medical simulator

Chapter 219 Big brother, you still know how to play! (Please subscribe!)
The sports medicine department of the Third Affiliated Hospital of Kyoto is a very mature department that operates very quickly. There is a pre-anesthesia room between the turnover of the previous patient and the next patient.

Moreover, after leaving the operating room, there are multiple recovery rooms that can be used for the recovery of patients under general anesthesia, which greatly speeds up the turnover of operations.

As soon as the last patient left, Peng Peng said to Su Min, who was about to perform the surgery, "Do you want to confirm the patient's diagnosis and operation method before the operation?"

This question, Peng Peng will ask this question before each operation, and everyone has checked it very carefully in the previous few times.

The diagnosis is definitely okay.

Their current school system is to study theory first, then do rounds at the bedside, and then perform surgery immediately.

It is equivalent to only three patients at a time, and all the medical history and examination results of each patient are familiar by heart, and there is no possibility of mistakes or misremembering!
Of course, Su Min, as the chief surgeon, went through all the patient's preoperative examination results again!
"It's okay, Mr. Peng. I'm going to start the preoperative preparation." Su Min's tone was completely different from before.

Before, he had some scruples, but in fact, the number of patients he had dealt with was not a small number of similar patients, and he was not so nervous when he really stood beside the bed and the operating table.

Maybe this surgery can't reach Peng Peng's level, but I can still guarantee good quality, and it's good to do it according to my ability, and it's not shameful!
After being fully prepared mentally and physically, Su Min continued, "Zhou Cheng, Yu Heng, thank you for your help."

The mask and hat can cover Su Min's long hair and short beard, but they can't cover his white skin and eyes, and if you look closely, you will find that Su Min's eyelashes seem to be a little long, long Not quite like a man.

However, in fact, his voice is of that kind that is particularly vigorous.

"Okay." Zhou Cheng also nodded, and then looked at Yu Heng beside him.

It was discovered that Yu Heng's eyes suddenly became very sharp, as if he really wanted to have a feeling of surpassing Su Min.

I don't know if it's because of the first meeting last night that Yu Heng's aloofness was directly torn apart by Peng Peng ruthlessly. Today, he has become a lot more kind. Although he seldom talks, at least he dare not leave the crowd too far.

It's just that he still has a sense of superiority that he doesn't know where it came from, and a feeling of not giving in and not admitting defeat.

However, apart from being so complicated, his eyes on Zhen Xing were very complicated, and he seemed to realize that Zhen Xing's last operation was better than him, and also realized that Zhen Xing avoided losing The mistakes he made were the mistakes he made, and there were also some small flaws that Zhen Xing didn't understand.

However, overall, it is better than him.

According to this inference, he may really have the worst foundation among the five.

He didn't know Zhen Xing and Zhou Muyun very well, and this was the first time they had met, but Su Min, who was from Jiaotong University in Shanghai, had never had a positive response before, but Yu Heng could tell during the quota competition.

Although in the end, Su Min's ranking was slightly lower, but in fact, Yu Heng didn't know what Su Min's comprehensive ability was.

Therefore, although he was not convinced, he still had an unknowing hint in his heart——

What Peng Peng said may not be true.

Routinely sterilized towels, bound hands with sterile gauze and suspended, with sterile film on the outside.

Only after such an operation can we really start the operation of shoulder arthroscopy.

Before the operation of shoulder arthroscopy and knee arthroscopy, the joint cavity needs to be filled. However, there are about ten common approaches to the shoulder joint.

Su Min finally chose to insert the needle from the posterior approach to fill the joint cavity.

The posterior approach is often used as an observation approach and is the first approach established in shoulder arthroscopic surgery. It is located approximately 1.5 cm downward from the posterolateral edge of the acromion and 1–1.5 cm inward, that is, the “soft spot” behind the shoulder joint.

Therefore, before the operation, you must first find the acromion. Finding the acromion is the simplest basic skill for a sports medicine doctor. Zhou Cheng just touched it a little, and then along the posterolateral edge, each 1.5cm lower and inner , select Needle Insertion.

