godfather of surgery

Chapter 654 YesI see!
For the lumbar 3 vertebra, Yang Ping began to demonstrate the technique of separating the tumor from the pedicle and intervertebral foramen.

This part is complex and the operating space is narrow, so the requirements for surgical skills are very high.

The intervertebral foramen surrounded by the upper and lower pedicles is the space for the nerve root to enter and exit, and it is easy to damage the nerve when it is separated.

Moreover, in such a deep and narrow space, it is difficult to deploy instruments. Therefore, ordinary doctors can only retreat to this kind of situation. Under the protection of gauze, they cut the tumor and cut off the pedicle.

But Yang Ping didn't want to do this. Once the tumor is cut open, no matter how well it is protected with gauze, it will inevitably leak, which violates the principle of no leakage.

Yang Ping decided to conduct a precise separation of this part, and the separation also started from the spinous process, because spinal tumors rarely invade the spinous process.

Starting from normal tissue, it is separated in a scientific order, which is the principle of leak-free resection.

It is only possible to operate within normal tissue at the outer border of the tumor throughout, only by starting with normal tissue.

As the separation progressed, from the spinous process to the lamina, when separating the pedicle and the vicinity of the intervertebral foramen, a layer of cortical bone was actually separated together.To easily separate the cortical bone, only a laser to the knife can do this. Ordinary scalpels cannot do it. To separate the cortical bone with ordinary instruments, only a sharp bone knife can be used.

Not only with the cortex, but also near the dural sac and nerve root, the separation also includes the dura mater and the epithelial membrane of the nerve. These unrelated tissue layers are regarded as the pseudomembrane of the tumor, and the whole layer is completely covered in this way. It was opened in a broken way.

Yang Ping adjusted the operation speed several times to adapt to the speed of equipment nurse Qiu Ruo and assistant Song Yun.

Surgery is a team work, and it is easy to cause some problems if you rush by yourself.

If Qiu Ruo could understand that the young professor slowed down a few times to accommodate himself, he was very moved.

There is no such thing as the chief surgeon accommodating the equipment nurse during an operation, but this is how it is now, the chief surgeon is obviously accommodating her, she is like a favored princess, she is very sweet in her heart, and at the same time she is more focused, hoping to be as fast as possible.

After the cortex is lifted, the laser knife easily completes the osteotomy at the pedicle.

The pedicles on both sides are separated using this wonderful method.

"This is because the periosteum has been violated, but the cortical bone is fine. With the soft tissue as a pseudomembrane, we have no way to start, so we can only use this extreme method. This method is called subosseous separation. When there is no laser knife, the sharp small bone A knife can also complete the separation, but it is very difficult, and it will be much easier to separate with a laser knife."

"As for the border of the tumor, I rely on the image of the tumor to judge, and then rely on the image in the brain and surgical experience to find the border during the operation."

"I am researching a more reliable staining method. I use dyes to stain the tumor, normal tissue, and tumor-normal tissue junction area into three different colors. With special research, the border can be directly seen during the operation, and the staining can be designed in the future. If the cutter head has the ability to identify the agent, it will call the police if it crosses the boundary."

Yang Ping explained to Song Yun while performing the operation.

It is the first time Song Yun has heard of this separation method under the bone, but if the vertebrae are not separated under the bone, tumor cells will definitely leak out.

Once it is separated from the bone, the problem will be solved, which is indeed a fantastic idea.

The dyeing method and induction method proposed by Yang Ping are also new ideas and have great research prospects.

"Surgical methods are very important, just like racing without restrictions on vehicles. No matter how hard you run, you can't run a racing car."

Yang Ping explained with a metaphor: If there is no concept and method of subosseous separation, and the habit of thinking that the soft tissue is a pseudomembrane is still present, the tumor at the waist 3 must rupture the membrane and leak.

Lumbar 3 successfully amputated the pedicles on both sides to complete the open loop.

No matter what method is used for total vertebral resection, the ring must be opened, just like a closed iron ring set on a pillar, it cannot be removed from the pillar up and down, either breaking the pillar or breaking the iron ring.

Obviously the patient's spinal cord and nerves cannot be broken, so only the annulus of the vertebrae can be opened.

The lumbar 4 tumors invaded much less, and the pedicles were not invaded. Conventional separation methods can be used to cut off the pedicles on both sides.

In this way, the separation of the posterior tumor and the open-loop steps of the three posterior vertebrae were all completed. This step took about an hour, which was slowed down to take care of the assistants and nurses.

In fact, the doctors and nurses of Xiehe are very high-quality, absolutely world-class, but Yang Ping is too strong!

"Do you want to take a break, everyone?"

