The road to the rise of great doctors

Chapter 65 The “eyes” of minimally invasive surgery

With the start of the competition, the sound of communication echoed everywhere in the training center. Liu Dong glanced at the side and then focused his eyes on the screen in front of him. In the middle of the field of view, strive to provide the best field of view to the subject.

Yes, his current role is mirror holder.

Laparoscopic surgery is increasingly used in the surgical field because of its minimally invasive advantages. However, domestic surgeons who have come from traditional open surgery directly become the chief surgeon, and the surgeon is their subordinate doctor. , I don’t have much experience in surgery. Sometimes the surgeon will move the mirror himself and then ask the hand holding the mirror to “hold it tight and don’t move it.”

However, the laparoscopic hand is very important, especially when the surgeon encounters complex situations that need to be handled and cannot multi-task.The surgical awareness of the mirror holder is as important as whether the eyes can properly capture the shining point.

An excellent telescope operator needs to have a knowledgeable brain, a strategizing heart, a discerning eye, and a sure-footed hand, so that he can guarantee almost every beautiful laparoscopic surgery performed by the surgeon.

But it is easier said than done.There are several points that the mirror holder needs to pay attention to when operating the mirror.

First, the field of view must conform to the operator's habits, or what kind of picture the operator sees is more conducive to his operation.Taking transabdominal approach surgery in gastrointestinal surgery as an example, the surgeon usually keeps the operating site slightly lower than the center of the field of view. If the position is not good, try to keep it as centered as possible.The reason for this is that the lower part of the field of view is mostly the retroperitoneum, pancreas, pelvic floor, etc., and it is rarely necessary to operate in these places.During exploration, or during most operations, when the surgeon's operating site is placed about the middle and lower 1/3, the upper part of the field of view can be clearly seen, making it easier to operate and observe a wider range.

Second, the direction must be accurate. Except for some cases where it needs to be reversed, in most cases the picture needs to be consistent with the perception of "up, down, left and right".Why?This is because during surgery, we need to look for anatomical landmarks based on this orientation, so that the surgeon can position the patient more accurately during the surgery and avoid deviation.Once it goes astray, it will waste time and may cause unnecessary damage.Of course, sometimes it doesn't have to be as accurate as "up, down, left, and right". Basically, it still has to conform to the operating habits and how to position it better. These need to be savored and considered carefully.

Third, your hands should be steady and not dangling or moving back and forth.After all, laparoscopic surgery is different from open surgery, which can be seen directly with the naked eye.Laparoscopic surgery is a bit like watching the pictures on TV and using instruments to feel, cut or suture.Compared with human hands, equipment still requires a certain amount of hand-eye coordination.If you sway around, you will easily feel like "motion sickness".

Fourth, during operation, different operations require different spaces.The mirror arm should adjust the distance between the lens and the tissue according to the surgeon's operation. It should not only provide the surgeon with enough space, but also allow him to see clearly - the closer the lens is, the bigger the lens will be, and the farther the lens will be, the smaller the lens will be.And if the distance is too close, the operating equipment or the tissue encountered will cast a "bloody fog" on the lens.

Liu Dong still has some experience and talent, and he has a very good grasp of his relative position.

He noticed that the practical mirror was not a 0-degree mirror, but a strabismus mirror, which was consistent with most surgeries.It can be seen that the practical mirror for training is still very close to clinical practice.

Organizing training is also a different kind of "product experience bar".

Liu Dong provided a good view and fully demonstrated the skills of a mirror holder.But his partner, the current surgeon, was at a loss and sweating profusely.

He shouted, "Closer, closer. Can't see clearly."

Liu Dong followed his request and moved the camera forward.But from his own perspective, it's clear enough for now.If you continue to move forward, there will not be enough space for the surgeon to operate, and the surgical instruments and the laparoscope's scope may "fight".All because the space is too small, moving one thing will easily hit another thing.That's why he wasn't that close in the beginning.When the surgeon had a clear view and was preparing to operate, he moved the mirror back slightly, allowing the surgeon to see clearly and providing a little extra operating space.

The surgeon didn't say anything. Maybe he didn't know what he needed.

Carefully, he began to incise along the drawn line bit by bit, almost cutting into the renal pelvis in the middle, making the surgeon's face flushed and sweat dripping down.After cutting and sewing, it took several iterations to tie the first knot.

It is still 10 minutes before the end of the first batch, but it is very obvious that the operation may not be completed.

Another stitch was added and the time was up.

Liu Dong looked around and found that only one or two people had completed the partial nephrectomy. The others seemed to have experienced a "ravage" and were exhausted.
The person who completed the operation felt relieved all over.This success will also bring them the hope of bonuses and expected success on the operating table in the future.If it can be completed, what is needed in the future is to complete it better and faster.

Just like writing a novel, when encountering a problem, encountering changes, or encountering negative reviews, some people just give up and cut the book, but they have never embarked on the final journey.Sometimes, being able to complete it is victory.To borrow someone's comment, "It's better to be a bad ending than a eunuch."

Liu Dong was in this round. Although the video showed that his operation was impeccable, and even though the two people who completed the job were slightly inferior in holding the mirror, it was a cooperative operation after all. A successful pair is better than a failed one. two.

In this round of scoring, Liu Dong is temporarily ranked "No. 3".

After the staff cleaned up the mess, they provided new kidney models.The laparoscopic operating instruments were also inspected and returned to their original places.Leave it open for the next round of activation.

Liu Dong has watched surgery videos and participated in surgery videos. He also saw other people's operations just now. So when he does it himself, how big a gap will there be compared with the masters?

Can you make certain preparations based on your experience in these operations so that you can achieve good results?
After thinking about it, Liu Dong felt proud. He walked to the surgeon's position and changed into a pair of sterile gloves.Wait for the mirror holder to enter the mirror, and then put the surgical instruments into the simulator along the operating channel after seeing clearly what's inside.

As the staff announced "start", the partner who came over slowly picked up the mirror body and started to enter the mirror along the operating channel.The current mirror holders are not proficient in the operation just now, because the usual work is mainly to hold the mirror, and they seldom operate it by themselves.Partial kidney resection is a test of surgical skills.Now that he has returned to his "old business", although the strength he has displayed is slightly inferior to Liu Dong, it is enough to cooperate.

(End of this chapter)