Put the hand above the shoulder, press the coracoid process with the index finger or middle finger, press the soft spot behind with the thumb, rotate the humerus with the other hand, and feel the position of the glenohumeral joint line behind with the thumb.

After the joint cavity was filled to about 60ml, the skin was broken with a sharp knife, and the subcutaneous tissue was bluntly separated with straight forceps and penetrated to the glenohumeral space, which is the space between the humerus and the glenoid of the shoulder.

During shoulder arthroscopic surgery, there are two gaps, one is the glenohumeral space, and the other is the subacromial space...

As a routine surgical procedure, it is necessary to start from the glenohumeral space first.

After the posterior approach for shoulder arthroscopy is completed, the core of the arthroscopic sleeve is inserted into the glenohumeral space, and the arthroscopic sleeve is inserted behind the lens under the protection of the sleeve.

The first step is to find the position of the biceps tendon. In this position, first observe the upper part of the shoulder joint or the articular cartilage part of the biceps tendon and glenoid.

Su Mincheng put the camera into the glenohumeral space, first adjusted the angle, and then moved forward slowly. His operation seemed to be very familiar with the operation he was going to do next, observing the humeral head and the cartilage part of the glenoid.

Then rotate the shoulders internally and externally, fully observing.

Proceeding forward, observe the upper and lower surfaces of the biceps tendon, the insertion point of the biceps tendon, and the superior labrum for partial tears.

When he got here, Su Min's operation was still very smooth, without any intention of stopping.

This is the basic skill, so! ?

but! ?

As soon as the camera is pushed in, all that can be seen at the time is the long head tendon of the biceps 'sleeping' there.

The reason why it is called sleep!
It is because the insertion point of the long head of the biceps tendon is completely disconnected from the lower part of the tendon.

Insertion point and tendon seem to be separated.

Each play their own way.

Seeing this scene, Zhou Cheng stopped the operation and was stunned!
Except for Zhou Cheng, Su Min, who was the chief surgeon, was in a daze at the time, and Yu Heng, who was in charge of the first assistant, had erratic eyes and a blurred mind.

The expressions of the 'bladder' person - Zhen Xing and Zhou Muyun changed drastically immediately. Zhou Muyun's eyes widened and he covered his mouth with his hand, while Zhen Xing next to him immediately moved his eyes to Peng Peng's body, as if Asking why?
Then, Zhen Xing saw it.

Peng Peng was also 'stunned' on the spot, but his blankness was different from theirs, like a wooden stake, he just stared and didn't respond to their strange expressions, as if he didn't know these people As if looking at him.

Mental quality is very strong!
"Mr. Peng, what is the preoperative diagnosis for this patient??" When Peng Peng, Zhou Cheng, and everyone else could sit still, Su Min couldn't sit still right now!
Now, he is the chief knife.

But now?
The intraoperative diagnosis does not match the preoperative diagnosis, and the intraoperative surgical method will also change. What should I do?
It's impingement syndrome that has worn out the long head tendon of the biceps!
But the tendon did not separate too much, and because of the interference of other soft tissues on the MRI, the ruptured end could not be seen! ? ?
This is not a simple shoulder injury surgery!
This is a major operation, and it is simply not something that ordinary students can do!It can even be said that it can be regarded as one of the most difficult teaching operations in the department.

"You continue." Peng Peng continued to order Su Min.

However, Peng Peng's words made Su Min's scalp tingle a little.

No?

Mr. Peng Peng, do you not understand the current situation?
This patient, the current diagnosis, he is wrong!

The technique of the preoperative talk is also wrong, you should find someone to come, right?

I continue?
I switch to open surgery now?

Once it was opened, it became a level IV operation, and Su Min did not dare to continue.

He laughed and said: "Mr. Peng, the actual condition of this patient is much more serious than expected. I think the difficulty of the current operation is beyond my operating ability, so I may not be suitable to continue to perform the operation. .”

