The road to the rise of great doctors

Chapter 82 Partial Cut

Zhao Jun listened and responded loudly.He turned around and said to the doctors in the department, "Listen carefully, you can't always encounter a superb surgeon like Director Li who teaches on the spot. Everyone should cherish it! Learn more! My I’m not young anymore, and the future still depends on you!”

With Liu Dong's skilled cooperation, Li Jing felt that although today's surgery was quite difficult, it went very smoothly.

When things go smoothly, I feel better, and my mood for teaching also rises.He was able to do postdoctoral research for many years after graduation. Most of the people who can do research are "good at being teachers". It is not unusual for him to teach.In the past, I taught others how to do experiments. Now, I teach both scientific research and surgery!

Li Jing said while operating, "Look at the position of the ultrasound knife. These yellow and translucent tissues are extraperitoneal fat. Our first step is to clean up the extraperitoneal fat and open Guillain's fascia."

After a few cuts, the fat is pushed to the iliac fossa of the pelvic cavity after separation.

"Then, this exposes the fat sac around the kidney. We open the perirenal fat sac and separate the gap between the fat sac and the kidney surface capsule. There are gaps in normal anatomical structures. No violence is needed. That's it. Separation along anatomical gaps"

"You guys under the stage, you can go to the computerized tomography scan again. According to the location suggested by the imaging examination, we can continue to search for the tumor, find the tumor and the surrounding normal kidney parenchyma, and free them out."

Li Jing pointed to the slightly convex tumor and said, "You can still see a little bit of this person's. Some completely endophytic tumors, or when the perirenal fat cyst is severely adhered, cannot be seen with the naked eye or are difficult to separate. Once it comes out, we can use intraoperative B-ultrasound to locate it.”

"The next step is to free the renal artery."

Liu Dong operated the laparoscopic mirror and cooperated very well.

Li Jing also felt very comfortable doing it and praised, "Yes, just find the renal hilum, where there are the renal artery, renal vein, and ureter."

Li Jing continued to dissociate, and after fully dissociating the renal artery, he used a "pug" to block the renal artery, and then asked the circulating nurse to start timing.

During partial nephrectomy, the blood supply to the kidney is completely blocked in order to reduce bleeding, ensure a good field of vision when removing the tumor, and ensure that the surgical margin is negative visible to the naked eye, which is very necessary to reduce the difficulty of the operation.If it cannot be completely blocked, bleeding will occur during resection. After bleeding, the edges of the tissue will be disturbed by blood and cannot be seen clearly.Therefore, the enhanced CT examination, CTA and other examinations done before surgery are to determine how many blood supply arteries the kidneys have!

Li Jing said, "Here are the scissors."

The instrument nurse handed the prepared scissors to Li Jing's right hand.

Li Jing used scissors to perform sharp separation, and then assisted with blunt push and pull to help judge and find the boundaries of the tumor.Then, an incision is made in the adjacent normal kidney tissue beyond the tumor boundary to completely remove the tumor.

"You see, after a good tumor resection, the wound on the kidney is in the shape of a 'crater'. The inside is smooth and round. You can see that the renal pelvis is not damaged. When suturing, you must also be careful not to damage the renal pelvis and avoid suturing it. Kidney vessels!"

After Li Jing completely removed the kidney tumor, he left a wound on the kidney.Then, he took the barbed suture prepared by the instrument nurse and began to suture the kidney wound.

After a while of operation, the blocking "pug clamp" was released. Everyone held their breath and carefully observed whether there was bleeding in the sutured wound between the renal hilum and kidney.After observing it for a minute, I found that the sutured area was still very clean, so I felt relieved.

The atmosphere in the operating room also became harmonious, and Zhao Jundu began to take the lead in telling a short joke, which made the traveling nurse giggle non-stop.

He carefully stopped the bleeding and put some hemostatic material that could absorb the bleeding, and placed the drainage tube at the lowest point of the surgical site.

This operation is basically completed.

Liu Dong took out the mirror and put it on the operating table.Then the sutured thread was taken, the drainage tube was fixed, and the three small incisions were almost perfectly sutured with three strokes, five divisions and two strokes.Apply the dressing and you’re done!

"Xiao Liu, you did a very good job of holding the mirror during laparoscopy. You are no better than several resident doctors. In fact, you should be better than them. Go to the skills center more often when you have time, practice basic operations, and grow. It will be quick. Don't be anxious." Li Jing patiently comforted Liu Dong, he was a little jealous of his talent!

"Yes, I understand. After I pass the qualification exam this year, I will register at the Medical College Affiliated Hospital. This way I can also be on duty alone. Before that, I still have to watch more, listen more, and learn more!" Liu Dong said with a look on his face Express your attitude humbly.

The two stepped down, and Director Zhao Jun and other doctors accepted the follow-up work with great discernment.

"Director Li, does this patient need to pay special attention to anything after surgery?"

Li Jing glanced at Zhao Jun, and then said, "This person's tumor is a bit deep, but the suture tension is not very high, and it is generally safe. However, we all know that some patients have big ideas and do not listen to their family members. Yes, but our doctor has to tell him. Let’s deal with it according to the principle of conservative treatment of renal trauma first, and make the patient absolutely bedridden.”

"Other preventive, anti-infective, symptomatic and supportive treatments should be consistent with other post-surgery patients."

"Okay, Xiaojiang, squeeze it out. You are the bedside doctor for this patient. You have to explain these postoperative precautions to the patient and family members several times. If you have nothing to do, go to the patient's bedside to take a look, especially pay attention to The color of the drainage fluid and the amount of drainage, and the color of the urine bag. Do you know why?"

"I know, Director. The color and volume of the drainage fluid mainly depends on whether there is arterial bleeding or heavy bleeding. Normal venous bleeding can be self-limited, but arterial bleeding requires a second operation."

"As for observing the color of the urine bag, is it because you are afraid of damage during suturing or suturing to the renal pelvis?!" Dr. Jiang, who was in charge of the bed, replied.

Liu Dong nodded after listening.The knowledge reserve of the bedside doctor is still good.

The surgical methods for kidney tumors are also gradually changing. With the improvement of anatomical understanding and the update of medical instruments and equipment, many surgeries that could only be performed through large incisions have become minimally invasive, and many surgeries that could only be performed on the entire kidney have become more minimally invasive. Radical nephrectomy surgery with resection becomes a procedure that partially preserves the normal kidney.However, these changes do not happen overnight. They require continuous learning by doctors and "doctors from leading hospitals" who need to lead other doctors to move forward.
(End of this chapter)