Gou in the operating room to add some upgrades

Chapter 196: Small surgeries can still make a difference (please subscribe)

By accurately finding the appendix, the operation is actually 70.00% complete.

The diagnosis had been confirmed before surgery. Apart from the infertility of 47XXY syndrome, it was simple appendicitis. Therefore, there were no surrounding abscesses or adhesions.

When there is no adhesion, it is in a free state.

Fang Xian's medical examination was not only able to touch and identify the colon, but also able to directly take out the appendix just right without squeezing it.

Even when the level of routine medical examination reaches level 4, some people have control of the strength and can pick out blood clots with one hand without breaking. This is the basic medical skill of level 4 routine physical examination. At level 4, a different concept and development direction...

There is no such thing as crushing.

Fang Xian's hand pulled out the appendix like a sheep.And it was pulled outside the incision.

"Dr. Fang, you can do such a small operation in advance, can you do it in advance?"

"What about your physical examination operation?" Huang Qian became confused.

This is another basic operation that requires at least level 4. How many advanced basic skills does this force have?

Fang Xian only smiled back and did not gossip.

The surgical process is all about curing the disease.

If it is a standard appendectomy, you can use forceps or hemostats to lift the distal end of the appendix, then expose the mesenteric root, clamp, cut, and suture the blood vessels at the root.

Mobilizing the appendix and avoiding appendiceal artery bleeding are other basic points of appendectomy.

But Fang Xian doesn't have to do this.

There was no way. His routine medical operation was at level 5, and his hemostasis was also at level 5. So, Fang Xian pinched the distal end of the appendix with his index finger and thumb, and then used his middle finger and ring finger to directly cut the root of the mesentery like this. Clamped.

After carefully feeling the narrowing of the blood vessels, Fang Xian pushed the retractor with his abdomen without clamping.

I just took the knife and started to cut off the mesangium.

Pressure to stop bleeding, a concept of level 4 hemostasis, was played by Fang Xian to the fullest at this moment.

Of course, Fang Xian did this not to show off his skills, but because his basic medical skills were too solid. As long as the quality of the surgery could be guaranteed, there would be variables in the original basic skills.

At this time, Fang Xian held the mesangial artery between the index and middle fingers of his left hand, and held the suture needle in his right hand and began to suture.

Of course, Fang Xian packaged the root of the appendix, the purse-string sutures to be performed on the cecal wall, and the sutures to be performed on the mesoappendix.

Of course it cannot be done by one person, but by two people.

"Doctor Huang, you do the stitching and I'll do the suturing. This can save some time." Fang Xian ordered.

Huang Qian said with a bitter expression: "Dr. Fang, I thought you didn't have stitches?!"

Fang Xian glanced at Huang Qian with an incomprehensible expression.

I'm doing the surgery seriously, and I'm trying my best to save the patient's surgery time with my operations. Are you kidding me?

Huang Qian quickly started operating without saying more.

After the purse string was sutured to the end, Fang Xian removed the suture needle, and Huang Qian finally used hemostatic forceps to replace the clamping position between Fang Xian's index finger and middle finger.

On Fang Xian's side, after all the preliminary preparations for purse-string suturing were completed, he clamped the root of the appendix and released it for ligation.

After the appendix is ​​severed, the stump is disinfected.

Use purse-string suture to bury the stump in the cecum, and clean the abdominal and pelvic cavity.

There was no pus, so it was simple suppurative appendicitis. The abscess was localized and not ruptured, so it only needed to be disinfected again and rinsed twice after Huang Qian's sutures were tied.

At this point in the surgery, you can start suturing.

"Tourist, prepare some saline and dilute iodine complex." Fang Xian called to the roving nurse.

At this moment, the circulating nurse was sitting in front of the timing panel, checking her cell phone.

Hearing this, he turned around and said, "What?"

"Prepare some cleaning supplies." Fang Xian said politely.

The instrument nurse watched Fang Xian's operation throughout and explained: "Sister Zhu, the operation is over. Can we suture after flushing?"

