Start with an emergency physician

The removal of the gastroepiploic membrane is relatively easy, but it is a test of strength, especially when separating. If you are not careful, the separation will fail and cause blood vessels or tissue rupture.

After easily separating the greater omentum from the transverse colon, Zhou Yuan began to separate the transverse mesocolon.

This is where special attention needs to be paid. The transverse mesocolon is easily broken.

""Electrosurgical knife, blunt separation." Zhou Yuan said.

Blunt separation?

Everyone, including Jiang Xiaoqi, frowned.

But because Zhou Yuan was concentrating on the separation, no one said the question in their hearts.

Zhou Yuan picked up the non-electric electrosurgical knife head and carefully cut the transverse colon mesentery horizontally. Then he put down the electrosurgical knife and separated the gastrointestinal ligaments in turn, and performed gastrostomy in parallel.

After all this was done, Jiang Xiaoqi coughed softly.

"What's the matter?"Zhou Yuan guessed

"Why do you choose to use a non-charged electric knife for blunt separation?"Jiang Xiaoqi asked.

He Jianyi was also curious:"Sharp separation causes the least damage to tissues, why choose blunt separation?"

Zhou Yuan explained:"The non-charged electric knife head is not sharp. Using it for separation can save time. In addition, it can ensure that the separation plane is advanced in parallel to avoid tearing the mesentery due to uneven force. Many doctors choose to use sharp scalpels for separation, which is naturally prone to problems."

He Jianyi and Jiang Xiaoqi looked at each other and saw the shock in their eyes.

""What are you standing there for? Haiyang, write it down in your notebook!" He Jianyi shouted.

Haiyang quickly took out a small notebook with"Zhou Yuan Junior Brother's Special Experience Book for Surgery" and started writing.

The people present were extremely excited.

This is the benefit of following an expert in surgery.

In textbooks, you can only learn that the non-electric electric knife head is blunt and not sharp, and what are the advantages and disadvantages of mixed cutting and pure cutting.

However, following an expert, he can let you know when to do what, when to use high frequency, and when to increase the output power.

"Next is the ligation of the pyloric vessels."

Zhou Yuan cut open the peritoneum at the lower edge of the duodenum to expose the pancreas.

In the surgical field, it is clearly visible that there is an upward bulge on the surface of the pancreas. The top of the bulge is the root of the right omental blood vessel.

This is a sign used to identify arteries and veins. Some experienced doctors often use this to distinguish. The artery runs upward along the bulge, and the vein runs downward. At the top of the bulge, the right omental vein merges with the right colic vein to form a trunk. Zhou Yuan carefully ligated it with No. 7 thread.

"Scalpel, scissors."

Hearing the tools, Haiyang asked curiously,"Are we going to perform sharp separation this time?"

Zhou Yuan nodded:"We are going to separate the subpyloric lymph nodes. We need to make a careful cut here, otherwise it will be difficult to separate successfully."

Zhou Yuan slowed down his movements, slightly increased his strength, pulled the tissues apart to make them tense, and then used the scalpel to make vertical, short-distance cuts along the tissue gaps. In some places where the tissue gaps were very small, Zhou Yuan changed to surgical scissors, penetrated the tissue gaps with the scissor tips, opened the scissor handles, separated the tissues, and then cut them open.

He Jianyi and others widened their eyes.

Whether it was separation or cutting, Zhou Yuan's movements were textbook-level, simply art!

"Can I come here often as the second assistant in the future?" Jiang Xiaoqi swallowed and said.

Sun Meng refused to blink:"I want to come too, I just want to be the fourth assistant."

Zhou Yuan did not pay attention to the conversation between the two. After completing the separation, he found the lower edge of the duodenum, stretched the duodenal wall to the right, and ligated the right omental artery at the root.

""Shit… can it be done this way?"

Haiyang finally understood why Zhou Yuan wanted to separate the duodenum instead of cutting it off directly.

Doing so would directly avoid the dense subpyloric veins and reduce the risk of surgery!

"The next step is to cut the duodenum." Zhou Yuan said.

Without waiting for Zhou Yuan to speak, Haiyang immediately handed over the non-traumatic intestinal clamp.

Zhou Yuan smiled, it seemed that Haiyang had caught up with the rhythm.

Zhou Yuan moved his stiff neck and returned to the operation.

About 2.5 cm away from the prepyloric vein, Zhou Yuan clamped the duodenum with the non-traumatic intestinal clamp.

"Kocher forceps."

Kocher forceps are toothed vascular forceps, and their use is as the name suggests.

After Zhou Yuan took it, he clamped the Kocher forceps on the proximal end of the duodenum.

Then, he easily cut the duodenum between the two forceps. Just as Zhou Yuan was about to reach out, Haiyang immediately handed him the hemostatic forceps with a smile on his face:"You want this, right? Hehe……"

Zhou Yuan's face froze,"Yes."

Taking the hemostatic forceps, Zhou Yuan began to separate the fibrous tissue between the posterior wall of the duodenum and the head of the pancreas.

"Zhou Yuan, what's your choice now?"He Jianyi couldn't help asking.

Now we should choose which digestive tract reconstruction technique to use. If it is jejunum replacing stomach, then the duodenal stump should be closed. If it is interlineation of jejunum and duodenum anastomosis, the duodenal stump needs to be retained for later anastomosis.

The choice made will directly affect the patient's digestion and quality of life.

Everyone, including He Jianyi, focused their eyes on Zhou Yuan.

———

The eighth update is here, and the ninth update is about to begin!

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