Where did Ma En still have trouble in Tanglou? His whole body was highly concentrated and his brain began to spin at a high speed.

"Tanglou, are you facing the wrong direction? Look in another direction."

Ma En said quickly. At this time, he realized how important Tanglou's mirror-holding skills were. According to Ma En's method, the camera walked a distance from the other end of the colon belt. It was clear and stable, but still found nothing.

"what's the situation!"

Ma En suddenly broke into a cold sweat on his forehead: "Can't it be such a coincidence that I encountered the legendary ectopic appendix?"

Director Cheng and Dr. Qing looked at him with eager eyes. Ma En was a little panicked, blaming himself for seeking death for picking such a case.

When Ma En was at a loss, Tanglou's voice sounded:

"Dr. Ma, maybe the colon we selected is wrong, and we need to start a new process to find the real right colon."

After hearing Tanglou's suggestion, Cheng Jian and Qingping just thought for a moment and thought of a possibility.

Ma En was half-understood, but it didn't matter. Tanglou had already started to move the camera and replaced it with another section of colon.

Under the camera, Ma En looked at a particularly long section of the colon, wondering how all the features were squeezed together. It was quite a long way down compared to the conventional appendix, and then he saw an abscessed mass.

"found it!"

When Tanglou told them that they had discovered the appendix, Cheng Jian and Qingping also raised their eyebrows. Sure enough, it was the long sigmoid colon that caused the appendix to appear in the right lower abdomen.

They have encountered this situation before. When encountering this situation for the first time, they can't find the appendix by following the regular colon. Most novices will panic.

This is because the knowledge is not comprehensive enough, falling into a fixed mindset, or not using your brain at all, which is very fatal on the operating table.

Fortunately, Tanglou is clear-headed enough.

Qingping smiled slightly and said softly: "Not bad."

"Dr. Ma, it's the long sigmoid colon that causes the appendix to deviate."

Tanglou explained that Ma En suddenly realized that he felt happy, but immediately felt very uncomfortable. He was the one who should popularize science!

Tanglou did not give Ma En much time to buffer, and directly explored the appendix, describing it coldly:

"...During the operation, it was found that the patient had a perforated appendix, gangrene at the root of the appendix, abdominal cavity adhesions, and adhesions between the appendix and flank, cecum, and ileum. It is recommended to use an aspirator to separate bluntly, and use an electrocoagulation hook to cut off the adhesions..."

Before Ma En came to his senses, Tanglou had already arranged the operation process.

"???"

Who is the chief surgeon?

Ma En was complaining in his heart, but his hand honestly took the suction device prepared by the equipment nurse.

The blunt dissection has just been completed, and the nurse's electrocoagulation hook has been delivered.

"... During the electrocoagulation process, pay attention to protecting the intestines, rehabilitating the right side, and being careful with tubular tissues..."

Ma En wanted to refute, but his hands kept moving, and he even felt that he was performing beyond his level.

The surgical field was clear and perfect, and the camera was always one step ahead, giving him the angle he wanted. Ma En himself felt that this operation was much smoother than before.

This is the wonderful experience brought by a good mirror assistant.

Although Ma En doesn't like Tanglou, he has to say this at this moment: It smells so good!

Ma En quickly completed the appendectomy, but immediately fell into trouble.

But he was embarrassed to speak, and his hand movements froze, and he paused for five seconds.

"Ma En, what are you doing?"

Qingping on the side asked with some confusion.

Cheng Jian didn't speak, but his face was a little gloomy.

Ma En's performance was too immature. It was a big taboo to stop moving during the operation. Even if he encountered a problem and couldn't solve it himself, wouldn't he ask his superiors?

Ma En's face instantly turned red, and he was really feeling miserable. Because the sigmoid colon was long and the patient's appendix was perforated and gangrenous, the diameter of the appendix that was cut directly exceeded 10mm.

That is to say, it cannot be pulled out from the casing of the operating hole. In the past, traditional laparotomy was used. This situation has never been encountered before.

What can he do?

The idea was so memorized that Ma En did not dare to look at Qing Ping and instinctively glanced at Tanglou, his eyes full of weakness, helplessness and pity.