"Isn't the operation only a little over three minutes?" The circulating nurse walked toward the medicine cabinet in confusion, her voice inexplicably joyful.

After hearing the words of the circulating nurse, the anesthesiologist, who was like an old monk who had just meditated, also stood up, stood on tiptoes and looked at the operation, and then looked at the timing panel in the operating room.

This moment jumps to 00:04:04.
In 4 minutes and 4 seconds, the operation was completed.

His expression was a little confused.

Huang Qian swallowed his saliva slightly.

However, Fang Yun's brows furrowed slightly.

His proficiency in appendectomy is still not that high. At this moment, Professor Zhu Daotao has probably completed the key operations to rescue a patient's blood vessel-related disease, and is waiting for him to suture it.

In fact, there is still a gap.

"Dr. Fang, how many appendices have you cut before?"

"I think the technique you used to cut the appendix just now seems unusual." Huang Qian hesitated for a while and asked.

Although appendectomy is an entry-level skill in surgery, its development has reached a limit precisely because it is an entry-level skill and a basic skill.

Few people will improve and modify the appendectomy procedure.

"The first one. I'm not familiar with it." Fang Xian was thinking about how Professor Zhu Guangyu compressed the time of arterial surgery to such a short time.

He was just an assistant before and had never thought about such a problem. Now that he has completed a formal operation, he will think about it.

Doing your own incision definitely saves a lot of time.

There was no time wasted in searching for the appendix. The incision of the mesoappendix and the direct replacement of suturing with hands saved time...

"Are you crazy? (Are you sick?)" Huang Qian was so stimulated by Fang Xian's words that he blurted out local curse words, but immediately shut his mouth.

Appendicitis is a serious surgical operation after all. It is an operation and you are done in 4 minutes.

You seem a little dissatisfied.

Can you be a human being?
Huang Qian thought he was really here to give Fang Xian the truth, but he ended up standing at the bottom of the well, and Fang Xian ran away. At the mouth of the well, he lamented that his operation was slow or something.

Fang Xian came back to his senses.

After looking at the strange expressions of everyone in the operating room, he pursed his lips and did not reply.

He knew that he might have used too much force in his emotion just now, and he also knew that the words he just said were a bit hateful.

However, different people have different standards. He didn't have much idea about the complete operation, so he needed to slowly summarize what should be done to make the operation better, instead of looking back. , my surgery is as good as it is done.

It is estimated that an appendectomy has almost reached its limit. However, Professor Zhu Guangyu is very proficient in vascular surgery and can basically perform it as an assembly line, which makes it as fast as a horse.

Needless to say the rest.

After cleaning, Fang Xian honestly began to perform full-layer sutures by himself.

Huang Qian's professional title and seniority are higher than his own. Although he is an assistant, he must do the finishing touches himself.

The appendectomy, apart from the sutures assigned to Huang Qian to stop the bleeding, and the contribution of the emergency department doctor to accurate diagnosis.

[You caused 102 damage points to appendicitis through appendectomy and gained 102 skill points.]

[You caused 49 damage points to the incision after appendicitis surgery through suturing, and gained 56 skill points.]

158 skill points were credited to his account, and Fang Xian felt very happy.

Although it is said that after such a small operation, it is better to wait for the bill to be collected, but this is also an opportunity for me to be formally exposed to surgery, to actually complete the operation, and to gain a lot of skill points.

Fang Xianke still remembered that when he first got this panel, Professor Lin Jiemo completed the fracture surgery, and his contribution rate was only 2 thousandths, and he got 2 skill points.

Fang Xian still remembered that once a blood vessel accidentally ruptured, and after he saved his life through hemostasis, he suddenly gained thousands of skill points.

From now on, days like this will no longer be rare. Even if it is a basic surgery or a simple surgery, the benefits of skill points are still not comparable to that of being an assistant.

At least it can be compared to simply being a sewing craftsman.

However, compared with doing a complete operation, the sense of gain and happiness gained from doing a suture craftsmanship training are not at the same level.

