godfather of surgery

It's really embarrassing. If the two chief directors left the lower-level doctors to do even the chest surgery, then they didn't do anything, which is unjustifiable.

If a paper were written on this case, the first author would definitely be Director Wen. Director Wen is an honest person. If he did nothing during the operation, it would definitely not be justified.

Therefore, Director Wen and Director Zhang honestly completed the last step of closing the breasts. In fact, this was the only step that could be done.

The scene was a bit funny. In the entire operating room, a group of doctors gathered around to watch the two big guys closing their chests and suturing skin. Under the glare of everyone's eyes, the two big guys pretended to be calm, but in fact, there were already ten thousand horses in their hearts. Galloping.

"Let the drainage go?"

"Let it go!"

Normally, lower-level doctors would do the work of placing drainage tubes, determining the length of the drainage tubes, and trimming the side holes of the drainage tubes. But now that I suddenly did it myself, it was still a little strange.

Dr. Chu didn't say anything at the side, just quietly watching the two big guys operate.

Perhaps because of his skill or because the boss had higher requirements for the side holes of the drainage tubes, Director Wen was still not satisfied after cutting two drainage tubes. Director Zhang accepted the trimming but was still not satisfied. Finally, the fourth drainage tube was cut. After discussion and cooperation between the two bosses, we finally got the trim to our satisfaction.

The doctors surrounding him didn't want to leave now, for fear of losing face by the two big bosses, so they still behaved as observers should do, as if they were observing a coronary artery bypass grafting.

"That Xiao Chu?" Director Wen finished the last stitch and raised his head to call his subordinate doctor.

Dr. Chu immediately responded: "Director!"

"Why are you hiding here? What time is it?" Director Wen asked.

Dr. Chu said: "Twenty-two past nine."

I am such a big living person, I have been standing here pulling the hook, why am I hiding here, Dr. Chu thought, but a strange smile appeared on his face.

Director Wen glanced at the electronic clock on the wall. It took a few minutes for the coronary artery bypass grafting, but it took almost half an hour to close the chest and sew the skin. It seemed that he had not done such work for a long time, so today was a good experience. It just shouldn’t be experienced in such public view.

"Dressing patch!"

Director Wen took the dressing from the nurse and taught Dr. Chu while putting it on: "Every detail must be done well during the operation. The dressing must be smooth and without wrinkles."

I told you this, but as soon as I put the dressing on it and touched it with my hand, a few wrinkles appeared, which was so raw.

"Look, director, I didn't press it properly. Do you want to change it?" Dr. Chu took the blame in time.

Director Wen frowned: "Forget it, it's okay, just be careful next time."

After the operation, Director Wen and Director Zhang felt hazy in front of their eyes. This may be the most difficult operation for the boss to perform.

In the orthopedic operating room here, Song Yun has exposed all the back sides of neck 4, 5, and 6, the automatic retractor has been placed, and the gauze pad has been padded.

Yang Ping finished handling the cardiac surgery matters and came in again. The time on both sides was controlled very well, and it did not affect the progress of his operation at all. Song Yun saw Yang Ping coming back so quickly and said, "What? They can handle it themselves? No. Professor, are you coming?"

"Oh, we have just built two bridges for them. Let's get started." Yang Ping stood up and the operation here was ready to begin.

Has the bridge been completed? It can't be so fast. This is coronary artery bypass grafting by cardiac surgery. It's not a split finger skin or a ruptured tendon. It can be done in a few minutes. It's a coronary artery bypass grafting. Song Yun also wants to ask about the specific situation. Yang Ping has already started. Song Yun Just keep up the pace.

"It's just two bridges. It won't take much time. I guess the operation over there is almost over."

Yang Ping looked at the surgical area. Song Yun had already performed subperiosteal separation on both sides of the vertebral lamina, but on both sides, the subperiosteal separation could not be advanced because there were articular processes, transverse processes, vertebral pedicles, etc. on both sides, as well as The intervertebral foramen where nerve roots enter and exit.

If the lamina is equivalent to a plain, then these structures are mountainous. Subperiosteal dissection is easy to perform on the flat lamina, but in the corners of the intricate protrusions, subperiosteal dissection cannot be performed at all.

Before entering the spinal canal, an ordinary high-frequency electrosurgery was used. Before operating the surgery, Yang Ping checked whether the various connections were appropriate. The use of the electrosurgery was very particular and there were certain safety rules.

The fixed point of the electrosurgical wire on the sterile drape cannot be wrapped around the instrument. Many doctors like to use the wrapping method.

