godfather of surgery

Chapter 384 Extreme Thief

About 1400 grams of the brain, hundreds of billions of cells, various electrochemical signals are transmitted all the time, the conduction methods and routes are very complicated, and the structure is far tens of thousands of times more complicated than our most advanced chips.

The brainstem with the size of a thumb is located in the deep part of the human brain and controls the heartbeat and breathing of the human body. It is densely covered with the most important nerve nuclei and conduction bundles, and the vertebrobasilar artery that supplies blood to the brain also passes through it.

In such a dangerous and complicated narrow area, the operating space is often limited.

Feng Lao's tumor was in the shape of a complex tree root, intertwined and intertwined. They meandered in the cracks between these nuclei and conduction bundles, and some of them adhered to the nerve nuclei, regardless of you and me.

Among them, the adhesion between the tumor and the dorsal nucleus of the vagus nerve is the tightest, and if the scalpel is slightly deviated, breathing and heartbeat will stop.

Professor Feng's spontaneous breathing was suppressed by the anesthesia, and the ventilator took over Professor Feng's breathing at a rate of 20 beats per minute, while the heart rate was maintained at around 70 beats per minute under the control of the anesthetist.

Unlike spinal orthopedic surgery, this kind of surgery cannot be done in a fast manner. Yang Ping stopped at every step, ordered the equipment nurse to prepare the equipment for the next step in advance, and explained the key points to the assistant.

Under the microscope, various structures are magnified and appear clear and fine. The laser knife cuts and separates precisely. The tiny thermal effect shrinks the tiny blood vessels to stop bleeding while cutting without damaging the surrounding tissues.

The dexterous and sharp laser head will not cause pressure on the surrounding tissue compared with the blade scalpel, and it is more suitable for operation in a small space.

The knife cuts along the posterior median sulcus, extending from the medulla oblongata of the head to the cervical spinal cord of the upper cervical spine. The arachnoid membrane is cut, the pia mater is cut, and the grayish-white brain tissue like tender tofu, under the cutting of the laser knife, slowly recovers. Slowly split longitudinally.

Going deeper bit by bit, the straight line does not deviate in any way each time, and the routes are always coincident and coincident with the anatomical gap. This kind of operation in the tissue gap is a guarantee of safety.

The bloodless operation was carried out to the end, and the care for the tissue was unbelievable, and the outline of the tumor was revealed.

Yang Ping began to separate the tumor. The tumor and normal tissue grew interlacedly without a capsule, so there was no boundary at all.

But Yang Ping was able to find the boundary where they penetrated each other. Under the separation of 0.1 mm precision of the laser knife, Professor Feng's vital signs remained stable for the time being, and the wavy line of the ECG monitoring showed a normal curve.

"Didn't you use fluorescent imaging?" Johannesson was very surprised.

In order to confirm the boundary between tumor and normal tissue in this kind of operation, the patient is routinely injected with a special fluorescent imaging agent before the operation, and then the microscope is turned on in fluorescence mode during the operation.

The surgeon can clearly distinguish the tumor with fluorescence imaging from the normal tissue without fluorescence imaging, and then perform precise resection under the navigation system.

It's a pity that even if it develops to this point, the success rate against a tumor like Feng Lao's is still less than one percent.

"Navigation equipment was also not used?" Johannesson couldn't understand.

Without the help of these two technologies, this operation cannot be completed at all, let alone the success rate.

Professor Fu of Magic Six Neurosurgery was also very surprised. Yang Ping didn't mention this when discussing the surgical plan. Everyone thought it was a routine thing and didn't need to be mentioned. But now, from the surgical perspective, no fluorescent light was used. What's going on with the display and without using a navigation device.

This doctor who graduated from Tiantan Hospital was mentored by a top neurosurgery expert in the country. Under the careful guidance of his mentor, he has also become a first-class neurosurgery expert in the country.

"We didn't use a fluorescent imaging agent?" Wen Rentao also noticed and reminded.

Yang Ping replied while operating: "No need, the fluorescence imaging under the microscope will interfere with my judgment. Although the navigation is accurate, the CT image as a guide is only an indirect image, which is of little significance to me."

For Yang Ping, he has performed countless surgeries in the system space and conducted countless anatomical studies to obtain real tumor anatomical images, which are far more accurate than fluorescence imaging and navigation.

For ordinary people, even for a top expert like Johannesson, fluorescent imaging and navigation are necessary, but for Yang Ping, it will become a burden instead.