"Teacher Peng, why don't you come to be the chief surgeon?"

Biceps tendon rupture is a condition requiring open surgery.

Cerclage fixation under shoulder arthroscopy is a technique that requires extremely high operating skills. In his own professional group, there are not many such patients.

Because if such patients are discovered before the operation, most of them will be sutured openly for the sake of insurance.Or it was closed by open sutures in prefecture-level cities.

Plus, this patient is again.

It is extremely rare that there is no way to see the rupture of the long head of the biceps tendon on the MRI.

The pre-operative conversation, pre-operative diagnosis, and intra-operative diagnosis were inconsistent. Does Su Min dare to continue to perform the surgery at this time?
Su Min didn't dare, because no matter how you put it here, it was the third hospital in Kyoto, not Ruijin where he was. His teacher, his team, and everyone he could rely on were not around.

Alone, even though she came here as a student, Su Min dared not do such a thing like tyrannical operations that were beyond her ability.

Peng Peng smiled, then looked at the others with great satisfaction, and asked, "All of you, has anyone read the informed consent form signed by the patient before the operation?"

"Has anyone carefully checked the specific information on the patient's plain film and MRI?"

This is not their job content, because they are here to study, not to be a bed doctor, and after a class, there is only such a short time, so it is impossible to complete the process of talking and signing, and naturally it is impossible to get the medical records to read This kind of thing.

They have long been used to managing patients without medical records, but what about reading films?

Who would have imagined that Peng Peng would deliberately dig a hole for them?

Even, Zhen Xing and Zhou Muyun once again glanced at the patient's preoperative MRI scan from a distance.

The result is still!
The shape of the long head of the biceps tendon seen on the MRI is very smooth, without any loss of continuity. It is almost impossible to diagnose such a patient through auxiliary examinations!

However, the gold standard for diagnosis in sports medicine is not plain MRI scans, but arthroscopy!

Look at the scene on the display screen of the arthroscope: the rupture of the biceps tendon far from the insertion point...

This shit?

Who could have imagined such a routine?
Moreover, such a diagnosis is inconsistent with the diagnosis of other patients in this section, unless the MRI of the next patient is replaced by this patient, and then the MRI of this patient is transferred to the next patient.

But it doesn't make sense. This group of patients should only have simple rotator cuff injuries?

So where is the patient's MRI?

"Come and try?" Peng Peng tried his best not to underestimate the strength of the five little ones this time.

He knew a general idea of ​​Zhen Xing and Yu Heng's abilities. Now that this operation has left Su Min in Bengbu, but there are still Zhou Muyun and Zhou Cheng, so he can look forward to it a little bit.

Zhou Muyun was in the same group as Zhen Xing, and Zhou Cheng formed a group with Su Min and Yu Heng. Of course, priority was given to those in the group.

Zhou Chengcheng asked: "In such a situation, Mr. Peng, do you still think we can be the main surgeon?"

This diagnosis and treatment procedure needs to be clarified. When Peng Peng spoke, it was Su Min who had already said that he was unable to do what he wanted. It must be confirmed that Peng Peng has already made an assessment of what they can do.

In this way, it can be called authorization.

What if there is a misunderstanding?

"If you feel confident, you can try." Peng Peng said.

Both Su Min and Yu Heng looked at Zhou Cheng, Su Min looked both expectant and fearful.Yu Heng was rather skeptical.But amidst the doubts, there was also a trace of fear.

Yu Heng knew Yang Yifeng, so after he learned that Zhou Cheng was from Hunan Province, he asked why Yang Yifeng didn't come.

Who is Zhou Cheng?How could it be possible that Yang Yifeng from Hunan Province did not come, but Zhou Cheng came instead?And it has never been heard of before, it shouldn't be!

After Zhou Cheng took over the position of chief surgeon, he didn't delay much, because Yu Heng and Su Min next to him were both knowledgeable people, and their kung fu was not weak.

