

In autologous liver transplantation, the original CPU is taken out, repaired and then put back. During this process, it is necessary to ensure that the computer cannot be shut down and can still operate normally. Once the CPU is repaired and cannot be reinstalled, the computer can only be scrapped. Allogeneic liver transplantation requires buying a new CPU to replace the original CPU. Although the computer is also required not to shut down, when dealing with the new CPU, doesn’t the computer still have its own CPU? How difficult is it to keep the computer from shutting down with or without a CPU? Big, obviously. If the new CPU is accidentally broken at this time, it doesn't matter. At most, it will fail this time and wait until next time to replace it. Isn't there still a piece inside that can be used.

In this case, even if all the steps of isolated liver resection + autologous liver transplantation go smoothly, there will still be complicated pipeline reconstruction, such as: hepatic artery, common bile duct, portal vein, suprahepatic inferior vena cava, infrahepatic inferior vena cava——
  If any step is not done well, if it is re-implanted into the human body, for example, if the blood vessels are not reconstructed properly, it will cause massive bleeding, which will be hopeless. If the common bile duct leaks, causing bile leakage, it will be life-threatening.

Director Shi Guosheng is one of several professors who perform this type of surgery in China. Currently, there are not many cases accumulated. Isolated liver resection + autologous liver transplantation basically takes him about ten hours.

Not long ago, Pengcheng performed a case of isolated liver resection + autologous liver transplantation. It is said to be the first case in Pengcheng's medical history. The operation took more than [-] hours, which shows the difficulty of this operation.

This is only as difficult as isolated liver resection + autologous liver transplantation. The operation Yang Ping is doing now involves eight organs. This difficulty is simply the Mount Everest of Mount Everest and the Tower of Babel of general surgery.

This operation must take a long time. Director Shi counted it and couldn't help but shudder. How many days and nights should this operation be done?

An isolated liver resection + autologous liver transplantation can take more than ten hours. The removal of eight organs + autologous transplantation, as well as the dissection of various lymph nodes, is not more than a hundred hours, it is not five or six hours. I have to work day and night to complete the operation. Even if some organs are not as difficult as the liver and pancreas, shorten the time to two or three days.

I didn't calculate the time before, I just rushed to see the operation. Now that I do the calculation, I feel like I'm going to collapse. What kind of operation is this? How many days and nights will it be done?
  Professor Shi had to turn his head to look at the few young people on the stand. Just these few guns, they could persist for days and nights, right?
  Look at the junior brother and other doctors. They are watching with great interest. Don't they realize the problem of time? Still in the dark? It is true that the ignorant are fearless.

For days and nights, even the people who were watching the surgery were now afraid, let alone the doctors who were standing on the stage performing the surgery.

The surgery in the video is still going on. The surgery has always adhered to one principle: the arteries and veins are temporarily preserved, and all other connecting parts are gradually disconnected. The tumor is not decomposed. The tumor and these eight organs are treated as a whole, as a "big organ" as a whole. Remove.

Don't these people know anything about this surgery, looking at a peep show?

"They are just the same team? Is there a relay team?" Director Shi Guosheng asked Director Fang.

Usually this kind of super major surgery takes a long time and requires several teams to take over each other and engage in relay races or wheel battles.

Director Fang was suddenly asked and his brain was short-circuited for a moment: "Relay? What kind of force is being relayed? Professor Yang still needs to relay when performing surgery?"

Director Shi was speechless by the tone of his junior brother's words. This was obviously the truth, but it could easily be regarded as "retaliation". If it weren't for the close senior brothers, Director Shi would have criticized him again. How could he have spoken like this? Yes, but the director of the other party, Director Shi, is already used to it. He has known since he was a student that this guy is like this. He speaks straightforwardly. He was a second-rate guy when he was a student, and he still is now. He has not changed at all.

Speaking of the relay, Director Fang suddenly felt something was wrong in his mind, but he didn't know what was wrong for a moment. He looked at the operating table, then at the audience, then at other people, and finally at himself. .

Why did you think the scene was so weird just now? What's wrong?
  "what happened to you?"

Director Shi felt something was wrong in his junior brother's eyes and asked.

Director Fang didn't answer, his eyes rolled around. What was wrong?

I rely on!

Am I not Isuke? Why are you in the audience? Why are they all on stage?

Didn't I agree that I would be Ichisuke?

Why am I in the audience, why am I in the audience——
  Song Zimo, Xu Zhiliang, you two are not authentic, why are you standing on the stage, that is my position, I was promised to be Isuke, why did no one remind me today. As a result of this, I accompanied my senior brother to the point where I forgot that I was an assistant. Now that the operation has started, what should I do?
  Did you swallow the front tooth that you lost by yourself? no.

Director Fang immediately walked to the operating table. First he pretended to be observing the operation, and then said out of the blue: "Dr. Song, it's a bit hard. How about I come and help?"

