The Godfather of Surgery

With Robert's help, Huang Jiacai went to inspect several American medical device companies.

Lao Cheng visited the hospital for special surgery in New York. The hospital sent an administrative staff to accompany him. He conducted in-depth research on the culture, management and structure of the hospital.

Confirming that Yang Ping was not affected by the accident, Robert arranged the operation according to the original plan, and the first operation was for little Andrew.

This operation was planned for two years by Robert, but he did not perform it because he was not sure.

If you are not sure, you can only wait. There is no turning back for the surgery. Once the surgery is broken, it is not only difficult to perform revision surgery, but also the effect is poor.

So Robert has been researching, hoping to develop a new surgical method to solve the multi-ligament reconstruction of the knee joint in children.

The existing surgical methods cannot even handle simple anterior and posterior cruciate ligament reconstruction, let alone this multi-ligament reconstruction.

For two years, Robert racked his brains and failed to make a breakthrough. It was not until he met Yang Ping that he saw hope in this matter.

Everyone is looking forward to how Yang Ping performed this operation, and what level of mentor Robert is talking about.

The New York Hospital for Special Surgery has long been ranked at the top of the world's orthopaedic department. These doctors are used to being the first and teaching others. In their careers, many doctors have never seen a hospital invite someone to perform surgery.

Now Robert invites a Chinese professor to perform the operation, and everyone is full of expectations and curiosity.

Because of the existence of epiphysis in children, the adult method is useless. Some people suggest surgery after adulthood, and some people design the method of extra-osseous suspension, but the method of extra-osseous suspension changes the anatomical center of the ligament, and the insertion point cannot be Obtaining firm tendon-bone healing is a helpless choice.

In short, to operate like an adult, the bone tunnel must be opened. As long as the bone tunnel is opened, the epiphysis must be damaged, and the damage of the epiphysis will cause skeletal developmental deformities.

Multi-ligament reconstruction of the knee joint is already very difficult for adults, and it is even more difficult for children.

In order to watch the operation, except for the doctors on duty in the ward, the doctors in the entire sports medicine department are rested, and other operations are not scheduled on this day.

Many doctors from other departments also came. Professor Jung, who was focusing on knee replacement, also took time out to see Yang Ping's surgery.

Because sports medicine and joint replacement are the same as joint surgery, many hospitals have different departments, and a doctor does both knee replacement and knee arthroscopy.

There is a reason why Professor Jung is so interested in Yang Ping's arthroscopic surgery. There are two key technologies in knee replacement—osteotomy and soft tissue balance. The ligament balance technique shown by Yang Ping's surgery is more important than the soft tissue balance of joint replacement. Difficulty, not on the same level at all.

Professor Jung wanted to see how this Chinese doctor, Robert's mentor, could adjust so many ligaments into a balanced state.

Engineers from OrthoPediatricS also rushed over to see how these instruments are used and how to complete the operation, especially the drill that can drill in a curve.

This drill was manufactured by OrthoPediatricS according to Yang Ping's drawings, but they don't know how and where to use it. After all, they are not doctors.

Little Andrew was on the first stage, and Robert himself acted as an assistant, taking Barrell to pose and sterilizing and laying out the sheets.

Yang Ping brushed his hands, put on a space surgical gown, put on gloves, and entered the position of the main knife.

The first assistant, the second assistant, and the instrument nurse have already been in place. There are ten instrument boxes on the surrounding instrument table, and they are well prepared, which is fully reflected here.

Yang Ping has visited the supply room of this hospital. It should be the most complex and advanced supply room in the world. It adopts factory and assembly line management. There are more than 100 operations every day, and each operation has about ten instrument boxes. There are ten instrument boxes, and some doctors have their own exclusive surgical instrument boxes because of their personal habits.

Every day, more than 1,000 instrument boxes are cleaned, collected, inspected, repaired, replaced, sterilized, and packaged after the operation. The whole process is monitored and tracked by a dedicated computer system.