The faintly flickering fluorescence will affect Yang Ping's visual judgment during the operation, and will interfere with the comparison between the anatomy during the operation and the pictures of his brain.

The picture in his mind far exceeds any fluorescent imaging.

The picture in his mind is more accurate than any visualization and navigation, made up of thousands of pictures condensed by Professor Feng.

Because countless anatomical studies allowed him to easily identify tumors and normal brain tissue with the naked eye.

Questions are questionable, Johannesson and Professor Fu are guessing that Yang Ping can make such a rigorous operation plan, and several cardiac arrests during the operation are taken into account when the nerve nucleus is disturbed. Sexual things are not considered.

Yang Ping must have a better way to complete the operation, so he will abandon the technical means that ordinary people need.

The fine gun-shaped double-click electrocoagulation tweezers are reliable microscopic tweezers when there is no need for hemostatic coagulation. Cooperating with the laser scalpel, the trace of the outline gradually becomes clear, and the deeply buried tumor emerges.

Wen Rentao and Zeng Ran sat next to pull the hook, and Wen Rentao was also in charge of suction, but the suction device in his hand didn't work. So far, there is almost no blood seen in the operation.

The blood vessels in the brain tissue are clustered and intertwined with each other. The laser knife tip can operate in the gaps of the blood vessels, and even the small blood vessels that must be damaged are electrocoagulated in advance.

Double-click electrocoagulation can precisely clamp the end of the blood vessel, and implement electrocoagulation with the smallest energy to stop bleeding.

The separation of the nerve nucleus and the gap was very fast, and soon, approaching the dorsal nucleus of the vagus nerve, a root of the tumor almost surrounded it, forming a tight adhesion.

Yang Ping stopped, gently put down the equipment in his hand, and took a short rest.

The next step is to separate the adhesion between the nerve nucleus and the tumor. This adhesion is very tight and almost indistinguishable. This is the anatomical basis for the low success rate of the operation.

Yang Ping picked up the equipment again, adjusted the two instruments in his hands, and searched for the best feel again.

Which is tumor blood vessel, which is normal blood vessel, which is tumor tissue, which is normal tissue, where is their safety gap, and where is the real boundary of tumor.

Rely on the pictures in the brain for precise guidance, the pictures are turned into instructions of the brain, the instructions are transmitted to the hands, and the hands control the laser cutter head.

Compared with ordinary scalpels, the slender laser head is more comfortable in complex and narrow anatomical spaces.

Professor Zhang did not go to observe the conference room, but walked back and forth at the door of the operating room. Han Jiangong and Hong Zhigang stood guard at the door of the operating room, and no one spoke.

The surgeries in other departments were also started one after another. Some doctors came here specially and took a look this way, knowing that Professor Feng's surgeries were being performed inside.

The focal point of the laser knife is 0.1 mm, and there is no mechanical collision with the tissue, so it is very light to use.

The instrument has an accuracy of 0.1 mm, but in the hands of doctors, it is very difficult to achieve the maximum accuracy throughout the process. This requires the hand to be very stable and not subject to any interference.

Because the human hand does not appear to be shaking, there is actually shaking.

This is why the picture shakes when taking pictures with super telephoto.

The trajectory of a 0.1mm scalpel according to the will of the person will inevitably have deviations. Even a simple straight line, viewed with a magnifying glass, cannot maintain the accuracy of 0.1mm all the time.

"The separation of tumors is very precise. Does their microscope have some special function that can distinguish tumors and navigate?" Johannesson couldn't believe that this operation was performed without the assistance of fluorescent imaging and navigation.

Griffin shook his head: "If there is such a device in the world, it shouldn't be that we don't know about it."

The operation entered the vicinity of the nerve nucleus, and Johannesson made a judgment based on anatomical knowledge, and the ballet on the tip of the knife officially began.

Judging from the video and pictures, this will be a delicate operation of life and death.

With the naked eye, it is almost impossible to distinguish tumors from nerve nuclei.

But the scalpel did it, and began to separate the tumor from the nerve nucleus. Even with a precision of 0.1 mm, weak thermal damage would cause interference.

If it is replaced by a mechanical scalpel, the interference and damage will be greater.

"It's churning on the tip of a knife!" Griffin tightened his heart.

"Have you seen "Extreme Thief?" Johannesson's heart began to pound against the chest wall.

"Seen!"

"Johnny Utah was soloing at Angel Falls when his buddy fell and was crushed."

"Dr. Yang cannot make mistakes, not once."

"However, even if he doesn't make a single mistake, there will be a few falls, and once he falls, he will have to grab a rock again during the fall and continue to climb."