Therefore, showing that he knows arthroscopic skills in front of them will not seem awkward at all, but only feels natural. Even, if Zhou Cheng knows nothing, that would be a strange thing.

Under such circumstances, that week's achievements were well played.

After Zhou Cheng took Su Min's position as chief surgeon, he politely said to Su Min and Yu Heng: "You two, thank you for your hard work."

Su Min and Yu Heng just opened their eyes to respond, and didn't speak, but the meaning was obvious, you go to work, what are you talking about?

Holding the arthroscope, Zhou Cheng checked the anterior portion of the inferior glenohumeral ligament and the middle glenohumeral ligament further downward.

Normally, the anterior bundle of the glenohumeral ligament attaches to the glenoid neck between two and four o'clock.The anterior joint capsule contains 3 separate ligaments with different attachment points.These ligament attachments are fairly normal, with only a small amount of synovial attachment.

Immediately afterwards, Zhou Cheng controlled the arthroscope to enter the inferior recess, and rotated the arthroscope toward the upper glenoid to inspect the glenohumeral ligament and labrum.The integrity of the glenohumeral ligament and labrum is also acceptable.

However, even at this moment, Zhou Cheng did not rush to open the next hole, but gently rotated his upper limbs outward. If the arthroscope can easily move forward in the joint, this phenomenon is called "Warren's passing sign". There is extensive ligament laxity.

Fortunately, this kind of situation does not exist. Peng Peng and others may not be able to know what they are doing, but Zhou Cheng, as the chief surgeon, must also pay attention to all the details that should be paid attention to.

But even so, Zhou Cheng frowned deeply!

Peng Peng walked out of the laboratory at this time, without saying a word, and didn't know what he wanted to do.

Zhou Cheng and others noticed Peng Peng's departure, Zhou Cheng frowned slightly, what does Peng Peng mean?
But in the end, Zhou Cheng continued to do it. With Peng Peng's authorization, he did not stop. The current situation is not beyond my expectation.At least according to the conventional process, restore all the operation steps of shoulder arthroscopy one by one.

I looked at the glenohumeral space before, but now I have to look at the subacromial space.

Immediately afterwards, Zhou Cheng took the arthroscope slightly out of the glenohumeral joint, inserted the prying core, and entered the subacromial space obliquely upward!
The arthroscope is re-entered from the arthroscopic sleeve, and the subacromial space is viewed again!

The subacromial gap turned out to be a mess!
There is a large amount of synovial hyperplasia inside, and the specific structure cannot be seen clearly at all. Moreover, when the arthroscope entered, the synovium was punctured.

A lot of bleeding red mirror.

"Back piercing!" Zhou Cheng shouted to the handwashing nurse.

Peng Peng washed his hands and came in. Seeing that Zhou Cheng was still operating, he raised his eyebrows, but he immediately understood what Zhou Cheng meant!Started to put on my clothes.

Then an assistant, Su Min, immediately inserted a lumbar puncture needle into the subacromial space from the front entrance to drain the water. Zhou Cheng immediately put the flushing fluid, and then washed the blood clean, restored the arthroscopic field of vision, and then Zhou Cheng moved up and down with the waist needle.

The needle for the lumbar puncture was found in view.

"sharp knife!"

After Zhou Cheng received the sharp knife, he punctured the needle along his waist and made another incision. After expanding it with straight forceps, he immediately started cauterizing with the plasma electric knife.

Clean up the joint cavity until only a small part has been cleaned and the shoulder joint capsule can be seen clearly, then Zhou Cheng called the hand washing nurse to bring the probing hook.

At this time, Peng Peng also finished washing his hands again, and walked to the side of the stage.It also seemed a little uneasy.

Moreover, Zhen Xing and Zhou Muyun, who were watching by the side, also washed their hands, put on their clothes, and came to have a close look.

Then Peng Peng found that Zhou Cheng suddenly ran to the gap between the shoulders again, frowned, and asked, "Zhou Cheng, what are you doing?"

