The Godfather of Surgery

Professor Feng lay supine on the operating bed, and the itinerant nurse connected the left radial artery indwelling needle to maintain the venous access.

Professor Ma, the anesthesiologist of Magic Six, placed a catheter in the right subclavian vein under local anesthesia, connected to various monitors, and dynamically monitored electrocardiogram, heart rate, arterial blood pressure, central venous pressure, pulse, and blood oxygen saturation.

Professor Ma intravenously injected fentanyl 0.2 mg, propofol 100 mg, and rocuronium bromide 50 mg. After successful induction of anesthesia, a spring stent tracheal tube was inserted and connected to an anesthesia machine for mechanical ventilation.

The breath sounds of both lungs were clear and symmetrical on auscultation. Professor Ma adjusted respiratory parameters to maintain end-expiratory carbon dioxide partial pressure of 35-45mmHg, inhaled isoflurane to maintain end-expiratory concentration of 1%, and planned to add 2 mg of vecuronium bromide every 40 minutes.

After the anesthesia was satisfied, everyone worked together to change Professor Feng to the prone position. All kinds of positioning pads and restraint belts were in place, and Professor Feng's eyes were also fixed in the closed position with protective tape.

The head was fixed on the Mayfield fixing frame. Yang Ping installed the fixing frame himself. Every screw was checked several times, especially the three skull nails. The plate holds the head firmly.

If the installation is improper, the bone that the vertebra enters is not enough, and the head slips during the operation, which will be fatal to Mr. Feng.

Not only the head and neck should be fixed firmly, but also the fixed angle should be maintained optimally. After adjusting these, Yang Ping checked the defibrillator again.

Yang Ping also personally inspected the sandbag used for CPR in prone position. This kind of sandbag is stuffed in the lower part of the sternum, so that when the heart is pressed, the back is pressed, and the lower part of the sternum is squeezed and sunk by the sandbag, which squeezes the heart and plays an important role. Equivalent to supine compressions.

Sandbags cannot squeeze the abdomen, and can only be placed on the lower part of the sternum. According to the principle of body position, sandbags cannot be placed in this position, which is easy to cause pressure ulcers.

Somatosensory evoked potentials and motor evoked potentials monitoring equipment in the brainstem and spinal cord worked normally.

So after these details were checked, and some precautions were repeatedly emphasized, Yang Ping took everyone to brush their hands with satisfaction.

Disinfection and preoperative check were performed. The anesthesiologist reported vital signs: heart rate 75 beats/min, respiration (mechanical ventilation) 20 beats/min, blood pressure 120/65 mmHg, blood oxygen saturation (low-flow oxygen inhalation) 100%.

Yang Ping wore protective glasses and started the operation with a pen-style laser knife with a sapphire blade.

I fiddled with the laser knife a few times in my hand, looking for the feel, and began to cut the skin.

According to the principle of two-point positioning, Yang Ping chose the posterior approach of the upper cervical spine to connect with the median occipital transmembrane medullary vane approach to form a combined approach.

There are fourteen safe areas for brainstem surgery, and six safe areas for the medulla oblongata.

This tumor involves the upper cervical spinal cord and the medulla oblongata, which should have been done by a spine surgeon and a neurosurgeon, but now Yang Ping has to do it alone.

Yang Ping's research on anatomy has gone far beyond these rough concepts of safety zones. In the brainstem area, he already has a mature and complex safety map in his mind. Even in the most dangerous areas, he knows how to smoothly implement the traversal.

The skin is incised, scalp clips are neatly clamped around the edges, and the laser scalpel is advanced layer by layer.

Two holes were drilled at the lower border of the transverse sinus on the lateral side of the external occipital carina.

The skull of the hindbrain was uncovered by the manhole cover, and the annular spinal canal of the upper cervical vertebra was completely opened from the posterior side, and the entire rhomboid fossa was exposed.

With this delicate craniotomy, the skull can be covered back like a lid after surgery, and together with the closed cervical vertebrae, internal fixation plate screws can be used for firm fixation.

The spinal canal and cranial cavity were opened, and the pulsating dura appeared in the field of view, and the upper cervical spinal cord and medulla oblongata were wrapped inside.

The entire brainstem is no bigger than a thumb, and the medulla oblongata is only a part of it, one third of which is the size of a thumb, and the upper cervical cord is about the size of a finger.

It also connects various intricate blood vessels and nerves, such as vertebral arteries, cranial nerves, and spinal nerves.

