medical simulator

Chapter 223 De-theorizing! (Please subscribe!)

Red flowers and green leaves, but all along, whether it is the Department of Orthopedics of the Kyoto University School of Medicine or the Third Affiliated Hospital of Kyoto University, when has it been a green leaf for others?

Therefore, what Old Gui said made Zhou Cheng and the others panic.

This is not a good compliment, and it can't even be regarded as flattery, and it's just a one-sided hatred. Zhou Cheng and the others don't even have an adult to answer the conversation, so they can only listen to what Gui Lao said.

They are not good at interjecting.

Immediately afterwards, Zhou Cheng and the others saw it, and the onlookers began to be unconvinced one by one, but perhaps because Old Gui, Pin Lu and the others were still there, they restrained themselves a little. Otherwise, someone will definitely come up and beat someone right away!
Why?
My own cabbage, no one in my family has to eat it, it was all eaten by others. It turned out to be a guest, and I have never seen a guest squatting on top of his head to shit...

After much difficulty, by the time Old Gui finished speaking, in fact, he had finished drawing hatred.

Zhou Cheng and the other five were all cowarded in a proper manner. From Zhou Muyun to Zhou Cheng, the five of them introduced themselves in a proper manner, and then performed the disciple ceremony to all the senior doctors above Peng Peng.

Then he lowered his seniority in a pleasing way to the Ph.D. and graduate students, hoping not to be targeted.

Although Zhou Muyun's move somewhat undermined the suspicion that Gui Lao and Pin Lu had set up for them, he didn't say much. It is estimated that they didn't take their words seriously, and they might still hope that Zhou Muyun and others would take them seriously. Seriously, I really feel that I am awesome.

However, the reason why it is not good to really put five people on fire is because Zhou Muyun and Zhen Xing are local students in Kyoto after all, one is from Hexie and the other is from Jishuitan. Come, then there is no need.

After Zhou Cheng and the others had finished introducing themselves, it was the turn of the students from Kyoto University to introduce themselves. However, at this time, Elder Gui said again: "Forget your names, you don't need to introduce yourself, you are not famous, and you are not famous. special."

"For the next operation, you should take a good look at it from beginning to end, how other people perform the operation, how others learn, and where the gap between you and them is."

After finishing speaking, Elder Gui turned his head and looked at Zhou Chengdao: "Let Doctor Xiao Zhou give you one of the surgeons casually."

Old Gui was the first to point at Zhou Cheng 'at will'.

Seeing Elder Gui pointing this out, Pin Lu and the others knew what was going on, and began to mourn and pity the students in their department again.

This Zhou Cheng doesn't look very 'serious', and has hidden a lot of skills.

Zhou Cheng was stunned for a while, then looked at Peng Peng and Mo Chengkong, Peng Peng stood up and explained: "The operation that Zhou Cheng performed before was the most difficult operation among the five of you, so, This operation is an extra operation."

"Let Zhou Cheng be the chief surgeon, you should have no objections?"

There is nothing wrong with Peng Peng's words. In terms of the difficulty of the operation, the transposition of the biceps tendon and supraspinatus performed by Zhou Cheng is the most difficult.

Under such circumstances, Su Min was scared and did not dare to take the lead.

It was Zhou Cheng who faced the difficulties. Under such circumstances, it would definitely be no problem to have one more surgeon.

Zhou Muyun and Zhen Xing raised their hands at the same time: "Mr. Peng, I apply to go on stage with Zhou Cheng."

Zhou Muyun's hands are tall and strong, they don't look much taller than Zhen Xing.

And after Zhou Muyun and Zhen Xing said this, Su Min's eyes were very alert and sharp: "Mr. Peng, according to the previous team assignment."

"Zhou Muyun and Zhen Xing are in a group with the tutor, and they are taking advantage of it!"

"You can't always take advantage of the cheap!"

A smart person will be very keen to catch any calculation that is beneficial to him, and whether he can tell it or not depends on whether it is worth it.

Everyone knows that Zhou Cheng's operational ability is very strong, but they all hope to see Zhou Cheng on the same stage, study closely, and pay attention to more details.

Zhou Muyun and Zhen Xing were already on the same team as Peng Peng and Mo Chengkong, and they wanted to come to Zhou Cheng to play the autumn wind, how could they agree?
Yu Heng said: "Teacher Peng, Su Min and I are not tired."

Another possible loophole was filled, and all suspicious paths were blocked.

In fact, when Yu Heng and Su Min said this, they didn't notice that they had already regarded Zhou Cheng as a very important person in the small team, even as a backer.

Peng Peng waved his hands to Zhou Muyun and Zhen Xing: "The operation is starting, follow the rules..."

Yu Heng and Su Min immediately stood up as the first assistant and second assistant, helping to put the patient on the operating table and do preoperative preparations, very happy.