……

After Fang Xian told Huang Qian that the patient would be sent back to the general surgery department, he left the operating room first.

When Fang Xian arrived at the door, he heard discussions coming from the operating room. "Doctor Huang. Who is this doctor? He seems to be pretty good at pretending?" asked the traveling nurse.

The anesthesiologist also said: "I almost thought I heard it wrong just now. The first appendectomy can be done within 10 minutes, and the suturing starts in about 5 minutes. Are you still not very proficient?"

"Fang Xian, Director Fang Yun's nephew! He's very awesome."

"The level 5 skills you possess are calculated by pile, in Central China."

"It's the Central China Region, not our Hunan Province Skills Competition. There, he showed 5 or 6 level 5 skills. Do you know what this concept is?"

When Huang Qian said this, he added: "I was distracted just now, so I didn't react, but in fact, compared to what Dr. Fang just said, Dr. Fang's previous record is awesome."

"The level 5 skills are packed with you."

"That's it!" After hearing Huang Qian's explanation, the anesthesiologist suddenly understood.

Everyone has different requirements for themselves. It is understandable that such a proud person should be stronger.

I just want to mess with him, it's too inappropriate...

After Fang Xian left the operating room, he suddenly discovered a very critical problem.

That is.

Appendectomy, in the traditional sense, has a relatively standard procedure.

For example, after finding the appendix, when separating the mesoappendiceal membrane, the procedure is usually to sew and tie it first, then remove the mesentery, and then perform purse-string sutures...

But Fang Xian himself had just become successful during the operation. He directly used the concept of hemostasis to stop bleeding and cut off the blood with his bare hands, disrupting the operation process and saving a lot of time during the operation.

The mesentery is cut first, and then the surgeon sutures his own purse, and the assistant sutures the mesentery and ligates the artery to stop bleeding, which can save operating time.

This is actually an innovation, an innovation in the surgical process.

However, it is of little significance, it will not improve the final quality, and it has relatively high requirements on the hemostasis of the surgeon. Even if the hemostatic forceps are used to clamp and stop the bleeding in advance, suturing still cannot save a lot of time.

In other words, Fang Xian inadvertently made a small innovation in appendectomy with high-level basic medical skills, but it was of little use. It only made the operation more difficult and saved a little time. Innovation.

You know, people with level 5 hemostasis skills will basically not do an appendectomy like him.

“Basic medical skills are too malleable?”

"There are many micro-innovations that can be made in every medical operation, but it is hard to say whether it can directly improve the quality of the operation. There are many uncontrollable factors. However, high-level basic medical skills are easy to use."

"At least it saves time." Fang Xian's mind was calm, and his whole person became particularly comfortable.

Although this kind of micro-innovation is useless, it is also an innovation, which means that my current Ruyi-level skills can make a crazy impact on traditional surgical methods.

Step by step?

For some people, it is definitely necessary to go through the process. Only after completing the process can they control every step of the surgical process.

But as far as the other party is concerned, it is not necessary.

Some procedures are for hemostasis, and some procedures are for exposure.

For example, today, Fang Xian's level of hemostasis and incision is very high. He can cut directly down without using an electric knife, and there is almost no bleeding.

There is also the operation of routine medical examination.

I thought it was not very useful, but it plays a key role in diagnosis.

But now, Fang Xian knows that he was wrong, very wrong!

This basic medical skill may be one of the most useful skill operations among all medical skills. It is comparable to a magical skill!It's just that I never had the chance to experience it before.

Isn't it great to be able to directly touch what is specific and also feel the changes in the blood supply inside?
Suffice it to say.

Fang Xian feels now.

Other operating skills can be improved through the accumulation of experience and repetitions.

But this basic medical examination, TM is a gifted job, related to your sensory organs and absolute body sensation.

As big as a surgeon.

At this point, Fang Xian finally understood why Professor Zhou Cheng and Professor Yang Yifeng both regretted that they could not reach this step.

