Nineteenth Century Medical Guide

Chapter 284. 280. Cut the Bladder Wonderfully
【The operation process is the core of this book, especially the content that is closely related to the patient. 】

[Multi-picture warning, you can skip it if you don’t feel it]

If you want to do a good job in the operation, you not only need the doctor to have a solid foundation in surgery, but also to do sufficient pre-operative assessment and preparation.

The core of these modern tasks is the doctor's preoperative examination, and what the patient has to do is to spend money + cooperate.A powerful hospital management system will help patients arrange everything. As long as the patients are obedient and the doctors are serious and responsible, the risk of most operations is already very low.

But in the 19th century, doctors had limited abilities. The only thing they could do was to help patients manage their bodies well and create conditions for successful operations.

Over the past week, Erdem has been cooperating with the preparations.Including no smoking and no alcohol, as well as keeping some autologous blood for backup two days before the operation.Of course, the most important thing is intestinal preparation. After all, urinary diversion requires a long section of intestinal tube, and cleaning the intestinal tract is of great help to the operation.

This is the benefit brought by modern medical theory and practical experience, which allows Carvey to easily perform operations that other doctors cannot perform.

But if you want to make the operation exciting enough, you need to consider various details.

Radical cystectomy itself does not require a large incision, usually the belly button will do.If the urethral diversion is performed together, especially with the intestinal replacement diversion this time, the incision area needs to be enlarged.

Considering the operation time, the contents of the abdominal cavity, the slightly obese body of the patient, and the series of tasks that the assistants have to undertake, it is a huge waste of manpower to entrust the mindless work of continuously pulling the hook to the second and third assistants.

In fact, Carvey had already sent a design drawing to Laszlo Instrument Factory a few months ago, which contained several sketches of abdominal surgery retractors.

It's just that military orders were more important at that time, and Carvey had very few abdominal operations, mainly focusing on cesarean section, appendix and hernia that only required simple retractors.In addition, he was also devoting himself to the military doctor's trauma surgery, so he didn't rush.

Even when Carvey asked them to rush to work on the cystoscope a few days ago, he never thought about rushing to make a retractor.

However, with the escalation of Erdem's requirements, the operation method has been changed, and the time may be extended to 4-5 hours, and the retractor has become very important. 【1】

"Withdraw the hook, put on the retractor."【2】

Carvey asked the nurse to take out the bladder retractor from the clean surgical instrument bag, freeing up both Herman and Damirgang's hands to participate in the operation. At the same time, he did not forget to introduce:
"If you want to take the road of refined surgery, you can try to use the automatic retractors I developed. They can save manpower. There are several models, and the average price is around 50-100 crowns."

Intuitive surgical operation is the best demonstration [3]. Compared with the cystoscope and urinary catheter mentioned earlier, the retractor, which saves a lot of manpower expenses, is easier to accept.

And Carvey asked the factory to prepare not only abdominal retractors, but also smaller forceps retractors that are more suitable for maxillofacial and eye surgery. 【4】

"Eyelid surgery too?"

"Yes, you can go to the equipment factory to ask for details. They also support three-day return without reason. But if you want to, I don't think you will do things that violate the dignity of a gentleman for this little money. After all, Felix Mr. has filed a patent application for me in this regard."

Carvey fixed the distance between the hooks of the retractor, and brought the topic back to the operation: "Just now, Mr. Mosier and I have roughly cleaned the retroperitoneal lymph. We only stop the bleeding and don't deal with those lymphatic vessels【5】. Official free bladder."

Enlarging the incision, maintaining a good operative field, doing a good job of lymphatic dissection, and fully mobilizing the lesion are all important components of a wonderful operation.

However, for radical cystectomy, if you want to achieve the "excellent" standard, you may have to do more and more difficult than other tumor resections.

Because of the particularity of the location of the lesion, the bladder is next to the vital organs of many men.For quite a period of time after this operation was created, male patients more or less had erectile dysfunction that could hardly be improved. 【6】

And Erdem is from romantic France, which is different from conservative Britain and Austria. Even in his 60s, he still has very high requirements for that aspect.