Zhou Muyun and Zhen Xing could only stand by and watch quietly, knowing that it would definitely be impossible to snatch things from Yu Heng and Su Min through informal means.

They were just thinking secretly, since they can't be robbed, how can they take their things through formal means?
……

Around the operating table, Elder Gui, Pin Lu, Mo Chengkong, and a few people whom Zhou Cheng and the others didn't know and didn't know for the time being, gathered together and pointed there.

There are also a large number of students, thinking about it there.

Even because of losing the coercion of Old Gui and the others, whispers have already begun.

"Brother, are these people very good?" A junior who seemed to have just entered the department asked this question.

"Very good!"

This is the answer.

No matter how unwilling to admit what Gui Lao said, there is one fact that is certain, that is, the strength of Yu Heng and others is not comparable to that of ordinary people in the department!
Even Teacher Peng Peng may not be much higher than their clinical ability.

And you know, Peng Peng is Corey's deputy senior, Ph.D supervisor? ! ~
The pre-operative preparations finally came to an end in an orderly process, and then came the formal part of the chief surgeon.

The nursing team here is no worse than the team that Zhou Cheng met in Shanghai No. [-] Hospital. They are quite professional, and almost all of them will prepare the equipment sets one or two items in advance.

Yes, their instruments are arranged in sets, which proves that they are very proficient in the operation process!

Naturally, Zhou Cheng was not bad either. Without too much verbal communication, he directly filled the knee joint with a syringe, and left a Pichu at the surgical approach to avoid excessive blood loss.

These are small details. The inverted blade cuts the skin, goes outside the joint capsule, bluntly breaks through the joint capsule, and then the cored sheath of the arthroscope enters the joint cavity directly. The view inside the knee joint is made out.

After adjusting the angle, go in and out of the water to wash away the blood stains in the field of vision. The refreshing field of vision makes the operation smoother.

For all arthroscopic surgeries, the first step is always a microscopic examination.

The arthroscopic equipment here is also similar to that in Shanghai. It is a partial automatic equipment that can be operated by the operator to take pictures during the operation.

"Synovial folds, medial meniscus rupture, anterior fork rupture, and bone marrow edema are a typical medial triad."

"Let's take the tendons first."

The diagnosis must be made first, and only after the diagnosis can the surgical indications be determined. An autologous tendon transplantation of the anterior cruciate ligament is required.

Tendon extraction is also a basic skill. Basically, the parts to be selected are similar with minor differences. First, the gracilis and adductor muscles are selected, and then knitting...

There is a special tendon harvester for tendon harvesting, so the process of tendon harvesting becomes extraordinarily smooth and silky.

Zhou Cheng basically took out the two tendons in a very short time.

However, the two tendons taken out by Zhou Cheng are completely different from the tendons taken out by Su Min before.Su Min's tendon has a part of muscle tissue and needs to be rested.

However, what Zhou Cheng took out was only a very small amount of muscle tissue remaining, which meant that the angle at which Zhou Cheng cut out the tendon was extremely suitable, and the muscle damage was minimized, only the tendon was removed.

It may be a bit exaggerated to describe the tendon as thin as a cicada's wings, but like a white hairtail, it is very appropriate.

The total time to harvest the two tendons is less than 1 minute.

Simply, old and spicy.

……

"Do you see it?"

"This method of taking tendons? It's cleaner than a butcher's cutting meat."

Pin Lu muttered: "How many people have practiced this skill?"

The crowd was silent.

Technology is the general term for skills and techniques.

"Skill" is a kind of experience gained through specific practice, and its expression is a series of operational behaviors of the practitioner in the process of practice!

"Technology" is a generalization of certain essentials of the aforementioned series of operational behaviors (including the basic procedures of operation and basic steps of behavior).

In the field of medicine, whether it is internal medicine or surgery, the real master does not have too many fancy operating skills, how thrilling it seems, and even, compared with jugglers, the operation of the doctor seems to be more complicated. Unremarkable.

In other words, they are all just very simple operational skills, but such simple operational skills are often the content that creates miracles.

Technology is more important than technology, which has always been an unspoken rule in medicine.

Art, from another level, is a kind of cognition.

Technology is just your embodiment of technology, how you realize the reality or operation of your own cognition, nothing more.

Therefore, at this moment, Zhou Cheng's operation method, in the eyes of Gui Lao and others, is quite gimmicky.

……

After taking it out, Zhou Cheng handed over the tendon to Su Min without looking at the length, and then he and Yu Heng directly started the operation inside the knee joint.

"Exploring the hook!" Although Zhou Cheng had confirmed the rupture of the medial meniscus before, to diagnose the rupture, he still needed to detect whether the meniscus was unstable.