A few falls are the few cardiac arrests that will occur during the operation.

"I am now going to enter the first death zone separation, Professor Ma, please pay attention to the ECG monitoring and evoked potential monitoring, and report to me at any time. Once ventricular fibrillation occurs, the sterile drape covers the operation area, and the torso is covered with a sterile drape. Both shoulders, remove the back ECG monitoring electrodes, complete the defibrillation as quickly as possible, remember, we only have five seconds, do you understand?"

"Understood!" Everyone knew their position, and they had repeatedly explained and practiced before the operation.

Doctor Wu sent by the ICU, the instructor of the emergency technical training in the entire Shanghai, is responsible for electrical defibrillation, pushing the defibrillator near the operating table.

Yang Ping took a deep breath, and the laser knife began to separate the adhered tumors and nerve nuclei. The cruel devil training made Yang Ping feel like a powerful machine in terms of his psychological quality and the stability of his hands.

But Yang Ping has human tactile feedback and thinking adaptability that machines do not have.

The laser knife is on the verge of death, with an accuracy of 0.1 mm, there must be no deviation. Even a small deviation will damage the nerve nuclei, and it will lead to cardiac arrest that cannot be revived.

The atmosphere in the entire operating room was condensed to the extreme, and everyone was concentrating on it, concentrating all their energy on a subtle point.

The tip of the knife goes deeper little by little, along the edge of death, the 0.1 mm life and death curve separates.

"Heart rate drops suddenly, 30 beats/min, blood pressure 40/20mmHg—"

"Epinephrine 1 mg, push it intravenously, withdraw the surgical instruments, cover the surgical area, and prepare for defibrillation!"

Rescue medicine was injected through the intravenous channel, and the folded sterile drape immediately covered the surgical area of ​​the head and neck, and the torso sterile drape was lifted, exposing Mr. Feng's entire back, all the way to his shoulders.

Everyone performed their duties, and the team cooperated seamlessly. The anesthesiologist finished pushing the medicine and stared at the monitoring screen.

After the normal ECG wave, suddenly, a ventricular fibrillation wave appeared, and then filled the entire screen.

Ventricular fibrillation - a fatal cardiac arrhythmia, a type of cardiac arrest.

"Sudden cardiac arrest - ventricular fibrillation!"

"Reverse defibrillation!"

The wires and electrodes connected to the ECG monitoring were quickly removed by the itinerant nurse. Almost at the same time, the cathode of the electrode plate of the ICU doctor Wu’s right hand was pressed against the lower back of the right scapula, and the anode plate of the left hand was pressed against the midaxillary line of the left fifth intercostal space. Defibrillation with 5J.

"leave!"

Everyone breaks away from contact with the operating table.

Discharge, the only straw of life was caught, a successful defibrillation, a familiar wavy line appeared on the screen of the defibrillator.

This is the wavy line of sinus rhythm, the wavy line of life.

The heart in everyone's throat was slowly put down, but the heart in the chest was still beating violently.

Cardiac arrest occurred during the operation, and no one was sure that it could be rescued, not to mention that it was caused by the interference of the nerve nucleus, and medical research on the brain is still very superficial.

Only Yang Ping calmly looked at the recovered ECG: "Reconnect ECG monitoring!"

"Sinus rhythm, heart rate 50 beats/min, blood pressure 90/45mmHg." The anesthesiologist reported, and 1 mg of epinephrine was administered intravenously again.Later, the heart rate was 60 beats/min, and the blood pressure was 100/60mmHg.

Yang Ping observed for a few minutes and confirmed that he was out of danger: "Replenish disinfection, add sterile drapes, replace surgical gowns and gloves, be careful not to contaminate the surgical area, and continue the surgery—"

Wen Rentao admired Yang Ping's calmness and composure. At this time, the main knife was the belief of the team members.

"One can never step into the same river twice."

Yang Ping has studied and simulated countless times in the system space, but the state of the patient and the simulation in the system space cannot be exactly the same.

Therefore, Yang Ping did not dare to relax at all, and made analysis and judgment based on the current state at any time to make the most favorable decision.

"The heartbeat center is disturbed and the adjustment is disordered. It must be cardioverted within five seconds. Each time, we only have five seconds."

Because the sterile sheet on the torso was lifted just now, some people have been contaminated and need to re-wash their hands to go on stage, and the sterile sheet on the stage must be covered again.

Everyone is in position and the operation continues.

　Today there are three chapters, more than 1 words, and there are two more chapters in the future.

　　
　
(End of this chapter)