Being at ease, what is wishful thinking?

Although Professor Yang Yifeng had already explained it to himself, now, Fang Xian realized the happiness that was as great as that of a surgeon.

Now you can enjoy the surgery and enjoy the fun of the operation.

The quality bottom line of the operation is guaranteed, but the process can be full of randomness and arbitrariness. Under such circumstances, surgery is not just a simple operation, but a simple repetition.

For example, let’s review this minor surgery.

If Fang Xian performs an appendectomy next time, Fang Xian can definitely increase the speed even faster.

He went down and cut the appendix directly, and then used powerful hemostasis to stop the bleeding.

Isn’t it just a few tens of milliliters of blood?What does it matter?
In an operation, the blood loss can reach up to one thousand milliliters or two thousand milliliters. It is common in the operating room.

For another example, Fang Xian is even thinking about whether he can use puncture to embolize the appendix artery directly, and then use puncture to directly seal the appendix nerve, and then bandage it.

After the patient enters the operating room, the appendix is ​​removed directly through a single-port laparoscope without anesthesia.

Finally, a ring ligation is performed and the appendix is ​​taken out.

For another example, Fang Xian went one step further and performed an appendix-preserving surgery.

That is, the appendix is ​​quickly debrided, the necrotic tissue is removed, the blocked appendix artery is opened, the normal blood supply is restored, and then the operation is completed.

After the blood supply is unblocked, the appendix can be retained and the patient can continue to live with the appendix, but appendicitis may occur again. The current clinical diagnosis of appendix function is that it is non-functional, which is of little significance.

But Fang Xian can easily perform such a technique.

Because of his many skills and high skill level, Fang Xian's mind can beat quickly, and he once again felt the joy of clinical practice.

Just, just back in the trauma center office.

Fang Yun had already finished breakfast. While reviewing the examinations of emergency patients, he asked, "I heard that you think today's appendectomy was too slow?"

"The first one ended in 4 minutes. You're still not satisfied."

When Fang Xian heard this, a smile appeared on his face: "Uncle Yun, your eyes and ears are really good. I just came back when I was here, and the small report has already reached your ears first."

"I was thinking about a problem at the time. In the operating room of the trauma center of Shonan University Hospital, there was a professor who could concentrate the key operations of vascular surgery in 10 minutes."

"No other meaning."

"Actually, I just said I wasn't familiar with it."

Fang Xian looked back and thought for a moment. It was because others had over-interpreted what he meant, right?
Hearing this, Fang Yun nodded and expressed his understanding: "Uncle Yun can definitely understand your thoughts, but outsiders can't. Before you meet a suitable team and build a team, you still have to be careful with your words and deeds, otherwise, every word you say will .”

"To others, it sounds pretentious and inconsiderate. This is the core charm of the team."

"If the people around you are like you, they will definitely recognize you and discuss with you how to improve..."

"Instead of being reported like you are today, saying you are faking it."

"How do you feel? This is the first surgery that is truly yours, so you feel a sense of accomplishment, right?" Fang Yunze asked again.

Fang Xian nodded: "Yes, Uncle Yun, I feel that my previous efforts have finally been put to use."

“It’s no longer a combination of surgery and treatment, one person can do it all.”

"However, I also feel a little guilty, that is, I have to start taking responsibility, and no one will take the blame anymore."

Fang Xian said it more objectively.

The change in role from student to doctor is actually a change in pressure and responsibility.

Students have teachers to keep them safe.

Doctors, especially surgeons, do not have many teachers to give you the full details. Even the director will let you bear part of the responsibility alone.

If you can't take responsibility, you can't handle things!

"Responsibility is the first step to growth, and it is actually very good. Without a sense of responsibility, there is no way to see the full clinical picture."

"Today's time is still yours to arrange freely. Starting next week, you can try to diagnose emergency patients in the department, choose the patient's surgery, and determine the disease type and outcome, and assign whether the patient should stay or be transferred to a specialist. And communicate with the patient’s family..."

(End of this chapter)