godfather of surgery

After more than [-] years of surgery, Director Shi has never seen such a skin incision. This skill is beyond ordinary. It doesn't look like surgery, but a kind of performance.

"One-shot flow!"

Director Fang is knowledgeable and explained things to his senior brother in a timely manner.

Just now, the senior brother came to the operating table alone to observe, and Director Fang naturally had to accompany him. Professor Yang's surgery would not be possible without a qualified commentator. He would be afraid of seeing it in a foggy manner, which would seriously affect the senior brother's mood.

Lao Fang knew that Yang Ping's skin-cutting technique was called Yidao style and had become his signature move.

Even Yang Ping's two major disciples, Song Zimo and Xu Zhiliang, have now mastered the Yi Dao style, but they are not so proficient and can only be regarded as so-so.

Even a so-so swordsmanship is probably rare in the world. This kind of swordsmanship looks easy but is extremely difficult to do. The thickness of skin in different parts of each person is different, and the toughness of the skin is also different. It is necessary to cut through with one knife, not too much or too little. When the knife cuts, you must be able to finely feel what tissue the knife is touching and which layer it reaches. This information is then fed back to the brain, which in turn instructs the hand to control the cutting strength.

"One-sword style? Why haven't you heard of this kind of incision?" Director Shi has never heard of such a novel vocabulary.

Director Fang had no choice but to continue to explain patiently and deeply: "This is Professor Yang's signature skin incision. That is, no matter what kind of surgery, the incision is made from the epidermis to the dermis and then to the subcutaneous in one go. There is no need for additional incisions, and it is neither deep nor shallow." , neither long nor short.”

Is there such a way to play? Director Shi was so shocked that his tongue was dry and his mouth was dry. You just cut the skin off, and you created your own school.

"Young people are having fun, this is just the beginning. You will see what magic surgery is later." Director Fang said proudly.

Shi Guosheng felt that when did his junior brother become so disgusting, why did he perform magic surgery, and could speak such dog-licking vocabulary? What level can be called a god? He actually talked about knowledge in front of him. If it weren't for his junior brother , I really said a few words to him, no matter how big or small.

Because the best angle of view is different for each step of the operation, Director Shi has to adjust his position at any time. Fortunately, the surrounding area of ​​the operating table is empty, so it will not affect him no matter how he changes his position.

Director Fang followed him wherever he went and was responsible for explaining the whole process.

The abdominal cavity has been opened. The first step is to explore the abdominal cavity. The exploration does not start from the pancreas, but from the organs surrounding the pancreas and the peritoneal cavity to understand the approximate scope of tumor invasion. The exploration slowly shrinks from the periphery to the center, and finally the pancreatic tumor is explored. .

After all, any preoperative imaging examination is indirect. Now intraoperative exploration is the real direct way to understand the tumor situation, and the scope of exploration is extremely wide.

The extent of tumor invasion of the liver; lymph node metastasis around the porta hepatis and celiac artery, lymph nodes next to the aorta, especially the lymph nodes at the ligament of Treitz, the location and course of the small intestine, mesenteric blood vessels, right hepatic artery, peritoneum and Whether there is tumor implantation in the pelvic cavity, etc. are all within the scope of exploration. Finally, the pancreatic tumor was explored. Yang Ping moved very gently to protect the tumor tissue from being destroyed and leaked.

Exploring all the way, laying gauze all the way, the movements were extremely fast. While exploring, preparations were already being made for the subsequent surgery.

Exploration starts from the periphery, but dissection will start from the center. The tumor originates from the pancreas, so dissection starts from the pancreas.

"Tissue scissors!"

The instrument in Yang Ping's hand has a soul. The scissors open and close unobstructed. Any blood vessels blocking the separation path are either avoided or cut off by clamping and ligation in advance.

The peritoneal forceps clamped the peritoneum and connective tissue at the upper and lower edges of the pancreas. The tail of the forceps was handed to Song Zimo. Song Zimo immediately turned the pancreas and spleen to the right until the upper edge reached the origin of the splenic artery and the lower edge reached the inferior mesentery. The vein joins the splenic vein.

When the pancreas was revealed, everyone was shocked. Due to the invasion of the tumor, the pancreas had been severely deformed, and it was impossible to tell where the tumor was and where the pancreas was.

Moreover, the mixture of pancreas and tumor was severely adhered to the surrounding area. Many people couldn't help but shook their heads. How could the operation proceed with such a bad start?
  "sharp knife!"

The scissors in your hand are replaced with sharp knives, separated and upgraded.

There are two methods of separation. Blunt separation, as the name suggests, uses relatively blunt instruments for separation, usually using the handle of a knife, the front end of scissors, the tip of a vascular forceps, or fingers. Blunt separation must make use of natural boundaries and loose connective tissue gaps, which is equivalent to The explorers followed existing roads.