The tone was exactly the same as before, as if he was simply asking Zhou Cheng what to do.

Zhou Cheng was operating: "I suspect that this patient also has rotator cuff damage. Generally, when the type 3 acromion has worn out the biceps tendon, the supraspinatus muscle closest to the acromion will definitely not be special. it is good."

"However, this patient's situation is a bit special."

"He doesn't have a type III acromion." Zhou Cheng calmly told Peng Peng what he saw, and moved the arthroscope to a position where he could see the acromion.

Zhou Cheng then looked at Su Min: "Does this patient have a history of trauma?"

"I remember that he has a history of trauma." During the ward rounds, Su Min asked about the medical history. Although everyone has heard it, Su Min must have the deepest memory.

"Yes! It was the fifth day after the trauma when I was admitted to the hospital. I came to the outpatient clinic only after the pain was unbearable, and then I was admitted to the hospital. The patient is currently 52 years old. He took an MRI in the outpatient clinic and showed acromial impingement syndrome. He is also suitable for his age. Then I took it in." Su Min quickly nodded and replied.

In the previous diagnosis process, it was only thought that the patient had acromial impingement syndrome, and a rotator cuff injury was suspected.

But, when you open it up, the first thing you see is a ruptured biceps tendon!

This made Su Min a little suspicious of life.

"However, I also saw just now that the biceps tendon injury of this patient is fresh, not old. And during the physical examination, no muscle atrophy was seen!"

"And the patient's MRI showed no edema in the tendon. Therefore, the patient is likely to have a problem with the MRI."

Peng Peng stretched out his hand and took the patient's shoulder joint capsule. After a little exploration of the deformity of the supraspinatus muscle, he suddenly saw the contracted supraspinatus muscle.

Then continued: "You continue to talk. Now you are the chief surgeon, and we are your assistants."

Peng Peng was very open-minded, and didn't say anything professionally related to disturb Zhou Cheng's thoughts.

Zhou Cheng said: "I also looked at the patient's supraspinatus muscle just now. It is a huge rotator cuff, and the retraction must exceed 5cm. This patient may eventually undergo biceps tendon transposition!"

"Yes, you are right, you continue. We have prepared the corresponding equipment. Tour, open the equipment bag!" Peng Peng immediately said to the patrol nurse in the operating room.

"????" Zhou Cheng raised his head and looked at Peng Peng.

Did you know the diagnosis of this patient long ago, or did you not know it long ago?I knew it a long time ago, why didn't I tell the correct diagnosis in advance, if I didn't know it in advance, what happened to the prepared kit?

Didn't you deliberately conceal your medical history in order to test us?

Oh my God?
You are a superior, you are a teacher, can we still trust you?

Peng Peng said: "You don't need to look at me. For this course study, all the patient's medical history, diagnosis, physical examination results, and film reading results, as well as the choice of surgery, are all up to you. I didn't say a word. I said it!"

"You didn't let me say too much."

"Since you have chosen to start from the beginning, you have to accept the end of this result."

The more Peng Peng said that, the more nervous Zhou Cheng and the others felt.

Especially Yu Heng and Zhen Xing, their backs felt cold, because before, they thought that Peng Peng was strong enough to be a teacher, so their previous operations were unscrupulous.

But now it seems that something is wrong with you, teacher?elder brother!
You know we are wrong, not saying a word, not making a sound, and still saying that now?Are you not afraid that we will make a mistake in the surgery?

……

The key operation of this operation is to re-fix the tendon.

You know, refixing the tendon is not as simple as suturing!
Under the strong pulling force and tension, if the place where the nail is inserted is not selected properly, and it breaks open from the middle with a bang, then this operation will develop towards an unknown and terrifying place.

Tendon is also very brittle, so in this case, it is best to have two nails driven in at the same time, which is the best choice.

These issues are difficult problems that must be considered before and during surgery.

