The Godfather of Surgery

Before the operation, Yang Ping wanted to have a brief communication with Guo Jingyao, and both Dr. Huang and Dr. Lin were by the bedside.

In Yang Ping's eyes, Guo Jingyao was just one of his many patients.

The doctor must clearly put the operating table on the ground, and the patient had better put the operating table on the operating table clearly. This is the purpose of communication.

Even if he has a net worth of hundreds of billions, he is no different from an ordinary person on the operating table. His body is still constructed according to anatomy and still operates according to physiology.

Books written by ancient people often describe celebrities who are born with an abnormality, either with arms reaching over the knees or ears so large that they hang over the shoulders. From a medical point of view, this should be regarded as a deformity.

Like an ordinary patient, Guo Jingyao longs to regain consciousness and strength in his legs, to stand up and live without a wheelchair.

He raised a lot of questions about the details of the operation, some of which were very naive and even ridiculous, but Yang Ping explained patiently that he didn't want his patient to go to the operating table with an uneasy mood.

At nine o'clock in the morning the next day, Guo Jingyao's surgery officially began.

The operation was arranged in a 100-level laminar flow hybrid operating room, which facilitated postoperative DSA angiography to confirm whether the fistula was truly closed.

The Chinese doctor Tiantuan was recharged and full of energy. Under the leadership of Dr. Huang, they entered the operating room.

Dr. Huang and Dr. Lin accompanied Yang Ping to help open the door, take slippers and clothes.

Not only did Zhang Lin have a new hairstyle, but his clothes, belts and shoes were all new, and his clothes had a faint machine smell from the new fabric.

This operation requires access to the spinal canal, and it is also possible to perform intraspinal vascular anastomosis. In order to reduce the probability of infection, unrelated personnel are prohibited from entering.

Except for Dr. Huang, Dr. Lin, anesthesiologists and nurses assisting the Tiantuan, other personnel are prohibited from entering the operation. If you want to watch the operation, you can only watch it in the viewing area of ​​the operating room through video.

Those barred from entering include August and Milton.

Yang Ping is the chief surgeon, and he has absolute power to make some regulations. The purpose of these regulations is only one: to make the operation as perfect as possible!

Guo Jingyao was lying on the operating table, his body trembled a little, and his heart rate also accelerated, reaching 105 beats per minute.

Don't be nervous! Fatty comforted him.

His voice also trembled: I'm not nervous, but I just can't control it.

not nervous? The body doesn't lie, Fat Man pushes the sedative from the vein to start the induction before anesthesia.

Under the action of the sedative, Guo Jingyao's body stopped shaking, and the heart rate also fell back to the normal range: 87 beats/min.

The tracheal intubation was successful and the anesthesia machine was connected. The Zeus anesthesia machine uniquely realized the integration of the information processing engine system and the vital signs monitoring system.

The patient ingests anesthetics through breathing, and through the circuit system, the anesthetics are sent into the alveoli, from the alveoli into the blood, and then flow along the blood in the blood vessels. Purpose of general anesthesia.

Guo Jingyao's spontaneous breathing was temporarily suppressed by anesthesia, and his breathing was handed over to the anesthesia machine.

The fat man made an ok gesture, and the gesture was very handsome: The anesthesia is successful!

Dr. Lin was in the audience, and Dr. Huang took the stage. For this kind of surgery, the operators cannot all be foreign doctors with temporary licenses, but must have doctors with normal licenses.

The intervening Dr. Zhou performed a femoral artery puncture and catheterization on Guo Jingyao in the lateral position, which was reserved for postoperative DSA.

After the femoral artery cannulation was completed, the patient changed from the lateral position to the prone position, lying on the prone frame dedicated to spine surgery.

The itinerant nurse Zhou Can used soft pads to protect the bony prominences; the abdomen was suspended to avoid the congestion of the spinal venous plexus caused by extrusion; the eyes were fixed and protected with glue in the closed position; the urinary catheter was checked for patency, and the genitals were not compressed.

Every detail is perfect, and the whole composed of details will be perfect.

Hand washing and disinfection sheets, 3M disposable sterile sheets, cover them one by one, exposing only the part of the operation.

Song Zimo connects the sterile handle to the shadowless lamp, and uses the sterile handle to adjust the height and angle of the shadowless lamp to the best.

Pause the check before starting the operation!

Everyone immediately concentrated and stopped all movements in their hands.

Guo Jingyao, a surgical patient, male, sixty years old, hospital number—

correct---

The doctors and nurses participating in the operation spoke in unison. If there is any objection, it must be raised on the spot. This is a right and an obligation.

Surgical site?

thoracic!

Surgical approach?

Posterior thoracic laminectomy fenestrated dural arteriovenous fistula plasty!

Estimated amount of bleeding?

Within 50ml!

The focus of surgery?

Avoid damage to the spinal cord and nerve roots, and successfully perform arteriovenous fistula formation!

The focus of anesthesia?

The patient's vital signs were stable during the operation.

Do you have any questions about this surgery?

No!

No doubt, please start the operation now.

The itinerant nurse closes the medical record book and checks it before the operation can officially begin.

Anesthesiologist, please report the patient's vital signs.

Heart rate 82/min, respiration 20/min, blood pressure 132/84mmHg, ear temperature 36.6°C——

Very good! I'm going to start the operation now, Knife!—

Pre-operative check-up is a serious task, and it should not be sloppy. It is the final determination of the surgical patient, surgical site, and surgical method.

