godfather of surgery

Chapter 653 Slow down
After anesthesia, Jing Yunsong lay naked on the spinal support.

The endotracheal tube is connected to the anesthesia machine, and the rhythmic mechanical ventilation of the anesthesia machine replaces Jing Yunsong's breathing.

Anesthesiologist Dr. Chen Shichao sat on the side of the patient's head, next to the anesthesia machine. From the time the patient came in to the completion of anesthesia, he only said one sentence: After the anesthesia is completed, the operation can begin! "

Then just sit there without saying a word, and don't participate in any small talk, a dutiful and conscientious tool man.

The G-arm X-ray machine was on standby, but it was not used much, except when the pedicle screws were placed.

Song Yun led Kong Weiquan to start disinfecting and laying the sheets. Qiu Ruo was already in place and the equipment table was unfolded. She began to arrange various equipment with her dexterous hands.

The roving nurse was checking how much liquid remained on the infusion stand and whether the intravenous access was unobstructed. Head nurse Xin sat in the corner and provided necessary support for the nurse at any time.

The other two doctors stood leaning against the G-arm machine, so that they could stay as G-arm machine operators and help push the G-arm machine. It was also an honor to participate in the operation.

The ready-to-use artificial spinal prosthesis in sterile packaging is placed on an instrument cart and is ready to be used at any time.

Wearing goggles, Yang Ping stood in a relatively empty corner of the operating room, put on surgical gowns and gloves with the help of the itinerant nurse, and then stepped aside, waiting for Song Yun to complete the disinfection and laying sheets.

After everything was ready, Yang Ping came to the stage and stood in the position of the chief surgeon.

After a serious preoperative check, Qiu Ruo handed over the scalpel.

Yang Ping took the scalpel and drew a vertical line on Jing Yunsong's back.

It's still Yang Ping's habitual one-cut technique, the skin cut only needs one cut, and the subcutaneous skin is cut through at once, neither deep nor superficial, and the subcutaneous fat particles burst out immediately with the splitting of the skin.

Most of the whole operation was done with a laser knife, and the scalpel was only used for skin incision. After the skin incision, Yang Ping returned the scalpel to the equipment nurse.

Qiu Ruo was stunned for a moment, then took the scalpel with a curved plate, and handed over the forceps with teeth.

The action at the beginning was a bit hasty, Qiu Ruo never thought that Yang Ping's skin-cutting was just a single knife.

There is no skin incision like this. Generally, the incision is made slowly along the incision line, and then deepened bit by bit. After repeated incisions, the skin can be finally incised to form the entire surgical incision.

The scalpel had just been handed over, and within three seconds, the skin incision was completed, how could Qiu Ruo react.

However, Qiu Ruo learned the lesson quickly and never dared to be careless again. This young professor is indeed very fast, and if he is not careful, he may lose his rhythm.

According to the operation steps, she picks out the instruments to be used in advance, puts them in a convenient place, and passes them over at any time. She also pays close attention to the progress of the operation and predicts which step the operation will take and what instruments are needed.

The scalpel was replaced by a laser knife, and the incision was continued. The laser knife was also very fast in Yang Ping's hands. First, he stopped the bleeding precisely, and then cut the back fascia. With the incision of the back fascia, the red muscles on the back were exposed. come out.

There are relatively few surgical instruments currently in use, and the switching of instruments is not very frequent. After making adjustments, Qiu Ruo can easily deal with it.

Starting from the midline, Yang Ping put a pair of toothed forceps and a laser knife against the spinous process and began to separate the muscles, peeling off the muscles on both sides from the spinous process and the lamina, and then pushed them away to both sides.

This kind of bone-bonding stripping, also called subperiosteal separation, is more convenient to operate on the long bones of the limbs, because the long bones of the limbs are generally tubular bones with a smooth surface and thicker periosteum.

The vertebrae are irregular bones with various protrusions and depressions on the surface, and the periosteum is also very thin, so it is very difficult to perform subperiosteal dissection on the vertebrae.

But Yang Ping's operation was fast and steady. Soon, the muscles were separated with the periosteum, attached to the spinous process and the lamina, and almost no blood was seen in the operation area.

Occasionally, the nourishing blood vessels that flow from the muscles to the vertebrae are also promptly killed by Yang Ping's laser knife.

Yang Ping's laser knife and toothed tweezers work perfectly together, as if the muscles, tendons, and ligaments are glued to the surface of the bone, and Yang Ping is just carefully lifting them off.