When Yang Ping visited, he found that they were very serious about the inspection of the equipment. Every instrument had to undergo a standard procedure inspection. The damaged ones were picked out immediately, and new replacement instruments were added on the spot, which was very efficient.

Some hospitals have equipment that is not in stock and needs to be replenished by the manufacturer. It is also registered and replenished as soon as possible, and each department will be notified in advance.

The instruments used in the operation, especially those designed by himself, Yang Ping checked every one and confirmed that there was no shortage before Yang Ping officially opened the stage.

The glass protection that hangs slowly from the ceiling surrounds the surrounding, isolates the operating table from the surrounding area, and ensures the safety of the operating area to the greatest extent.

Preoperative check, opening, placement of probes, and inspection of various anatomical structures within the knee joint.

The probe fits perfectly in the child's knee joint, always in the gap, without any collision with the cartilage.

Every time the position of the knee joint is changed, there is no need to wait. The probe travels almost synchronously with the change of the position of the knee joint, and the two work together perfectly.

Stryker's latest naked-vision 3D arthroscopy device is very easy to use, and the image presented on the screen is a clear 3D, rather than a two-dimensional plane.

Those that should be palpated with a probe should be palpated carefully; those that should be stopped and observed carefully should never be handled roughly; those that should lift the meniscus should never be omitted.

Time that should not be wasted, not even a second, the proficiency of surgery has entered a state of enjoyment.

In the teaching room of the operating room, everyone watched the video. The whole process of arthroscopic surgery was completed under the camera. The main surgeon also watched the real-time video to complete the operation, so the field of view of the main surgeon was the same as that of the audience.

The atmosphere is delicate, fast but not impatient, elegant but not frivolous, and has made the operation an artistic appeal.

Professor Jung, an amateur music lover, has a professional level of violin performance. He not only has the ability to make rational judgments on surgery, but also has the ability to make emotional judgments.

Surgery can form a perceptual charm, which means that rationality has reached the extreme, and harmony and rhythm are generated invisibly. This level must be a master among masters, and it is definitely not something ordinary people can achieve.

Professor Jung sighed that from the operation of this Chinese man, he could see a kind of temperament - broad, deep, simple, and sensitive. This was not obtained by logical reasoning, but obtained by perceptual imagination.

The examination of the knee joint has been completed, and the next step, the reconstruction of the anterior cruciate ligament, is required for this operation. There are several ligaments to be reconstructed.

The equipment nurse was a little overwhelmed and couldn't keep up with the rhythm. Robert had already coached her on the surgical procedures many times, and she was mentally prepared, but she still couldn't keep up.

Maybe the speed of the operation was beyond her imagination, and the sister-in-law became a little nervous. Robert comforted her: Don't worry, Dr. Yang will stop and wait for you.

Robert was worried that she would collapse, and Barrell held his leg and Robert assisted with the delivery of the equipment, and the scene was stabilized.

Prepare the tunnel opening. According to Robert, Dr. Yang will use the sagittal curve to drill holes to bypass the epiphysis. Everyone is eager to see how Yang Ping performs the curved tunneling.

Curve drilling, no need for a guide pin, can only be drilled by hand at present, we can use computer software to navigate in the future, there are three drilling methods, sagittal curved drilling, coronal curved drilling, and horizontal curved drilling. In order to avoid damage to the posterior nerve and blood vessels, a small incision needs to be made on the anterior side of the knee for the second curve, and reverse drilling is performed from front to back; for horizontal curved drilling, the postoperative stress will be concentrated on the epiphysis line Below, it is easy to cause epiphyseal distraction stress concentration, and in severe cases, epiphyseal separation; coronal drilling is the safest, most convenient, and the best effect, which can avoid the shortcomings of the previous two drilling methods.

Yang Ping explained while he was doing it. Robert thought it was too simple. He thought that Yang Ping would perform curved drilling in the sagittal plane. The way he guessed was precisely the first one that Yang Ping eliminated.

The coronal plane is the imaginary plane that divides the person into front and rear halves; the sagittal plane is the plane that divides the person into left and right halves; the horizontal plane is the plane that divides the person into the upper and lower halves.

