Only three days after the preoperative discussion, Yu Shuilian's surgery officially began.
In order to prepare for the surgery, Yu Shuilian underwent a thorough intestinal cleansing three days ago and was not allowed to eat. All nutrition was supplied by intravenous nutrition.
The purpose is to remove any food residue from the intestines during surgery and to minimize the probability of infection.
The urine bag and feces bag are temporarily removed, and the excretion of urine will be taken care of by a sterile renal pelvic drainage tube inserted during the operation and connected to the urine bag.
Because there is no food, there is no feces produced temporarily, so there is no need to worry about feces contaminating the surgical area during the operation.
However, after this operation, for a period of time, the bladder and colon fistulas need to be kept in place so that urine can be discharged directly from the kidneys through the drainage tube to avoid affecting the survival of the reconstructed urethra.
For at least one week after the operation, intravenous nutrition will be used to supply the nutritional needs of Yusuilian to prevent feces from contaminating the surgical site, even a little bit.
Just like a newly built highway, vehicles are not allowed to pass until it is completed.
Sometimes, women are more resilient than men. Yu Shuilian has psychologically accepted her identity as half a human being, and will spend the rest of her life in this state.
For her, this is the normal state of life in the future, just like a paralyzed person in a wheelchair, a blind person using a cane to find his way, and a deaf-mute person communicating with others in dumb languages. This is a special state of life.
After experiencing the first life-and-death surgery and the second surgery, Yu Shuilian behaved very calmly, without any hesitation or worry.
In the face of this kind of blow, some people sink, but some people can re-recognize life.
Her husband and son kept holding her hands and followed the cart to take her to the door of the operating room. The son obediently kissed his mother's cheek and clenched his little fist: "Come on!"
It took a long time for the husband to let go of his hand: "We'll wait outside, don't be afraid-"
Anesthesia, positioning, brushing hands, disinfecting and draping --- repeat the process more than ten times a day, and you can never go wrong in your dreams.
Song Zimo was the first assistant, Gao Qiao was the second assistant, and Xu Zhiliang was watching on the stage.
The knife was like a paintbrush, cutting open the stump of Yu Shuilian's body.
Due to tissue adhesion caused by trauma and surgery, the anatomical relationship was no longer normal during the second surgery, but the surgeon was still as skilled as ever.
Whether it is the direction of the scalpel on the same plane or the depth of the scalpel across planes, there is no impact due to changes in anatomy.
The direction and combination of the incisions make people confused for a moment. Some are straight lines, some are diagonal lines, some are arcs, and some are wavy lines.
No matter the direction or length, it seems that I already have accurate data in my heart. I can start and stop the knife very smoothly, and the knife is heavy and light, and it is accurate.
But why is this?
Until the incisions began to penetrate deep into the abdominal cavity, Takahashi was completely confused except for Song Zimo, who had been following him for a long time, who could see some clues.
Why did it start like this, and where will the surgery go in the end?
I can't understand the beginning and can't guess the ending. This feeling is very funny.
When the tunnels planned to house the urethra, YinDao and anus were opened, Takahashi finally felt a certain part of the elephant.
The colon is not incised, but is turned outward from the end, and stops when it reaches a certain length; then, the remaining opening of the bladder neck is opened, just like the inversion of the colon, like turning a sock inside out.
The inner surface of the lower section of the descending colon has been exposed to the outside.
Under the microscope, the mucosa of the colon is peeled off little by little with Snake microscissors. It is not simply peeling off the mucosa. As the mucosa is peeled off, the nerves that innervate the mucosa, which are thinner than the nerves in a baby's finger, are peeled off one by one.
exposed, but still retains the connection with the mucous membrane.
The mucosa of the colon, along with the nerves, was completely peeled off without any holes. The mucosa was removed and the surrounding nerves were severed.
When the recipient site is ready, the removal of bladder mucosa from the donor site begins.
With the same superb technique, the mucosa along with many nerves was removed. In order to maintain the integrity of the respective mucosa, the two pieces of mucosa were exchanged.
