Oncology Physician Life

Chapter 54 Chapter 53 Da Vinci Surgical Robot
In the ward area, the doctors rounding the ward surrounded the beds of 18 patients.

Lying on the bed was a young man in his early twenties, who had just graduated and entered the company as an intern. During the physical examination, he found a gastric ulcer. After a few weeks, the stomach pain gradually worsened. He went to the hospital for an examination and found a stomach shadow.

Attending doctor Li Xiaojun handed the patient's stomach PET-CT film to director Qi Song.

Qi Song looked at the light, and Xu Youshu began to report the medical history: "The patient's film showed that there were large ulcers in the gastric curvature area of ​​the stomach body. Three weeks ago, there were symptoms of heart pain, free acid exceeded the standard, and the occult blood test was positive."

Ji Han glanced at Xu Youshu and asked, "If you were the attending doctor, what kind of treatment plan would you give?"

Xu Youshu has done his homework a long time ago. He has studied this case in advance, and he speaks with a lot of confidence: "The patient has a large area of ​​suspected cancerous ulcers in the curvature of the stomach. It is recommended that when the cancer cells have not metastasized to the cardia, remote Two-thirds of the stomach body was removed."

Ji Han continued to ask: "The patient has already shown the characteristics of twisted and hardened stomach. If two-thirds of the distal gastrectomy is performed at this time, an anastomosis of the gastric curvature and rectum will inevitably be performed with a stapler. In this case, the prognosis is not very good, and there is a high chance of empyema, or even peritonitis, have you considered this? What should I do?"

"This……"

Xu Youshu did not consider this point. Seeing that the eyes of the professors and doctors in the room were all on him, he immediately became nervous, "If, if it is not removed, palliative treatment is used, and the risk of tumor metastasis in the later stage is even greater. At that time, even one-third of the stomach body may not be preserved, and the whole stomach will inevitably be removed, which will greatly reduce the quality of life of the patient in the future."

Ji Han looked at Shu Yusheng who came back from Hokkaido University: "You think so too?"

Shu Yusheng glanced at Xu Youshu, who was also very nervous, and nodded: "I think Dr. Xu's consideration is very reasonable. For the sake of the patient's quality of life in the future, it is better to remove it."

Ji Han nodded: "Since you both think so, then you two will be divided into one group. Your research topic this week is the follow-up treatment of this case, including the specific operation plan. Before Friday, a summary will be published. Go to my mailbox, and the grades will be included in the daily internship performance evaluation for both of you."

"Good Professor Ji!" Shu Yusheng hurriedly responded.

Xu Youshu took a deep breath.

Seeing the team leaving after the ward round, the interns completely relaxed.

Shu Yusheng looked at Ji Han, who was unsmiling among a group of doctors, and frowned: "I feel that Professor Ji doesn't like me very much? Why do you want Dr. Xu and I to do this case alone?"

Tan Tan patted him on the shoulder: "Don't think too much, you may just come here and don't know Professor Ji very well. He is always cold to everyone on weekdays, never smiles, and treats the interns below, It's really super strict! You kid must do well, don't take chances!"

Xu Youshu sighed: "I originally wanted to take advantage of the holiday to go to the beach this week."

"Play?" Zhang Linlin knocked his head hard, "Please, Dr. Xu, what are you thinking in your head? You still want to play. If you can't finish the homework assigned by the third-line doctor this week, you can live forever." Go home and play."

As she said that, Zhang Linlin was furiously holding the folder, "I'm 31 this year, and I haven't even been in a relationship yet! Seeing that I'm going to be old! You know, my brother who doesn't live up to expectations, this year's child Three and a half years old, and my little sister is getting married this year and preparing to conceive, only me, only me is still single, don't ask me why! It's just because I chose to be an oncologist!!"

During the lunch break at noon, Jiang Li took some time to go to the ward to take a look at Qiao Andi who was about to undergo craniotomy in the afternoon.