Since the operation of pulling out the casing is the final step, the cavity cannot be found, and Tanglou was not aware of it.

Seeing Ma En's expression about to cry and his frozen movements, Tang Lou confirmed in a low voice: "Can't you pull it out?"

"Well, it's stuck!"

Ma En nodded heavily, as if he had a dark face that had been constipated for a month.

"If the mesentery is thick, you can trim it and drag it out from the casing multiple times."

"!!!"

Oh my god, Ma En also reacted, it’s so simple!

The operation was naturally extremely simple, but this was the first time he encountered this situation, and there were two big guys eyeing him. Ma En's thinking was naturally rigid.

After being reminded by Tang Lou, Ma Encai quickly trimmed, and the lens also thoughtfully provided a close range, sufficient brightness and field of view.

At this time, Ma En was about to burst into tears. Damn Wang Daquan with his weak hands and brain, Tang Lou, a caring little cotton-padded jacket who is called the chief surgeon.

It's like an adult's stool that has been held in for a week has been purged, relieved and radiant!

Ma En understands Qing Ping very well.

It's him, he also wants a mirror-holding assistant like Tanglou, it's so useful.

"The appendix is ​​thicker than the sleeve and can be put into a specimen bag before being taken out, which can effectively prevent incision contamination."

Tanglou continued to add.

"okay."

Ma En himself did not realize that the entire operation process had completely followed the rhythm of Tanglou.

Qing Ping on the side said gently to Cheng Jian: "How is it?"

Cheng Jian didn't speak, but his eyes lit up. He was also a little tempted by Qing Ping's previous proposal. Maybe he could give it a try?

Tang Lou is indeed very familiar with the laparoscopic surgery process, and he can deal with emergencies with a certain degree of advance and retreat. He even feels an aura in him that only senior surgeons can have. The eight-character summary is:

The command is measured and free.

Since the patient's appendix is ​​not only perforated but also has gangrene, the treatment of the edges near the gangrene is very particular.

The distance between the edge of gangrene and the cecum is different, the degree of gangrene is different, and the methods used are also different.

Although Marn had tried it under the Maxwell incision method, this was the first time he encountered it during laparoscopic surgery. He had an idea, but he was not sure.

"Tanglou, what do you think?"

Ma En asked for advice sincerely this time.

Tanglou controlled the camera, scanned the base of the appendix again, and thought for a few seconds:

"Dr. Ma, look at the gangrenous edge of the appendix root at a close distance of 5mm from the cecum. I suggest using simple ligation + 8-figure cecal seromuscular suturing."

"Why not just sterilize it?"

Cheng Jian on the side also became interested and asked directly?

Ma En looked at Director Cheng unexpectedly. In fact, he was also a little confused, because he was only thinking about sterilization.

"Simple ligation is suitable for cases where the edge of the appendix is ​​more than 5mm from the cecum. Because the distance is too short, simple ligation is prone to cracking in the later stages."

Cheng Jian nodded and continued to ask: "What if the current edge distance is within 3mm?"

Ma En was trembling on the side. Fortunately, Director Cheng didn't ask himself, otherwise he would have been scolded again.

Tanglou's tone did not change at all: "If it is within 3mm, then simple ligation + purse-string embedding is necessary. This is the best way to prevent later fecal stone infection."

"What if the roots are severely gangrenous and perforated, and even purse embedding can't handle it?"

Listening to Director Cheng's three consecutive questions, Ma En didn't dare to take a breath. He was panicked and envious. Of course he was panicking, but he was envious of Tanglou. He was talking in front of such a difficult three consecutive questions.

.

It would be great if he could help him.

What a show!

Sure enough, Tanglou gave the last correct answer: "Then it can only be processed with the Endo-GIA cutting and closing device."

After getting a satisfactory answer, Cheng Jian finally calmed down.

With the assistance of Tanglou's national service team, Ma En perfectly completed this laparoscopic appendicectomy that was beyond his capabilities.

Before Cheng Jian left the operating room, he said to Qing Ping:
Chapter completed!