Because of the coupling phenomenon, the working cable or electric knife will transmit energy to the adjacent cable or metal instrument. If the electric knife pen connection is wrapped around the fluorescent tube and the electric knife is started, the fluorescent lamp that requires 220V voltage can be lit, so if the electric knife is Cables wrapped around vascular forceps or other instruments for fixation can easily cause the vascular forceps to heat up, causing danger.

"Anesthesiologist, what is the oxygen concentration of the patient?"

"30%!"

It seems that the anesthesiologist also has this knowledge and is very careful. If the oxygen concentration is higher than 40%, there is a risk of burning the patient when using the electrosurgical knife.

After everything is confirmed, the operation begins.

The tip of the electric knife begins to extend outward from the vertebral plate, and begins to perform subperiosteal separation of the complex transverse processes, upper and lower articular processes, and vertebral pedicles. This is true subperiosteal dissection. The electric knife always sticks to the bone and completely separates the periosteum. Lift up, all other tissues are outside the periosteum.

The actual subperiosteal dissection is performed with an electric knife. The dissection is thorough and does not cause bleeding. The operation looks very comfortable.

Soon, the posterior lamina, transverse processes, and articular processes from neck 4 to neck 6 were completely exposed. The attached muscles were covered with gauze, and then pulled to both sides by retractors. When it came to the exposure of the retractors, it was Zhang Lin and Xiao Wu who The retractors are the best and they are irreplaceable. Neither others nor automatic retractors can replace the delicate retractors of Teacher Zhang and Teacher Wu.

The next step is to open the window. The lamina of the three vertebrae must be opened, because only through the window can the tumor, spinal cord and nerve roots in the spinal canal be exposed from the back side, and the tumors around the nerve roots can be removed. Cleaning of the interholes also needs to be done from this window.

In surgery, exposure is a profound knowledge. Doctors who do not know how to expose themselves will be immersed in the surgery for a long time and cannot see the target of the operation. Or even if they can see the target of the operation, they will feel that the operation is very frustrating.

This is why some people find it easy while others find it difficult to perform the same surgery. Exposure is also an important factor.

Unknowingly, more and more people were watching in the operating room. These people were all from the cardiac surgery department. Yang Ping came and walked gently just now. When they woke up from their daze, they realized that These few minutes showed what a superb level of surgery it was.

The orthopedic operating room is different. Screens that can broadcast live broadcasts have been installed. This is for teaching purposes so that the doctors in the audience can see the details of the operation at any time. Otherwise, they would all gather around the operating table, which would increase the risk of contamination during the operation. But what? Can't see it either. It is different with the LCD screen connected to the camera on the operating light. Every detail of the operation will be transmitted to the screen by the camera.

At this time, a faint wisp of smoke drifted across the screen and was captured and taken away by the attractor.

The smoke produced by these electric scalpels has a good name - aerosol, burning smoke or thermal plume. This layer of smoke not only interferes with the field of vision, but also poses a threat to the doctor's health, so it must be removed in time. Generally, suction can be used. A more advanced method is a specialized smoke trap.

Fatty Liang once conducted research and found that the average smoke generated in the operating room every day is equivalent to the smoke produced by burning 27 to 30 cigarettes. It contains a large number of ultrafine particles, and the particle concentration can reach more than 3×108/m3, and 95% of it is Aerosols with particle sizes less than 5 μm are difficult to remove after entering the alveoli. Long-term inhalation can cause diseases such as bronchiolitis, emphysema, and pulmonary fibrosis.

This is not the most important thing. The most harmful thing is that surgical smoke contains more than 600 harmful chemical components, which are mainly divided into three categories: polycyclic aromatic hydrocarbons, volatile chemicals and volatile organic compounds.

Polycyclic aromatic hydrocarbons, including benzopyrene, benzanthracene, etc., are carcinogens, teratogens, and genotoxic.

Therefore, as a surgeon, you must know that exposure to smoke is harmful to health, and you must try to find ways to reduce exposure.

After entering the spinal canal, the electric knife was replaced by a sharp knife, and the forceps in his hand were replaced by bipolar electrocoagulation.

The separation in the spinal canal will be carried out close to the nerve roots. The heat of the electric knife can easily cause thermal damage to the nerve roots, but the sharp knife will not.

The sharp knife is in different positions in Yang Ping's hand. The tip of the knife can remove tumors around the nerve roots from any angle.

It’s just that the tumor has completely wrapped the nerve root. How to liberate the nerve root from the compression of the tumor? When everyone was thinking about this problem, a section of the nerve root was already exposed in the surgical field.

Under the squeezing and ravage of the abominable tumor, the nerve roots have lost their original luster and elasticity. The original fullness and roundness have long since disappeared, replaced by flat and concave shapes.