The child didn't feel anything, and still maintained an optimistic attitude, and actually persuaded his parents to be normal.

Nurse Li Xiaomei came in with a stainless steel tray containing pure needles for Babinski's sign examination.

Li Xiaomei said softly to Qiao Andy, who was lying on the bed, showing two crisp white feet: "Don't be afraid, Andy, sister nurse is going to check you up, it will hurt a little, you have to hold it back."

Qiao Andy's eyes widened, looking at the sister nurse who took out the pure needle from the stainless steel tray, even though her eyes were full of fear, she still nodded bravely: "Well, sister nurse, I'm not afraid, I'm not afraid."

Lu Jiajia was on the side, cooperatingly holding Qiao Andy's ankle with his hand, making him lie on his back.

Nurse Li Xiaomei used pure needles along the outer edge of Qiao Andi's plantar, from back to front to the base of the little toe, and then turned to the inside.

After Qiao Andy's big toe was stimulated, he immediately stretched his back, and the other four toes spread out in a fan shape.

Jiang Li glanced at the side, signaling Li Xiaomei to stop.

Babinski's sign (Babinski's sign) examination is a common examination for patients with central nervous system tumors. A pure needle is used to draw along the lateral edge of the patient's plantar from back to front to the base of the little toe, and then turn to the inside. Test Methods.

If it is a normal person, his toes will show flexion toward the plantar surface, that is, Babinski's sign is negative.

However, if it is the same as Jo Andy's performance, showing the dorsiflexion of the hallux and the fanning of the other four toes, it is a positive Babinski sign.

This state shows that patients with upper motor neuron injuries, such as cerebrovascular accidents and spinal cord transection injuries, will have this manifestation.

Jiang Li took the results of Qiao Andy's cranial pressure examination last night. The intracranial pressure ICP (intracranial pressure) continued to be above 2.0kPa (200mm H2O) (normal value 0.7-2.0kPa), and the intracranial pressure was a bit high.

Jiang Li told Qiao Andy's parents: "The craniotomy will be performed in the afternoon. Come in and keep quiet in the ward. Pay attention to the child's breathing state. If the child has any abnormalities, please contact me immediately."

After finishing speaking, Jiang Li turned to look at Lu Jiajia: "Inform the operating room later, ask the second assistant to remember to prepare the scalp and blood, and ask the first assistant Zhang Linlin to open a vein before the craniotomy, and inject mannitol and furosemide (furosemide) into the child. m), promote glomerular filtration and NA absorption, and let the intracranial pressure drop first, reaching the critical point of surgery.”

At this time, Ji Han went to Lujiazui to attend an academic conference after checking the room. When he arrived at the hospital by taxi in the afternoon, the clear sky suddenly turned dark and the clouds were churning, which foreshadowed that a downpour might fall at any time.

He walked into the corridor outside the ICU, and Tan Jiadong was standing by the window smoking.

He lit one and took a big puff on his lips. The lingering nicotine made the man in his 50s look even more haggard.

In just a few days of seeing each other, Tan Jiadong's bags under his eyes became much deeper. Ever since Tan Jiadong quarreled with his two sons outside the ward last time, neither the eldest son Tan Weiguo nor the second son Tan Weijia appeared outside the ward for several days, as if they had completely disappeared. The audio is average.

Tan Jiadong's wife, Liu Fengzhi's condition cannot be delayed any longer, and the hospital office has also issued a notice to pay the medical expenses in arrears.

Seeing Ji Han coming from a distance, Tan Jiadong hurriedly snuffed out the cigarette butt in his hand and threw it at his feet, which made the cleaning lady beside him very angry: "How many times have I told you, you should go to the smoking area when you smoke. , Smoking is not allowed here in the ICU. Why can’t I understand after I’ve told you so many times? Every time there are cigarette butts and ashes all over the floor, you have to be considerate of our cleaning! Our job is not easy. !"