If this was not taken into account, the life-saving surgery would have easily killed the rest of his life, and the wonderful surgery would have ceased to exist, and the patient might even be dubbed "killing hope for life" by the patient.

This is also one of the important reasons why Carvey postponed the operation.

"You must have thought about why I changed the date of surgery before. Newspapers and media have made hype about it, but the reason is actually very simple." Carvey carefully separated the structure between the bladder and the peritoneum, "That's what I was doing at the time. Capacity has not yet met Mr Erdem's expectations for the operation."

Anyone with a discerning eye can see that Carvey is fully capable of performing cystectomy directly, and is also fully capable of getting the patient to agree to the original surgical plan.

The reason why it was delayed for so many days was simply because of Edem's status.His identity determines that he must be satisfied with the choice of surgery, so that he has the opportunity to have a good relationship with the French.

Although the vast majority of Austrians on the stage are still trapped in the war seven years ago, they feel that France is the enemy, and they all feel that the Frenchmen lying on the operating table are too greedy for "health".But now that Austria has suffered a loss in the Prussian-Prussian War, it should also win over France based on the principle of France-Austria friendship and relying on Prussia.

This surgery puts Carvey under a lot of pressure, but for the audience, what matters more is what Carvey practiced.

"The diagnosis is a tumor. It's good enough to be alive. I don't know what else Mr. Erdem wants?"

"Before I say this, I still want to talk about a wounded soldier I met on the battlefield." Considering that everyone knows little about the X function, Carvey did not directly talk about the theory, but made up an example, "That The wounded soldier was shot in the buttocks, and the bullet passed through the skin, fat, muscle, and rectum, and landed just below the bladder, right next to the prostate gland."

"Is this wounded soldier related to today's operation?"

"Related." Carvey simply skipped the treatment process, and quickly said the result, "It took us more than two hours to help him remove the bullet and suture the ruptured rectum. The operation was successful, at least in my opinion Overall, he is satisfied. But after the operation, he encountered a rather troublesome problem."

"what is the problem?"

Carvey nodded: "Unfortunately, this is what Mr. Edem wants, otherwise he wouldn't be able to live for a moment."

“As expected of a Frenchman”

"This is the Academy of Surgery, not the Hofburg Palace. We should still focus on surgery, not those annoying political topics."

"Yes, Dr. Musa is right, let's talk about the wounded soldier. Could there be obstacles after the operation? Could it be the case before the operation?"

"Obviously not, he is very familiar with Hoynz Street."

"Maybe the bullet wound damaged something important?"

"The bullet hit the rectum just behind the bladder and didn't hit the front."

"That's the trauma of the surgery itself affecting his function."

"I also think it's an operation, so I reviewed the neuroanatomy of the pelvis again in the past few days, and I found something interesting." Carvey slowly peeled off the peritoneum on the top of the bladder, slightly surprised by Mocier He said under his gaze, "The normal process of ejaculation-ejaculation-elevation has nothing to do with the existence of bladder, prostate, sperm and even urethra."【7】

The amount of information in this sentence is so huge that the audience on the stage couldn't open their mouths to say a word in disbelief.

"What's that about?"

"The cavernous body of the vagina, to be precise, is the nerve that controls it."

Not long after a surgery started, Carvey threw out several new ideas, each of which was an update and improvement of existing medical theories and a major breakthrough.The most surprised audience was not them, but Mosier who was standing opposite Carvey.

For the past five days he has been virtually inseparable from the young man.The two assistants would sometimes go home to rest, but they basically lived in the hospital, and even lived in the same room for rest, just to communicate with each other about the details of the operation at any time.

Mosier was at a loss: when did he come up with this theory?
on the front line?
Or was it five days ago?
He has a lot of questions, but now that the operation is in progress, it is not good to ask questions suddenly, so he can only follow Kawei to continue to deal with the bladder.