However, this is not a problem for Zhou Cheng. Zhou Cheng's tendon reconstruction, tendon suture, and transposition are all at a perfect level. The only limitation is that Zhou Cheng has not done this himself under the operation of an arthroscope. surgery.

But he knew how to do this surgery, and he didn't need to learn it deliberately. He already had a corresponding plan engraved in his mind.

This is equivalent to after you have learned addition, subtraction, multiplication and division.

3*2+10÷2=?

You may not have done this calculation problem before, but you can still solve it with your own foundation.

Zhou Cheng chose to operate the supraspinatus tendon first.

The supraspinatus muscle originates from the supraspinatus fossa, passes outwards under the coracoid shoulder arch, and ends at the uppermost ossicle surface of the greater tuberosity of the humerus.It is tightly combined with the joint capsule to form the top of the rotator cuff and the bottom of the subacromial capsule. Such an anatomical position is destined to be the most vulnerable to damage under acromion impingement syndrome!

The supraspinatus muscle is originally located on the greater tuberosity of the humerus, and it will lose its original shape after being fixed.

At this time, Zhou Cheng immediately called the roving nurse to bring up the expander and rivets. He needed to suture the supraspinatus muscle first, and the suture method of the supraspinatus muscle is currently the most popular and most effective treatment method. The fixing method of the outer row of nails.

This required placing the rivet 15-21 mm distal to the greater tuberosity, and then using the suture bridge technique, a double row of positioning holes was made.

"Puncher." Zhou Cheng shouted again.

This is a routine rotator cuff suture procedure, so the nurse who washed the hands had already prepared it and brought it over.Zhou Cheng actually knew some better sewing methods, but there was no need to show them!
His current status is a student, not a teacher, so he doesn't need to pretend, he just needs to hand in an answer sheet.

However, Peng Peng before gave Zhou Cheng the best example of how to submit the answer sheet!

It would be nice to be comparable to Peng Peng...

This hole punch is not electric, but manual, because the expander will not allow electric instruments to enter.

First implant two inner rows of rivets X Bio-Corkscrews FT (note: the following values ​​are directly replaced by rivets), the rivets have thread, and the suture needs to be passed through the rotator cuff tissue with a threader, and then knotted in the body .

This requires the use of a surgical instrument, the Scopion.

This instrument has a curved needle head, which is much lighter than the traditional method of suturing with ordinary straight needles.

This step is key.

If the thread of the rivet cannot pass through the rotator cuff, it is equivalent to the thread connecting the two nails, which fixes a loneliness.

This manipulation requires very high sensitivity and intense concentration.

After the two threads were taken out from the entrance of the shoulder joint through the green thread, they were inserted into the needle hole of Scopion, and then Peng Peng passed the position of the exit of the suture, and put the Scopion needle (note: the needle used below) instead) into the shoulder joint.

Peng Peng had known what Zhou Cheng meant a long time ago, and immediately pulled the supraspinatus tendon closer to the greater tubercle without ordering, and exposed the position of the needle to the most suitable place.

At the same time, Zhou Cheng also placed the camera in the farthest but most comfortable viewing position, so as not to block the second assistant Su Min's pincers, nor Zhou Cheng's stitches.

The suture needle quickly penetrated into the tendon of the rotator cuff with sufficient operating space and vision.

After threading a stitch, Zhou Cheng immediately held the pliers with the other hand to catch the thread sent over.

This operation takes less than three seconds.

Peng Peng was taken aback at the time, thinking that he had read it wrong, and blinked, but saw that Zhou Cheng's hands had indeed pulled the thread firmly.

This method?At this speed, many children with question marks came out of Peng Peng's heart.

During this process, what normal sports medicine physicians should not do is to first expose the grasping forceps to the field of vision, then move to the point where the tendon line has passed, and then compare it left, right, left, right, back and forth.

Open the pliers again and bite, then pull and test it, if both sutures can be pulled out, it proves that it has been pulled, and then he will withdraw the stitches?
how?

What if you don't follow the routine?
Surgery continues.

