My medical path

Chapter 80 Posterior Approach to Excision of Popliteal Cyst
The second operation is to cut the cyst behind the popliteal fossa.

One of the current surgical methods for this operation is traditional incision and removal, and the other is minimally invasive arthroscopic surgery.

The traditional incision requires an S-shaped incision behind the popliteal fossa.

Because the popliteal cyst is generally deep, the incision should not be too small, usually more than ten centimeters.

And because the knee is bent back, this part is prone to sweating, and the wound is prone to wound infection here.

If arthroscopy is used to do it, the incision will be much smaller. A wound as big as two little fingertips can solve the problem.

But using arthroscopy to complete this operation is not possible for all doctors.

It usually requires very skilled arthroscopic techniques and doctors who are very familiar with local anatomy to dare to use arthroscopy.

Because there are important blood vessels and nerves behind the popliteal cyst, if you are not careful, it will cause disastrous consequences.

Before the system, Chen Bo could only choose traditional surgery.

After all, the success of one hundred surgeries does not mean anything, but the failure of one surgeries may mean the end of one's career.

Now that Chen Bo has a wisdom system, he has higher requirements for himself.

And before the operation started, he had repeatedly simulated the operation in the surgery expert area, and now he is full of confidence.

Because he brought doctor Luo Ming along as a trainee, Chen Bo still wanted to explain some basic knowledge to him bit by bit.

For example, in this operation, the choice of incision, why did the posteromedial approach enter from the gap between the medial collateral ligament and the sartorius muscle?
How to avoid damage to the superficial great saphenous vein and saphenous nerve?
Why does the posterolateral approach need to enter from behind the iliotibial band?
And why can't it go beyond the front lateral collateral ligament?
How can we avoid damage to the common peroneal nerve?
…………

Because Luo Ming's foundation is weak, although he can understand, he is still at a loss after all. Instead, Ma Shangqu, a young resident, nodded his head frequently.

After all, Ma Shangqu has a certain foundation of arthroscopy, and the basic knowledge that Chen Bo explained to Luo Ming is just a timely rain for him.

After reading and forgetting in textbooks, some knowledge points without specific concepts were instantly linked together through Chen Bo's explanation, and gained a clear understanding.

Chen Bo made marks on the patient's legs while explaining. This is an important task in the preparation for the operation. Marking out the important structures will prevent you from getting lost during the operation.

Zheng Yi, the surgery patient, was very nervous lying in the operating room, but now hearing Chen Bo's detailed explanation to Luo Ming and the others, the nervousness was much relieved.

"Dr. Chen has such a wealth of professional knowledge, and is the teacher of these young doctors, his surgical skills should not be much worse..."

Zheng Yi thought to herself.

Now that she felt relaxed, Zheng Yi dared to consult Dr. Chen about her condition:

"Doctor Chen, how soon can I get out of bed and walk after the surgery on my foot?"

Chen Bo just made a mark, and when he heard Zheng Yi's words, he replied with a smile:

"You, you can come down tomorrow, and you can walk home."

"Really? Thank you so much! I'll leave the surgery to you!"

Zheng Yi originally thought that it would take at least a few days for the wound to heal before she could get out of bed, but she would be able to walk home after hearing this, and she was very happy in her heart.

Because it is a minimally invasive surgery, it does not require too many people on stage, so Chen Bo only took Luo Ming to practice surgical hand washing this time, and did not let him on stage.

Ma Shangqu was still the assistant, Jia Zengyi was the equipment nurse, and Wang Ruoyun was the anesthetist.

This time, Ma Shangqu has already completed the preparations for disinfecting the towels.

"Put on the tourniquet, pressure 40, time 60!"

Chen Bo used the blood drive belt to drive blood from the patient's lower limbs and gave instructions.

The operation requires knees to be bent at [-] degrees, and Ma Shangqu is left to support the legs.

"Here comes the sharp knife!"

Chen Bo stretched out his hand, and Jia Zengyi immediately handed him a sharp knife.

Chen Bo took the knife, and quickly poked two small incisions at the inner and outer incisions he marked.

This abnormal movement caught Zhang Yu's attention.

Because according to the normal operation, Chen Bo should first establish the two small openings of the front inside and the front outside, enter the arthroscope, and then establish the two small openings of the back inside and the back outside under the light of the mirror.

"Chen Bo doesn't want to open the two small openings at the back without entering the joint cavity, does he?"

The sudden idea shocked Zhang Yu, and he couldn't help asking:
"Chen Bo, are you going to enter the joint cavity?"

"From the film, it can be seen that the cyst does not communicate with the joint, and the main structures in the joint are good, so there is no need to enter the joint cavity."

Chen Bo explained.

"Then how do you ensure that your approach is accurate?"

There was a big question mark on Zhang Yu's head.

"Hand feeling!"

While answering, Chen Bo picked up the puncture instrument and began to puncture.

The intelligent system scan has been turned on. Under the monitoring of the system, Chen Bo quickly inserted the arthroscopic lens...

Zhang Yu just wanted to ask "What if I accidentally penetrate a blood vessel and nerve?" When he saw that the condition behind the popliteal fossa was clearly displayed on the arthroscopic monitor.

This made the words he had just reached his mouth stuck in his throat, turning him into a daze with his mouth open!

To what extent do you have to be familiar with anatomy to complete this seemingly simple but very difficult operation so easily and freely?

It was also the first time for Ma Shangqu to see arthroscopic surgery with a posterior approach, and his eyes were full of curiosity.

Luo Ming, on the other hand, has never touched an arthroscope, so he doesn't know where to look under the lens.

"Doctor Luo, look, this is the posterior cruciate ligament, this is the posterior horn of the medial meniscus, this is..."

Chen Bo told Luo Ming everything about the structure under the lens, making Luo Ming nod his head as if he had encountered timely rain.

At this time, even Ma Shangqu was envious of Luo Ming. He had the opportunity to get such a detailed explanation from Chen Bo on the first day of his arrival. He really wanted to say:
"Brother Bo, I actually lack this knowledge, and I really want to know..."

Zhang Yu had already woken up from his daze, looking at Chen Bo's two hands operating the arthroscope, he was a little absent-minded.

Chen Bo's arthroscopic surgery feels the same as an incisional surgery. His hands don't shake at all, and the camera can see wherever he wants to see, and the hand on the other side can cooperate seamlessly.

As far as this technology alone is concerned, Chen Bo has no way to be picky.

Zhang Yu has also seen many big names in the country perform operations, and he feels that Chen Bo's efficiency is even higher than those big names...

The insertion of the arthroscopic instrument can be completed in one puncture without an anterior approach. There is no unnecessary movement, and the display is clear under the lens, and the operation can be done at will...

He felt that it was right for him to work hard to learn painting skills... After all, he felt flustered without any special skills...

(End of this chapter)