If there is no impact on stability, the ruptured meniscus needs only rest.If it has a certain impact on stability, it must be sutured.

Of course, even if the stability is good, it can also be sutured, which will have more protection for the knee joint.This is also one of the contents of knee protection surgery.

However, if the rupture of the meniscus does not affect the stability, it would be a slightly wasteful operation to suture it.

Different scholars have different understandings of this, but Zhou Cheng still advocates not suturing, only trimming.

Therefore, after confirming its stability with the probe hook, the bite forceps were used, inserted into the joint cavity, and slightly trimmed.

During the trimming process, Yu Heng and others discovered that the pliers in Zhou Cheng's hands were like nail clippers. It only took three or five strokes to strike where to point, but they were trimmed very neatly, and there were still The original radian!

This?
Ordinary people use pliers to do this kind of meniscus plastic surgery, it is all click, click, click, like being bitten by a mouse, it is very ugly and very uneven.

But what Zhou Cheng is doing now?
How is this possible?
How many times is this?

dream?

When Yu Heng came back to look at Zhou Cheng, he found that Zhou Cheng had put the jaw back in place, and then said to Yu Heng, "Extend your foot a little, I'm going to deal with the synovial fold below the patella."

"Oh, good! I'm sorry." Yu Heng realized later.

In fact, he was distracted just now, so he didn't follow Zhou Cheng's operation thinking, which was his dereliction of duty as an assistant.

Zhou Cheng shook his head casually. Then, after Yu Heng placed the knee joint in the corresponding slightly flexed position, Zhou Cheng used arthroscopy to expose the synovial folds, and the other hand used a plasma electric knife to remove the synovial folds. Fold so a little.

The synovial folds, which were like a fan, disappeared all of a sudden!
It's like magic.

Yu Heng's hands shook slightly.

"Finished?" he asked.

"Well, the synovial folds just need to knock out the pedicles."

"Bend the knee joint! We start to do femoral and tibial sinus tracts." Zhou Cheng said.

It took Zhou Cheng only half a minute to operate the synovial folds, as if he was juggling.

And just like that, Old Gui and the others saw the difference in Zhou Cheng's operation.

Precision!

fast!
Don't procrastinate.

After Yu Heng bent his knee joint again, his field of vision came to the stump of the anterior cruciate ligament in the intercondylar notch.Zhou Chengcheng cut off the stump, and then began to work on the femur.

In a state of flexion, a Kirschner wire is driven into the remnant of the anterior cruciate ligament in the intercondylar fossa of the knee joint, exits from the medial condyle, and then breaks through the skin...

Then start tunneling the femur.

The canal of the femur can be divided into several concentric circles.

calculation of depth,
Then it is the channel treatment of the tibial end, and the tendon is drilled with a locator.

The exit is chosen at the insertion point of the anterior cruciate ligament at the tibial tuberosity...

Zhou Cheng seemed to have rehearsed the entire process countless times.

As an assistant, Yu Heng didn't even know that the operation between him and Zhou Cheng could be so casual and smooth.

Yu Heng only knew that his consciousness was a little numb, and he was no longer as arrogant and unconvinced as he was in the morning.

All the while saying, "Can I?"

Zhou Chenghui: "Yes."

"Is that possible?"

"It will be all right."

Then it is really possible, it seems that no matter how he is Yu Heng's assistant, it is right.

What kind of knife is this?

After the channel was finished, Zhou Chengcheng looked over, and Su Min just finished braiding the tendons.

Zhou Cheng looked at the operating table, added a suitable loop plate, pulled it from the femoral channel through the guide wire, and shook it left and right, and the loop plate passed through the biisocentric channel of the femur just right. , reaching above the medial condyle of the femur.

Immediately after that, sort out the loop plate and adjust the length of the tendon appropriately so that the top of the braided tendon reaches the top of the large channel of the double isocentric channel. On an absorbable screw.

"Click!"

"Click!"

The absorbable screw rubs against the bone of the tibia, and the clicking sound is very sharp and sharp.

But after a few clicks, the clicking sound gradually became smaller.

After a while, Zhou Chengcheng removed the fixing screws on the tibial end.

There is still a certain amount of tendon tissue left at the end, which is the excess tendon tissue. Cut off all these tendons directly with a sharp knife.

It's better to be rich than not long enough.

Then, Zhou Cheng moved again in all directions, and after confirming that the current anterior cruciate ligament was handled quite properly, he slowly put the patient's feet on the operating table, and began to wash, sewing etc.

Next to them, Su Min and Yu Heng noticed from the corner of their eyes that the faces of the onlookers beside the operating table seemed to be a little strange, and then they raised their heads and found that many people were walking towards the operating table. Glanced back and forth on the nearby timing panel.

"00:38:35:74."