As an assistant, Song Yun was a little dazzled by the sharp knife in Yang Ping's hand. If it hadn't been for the tumor removal in the corner today, Song Yun wouldn't have known that an extremely ordinary sharp knife could be used in this way. This instrument is useful How flexible.

"Professor, does your knife-handling technique have a name? Why have I never seen it in the book?" Song Yun couldn't help but ask.

In fact, had it not been for this special surgery, Yang Ping would not have been forced to use this self-created technique outside of textbooks.

When he was practicing this knife technique, Yang Ping didn't think about giving it a name, so he chose a name casually: "Flower Knife! The tip of the knife is always at the best angle, especially suitable for complex anatomical areas."

I haven't mastered the flower sword and ichitō style yet, and now there are new tricks for the flower sword. This is to keep learning.

Song Yun remembered the name. He didn't have time to see how the scalpel was transformed in Yang Ping's hands because he had to concentrate on being a good assistant.

"Real subperiosteal dissection is easy to do on the long bones of the limbs, but it is very difficult to do on complex vertebrae. Only the lamina of the vertebrae is relatively flat, making it easy to do subperiosteal dissection. However, complex anatomical parts like the intervertebral foramen are almost impossible to do. It’s possible, but subperiosteal dissection is the safest, so you must master all-terrain subperiosteal dissection when performing orthopedic surgery.”

The sharp knife continues along the nerve root and begins to reach the intervertebral foramen. The tip of the knife is separated against the bone, and the complete periosteum is continuously lifted. The so-called subperiosteal dissection is actually to remove the tendons and flesh from the bones. It is necessary to remove the tendons and meat in one piece without any tendons and meat sticking to the bones. This is a qualified subperiosteal separation, that is, to completely separate the periosteum and bone.

The tip of the knife actually circled the oval hole of the intervertebral foramen, going in bit by bit, and then connected on the exit side to continue separation.

"Professor Yang is busy."

"I'll just take a look."

The cardiac surgery operation was over. During the break, Director Wen and Director Zhang came over to see Yang Ping. The guy who completed the coronary artery bypass grafting in a few minutes was actually an orthopedic surgeon.

There were many people in the operating room. The two bosses couldn't find a suitable position and could only watch the screen from a distance.

These young doctors were all focused on the operation, and no one noticed anyone coming in.

Several intervertebral foramina were peeled off in this way, and then the epidural tumors were peeled off. In addition to the tumors inside the spinal cord, Yang Ping planned to clean up the tumors in the spinal canal. Only by cleaning up can complete decompression be achieved. effect.

There is no obvious dividing line between the tumor and the dura mater, but Yang Ping still found a potential invisible dividing line.

The tumors in the spinal cord have not moved, but the tumors outside the dural sac, especially the nerve root tumors responsible for pain, have been completely peeled off. Even the intervertebral foramen have been peeled off cleanly, and the nerve roots appear to be very loose.

In theory, the nerve roots have been liberated from the compression of the tumor and the pain will be relieved. However, no one knows what the effect will be. There are too many uncertainties in medicine.

As long as Yang Ping is willing, the tumor in the spinal cord can be cleanly removed in this case, but it is completely meaningless and will increase the possibility of high-risk paralysis in vain. The purpose of surgery is to solve the problem. When the purpose cannot be achieved, surgery No matter how beautiful it is, it means nothing.

Surgery is a means, definitely not an end!

"You go and do the surgery, I'll take a look over here."

"Then I'll call you again during dinner?"

Director Zhang was attracted by the operation and planned to stay to see the operation again, but Director Wen could not get away and could only return to his operating room.

Why is the scalpel on the screen so flexible? It can be peeled off from different angles. It seems that the hand holding the scalpel can move 360 ​​degrees, just like the mechanical arm of a surgical robot.

Director Zhang couldn't help but be curious and came to the operating table to have a look. He was dazzled by the knife. He couldn't figure out how to hold it and why it was so flexible.

What kind of technique is this for holding a knife? Why have I never seen it before?

As a senior doctor, I am very good at holding the knife in any posture, including the pen holding method, the bow holding method, the grasping method, and the reverse lifting method. I have never seen this kind of knife holding posture. It can be reversed, smooth, or left. Right, it can go up or down. This young man is really unconventional, even holding the knife is different.

Director Zhang was very attentive. He stared at Yang Ping's hand shape, then went to pick up a pen from the shelf, held it like this, and tried it. It was really like that. He was flexible when he should be flexible and stable when he should be. Stablize.

The anesthesiologist stared at Director Zhang, who was a little embarrassed and laughed.

The anesthesiologist pointed to the pen in his hand: "This is my pen. I want to record something. Can you give it back to me?"

PS: I'm a little busy today, so I haven't posted much, sorry!