The lamina, spinous process, transverse process, upper and lower articular processes, these complex convex structures are not obstacles at all in Yangping. When the muscles are separated from the spinous process and the lamina, they still carry the complete periosteum. The layers are very clear.

As the first assistant, Song Yun has the best vision to directly observe the surgery.

He had never seen such a clear separation technique.

"The preoperative image showed that only the lamina of the lumbar 2 was intact and not invaded by the tumor. I opened the lamina opening. The opening of the lamina must be at least 1.5 centimeters larger to open the ring. It can be very easily if it is more than [-] centimeters." Unlock the loop!"

Yang Ping continued the operation while explaining to the assistant. The explanation in advance could make the assistant understand the intention of the surgeon.

After all, the number of assistants working with me is very small now.

After the muscles are separated, the back of the lamina is smooth without a trace of soft tissue. The energy of the laser knife is upgraded and switched to a mode that can cut bones.

The energy level of the laser knife can be adjusted at any time to adapt to the cutting object at any time, such as cutting bones, the energy level is higher than that of cutting soft tissues.

As the focused laser cuts bit by bit, the normal lamina is removed from behind a square bone block, and then the orthopedic block is taken out.

The ring-shaped vertebra forms a defect at the back, which opens the closed ring of the spinal canal. When the vertebra is removed, the spinal cord and cauda equina can be freed from this gap. Otherwise, the spinal cord and cauda equina are trapped by the vertebra, and the vertebra cannot be removed.

Yang Ping's basic operation idea is very clear. Open the spinal canal from the back, let the vertebrae completely unset, then resect the tumor along the border of the tumor, and finally extract the vertebrae and tumor together.

As for taking out the whole tumor from the front or taking out the tumor from the back, it depends on the invasion direction of the tumor, whichever is more convenient to use.

After the square lamina bone was taken out, the operation on the posterior side of the waist 2 was temporarily completed, and Yang Ping stuffed the developing gauze into the operation area.

Next is the operation on the posterior side of L3. In this vertebra, Yang Ping will demonstrate the technique of tumor separation at the pedicle and intervertebral foramen.
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The start made Cheney a bit unacceptable.

He is the world's top spinal tumor expert, of course he can understand the level of demonstration surgery.

First of all, this separation method is very novel, boldly giving full play to the advantages of the laser knife, and truly achieving subperiosteal separation of bones, which is already a step ahead of Cheney in concept.

Secondly, the chief surgeon is very familiar with the anatomy of the spine and tumor. He knows where the natural boundary of the tumor is, so he always follows the tumor boundary and separates it from the normal tissue near the boundary.

In addition, the surgical operation level of the chief surgeon is indeed very high. For example, the soft tissue is separated from the spinous process and the lamina, with a complete periosteum throughout. After the separation, the lamina in the operation area is almost smooth without any soft tissue attachment.

Tumors are not like potatoes in the soil. They are completely different from the surrounding soil, with clear natural boundaries.

The tumor grows invasively to the surrounding tissue, and the boundary between it and the surrounding tissue is very blurred, and the so-called boundary and pseudomembrane are difficult to find.

But the chief surgeon found it easily, indicating that he has studied a large number of such tumors and is already very familiar with its boundaries.

Finally, bleeding was rare throughout the procedure.

Cheney was staring at the surgical operation on the huge screen, and his whole body was in a state of high tension. The tension was not due to other reasons, but some kind of oppressive force covering him, making him unable to breathe.

He had never seen such an operation, or, he never knew, that it could be done.
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Vascular clamp!

Vascular clamp with wire!

needle!

Wire cutter!

With toothed tweezers!
Lamina hook!

Nervous stripper!
Nervous hook!

As the operation continues, more and more types of instruments are needed, and the frequency of surgical instrument switching is also increasing.

Yang Ping was completely absorbed in the operation, not paying attention to whether others could keep up with the speed.

As I was doing it, I stretched out my hand for a long time, but there was no feeling of a pat on the palm of my hand.

Yang Ping turned his head, the equipment nurse looked at him with timid eyes, and carefully patted the long-overdue equipment on Yang Ping's palm.

The equipment nurse didn't keep up and lost the rhythm.

Because Xiao Su is an equipment nurse, Yang Ping is very kind to the equipment nurse.

Some professors throw knives outside and lose their temper with assistants and nurses at every turn, but Yang Ping never does that.

Seeing Qiu Ruo's guilty and uneasy eyes, Yang Ping immediately realized that he was moving too fast, she didn't keep up with the rhythm at all, slower is allowed, it won't affect the operation, so let's go slower.