"Ah?" Su Min was very surprised, unable to calm down at all, and made a sound.

Su Min and Yu Heng trembled slightly.

In the last one, when Su Min was the chief surgeon, the operation lasted an hour and 10 minutes, or an hour and a half.If it was only about the length of time, Su Min could be beaten while hanging by Zhou Cheng.

Although Yu Heng couldn't see clearly what Su Min's expression was like at the moment, his fearful eyes betrayed him a bit.

"Su Min, what's the matter?" Zhou Cheng asked after hearing Su Min's words.

Su Min quickly shook her head, knowing that she had lost her composure too much. Now that Zhou Cheng was the chief surgeon, if he caused an accident in Zhou Cheng's operation because of his gaffe, then the crime would be serious.

"It's nothing!~" Su Min was a little absent-minded.

"Why don't I stitch it up." Zhou Cheng offered.

……

And just under the operating table, Gui Lao and Pin Lu watched the whole process of the key operation of Zhou Cheng's operation.

Elder Gui gave Pin Lu a look, Pin Lu understood, and tugged on Mo Chengkong's sleeve next to him.

In the name of senior doctors, three people left the operating room.Although other people were curious, they did not dare to imitate, let alone ask them why they quit.

Elder Gui, Pin Lu, and Mo Chengkong came out of the operating room and started asking questions in a hurry.

"Old Gui, old Gui, does this count as de-theorizing?"

"Is it a surgery that relies entirely on manipulation?" Mo Chengkong asked.

Mo Chengkong is the youngest of the three, so his inner doubts at the moment are the deepest.

The layman looks at the excitement and the insider looks at the doorway.

Perhaps, the students also noticed that Zhou Cheng's surgery was performed quickly and well, but they didn't know how to describe it as fast and as good.

Thief is awesome, so fucking sneaky, maybe it's the peak praise they thought.

But in fact, Mo Chengkong, although he looks like a fat man with a big head and big ears, after all, as a professor, he knows how to praise, or how to describe Zhou Cheng's current strength and realm.

De-theorizing means temporarily ignoring any details related to good prognosis and improvement in operation, but performing the operation according to the official version of a certain operation in a tortuous manner.

It can be said to be the most official surgical procedure, very basic, so basic that it does not involve any personal understanding and ideas.

For example, some people think that dual channels are not good, and they need to add horizontal fixing screws.

Some people think that where and what treatment can be done will make the prognosis of surgery better.

However, when these people, including Mo Chengkong, Gui Lao and other academicians, were improving and improving the operation, they were only improving the method, not simply improving the operation and technology.

Technical technology, in fact, the peak of a person's operation, is limited.

In layman's terms.

The quality of technology is related to technology and technology. Maybe a person's operation is not top-notch, but his understanding of the game and operation are top-notch, so he can also play well.

For some people, the operation has reached an unimaginable peak, and the details of each frame have reached the highest level of controllability. When he plays the game, he does not need to participate in and superimpose any understanding of the game. understanding.

Just follow the equipment route recommended by the system to produce equipment, and still be able to reach a very high level and win the game. This is a non-theoretical operation.

"It's not certain yet, but the possibility is very high."

"It's a miracle."

"I never thought that there are really people who can do de-theoretical operations in medicine. I can't even imagine it." Old Gui took a few deep breaths before finally uttering such words.

Pin Lu, who is currently the director of the sports medicine department, quickly thought of the crux of the problem: "Mr. Gui, let me ask a question. This Zhou Cheng, why did he perform de-theoretical operations?"

"Is he afraid that we will see his theorization, his operation style and genre?"

"Or, he just has no genre at all?"

Old Gui immediately shook his head: "No, it's not that Zhou Cheng doesn't have style, it's not that he doesn't have his own school, he has it, he just doesn't want to show it."

"So, his current operation was performed after he restrained himself."

"He's really a born surgeon."

"Okay, very good."

When he said this, old Gui's eyes almost glowed with light.

A person who can go to theory to complete the operation has a strong heart that ordinary people can reach.

After de-theorizing, the potential of a person who can perform an excellent operation will be unimaginable.

"Old Gui, old Gui. This little Zhou belongs to Hunan Province." Mo Chengkong felt that it was necessary for him to remind Zhou Cheng's current status so that Old Gui would not be overjoyed.

Sure enough, when Mr. Gui heard Mo Chengkong's words, he half-closed his eyes and said meaningfully: "Didn't you say that Xiao Zhou is not a student of the Affiliated Hospital of Shonan University?"

"Ah?" Mo Chengkong was stunned.

"Anyway, I haven't found my student status yet."

"The rest, leave it to the Admissions Office of Kyoto University." Gui Lao said again.

Pin Lu and Mo Chengkong: "..."

"???"

Not so much, right?

(End of this chapter)