Tan Jiadong hurriedly apologized, knelt down to wipe the soot on the floor with his hands, but was stopped by the cleaning lady: "Forget it, forget it, don't use your hands, it's so dirty, I'll sweep it later!"

Tan Jiadong hurriedly nodded and apologized, and walked towards Ji Han: "Professor Ji, can you accommodate with the hospital, my daughter-in-law can't be discharged from the hospital, she's going to have an operation, she's going to have an operation!"

Ji Han stopped in his tracks: "I understand you very well, but the hospital is not a welfare home after all, and the hospital office has called for payment many times, and you have also defaulted on a lot of medical expenses. The hospital took care of you a few times ago, and it also reduced or exempted some. But the hospital office has investigated your family, and your family is not without financial conditions. Your two sons have good jobs and make a lot of money a year, so the hospital office may have no choice but to continue..."

Before Ji Han could finish speaking, Tan Jiadong suddenly gave himself two resounding slaps.

His wrinkled cheeks immediately turned red and swollen: "It's all my fault, my fault, why did I give birth to two white-eyed wolves, the daughter-in-law of the eldest and the second did not agree to operate on his mother, saying it was so big Older people can live enough, and they may not get better after the operation, and they spend a lot of money, but she is clearly only 55, younger than me, I can't help it, I can't help it, the family's money is given to two Son, do work for them, buy a house, marry a wife, do you think people’s hearts are fleshy? How could the two of them be so cruel and watch their mother die!"

Ji Han let out a breath, and shook his head: "There's no way, if your family can't make up the payment before five o'clock this afternoon, Liu Fengzhi will be discharged from the hospital."

Tan Jiadong remained silent, his back seemed to collapse all of a sudden.

He nodded, walked silently to the chair and called the eldest son, saying that if he didn't pay the money today, his mother would go home and die.

On the phone, the eldest son Tan Weiguo seemed very impatient: "Why are you rushing, I understand, I am busy now, I will call you back later."

Before Tan Jiadong finished speaking, the eldest son hung up the phone.

Tan Jiadong called his second son Tan Weiguo again, repeating the same words again.

There was silence on the phone for a long time before Tan Weiguo said in a low voice: "Dad, I won't tell you for now. Your daughter-in-law is by your side. You are looking for my elder brother. You let him handle the money matter."

Tan Jiadong looked at the phone that was hung up again, and gripped the phone tightly, tears streaming down his face.

The two sons are the treasures of the old couple. When they were young, the old couple of Tan Jiadong worked hard to make money, raise their children, and brought up their two sons. They thought that when their sons grew up, they could rest too!

Raising a son to guard against old age, raising a son to guard against old age, but how can it really wait until the two of them are old and sick, and become a burden that the sons dislike!

"Son, you are all the treasures in your mother's heart, how can you be so cruel! Let your mother die!"

Ji Han glanced out the window, the sky was terribly gloomy, a heavy rain that could fall in an instant, seemed to be threatening to engulf the entire city.

The dark clouds in the distance pressed down in large swaths, as if they were going to overwhelm people.

He glanced at Tan Jiadong, but said nothing. Every family has a difficult scripture to recite.

At one o'clock in the afternoon, the surgery center of the oncology department.

Today's operating room is still very busy, more than a dozen operating rooms are in progress almost at the same time.

In the first cloakroom of the operating preparation room, medical staff in green sterile gowns shuttled back and forth, making the cold corridor seem very busy.

The nurse pushed the five-and-a-half-year-old Jo Andy into the operating room, where the anesthetist was already waiting.

Dr. Sun from the anesthesiology department looked at the little boy with a watermelon head and smiled softly: "Don't be afraid, just sleep well for a while, and when you wake up, you can go out and play happily."

The five-and-a-half-year-old Qiao Andy turned his head around, puffed out his cheeks and smiled at the anesthesiologist: "Uncle doctor, will I be able to recover after the operation?"