The blood vessels on the bladder and the umbilical ligament wrapping the umbilical artery were separated. After cutting, the two slowly completed the separation of the top of the bladder.Then move the free surface down the surface of the bladder to gradually expose the retrovesical depression and incise the peritoneum. 【8】

"Here is the gap between the bladder and the rectum." Carvey used a scalpel and scissors to separate here [9]. "It is the nerve bundle that really affects the whole process, not a certain organ. So the injured person Although Bing only damaged his rectum, he still lost his bouncing function due to bullets and scalpels."

"Dr. Carvey thinks you can prevent erectile dysfunction if you keep those nerves?"

"Correct."

"Do you have proof?"

"No."

"What about the experiment?"

"nor."

"Is this too arbitrary?"

Carvey answered quite simply, with an attitude that doesn't matter whether you believe it or not: "You can leave any doubts to verify after the operation. According to the previous agreement, Mr. Edem will recuperate in Vienna for a month before returning home. You have plenty of time."

This is not the first time that Carvey has put forward a new point of view. After more than half a year of information shock, everyone is more acceptable than Mosier.

But at the same time, it also raises a new question, since the boob function is related to nerves, how to protect those nerves?

"First of all, we need to know where the nerves are." Carvey said, "The nerves that control the swelling come from the pelvic plexus, and a large number of them are distributed in the retroperitoneum, the anterolateral rectum, and the posterolateral aspect of the seminal glands, forming a sagittal plane network【10 】."

After that, he gently pressed the bladder, revealing the side anatomy:
"Before doing the side separation, let's look at the jing nang [11], the jing nang is an important anatomical landmark to identify the pelvic plexus. In a lot of previous exercises, Mr. Mocier and I have been able to distinguish this nerve proficiently. neurovascular.

The shape of the nerve should be more lateral, you only need to free the branch of the blood vessel, and do a small-scale separation and ligation near the side of the sperm to avoid the nerve.”

Mosier was completely bewildered.

Where have I ever worked with him to distinguish nerves and blood vessels? As a first aid, what he needs to do is to fight when the main surgeon separates the tissue, stop the bleeding in time when he sees bleeding, and hold the thread when ligation is needed. Sometimes he is also required to do it. Suture ligation.

He just passively accepted the tasks given by Carvey and tried his best to do his best.

In the past few days, I have learned to suture the deep abdominal cavity with a needle holder, and I have also learned to use a red-hot wire to do spot burning to stop bleeding.As for where the organization separates this kind of subjectivity from, it's not involved at all, and it can't be involved, because just keeping up with Carvey's rhythm is exhausting.

"Hey, when did I separate the blood vessels and nerves with you?" Mosier asked with a suppressed voice.

Carvey smiled, did not explain, and continued to do the side separation work: "...removing the accompanying blood vessels and nerves, we also need to separate the sperm on both sides of the bladder. As long as the border of the tumor does not invade them, Considering Mr. Erdem's energy, we still have to try to stay."

Suddenly, his hands and voice stopped at the same time, and when he looked at Mossière in front of him, he lost his voice.

Some audience members on the stage hadn't noticed the strangeness of Carvey, and asked again and again: "And then? What's left?"

Mocier, who had practiced with him for a long time, understood his current mood better. Kavey, who had devoted himself to the operation, was most worried about the growth of the tumor.

As cautious as he is, he will definitely consider various variables in practice, and will also make plans to deal with these variables in advance.But the variables are also divided into grades, among which the most unacceptable for Carvey is the tumor spread.

Mosier also stopped the hemostat in his hand and asked, "Is there any adhesion on the left side?"

Kavey nodded, and touched the outside of the tumor with his hand along the protrusion to the side: "Maybe there is also the prostate."

Mosier frowned: "It won't come together."

"As I told you before, I'm afraid this situation won't last."

Carvey sighed, pulled out his right hand for exploration, and said to everyone on the stage: "As more and more bladders become free, the scope of my exploration has also expanded. Mr. Edem's tumor did not grow backwards, but completely It deviates to the left side where it is located, and it has already involved the sperm. I am afraid that I will have to change the scope of resection for the previously scheduled surgery.”

(End of this chapter)