Doctor of Healing

"Don't teach my little Ji badly." Director Liu brushed his hands back, and just heard the itinerant nurse chatting with Ji Xiang, he wiped his hands while putting on his clothes, "Tomorrow I'm going to take Xiao Ji to throw knives, why isn't it better than being the head nurse .”

"It's just you guys, you're as tired as dogs, and you've got your life to earn but your life to spend." The itinerant nurse didn't even want to take Director Liu's words back.

"We have lofty ambitions in urology, how can orthopedics compare with us." Director Liu put on his clothes and handed the belt behind his back with his hands crossed.

"I won't wear it myself!"

"I'm used to it. It's been like this since I first started learning surgery. I don't know how to perform surgery without tying my clothes." Director Liu smiled and chatted nonsense with the itinerant nurse.

"Why do you have such high aspirations?" The roving nurse fastened the strap of the sterile gown, and squatted down to help Director Liu pull the lower corner of the sterile gown to make the clothes smoother and more comfortable.

"Du Fu, the sage of poetry, said in the Tang Dynasty that this was certified with a seal."

"What?"

"The middle-aged man is absolutely short, why guard the king's city?"

"..."

After Ji Xiang finished laying out the list, he happened to hear what Director Liu said.

Tsk tsk, he is really a cultured old hooligan.

Director Liu was just talking nonsense, and it didn't affect his concentration and concentration at all.

Seeing Ji Xiang standing directly on the assistant's seat after laying out the list, Director Liu didn't say much, and stood on the operator's seat to start the operation.

The patient was under general anesthesia, and Director Liu made a 1.5cm incision under the costal margin of the posterior axillary line to the retroperitoneal cavity.

To stop bleeding from the incision, he stretched his fingers along the incision to push open the peritoneum, inserted a balloon, and injected about 800 mL of air.

"Technology has improved really fast. When I was just learning surgery, I removed all my kidneys and opened the knife directly. I stretched my hand in and pinched the kidney pedicle and clamped it directly. The operation was simple." Director Liu injected air into his hands Put in the sterile field and start small talk.

We have to wait here for a while, Ji Xiang knows.

"Tell me, how many waists have you got in your life?" The itinerant nurse said contemptuously, "Aren't you afraid that you won't have a waist in your next life?"

"Healing diseases and saving lives, can that be called a kidney?" Director Liu said, "Telling you about technological progress, you don't even understand."

"As if you understood."

Several people chatted indifferently, and Ji Xiang was carefully observing the difference between the equipment in the operating room and the system operating room.

There is a big difference. The system operating room should be the upper limit of this era, whether it is hardware or software.

After staying for 5 minutes, Director Liu shut up and started the operation again. He could switch between the two states freely.

Director Liu enlarged the retroperitoneal space, deflated the air bag and exited the balloon, and placed the cannula at an appropriate location according to the tumor location.

After the surgery was done, Director Liu gradually became serious.

He is gradually adjusting his state like a hero who is about to compete in martial arts and face the enemy of his life.

Director Liu fixed the posterior axillary cannula with No. 7 wire, and then inflated CO2 gas to maintain the pressure at 12-14mmHg.

The space was observed under the laparoscope, and the renal artery and renal vein were freed from the renal fat capsule along the surface of the psoas major muscle.Then free the fat around the kidney and try to get as close to the renal tumor site as possible.

After doing this, everything is no different from previous operations.

But when Director Liu continued to wander, he immediately discovered the difference.

The closer to the tumor, the more convenient it is to mobilize the tissue. Because of the embolism, the tumor and the surrounding tissue within 1cm have already undergone ischemic necrosis, and after the end of the initial edema period, there will be delamination with the surrounding blood supply tissue. .

It was so!
Director Liu confirmed his guess.

Although laparoscopic surgery cannot touch the changes in kidney tissue with hands, Director Liu has performed similar operations for many years, and local changes can be felt with long forceps.

He cut off the renal pedicle artery with a clamp to control the blood supply to the renal pedicle.

After the clamp is secure, about 100 ml of iced saline is injected through the aspirator, and the temperature is lowered locally to protect the kidneys.

It is gradually separated near the tumor, and the tissue around the tumor is the same as the puff pastry, so it becomes easier to dissociate.

In the past, during the countdown period, the operation was very intense, and I was afraid that the operation would not be completed smoothly due to the delay.

After all, the renal artery is clamped and closed. Once the tumor cannot be removed and the blood supply is opened again during the countdown, at least 10 minutes will be wasted for the next closure just to stop the bleeding.

In that case, the simple operation would be complicated, and the difficulty would rise sharply.

However, tumor resection after interventional surgery is completely different, and the difficulty of surgery plummets.

Soon, Director Liu realized another benefit.

During the countdown time, it is enough to dissociate and cut along the necrotic site, because the place where the embolized tumor artery has no blood supply is the place where the tumor artery supplies blood.

This is so special!

The more Director Liu works, the happier he is.

"Specimen bag." Director Liu said in a low voice.

"Director Liu, did you cut it off?" The anesthesiologist still reported the time every minute to remind the operator.He didn't expect it to be so fast!
"Yes." Director Liu nodded happily.

The anesthetist had just completed the anesthesia record and hadn't had time to look at the screen.

Looking up and distinguishing carefully, the anesthesiologist's mask moved a little.

"Director Liu, why do I feel that it is different from the previous surgery?" the anesthesiologist asked doubtfully.

"Didn't I say that the patient first embolized the tumor's blood vessel, and the tumor tissue and surrounding tissue were necrotic to a certain extent." Director Liu put the tumor and adipose tissue into the specimen bag and pulled it out.

"The necrotic tissue and the surrounding normal kidney tissue are really layered and well-defined." Director Liu couldn't help but praise.

"2 zeros absorbable thread."

"I'll go, Director Liu, you really study new techniques!" The anesthesiologist said in surprise.

Doctors at Director Liu's age seldom come into contact with new things, and their backgrounds are thick enough, so why bother to make things difficult for themselves.

Besides, is mature technology also responsible for patients? Most of the old directors and professors think so.

According to the description in the medical records, the patient had undergone an interventional operation a few days ago. The anesthetist was surprised. He didn't know the significance of doing so.

But from the perspective of the operation process, the significance of doing so is simply too great, and the difficulty of the operation has plummeted.

The equipment nurse handed over 2 0 absorbable sutures with needles to Director Liu.

The figure "8" was sutured, and Director Liu carefully added two more stitches.

After loosening the vascular clamp and restoring the blood supply to the renal pedicle, Director Liu and Ji Xiang observed whether there was active bleeding on the wound.

There was no active bleeding, the wound was covered with hemostatic gauze, and a silicone drainage tube was placed around the kidney.

The operation was over before the itinerant nurse and the equipment nurse had finished counting the equipment.

"It's over! Call it a day!" Master Liu said in a high-spirited manner.