Seeing the anesthetist nodding, Jo Andy giggled cheerfully.

The anesthesiologist began to prepare for deep general anesthesia, and the equipment nurse pushed the Da Vinci robot into the operating room.

The hospital uses the world's most advanced Da Vinci XI surgical system.

As China's formal medical care has entered the "precision medical era", minimally invasive robotic surgery has almost spread to major tertiary hospitals.

This Da Vinci surgical robot has two parts, one part is like a crab, with four mechanical arms for full micro-manipulation, and the other part is the main console two meters away.

The doctor operates the operation just like driving a car. Sitting in front of the main console, through the 3D eyepiece field of view on the control screen, the two hands control the joystick and the two feet control the pedals, and issue various instructions to the Da Vinci robot.

The four robotic arms in the front section, after receiving the order, accurately perform various fine operations such as movement, pinching, separation, resection, electrocoagulation, and suture.

When Qiao Andy entered the anesthesia, in the operating preparation room, one-assistant and two-assistant itinerant nurses rushed in like a tide.

Jiang Li had already changed into sterile clothes, stood in front of the stainless steel sink, put his bare arms under the infrared sensor head, poured cold disinfectant on it, tore off the disposable cleaning bag, took out a small brush to clean his nails carefully with the arm.

Lu Jiajia, together with Shu Yusheng, Xu Youshu, and four or five interns from the tumor surgery department, changed into sterile clothing under the guidance of the itinerant nurse.

While washing his arms, Jiang Li told them: "After the surgery, stand in the open space behind, don't move around, don't talk, quietness is the only rule in the operating room!"

Everyone nodded hastily, all of them showed excited expressions on their faces.

Zhang Linlin glanced at a few people, and whispered: "Wait a while to lift the child's celestial spirit cover, I see if you are still excited!"

After 10 minutes, the surgery is ready.

Jiang Li tapped the sensor at the door of the operating room with his foot, and the door of the operating room slowly opened.

She straightened her arms, and the roving nurse immediately put on the sleeves of the surgical gown that had been prepared a long time ago. Afterwards, Jiang Li turned around neatly and wrapped the surgical gown around her body.

The itinerant nurse took advantage of her turning around to fasten the laces of her surgical gown.

Several people cooperated with each other tacitly, and a set of procedures came down, and the interns showed envious eyes. When will I be able to perform this operation handsomely?
Standing under the arm of the da Vinci robot, Jiang Li moved the machine away to reveal enough space for the craniotomy operation. She looked in the direction of the monitoring nurse, and all the instruments had been turned on, and then she looked at the anesthetist.

The anesthetist nodded and made an ok gesture.

Soon, there was no sound in the operating room, and it was eerily quiet, except for the ticking sound of the cardiac monitoring equipment.

The hand washing nurse counts the surgical instruments on the operating table.

The second assistant is a two-year resident in brain surgery. He is a shy boy named Zhang Guo. With the help of the itinerant nurse, he has completed the intravenous access and prepared the scalp and blood.

Jiang Li glanced at the electronic time displayed on the wall: "Time, one thirty-three in the afternoon, the operation begins."

The brightness of the shadowless lamp was gradually increased, and Jiang Li put on goggles.

Before the operation, Zhang Linlin had already drawn eye-catching red craniotomy auxiliary lines on Jo Andy's five-year-old bare head according to the previous plan.

The red auxiliary line extends from the little guy's left ear to his right ear.

The intern looked at the screen set up in front of the operating table, not daring to breathe.

Jiang Li stretched out his hand to the side, and said neatly: "Scalpel"

The second assistant immediately handed over a shiny pointed scalpel from the equipment nurse, and handed it to Jiang Li.

Jiang Li pointed the sharp knife head at the red craniotomy line on Qiao Andi's scalp, raised the knife and began to cut the scalp, a line of blood oozes from the little guy's scalp.