The coronal plane curve is drilled, and the curve will be profiled in the coronal plane.

Begin to drill the coronal plane curve, the soft drill can change the direction arbitrarily, and perform directional drilling.

If you are not skilled, you must use C-arm fluoroscopic monitoring, or use navigation equipment to help prevent damage to the epiphysis.

Of course, Yang Ping doesn't need such complicated auxiliary technology, he can drill with bare hands, he is too familiar with anatomy.

Yang Ping explained Robert's words, but it was a reminder: Dangerous scenes, don't follow suit.

The drill starts drilling from the lateral wall of the femoral intercondylar fossa, the anatomic center of the anterior cruciate ligament, toward the outside. Without such a steerable drill, this curved tunnel could not be drilled anyway.

Along the safety zone below the epiphysis, the drill bit is drilled along a preset curve outside the lateral condyle of the femur, and then the flexible protective sheath that can be turned is put in to prevent the drill bit from twisting the soft tissue in the next step.

Under the protection of the sheath, the drill bit turns and crosses the epiphyseal line. Just above the exit, another safe area, the drill bit drills in. This is the opposite direction from before, from the outside to the inside, halfway through, no need to drill through.

This operation is hidden in the bone tissue and cannot be seen on the screen. In order to confirm that the tunnel did not damage the epiphysis, Yang Ping decided to perform a C-arm fluoroscopy.

The glass shield is raised, everyone ducks, and the C-arm operator performs a see-through.

The drill bit is still in the tunnel, and the metal shadow is the direction of the tunnel. The two curved metal shadows above and below the epiphyseal line are very beautiful, and the epiphysis plate is not damaged.

Curve drilling, beautiful curve drilling! Professor Jung was amazed.

Soft drills are often used in orthopaedics, especially for drilling in small spaces. In some dead spots, the hard straight drill pipe will be pinned and cannot be drilled, just like bullets have dead ends.

Therefore, soft drills are widely used. Because the drill rod is flexible, soft drills can apply stress to change the direction of the drill bit and complete drilling at almost any angle.

However, it is only possible to determine any drilling point, and it is impossible to control the route of the tunnel through which the drilling passes.

Now this Chinese doctor has designed this set of instruments, which can be used to drill holes in any path.

No wonder Robert took him as his teacher and secretly went to China to study, the Chinese are too smart.

This doctor is not only highly skilled in surgery, but also advanced in concept.

The tibial tunnel was drilled in the same manner as the coronal curved segment drilling.

The tendon is implanted into the bone tunnel, and the two ends are embedded in the bone tunnel. The tendon fixation method does not use the commonly used micro-flip plate suspension fixation, but a novel built-in anchor.

Anterior cruciate ligament, posterior cruciate ligament, medial posterior structure, medial and lateral structure, many ligaments are drilled with curved holes and fixed with built-in anchors, so that children's surgery is as mature as adults.

The combination of new instruments and superb surgical techniques makes this world-leading surgery simple and straightforward.

Moreover, the new device strictly abides by the relevant regulations of the FDA, avoiding the trouble of approval.

How did Robert know this Chinese doctor? Jung felt itchy.

The attending doctor in the sports medicine department next to him shook his head: I don't know.

Dr. Yang only focuses on sports medicine? Professor Jung asked.

I heard no, spine, joints, trauma, sports medicine are all good! the attending doctor replied.

Professor Jung was very dissatisfied. This guy, Robert, found such a good teacher, but he never mentioned it to him.

Petty, mean, selfish, narrow-minded!

Professor Jung was indignant, and he went through all the words he could think of in his mind. Afterwards, he asked Robert to settle the account and settle the account well.

Why, there is such a mentor, who never revealed the slightest information.

If you only focus on sports medicine and arthroscopic surgery, you can understand that this instructor is also good at joint replacement!

The last time he went out for a week, he was vague and said that he would go to China to attend an academic conference.

This dishonest man, dishonest man!

The next one is ready to start. Someone reminded Professor Jung.

The second operation is in another operating room, ready to begin.