Blunt separation uses the force of tearing to tear off connecting tissues. If there are no natural boundaries and no gaps in loose connective tissue, this kind of separation will be impossible. For example, if tumors and organs infiltrate and grow, how to bluntly separate them.

Sharp separation is different. It uses tissue scissors and scalpels to separate. It cuts off the connected tissues. Cutting is obviously finer than tearing and causes less damage, but it requires higher skills and the risk of surgery is greater. This is equivalent to the explorer having no way to go and having to find a way.

Tissue scissors are the basic tool for sharp separation, but sharp knives are more precise than tissue scissors, but they are also more risky. Few people use sharp knives for sharp separation in this kind of surgery, because it is easy to cause accidental injuries.

Faced with such a chaotic situation, Yang Ping felt that only a sharp knife was the way to go. This was a special weapon for masters.

Faced with various tissues without boundaries, Yang Ping's sharp knife began to show its power. He tried to cut along the border of the tumor with a portion of the surrounding normal tissue, so as to ensure the completeness of the resection.

At the confluence of the inferior mesenteric vein, two vascular clamps clamped the splenic vein on the far and near sides. Almost at the same time, the clamp tail was immediately transferred to Song Zimo's hands.

Originally, the splenic vein should have been cut off at this time, but the splenic vein was not cut off, but was preserved. It was just shaken, and for some reason, the surrounding unknown blood vessels had been clamped and severed.

At some point, the surgeon's hands were filled with forceps and sutures, and they were inserted into and out of the abdominal cavity. The suturing and ligation of the blood vessels had been completed. The assistant's thread scissors shook, and the two vascular forceps came out of the abdominal cavity.

Director Shi stared at the surgical area, obviously feeling dizzy. He moved his neck and wondered if there was something wrong with his cervical vertebrae. Some cases of cervicogenic dizziness would be like this, but it didn't look like it. He turned his head away from the surgery. He didn't have this problem at all. Symptoms, but as soon as I stared at the surgery again, the dizziness and dizziness returned.

Hypoglycemia? No, I had a very rich breakfast.

Could it be dizziness? Director Shi's mind flashed, he had undergone surgery for more than [-] years, and if he had bleeding, it would make people laugh out loud if he told it.

After many attempts, Director Shi finally discovered the cause of dizziness.

It turned out that the operation was too fast, and the instruments were made of metal and were somewhat reflective. The coming and going of the instruments made Director Shi dizzy.

I can't see the details of the surgical steps clearly here. I can't see clearly at all. It's like a magician performing a magic trick. In a flash, a dove appears in his hand. Every movement feels like this.

Let’s just say that this pliers has a thread. I didn’t see the steps of ligation and loosening the pliers. I just put it in and took it out, the pliers were released, and the knot was tied.

It feels like the actions are not continuous at all. There is no transition from one action to another. It seems that the intermediate steps are completely cut off, so the action feels like it is completed in an instant. How did he do it? You insist on treating surgery as a magic effect, and you have to figure out how to perform a simple action.

I came here to see the surgery, not the magic trick.

Professor Shi Guosheng was really angry. You said that this was done. It was completely unreasonable. Just tie the knot. You put a pair of pliers on the thread and put it in and then took it out. The knot was just like that.

The more Director Shi looked, the more dizzy he became. Don't faint if this goes on. There was no other way. Director Shi had to stop and rest for a while. He had been operating for more than [-] years. If he collapsed in Sanbo Hospital today due to "fainting blood" Operating room, how to gain a foothold in the world after word spreads.

Being careful, Director Shi took a few steps back, closed his eyes and rested for ten seconds. “Professor, I’m a little dizzy!”

At this time, Xia Shu, who was helping on the stage, also felt something was wrong. He found that he felt dizzy and felt like vomiting while watching.

Could it be that he fainted from blood? Xia Shu also thought this way. He had never had this problem before. If he fainted from blood and fell here today, it would be a big joke. Not only would he lose face, but Fuwai's face would also be lost here.

It seems that surgeons sometimes think alike.

"I'll take a break!" Xia Shu had to withdraw. Fortunately, he was not in an important position, just a dispensable assistant with no number.

Xu Zhiliang said while doing the surgery: "It's okay - it's just that the surgery - it was too fast and my eyes were dazzling. In the future - if I have more surgeries - I will naturally get used to it. I just started - it was the same way. What now?" Nothing - nothing."

Professor Shi Guosheng finally felt more balanced. Look, I'm not the only one who can't do it. Your own doctor is also like this. He's dizzy.