As the incision was completely enlarged, Jiang Li took the scalp clip from the second assistant with his white rubber gloved hand, immediately clamped the cut scalp, flipped it over with his hand, and completely lifted the scalp , exposing the inner flap.

On the magnified screen in front of the operating table, one could clearly see the fluffy blood under the scalp.

Jiang Li stepped on the negative pressure suction device vigorously, and immediately, this layer of bloody velvet was suddenly sucked by the device, and was sucked into the liquid storage bottle from under the scalp.

The blood immediately dyed the white straw completely red.

Soon, the blood under the scalp was sucked dry, exposing the hard skull.

The female interns were so frightened that they immediately closed their eyes.

Before the interns got used to it, Jiang Li took over the electric drill from the second assistant!

Soon, there was a buzzing electric drill in the operating room, and several small holes as thick as thumbs were drilled out of Qiao Andy's hard skull.

The second assistant immediately handed over the chainsaw again!
The sound of the chainsaw pulling the skull sounds harsh.

Shu Yusheng could still pull himself together. When he was at Hokkaido University in Japan, he personally performed autopsies, and his expression remained calm.

Until, Jiang Li opened the last hole with a chainsaw, and a stream of blood splashed out from the small hole, splashing onto Jiang Li's mask and the surgical gown in front of him, soaking a large pool of blood red.

There was an exclamation from the crowd of interns.

Jiang Li glared in the direction of the intern, and said calmly, "Wipe the blood!"

The itinerant nurse immediately wiped the blood off Jiang Li's forehead and vision with a gauze.

Until Jiang Li used the clips to take out a shell-like gray bone flap about three millimeters thick, that is, the skull, and threw it into the stainless steel tray dragged by the itinerant nurse.

This bone flap, that is, the skull, will not be used anymore. After the operation is successful, Jiang Li will replace it with an artificial bone flap.

Following the removal of the bone flap, Qiao Andi's five-year-old brain was completely exposed to the surgical field. Jiang Li turned his head to look in the direction of the anesthesiologist, and asked, "How is the patient's physical condition?"

The anesthesiologist kept staring at the instrument: "The heartbeat is normal, the intracranial pressure is at a critical point, and the operation can be performed normally."

Jiang Li felt relieved and asked the equipment nurse to start preparing the Da Vinci surgical robot.

The equipment nurse moved the da Vinci surgical robot with four thick mechanical arms like a crab to the position in the surgical field of the patient's brain.

Jiang Li turned around and sat in front of the console.

The screen in front of her was magnified a hundred times, revealing the central nervous system of Jo Andy's brain.

Same as the results of the MRI test!
The tumor occupied the left basal ganglia of Jo Andy's brain, and there was a large area of ​​edema around it. The pressure on the left ventricle was obvious, and the midline shifted to the right.

The gray-white glioma, like a sudden foreign body, was stuffed into Joan Di's brain.

Moreover, this tumor is implicated with a bunch of nerve centers, and countless nerves are densely intertwined.

Some interns didn't dare to continue watching, and ran out of the operating room with their mouths covered, came to the window, opened the window, pulled off their masks, and breathed in the air in the dark sky outside.

In the operating room, Jiang Li began to operate the joystick to move the four robotic arms of the da Vinci surgical robot.

Craniotomy is also the most difficult of all surgeries.

The psychological weight of the chief surgeon is no less than a Mount Tai.

It can be said that there is a lot of fighting between square inches!
Each of her cuts must be just right, not one inch in, not one inch back, if you are not careful, you will hit the patient's central nervous system!

One wrong cut can lead to blindness, language barrier, and paralysis of the patient!
As the operation time passed, the dark sky outside the hospital suddenly burst into thunder.

In an instant, heavy rain came to the city.

The strong wind was mixed with a heavy rain curtain, and it hit the city with such force.

On the dark clouds, there seems to be a demon at work.

(End of this chapter)