Pulled the remaining thread back in and then pulled it out again.Then the other two strands of the other rivet were fixed to the tendon in the same way.

The entire operation process was very refreshing and only took less than 8 minutes.

But in fact, this is one of the most time-consuming and difficult points in the rotator cuff suturing process.

What, is that the solution?
Zhou Cheng did it happily, and said: "Next, we will separate the two bundles of sutures and tie them into knots, and then insert the knotless anchors into the bone ends of the outer row. The inside will form an open 'zone' shape."

"Before that, we need to tie a knot." Zhou Cheng was explaining his intentions, otherwise, all the situations would only depend on his understanding, so as not to make mistakes.

At this time, a special arthroscopic knotter was needed to tie the knot. Zhou Cheng quickly used it. With just a little force, the upper edge of the supraspinatus returned to the position of the upper edge of the rivet.

Then pull the lower edge over.

Play the nail track of the outer row of nails again.

The four sutures of the upper and lower inner rows of rivets are distinguished, and one of the upper and lower sutures is passed into the knotless anchor, and then driven into the upper row of the outer row of nails.

Pull the suture taut.Immediately begin tapping the knotless anchor until the laser-marked line is submerged in the cortical bone.Turn counterclockwise for 6-7 weeks to cut the thread.

After Zhou Cheng finished operating one, he thought that this was Su Min's assessment, and then looked at the time on the operation timing panel. Cheng felt that his technique was okay.

He said, "Su Min, will you handle this knotless anchor?"

Knotless anchors are threaded, and they will be embedded inside after being knocked in, which is very stable, but if the nail channel is too loose due to excessive force, it will be unstable.

Su Min was stunned for a moment, looked at Zhou Cheng with complicated eyes, and said hello helplessly!

Although what Zhou Cheng said now is suspected of rewarding opportunities, but what Zhou Cheng seized before was the opportunities he gave up, and he was able to complete the operation so well.

This is his ability and strength, he also told Peng Peng himself, it is beyond his ability!
This is a grade IV operation, and it can even be said to be one of the most difficult operations in sports medicine!
While Su Min's heart was stirring, he quickly took another knotless anchor, quickly folded the silk thread, and passed the self-contained threads of the remaining two inner row nails into the pinhole of the knotless anchor. go.

Then it penetrates through the sleeve to the position of the nail track in the outer row.

tension!

After the tension is equal to that of the upper and outer rows of nails.

He winked at Zhou Cheng.

Zhou Cheng also immediately completed the thread-cutting operation, so Zhou Cheng naturally gave up the main operation position to Su Min.Su Min finished this critical operation, and when he was about to come out, Zhou Chengcheng said, "Su Min, go ahead."

Su Min felt that Zhou Cheng's tone was very familiar. It was the tone she used to speak to her seniors when she was in the department. It was to take care of their feelings and not embarrass them. Kind words to them.

He himself felt at the time that he absolutely did not mean to be arrogant.

But when he changed from a speaker to an obedient person, his mood was still different.

But fortunately, this operation started from him and ended from him, from the beginning to the end, this is the respect Zhou Cheng gave him, and there is no other meaning!
Although Zhou Cheng retreated to the second line, everyone, including Peng Peng, glanced at Zhou Cheng inadvertently.

That look seemed to say, although everyone is very powerful and knows that you are a bit powerful, but you are so ruthless for the first time, isn't it a bit too much?

Peng Peng slowly took off his surgical gown.

In the audience, Zhen Xing and Zhou Muyun were whispering.

"Junior Brother Zhou, can you complete this operation alone?"

Zhou Muyun's expression suddenly became very serious: "It's a bit difficult, but with some time and familiar assistants, it should be possible!"

"But, isn't it like this?"

"He is controlling time." Zhou Muyun is tall, his eyes are very sharp, tall and fat, his condescending gaze is a bit blurred, as if he is looking up at someone.

"Teacher Peng completed the operation in 22 minutes. Before that, Yu Heng completed the operation in 24 minutes. Brother, you completed the first hand speed Hu in 28 minutes."