Now the operation needs to perform complex and precise incision and separation to stop the bleeding in this finger-sized space. There can be no mistakes. A small mistake will cause the death of the patient.

Because the tumor involves only the medulla oblongata and the upper cervical cord, all approaches need not be used.

Yang Ping holds a laser scalpel in his right hand and a gun-shaped bipolar coagulation forceps with light source in his left.

With the ultimate proficiency in dissection, all obstacles to the surgical target are removed.

The entire posterior aspect of the upper cervical cord and brainstem from the scalp to the entire posterior portion of the brain stem was safely exposed, with hardly any hemorrhage visible.

The accuracy of the gun-shaped double-click electrocoagulation forceps is amazing. Before each bleeding point appears red, it is solved by double-click electrocoagulation in advance, and the hemostasis action is completed once, and the action will never be repeated.

microscope!

A Carl Zeiss neurosurgery microscope is pushed into the operating area.

Yang Ping changed the gloves, adjusted the focal distance and pupil distance by himself, and then replaced with new sterile gloves until he was satisfied.

The fine light of the laser knife, Y-shaped incision and opening of the dura.

The median foramen of the fourth ventricle is opened, with the choroidal tissue, cerebellar tonsils, and posterior inferior cerebellar artery on the outside.

The cerebellar tonsils and posterior inferior cerebellar artery are pulled bilaterally with a gentle nerve pull.

The choroidal tissue and inferior medullary veil were isolated, exposing the entire rhomboid fossa.

At this point, the dorsal area of ​​the brainstem exposed by the transmembrane vena approach appeared in the field of view, and the safe operation area near the facial colliculus was placed in the field of operation.

The entire reveal was actually completed within a few minutes, and the movements were smooth, steady and brisk.

The main knife does not want to waste time in revealing this step.

Wen Rentao and Zeng Ran's work is just pulling hooks to attract and reveal.

The whole process was bloodless, and the attractor in Wen Rentao's hand didn't play a big role, making him look lazy.

It's too fast, the real bloodless operation is really beautiful! Johanneson sighed, worthy of an 80% success rate.

The surgery has just completed the revealing stage. The superb surgical technique, clean and clear surgical field of view, and extremely skilled anatomy have convinced Johanneson.

The so-called layman is watching the fun, and the expert is watching the door. As the world's top neurosurgery expert, he has a deeper understanding than others.

However, it was hard for him to believe that this was an orthopaedic surgeon performing an operation.

He seemed to know every possible bleeding point in advance. This is the first time I have seen this kind of bloodless operation. As an oncology surgeon, Griffin is particularly sensitive to hemostasis.

Woodhead has not looked away. As a spine surgeon, his surgical scope often extends to the medulla oblongata. In the United States, spine surgery is not a branch of orthopaedics, but is considered a branch of neurosurgery.

At this time, he highly appreciated this bold and bright reveal, and at the same time, he felt that it was difficult to replicate this out-of-the-box technique, which was very particular about bone treatment.

I'm afraid it's difficult to replicate this kind of finesse? Woodhead was both envious and helpless.

He was thinking about how Yang Ping received surgical training to acquire such fine and skilled anatomical knowledge and surgical ability.

The field of view under the microscope, the laser knife, the gun-shaped double-click electrocoagulation forceps, and the suction device with light source are in the surgical field.

The exposure in the front is just a foreshadowing, and the operation in the back is the real step.

This scalpel moves the center of life without error.

Focus, guys, Johanneson reminded.

The three of them sat up, focused, and began to watch the video of the surgical field under the microscope.

The entire conference room was silent, and the breathing of the neighbors could almost be heard.

Anesthesiologist, I am going to cut the upper cervical spinal cord and medulla oblongata, start to isolate the tumor, and pay close attention to the vital signs.

The defibrillator begins to prepare, remember that once ventricular fibrillation occurs, the anesthesiologist will report immediately, and the defibrillator must complete the defibrillation within five seconds.

Yang Ping reminded everyone, but the danger has not come so quickly for the time being, and it is very necessary to let them enter the state in advance.

The laser knife begins to cut along the posterior median groove of the medulla, which is one of the safe areas of the medulla.

The line of the knife is straight, as drawn by a ruler.

Today I can only post a chapter for the preparation of the surgery. The main part of the surgery will be posted at one time tomorrow, and it still needs to be polished to look cool.