After the discomfort subsided, Director Shi did not dare to stare at the surgery area this time, so he had to come back and watch the synchronized video. Fortunately, everyone still gave the boss face, and the position he stood before was always empty and no one filled it.

But in just a short while, the operation had been completed, ligating and cutting off the superior and inferior pancreaticoduodenal veins and the small venous branches that led to the portal vein and superior mesenteric vein.

The head of the pancreas, duodenum, stomach and bile duct are being dissociated. Watching the video is better than looking directly at the surgical area. After all, there is no reflection to dazzle the eyes. However, a new problem has arisen. The bright sharp knife in the video is scary to look at. , the sharp knife is doing sharp separation. Using a sharp knife in this place is really scary and frightening.

The operation video is actually more clear and comprehensive than looking at the operation area directly, especially the details, which are more delicate, so every detail is displayed. Professor Shi Guosheng was dizzy just now, and now his heart is pounding.

Operating your sharp knife in such a dangerous area would make anyone tremble.

In fact, when it comes to surgery, the more advanced a person is, the more involved he is, because he knows where the dangers are, so he has a full sense of involvement. On the contrary, the rookie is ignorant and feels very at ease, but he does not understand very well and does not understand what steps are dangerous. So just look at it.

Among the audience present, the person with the strongest sense of empathy is Director Shi, so he is the hardest working person.

Oops, there is an artery there, it will spurt out blood and retract, slow down!

I was just worried about the arteries, but they had already exposed and separated them. Another breath later, and the arteries had been clamped, ligated and cut. This is the first time I have seen this level of surgery. How many surgeries are needed to do this, this anatomy? How familiar the knowledge is, where did you practice it?

For a young doctor under thirty years old to have such a high standard, this is simply cheating. Professor Shi Guosheng was suddenly at a loss for words and could only think of this popular vocabulary to express what he saw.

The sharp knife can maneuver through complex ravines with ease. So far, it has not removed a small blood vessel by mistake, and it has not damaged any non-target tissue. The entire surgical area is clean and pleasing to the eye.

The basic skills of surgery are externally reflected in two aspects: anatomy and hemostasis.

The master's surgical anatomy is clear and the bleeding is very thorough. The operation is neat and clean, and there is almost no visible bleeding.

The upper end of the jejunum and the mesentery of the uncinate process have been cut off, and the spleen, pancreas and duodenum can now be removed. However, the tumor tissue is still connected to the liver and other organs, so Yang Ping has no plans to take out these tissues for the time being.

Now these organs have no tissue connected to the body except the arteries that supply blood and the veins that return blood. Once these blood vessels are cut off, these organs can be separated from the body with the tumors, but other organs have not been separated yet, so Yang Ping temporarily The plan is to preserve these blood vessels and allow them to receive a normal blood supply.

Equipment dealer Huang Jiahui came in and started setting up the table. What equipment would be used for this surgery?

A stapler? Titanium clip?
  It seems that this operation does not require anything else, it is just these things.

Director Shi wanted to take a look, but was afraid of walking away and missing key steps.

"Go and ask, what kind of equipment are they preparing?" Director Shi poked the junior brother with his elbow.

Director Fang reluctantly moved over there and asked Huang Jiahui: "What equipment are you preparing?"

"Artificial blood vessels!" Huang Jiahui said while setting up the stage.

Artificial blood vessels?
  Director Fang didn't want to waste too much time here. If his senior brother hadn't ordered him to come, he wouldn't have wanted to ask this.

After asking a few cursory questions, Director Fang immediately returned to his seat. The director's majesty was still there, and no one dared to occupy the vacant seat. Seeing Director Fang return, Director Shi asked: "What is it?"

"Artificial blood vessel!"

"What are artificial blood vessels used for?"

"this---"

Director Fang didn't ask just now.

"Let's find out more."

Director Shi said.

Director Fang is extremely disgusted. Now he is watching the surgery more enthusiastically. You always order me to do other things. Can you please stop doing this? Although we are brothers, I also have pursuits.

"She doesn't know either." Director Fang said casually to deal with it.

Why don’t the equipment dealers know what their equipment is used for? Director Shi found it so strange, and Director Fang said randomly: "Professor Yang performs surgery like this, it's like magic. The equipment manufacturer only supplies the equipment according to the order. We won't know what it is used for until we get to the stage."

Damn it, even scholars can be rude sometimes. Director Shi blurted out "f*ck", but the voice was too low, and the doctors around him were focused on the operation and didn't hear it.

The sharp knife on the picture is separating the porta hepatis, which is where tumors are entangled and is very complicated and dangerous.

But the sharp knife seemed to be playing, almost wrapping around the blood vessels bit by bit.

Is this surgery or magic? Can someone please explain to me clearly that sharp knives can be used in this place? And the sharp knife is so exaggerated!