"The current time is only 22 minutes. The second half and the first half are still done by Su Min."

"So, this Zhou Cheng, he's not playing with us, he's playing with Teacher Peng Peng!" Zhou Muyun looked like he was facing an enemy, and he was no longer as calm as before.

Tall and fat, he is not as simple and honest as before.

Because Zhou Cheng didn't bring them to play, it was quite abominable, but it was a pity that Zhou Muyun was going to play the next one. He didn't know if he could do what Zhou Cheng did, but he was sure of one thing.

That is, Zhou Cheng has already played with Peng Peng.

……

Zhou Muyun could see that, as a teacher, how could Peng Peng know nothing?
Even, just when Zhou Cheng returned the operating position to Su Min after finishing the crucial operation, Peng Peng's heart skipped a few beats.

isn't it?
This Zhou Cheng, he wouldn't want to return the operating position to delay time, would he?

Is this just to save face?Are you still stepping on me?

Interesting, interesting!
Peng Peng was delighted, because he hadn't been able to find a friend with whom he could fight equally for a long time.

Those who can beat him now are all he can't beat!
"Let's start the third operation. You, come to be the chief surgeon." Peng Peng pointed to Zhou Muyun.

……

Then, for the third case in the second lecture, it was Zhou Muyun's turn to perform the surgery.

This case was due to the unexpected situation of the patient that Su Min encountered before, so this time, Zhou Muyun carefully read all the patient's information again.

After finding out that there was no accident, his mood was a little complicated.

Because, if they are all such routine cases, even if his data in all aspects surpasses Zhou Cheng, it will not help?
They are not questions of the same level of difficulty, so is it meaningful to have high and low scores?
Of course, this did not prevent Zhou Muyun from going all out in order to express himself. In the end, the time he completed the operation was shortened to 10 minutes.

Just horrible.

For a rotator cuff suture, the total time from the beginning of the operation to the end of the operation is 10 minutes.

In general places, it is basically an hour to go up!
You also need to know that this Zhou Muyun is just a student, his age is unknown, and his grade is unknown!
After Zhou Muyun finished his operation, today's class finally came to the lunch break in the afternoon.

It's already 12:30.

Because they are taking care of their own food and lodging, and there is a lunch break, they have to go out to find food. In fact, they are looking for food opposite the hospital or opposite the hospital.

This time, the five of them got together, and even Yu Heng didn't have such a special arrogance anymore.

There are different tastes in different places, so just choose to eat noodles, and finally add seasoning by yourself.

Zhou Cheng almost booked out the chili pepper, and added two spoonfuls, which didn't taste right.

Zhou Muyun and Zhen Xing persuaded Zhou Cheng to add some garlic to taste, but Zhou Cheng couldn't appreciate it, so they imitated Zhou Cheng and added some chili oil, and each of them became a pug, laughing and crying. Out.

Looks a bit like an actor.

However, after eating, Zhou Muyun and the others did not just leave. Instead, they each ordered a bottle of water and asked, "Do you think this training class is weird?"

"From the time we came, to now, there is only one teacher. Then all the patients are prepared in advance, and there are no crowds of onlookers, as if we don't exist at all."

"In the operating room where we are the chief surgeon, there is no one who accidentally goes wrong."

"So I think we may have been tricked by the Kyoto Third Hospital!"

"My guess is this. It is possible that our courses and the entire operation are being broadcast live, and there are other people in other places monitoring our every move during the learning process."

Zhou Muyun's words made Zhou Cheng and the others think about it, but they didn't think it was particularly credible.

Seeing that no one responded, Zhou Muyun said, "Really, you have to trust me, because our Peace Association did the same thing in the past..."

"???" Several people scratched their heads and looked at Zhou Muyun, with a rather persuasive look in their eyes.

Zhou Muyun was the first person to expose his identity!
Peace!

Brother, you know how to play! ?

(End of this chapter)