In fact, Song Yun was struggling to keep up with the rhythm. Several operations were originally done by the assistant, but because Song Yun didn't keep up, Yang Ping replaced the assistant and completed the operation by himself.

Slow down!

"No rush, slow down!"

Yang Ping gently comforted Qiu Ruo, took the equipment, and then consciously slowed down.

Qiu Ruo usually reacts and moves very fast, and has never been unable to keep up with the speed.

It's just that Professor Yang's speed is really too fast, beyond Qiu Ruo's cognition, Qiu Ruo has never seen such a fast operation.

And this is a spinal tumor, shouldn't it be cautious?
Some professors still do one step and watch one step, but Professor Yang's whole process is very fast, which is completely different from other professors.

Just now after Qiu Ruo lost his rhythm, he was afraid of being scolded, but Yang Ping's eyes were not blaming, but comforting. Later, he slowed down completely to accommodate himself. Qiu Ruo felt warm in his heart. He didn't expect Professor Yang to have such a good temper.

Even if he deliberately slowed down, Yang Ping's speed was still very fast.

Head Nurse Xin was beside her, and she saw the whole scene just now. The young professor's operation speed was really ridiculously fast. If Qiu Ruo couldn't keep up with the speed at all, if it wasn't for his face just now, she would really have to temporarily arrange an equipment nurse On stage, I'm afraid it will be a bit embarrassing.

Fortunately, for the sake of face, this young man can slow down and take care of the speed of the nurses on the stage.

Head nurse Xin is very grateful. If it is really possible to add a nurse temporarily, but this shows that I have made a mistake in the arrangement. The doctor reminded me, and Professor Yang himself mentioned this matter, but he vetoed it.

This matter was blamed by Professor Liang, and criticism was inevitable.

Qiu Ruo felt that she was not doing enough work. She looked at the head nurse and found that the head nurse didn't say anything, which made her feel better.
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As the operation progressed, Professor Cheney became more and more focused.

This kind of surgery is more advanced and mature than my own method in terms of concept and operation, how is it possible?
Before they asked to learn my new technology, how can they surpass me so easily now.

Did they steal their technology in some other way and improve upon it?

Impossible, my technical details have not been included in the thesis, and no one has really mastered it except for the assistants and the few doctors I personally supervise.

Moreover, this surgical method is completely in two directions from concept to operation and its own new technology.

This Chinese total vertebrectomy completely surpasses our own method of total vertebrectomy, and it truly achieves resection according to the boundary!
Where did this technology come from? Cheney never believed that it was created by the Chinese themselves.

It takes time and a lot of energy, and it doesn't mean that you can surpass it if you surpass it.

Check it out first!

After treating the posterior side of the lumbar 1 vertebra, the surgeon completely separates the spinous process, lamina, transverse process, and the muscles and ligaments attached to the upper and lower articular processes, and then opens the loop on the lamina, and starts to process the lumbar 3 vertebra after the loop is opened.

Cheney vaguely felt that the surgeon was only opening the vertebrae from the posterior approach to separate the tumor, and later on the anterior approach would take out the three vertebrae and the tumor at one time, instead of dividing them into three parts as he did.

When the surgeon separates the tumor, it is completely centered on the tumor and has been operating in the surrounding normal tissue. After such a long time of separation, the tumor has been wrapped in its own boundary.

Looking at it, Cheney was almost certain that the purpose of the chief surgeon was to remove the tumor and three vertebrae from the front at one time.

Posterior open loop, front and rear combined 360-degree tumor separation, anterior tumor removal, and posterior fixation and stabilization of the spine.

There are only three steps to this complicated tumor. It is clear that this is a true en bloc resection. The whole operation is performed within the normal tissue around the tumor. Moreover, the tumor as a whole is wrapped and sealed by the normal tissue, and there will be no leakage when it is taken out.

It's hard to do, isn't it?

No, it's not that hard, basically impossible to do.

Because Yang Ping did not allow Director Hu to be his assistant, it was not interesting for Director Hu to stay in the operating room. He returned to the orthopedics conference room and watched the operation with everyone, and accompanied the American guests who came from afar.

"Professor Hu! Is this going to open the loop in the posterior, separate the posterior, and then separate the anterior, and take out the entire tumor and three vertebrae at one time?" Cheney couldn't help asking Professor Hu beside him.

Professor Hu nodded: "Concentrate on watching, if there is any problem, we will ask it after the operation."

Cheney was very embarrassed by Professor Hu's words, like a student who was not paying attention in class and being scolded by a serious teacher, he shrank back to his seat and continued to stare at the screen.

(End of this chapter)