Of course Yang Ping wants to complete the operation in one go, but I don't know what everyone thinks, if he really can't keep up, it's better to take a break.

"It's okay, you can continue!"

The first one to respond was Qiu Ruo. She would feel even more sorry if she rested again. She had already received special care from Professor Yang.

"Professor Yang, do you want to add an equipment nurse!" Head nurse Xin offered now.

Head nurse Xin has been working in Peking Union Medical College since she graduated from Peking Union Medical University. She has never seen any kind of professor, but she has never seen a professor like Yang Ping.

The operation was ridiculously fast, and it was done so well. This kind of skill can really be described as a stunt!
"No need, Nurse Qiu cooperated very well. It's rare to cooperate so well for the first time. Xiehe is Xiehe."

Yang Ping gave enough face to the equipment nurse and Xiehe today.

I am a different kind, and I can't ask others to be different. Yang Ping still has self-knowledge.

Hearing this, Qiu Ruo felt warm in her heart and was very grateful.
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Cheney never took his eyes off the screen, watching every detail of the operation intently.

Three vertebrae, the posterior surgery took only one hour.

My usual posterior separation is much rougher than this. This kind of tumor can never be separated within five hours, but now Xiehe's chief surgeon only takes one hour to complete the separation.

The speed is so fast, so what about the quality?
As long as you are a serious expert, you will be able to see the quality of this kind of god-level surgery.

The chief surgeon uses a variety of techniques in the operation, some of which are traditional, such as subperiosteal separation. Even with these traditional methods, this chief surgeon has used them to a new level. The entire subperiosteal separation has no damage to the periosteum. The surface of the texture is smooth.

Some are methods that Cheney has never seen before, such as the novel subosseous dissection, which extends the understanding of tumor boundaries, and the periosteal dissection, which extends under the bone with the help of a laser knife.

This is not only the progress of the operation, but also the renewal of the concept.

With the Chinese-style total vertebral resection in full swing, Cheney's self-esteem was seriously hit, no, it was seriously crushed.

Chinese-style total vertebral resection far exceeds Cheney's surgical method.

The mineral water bottle was in Cheney's hands, and there was no normal place left after he squeezed it back and forth.

He had many questions in his mind to ask Director Hu, but Director Hu kept staring at the screen without looking away, and Cheney didn't dare to speak.

"Where is the bathroom?"

Cheney's bladder was a little tense, and he couldn't hold it back anymore, so he asked Director Hu.

"Concentrate on it! If there is any problem, we will ask it after the operation!" Director Hu replied again.

"Yes, I see!"

Cheney sat upright again, and it should be okay if he can bear it any longer. The bladder has the ability to reabsorb, so let's wait and see.

Professor Lu Donglai, director of the Medical Office, was born in tumor surgery. After seeing this level of surgery, he finally understood why Professor Liang spent so much money on Yang Ping.

When it comes to selecting people, Mr. Liang's vision is that Xiehe is the first, and no one dares to put it second.

Zhang Chunquan, who was mediocre back then, was caught by him and poured a lot of effort into it. Although this kid has gone to the United States now, it is undeniable that his ability is absolutely top in the world. Zhang Chunquan took the number one credit, and it is said that he will be awarded the Nobel prize in the future.

It is a pity that Zhang Chunquan went to the United States and never returned. He became an American citizen. Not long ago, Xiehe commissioned Professor Liang to contact Zhang Chunquan, hoping to introduce him back to China, but Zhang Chunquan resolutely refused. Even if he does not return to China, he will be a visiting professor and do something for Xiehe. Contributions are fine, but this Zhang Chunquan even refused to be a visiting professor, and he refused so decisively, which made Mr. Liang sad for a long time.

Professor Lu thought of this, and looked sideways at Professor Liang, isn't he sick and bedridden?The day before yesterday, I visited his home with the dean, and yesterday I called Professor Liang's wife to inquire about his condition, to see if he could be persuaded to go to Xiehe Hospital for treatment for a few days.

How come you are alive and well today, sitting here to participate in a meeting to observe the operation, you don’t look sick at all, and you have a fever after lying in bed for a few days, how can you recover so quickly?

When Professor Lu was wondering, Professor Liang grabbed the mineral water bottle and took a few sips, almost the whole bottle of mineral water was gone.

With this appetite, I drink a whole bottle of water at once.

"Mr. Liang, your student's surgical skills are a bit exaggerated. I said Mr. Liang, the talent you fancy is definitely one in a million, so I, Lu Donglai, signed without blinking an eye." Professor Lu said it as if it was real .

Professor Liang didn't buy into him as the director of the medical department: "Of course you didn't blink, because you signed with your eyes closed under my coercion and lure, and you didn't sleep well for three days after signing, right? Can you sleep well tonight?"