When Song Zimo heard Director Fang's voice, he didn't understand what he meant, so he said, "It's okay, it's a joke, it's okay."

Director Fang circled around the operating table, feeling anxious. How could he let go of such a good opportunity? Not to mention that he could learn a lot of things. It was just an operation. Although he was only an assistant, he would brag about it later. , you can also start with "we". This surgery can last a lifetime.

But now Song Zimo is a supporter and he does a good job on stage. If he forcefully pulls him down, he will look very unqualified.

At that time, it was not that others were rushing to perform the surgery, but that I foolishly did not brush my hands and stayed with my senior brother in the audience. It is possible that the young man misunderstood that he wanted to accompany the guests, so he gave up the opportunity to go on stage. He was so confused that he was actually in the audience. , just discovered it.

If the operation hasn't started yet, Lao Fang will definitely go straight. Can you please do me a favor? I will help. But now that people are on the stage, due to human emotions and reasons, we should not pull them off the stage, and we cannot always disturb them. In this way Lao Fang is still aware of the impact on surgical safety.

What can I do?
  Director Fang was like an ant on a hot pot, anxious.

"Professor! Is the situation worse than imagined?"

Song Zimo saw that the anatomy inside was a mess, and all the anatomy in the textbook was invalid here.

"Calm down!"

Yang Ping reminded that the work at hand has not stopped.

Song Zimo raised his head and glanced at the professor. His confident look was that of a god. No wonder August said the professor was "a man from the earth."

"I'm calm."

Song Zimo cheered up and followed the professor's rhythm. However, this was not anatomy, it was clearly a mess of dough. This was hell at the beginning, and there were many steps that were far more difficult than this.

"Dr. Song, do you want to take a rest? It's okay. You come down and rest. I'll help you for a while."

Director Fang finally seized the opportunity.

"It's okay. What's going on here? The operation has just started and I'm very energetic." Song Zimo replied.

Director Fang sighed inwardly and walked around a few more times. After just such a delay, the liver has been almost separated. Except for a few arteries and veins, the liver is almost free. Now it is separating the inferior vena cava. This is the separation step. The most difficult one can cause massive bleeding if you are not careful.

"I'm sorry, brothers. You said that today's incident happened because I forgot that I was Issuke in a hurry, and I asked you to help replace me. I'm really sorry."

Lao Fang is really straightforward and candid.

But at this time, no one heard it, especially Song Zimo, because everyone was focused on the operation. They didn't pretend not to hear it, they really didn't hear it.

What a tragedy. Everyone didn’t hear what I said. It’s impossible to say this again and again. It’s obviously disturbing other people’s surgeries.

Lao Fang has no choice but to stay by the operating table and watch, waiting for opportunities.

The peritoneum and loose tissue in front of the common hepatic artery are cut, and the common hepatic artery, proper hepatic artery, and gastroduodenal artery are separated above the head of the pancreas. The gastroduodenal artery is also separated and pulled distally with silk thread. Continue the dissection until a satisfactory length is reached, and then dissect upward along the common hepatic artery until it joins the celiac artery. In this direction, begin to dissect the inferior vena cava.

The lymph nodes at the upper edge of the pancreatic head have been invaded by metastases. They have been separated as part of the "larger whole" and are waiting for the final uprooting.

The lymphatic tissue and connective tissue on the right side of the gallbladder were cut in normal locations.

Yang Ping's hands sometimes cooperated and sometimes operated independently. One hand was separating a blood vessel, and the instrument in the other hand was actually separating another part. The two hands were separated and operated independently.

What kind of irritating operation is this? If you don't look carefully, you won't know. If you look carefully, you will be shocked. You would think that two people's hands are operating separately. One person can operate it completely independently with two hands.

This is really a magical operation, it is equivalent to two independent people doing the surgery, and the speed is doubled all of a sudden.

It is completely unreasonable to be reasonable in doing things. How can a person operate his two hands independently and do their own work, but this is obviously the case now.

Now Director Shi Guosheng finally understood that there were two first assistants on the stage. He said why the work of these two people, first assistant and second assistant, was so unclear.

These are two assistants, one cooperates with his left hand, and the other cooperates with his right hand.

There are also these retractors, which are really good at pulling. They are exposed all the way down along the steps of the operation, so that the two hands during the operation do not have to worry about other things and can only do the work of the surgeon.

Let me go, I can still do this surgery, am I still a human being?

Director Shi Guosheng really couldn't figure it out. He really couldn't figure it out. He was considered a master in oncology surgery, but now he felt like he had never seen anything before and would be shocked by everything.

"Fighting each other?"

There is a general surgeon who is a fan of Yang Ping. When he saw the current operation, he immediately called out the name of the technique.

It's another knife flow, another fight between left and right, a serious operation, but it looks like a martial arts novel.