Before a surgical patient enters the operating room from the ward for surgery, it needs to be checked three times. When picking up the patient in the ward, it is checked once.

The tireless verification will minimize the mistakes of wrong patients, wrong parts, and wrong operations.

On the screen in the viewing area, during the preoperative check, August, Milton, and Atsushi Kobayashi also stood up and respectfully, as if they were there.

This sense of ritual can always remind the surgeon to maintain awe for surgery and awe for life.

The yellow line on the floor next to the operating table is the forbidden line, and those who observe the operation must be outside the yellow line.

If the yellow line is crossed, it is easy to contaminate the operation. Once contaminated, there is a risk of infection. Infection is a catastrophic consequence for any operation, especially orthopedics, which is simply devastating.

In the barbaric era of surgery, there was no disinfection, no anesthesia, and no hemostasis and blood transfusion. In this era of three-no-surgery, even a simple amputation operation had a mortality rate of 50%, death from pain, death from bleeding, and death from infection.

It is hard to imagine that at that time, after amputation surgery, in order to stop the bleeding, some doctors would press the bloody limbs into scalding boiling water or boiling oil, and the patients often passed out in pain.

At that time, it was a lucky thing to be alive after surgery, and it depended on which side of the coin tossed.

After the three major technologies of disinfection, hemostasis and blood transfusion, and anesthesia were solved, surgery officially entered the modern era.

The only on-site observer, Dr. Lin Mingyuan, consciously stood outside the yellow line.

The noise from the air handler and air conditioning system, and the breathing sound of the anesthesia machine, have become the background sound of the operating room, and everyone has long been used to it.

Yang Ping was wearing a surgical gown, sterile cap and mask, and his exposed eyes were also protected by goggles. Song Zimo was standing opposite, and Zhang Linxiaowu was standing beside them.

The knife in the palm of the hand is like a pet that has been raised for many years, with spirituality.

A 10-centimeter longitudinal incision was drawn, which cut through the skin with one stroke, and the deep fascia was cut with an electric knife. The bright red bleeding point was eliminated by double-click electrocoagulation at the initial stage.

A subperiosteal dissection is performed along one side of the spinous process, which reduces bleeding.

The paravertebral muscles are stripped off the spinous process and the lamina against the bony surface.

The snow-white gauze was pinched in Song Zimo's hands, ready to be used to stop the bleeding at any time, but it never came in handy.

The less surgical bleeding, the less interference to the patient's physiological function, and the better the performance of the surgeon.

Several cameras on the shadowless lamp shoot the surgical area from different angles and transmit the images to the screen.

There is no extra movement, and every step is extremely concise.

In less than three minutes, the surgeon exposed the lamina in a bloodless state, the automatic retractor was put in, and the surgical space was exposed.

The operation is very easy and the movements are extremely precise. This kind of operation has entered another realm.

Can you do this? After entering the lamina, without gauze? August asked.

Milton shook his head: I can't do it, and neither can you.

Does he have magic that can temporarily stop the flow of a patient's blood? August always had some odd ideas.

Remember, you are a doctor, Milton reminded.

Doctors are differentiated from wizards.

Why didn't you say it was a barber?

The first doctors in Europe were barbers. The red, white and blue marks at the entrance of the barber shop originally represented blood, white cloth for wiping blood, and veins.

With a window on the lamina, doesn't he need to use some anatomical landmarks or imaging means to locate it?

If the route is very familiar, why do you need to navigate?

Punch-opening windows, this is my specialty.

The cover-opening window requires an excellent technique to open the window from the lamina, and the size of the outer and inner surfaces of the lamina is different. The same as the principle of the manhole cover, the outer opening is large and the inner opening is small. After the operation is completed, the cover can be reset, just fit, and will not sink in.

In doing so, the back of the vertebra is protected, there is no bone defect, and the spine is more stable.

The lid is lifted and the dural sac is revealed.

In the middle of the spine is a hollow bony canal, which hides the spinal cord. Like the brain, the spinal cord is the nerve center of the human body, but the brain is a high-level center, and the spinal cord is a low-level center.

The spinal cord is similar to soft tofu. It is very delicate. It is covered with several layers of membranes. The outermost layer is the dura mater. This operation will be performed outside the dura mater.

The fistula has been found, just under the window. Milton looked at the screen.

With such precise positioning, he is at least five years ahead of us. August sighed.

No, there is no one else here, just us, we can be a little bolder, so why not ten years. Milton is serious.

Oh my god, the blood vessels are really domineering in front of the arteriovenous fistula and can't be retracted, damn it.

Only a little gap can be exposed. It is very difficult to complete the operation in the gap.

Under the microscope, two tiny rubber strips gently retracted the blood vessel a little, revealing the gap for the operation.

The target of the operation was lying quietly under the window. It was cunning and cunning, escaping round after round of case analysis, and finally fell into Yang Ping's hands.

It would be great if there was a surgical robot for microsurgery. Only with delicate robotic arm terminal instruments and a 360-degree direction of motion can we handle this kind of surgery.

Could it be that Dr. Yang's wrist and fingers can move 360 ​​degrees?

Look carefully.

I'm looking!

Today is a sad day. Academician Yuan Longping is gone, and Academician Wu Mengchao is gone. A moment of silence! Grandpa Yuan, Grandpa Wu, go all the way!