Professor Lu's ridicule towards Professor Liang did not change his face and his heart beat: "I did not sleep well for a few days after signing the papers, so excited!"

The skin is thicker than the city wall, and there is only Lu Donglai in Xiehe.

Thanks to Professor Liang, now thanks to the introduction of Yang Ping, Professor Liang is the first, and Lu Donglai is the second.

After a while, maybe Lu Donglai will be number one and Professor Liang will be number two.

With Lu Donglai's provocative level, it can be done.
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After the posterior surgery is completed, the posterior surgical area should be temporarily closed, the special position is stuffed with gauze, the incision is temporarily closed with skin nails, and then a sterile medical film is attached.

Turn the patient over to a supine position, re-sterilize the drape, and perform anterior surgery.

Yang paralleled the laparotomy and cut it layer by layer. All blood vessels that should be ligated along the way were ligated in advance, and no bleeding was caused by missing any one.

This preemptive hemostasis technology makes the operation area very clean and makes people look very comfortable.

Soon the vertebral bodies and tumors from L2 to L4 in the retroperitoneum were exposed.

The tumors in L2 and L3 invaded the abdominal cavity forward and were seriously adhered to the abdominal aorta and inferior vena cava, and the wall of the large blood vessels had already been invaded and degenerated. After Yang Ping's investigation, he believed that if left alone, the risk of aortic dissection would be extremely high in the future. So Song Yun asked for support from the vascular surgery department to place artificial blood vessels to prepare for a rainy day.

This was also the situation estimated before the operation, and the vascular surgery department was also prepared. When they were notified, they were already in the operating room.

If it was in Sanbo Hospital, Yang Ping would not need to call for a vascular surgeon at all, he would put in artificial blood vessels by himself, and he would do everything by himself.

In Sanbo Hospital, he has full surgical authority, and it is estimated that he is the only surgeon in the country who can have such special treatment.

Of course, his assistants also received this special treatment.

But not in Xiehe, his authority is only within the scope of his old profession --- orthopedics.

Even if the abdominal aorta and inferior vena cava are explored, the subsequent separation of the aorta and inferior vena cava is still a side job. If Director Hu does it, this step will also require the coordination of basic surgery and vascular surgery.

If it is an emergency life-saving situation, Yang Ping will make an exception. Now is not the time for emergency life-saving, and he can only act in accordance with medical regulations.

Yang Ping always believes that doctors should be rational rather than emotional.

Director Zuo Ruiting of Union Medical College Vascular Surgery came to support with two assistants. The Department of Vascular Surgery of Union Medical College receives many emergency operations for aortic dissection every year, so Director Zuo basically has no concept of Saturday and Sunday.

In his own words, Wangfujing Pedestrian Street is near Xiehe, and he can see the lively scene from the window, but he seldom goes shopping, sometimes he just looks through the window to enjoy his eyes. Very little rest, too many surgeries to keep up.

Called by the Department of Orthopedics to cooperate, Director Zuo has no complaints. He has already familiarized himself with the condition in advance. This time, he took his assistant and just looked at the video pictures: "This patient needs to be implanted with artificial blood vessels in advance, otherwise ninety percent of the time there may be a serious accident after surgery. The artery was dissected and torn. We had such an operation not long ago. After abdominal tumor surgery, the tumor was adhered to the aorta. Three months after the operation in another hospital, the aortic dissection was formed, and it was torn more than 20 centimeters from top to bottom. Fortunately, it was delivered in time and rescued."

Director Zuo has rich experience, he has rescued many patients with aortic dissection, and he snatched people from Lord Hades every three days.

"Brush your hands!"

Director Zuo is a bold person, he gave an order and brought two assistants to the stage.

Surgeons, just like surgery.
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Yang Ping withdrew temporarily, resting his hands in the glove pockets on his chest.

"Professor Yang—"

While Director Zuo was washing his hands and the operation was suspended, Qiu Ruo whispered.

Yang Ping turned his head when he heard Qiu Ruo's voice, and the equipment nurse was smiling at him: "Thank you!"

"You're welcome!"

"You—look at the equipment I prepared, right? Wait for the one you want to use."

Yang Ping took a look, yes, these are the equipment.

In fact, Qiu Ruo is really an excellent equipment nurse, worthy of being a graduate student of Xiehe, but she is still a little worse than Xiao Su at home.

"That's right, these are the equipment, keep your speed steady, don't worry."

"Well, thanks!"

She didn't expect that the great professor would respond to her and chat with herself, she thought that Yang Ping could only say a few words in a coping manner.

(End of this chapter)