The bladder mucosa with the pressure sensor is transplanted to the lower colon, no more, no less, just to fill the defective area just cut. The nerves of the bladder mucosa anastomose with the nerves around the recipient area, one by one, even if 12-0
With the micro-suture needles, each nerve can only be sutured with two to four stitches.
The colon mucosa fills the defective area of the bladder mucosa, and the nerves are also connected. Although the colon mucosa does not have pressure receptors, the pressure receptors in other parts of the bladder continue to maintain the urge to urinate.
The east wall was removed to repair the west wall, but the east wall is still stable and can protect against wind and rain.
Two pieces of fresh mucosa were cut off and the exchange was completed without stopping. The most delicate part of the operation was completed in this way.
Takahashi did not dare to blink under the microscope. The operation that no one had ever been able to achieve was now realized under his own view under the microscope.
The whole process was as uneventful as a routine surgery.
Under the microscope, the venous pipes intercepted from the abdominal cavity are still peeled off layer by layer with Snake brand micro-scissors. The blood vessel walls are actually peeled off completely and without damage layer by layer according to the tissue level.
down until desired thickness.
It's like cutting a thin piece of A4 paper into several layers. Each layer is a complete piece of A4 paper. Even if it is so thin that it is transparent, there are no breaks and the complete plane is retained.
The qualified vein is inverted, anastomosed to the urethral stump at the bladder neck, and buried in an open tunnel along the established route.
No wonder so many people failed and finally had to give up research on this kind of surgery. Who else but him would have such ultimate knife skills.
The two most difficult steps are completed, and the next steps, colon reconstruction YD and pectoralis minor sphincter reconstruction, are no longer difficult at all.
The preoperative 3D printed mold was implanted into the reconstructed anus, urethra and YD to prevent and treat postoperative adhesions.
The suturing of the outer openings of the three reconstructed structures is extremely particular. The beautiful rings are everted and then sutured to the surrounding skin, just like a naturally formed transitional part.
The knife hasn't stopped yet. Various enhancements to the incisions and various combinations of lines have caused the skin and tissue flaps to be turned up piece by piece and reorganized. Some are turned over, some are buried, and some are folded.
The non-damaging cosmetic suture needles and threads are used wherever they go, like Ma Liang's paintbrush, with the overlapping use of surgical techniques such as incision, suturing, transplantation, and transfer.
The anus, urethra, and penis are arranged in a natural order. WaiYin's skin and tissue flaps are reshaped to look real, and even artificial butt cracks are created.
The remaining bilateral iliac bones had been rounded during the first operation to replace the original ischial tuberosities, and the remaining muscles were transferred to the bilateral artificial ischial tuberosities as much as possible.
In this way, half of the body can stand upright with the help of two support points with muscle cushioning, as if the buttocks are still preserved.
During the first surgery, Yang Ping had already considered the second surgery, and many steps were taken to prepare the ground for the second surgery, such as laying out the muscles around various reconstruction channels.
Only then did Takahashi realize that Yang Ping's ability to design surgeries was far from what he had imagined. He had already considered that kind of out-of-order surgery to be unattainable.
But now, when Dr. Yang was racing against time, he had linked the two surgeries together. When he sequenced the surgical steps, he had gone beyond the surgery at that time, and his mind had been connected to the second surgery.
Unattainable, yet unattainable!
Beyond the insurmountable mountain, there is a higher mountain.
If there is no infection or accident, Yu Shuilian will have a nearly normal anus, urethra and penis, and half of the body will retain the most basic functions of the human body.
All she has lost is her ability to walk. If one day she can really use a powered brace, she will be able to walk upright like a normal person.
Trauma surgery, urology surgery, general surgery, repair and reconstructive surgery, plastic surgery, and many other top surgeries were combined to complete this artistic masterpiece.
No matter which surgery is placed in the corresponding specialty, it is out of reach.
But who knew that these superb skills could only be obtained by Yang Ping in the system space, completing one devil's training after another in the system.
A space only for himself, a space with endless case analysis, surgical training, and anatomy learning, which requires perseverance and perseverance to overcome loneliness and loneliness.
Only those who have the heart to become gods can be so persevering.
"The man standing on the top of the mountain!"
Miyuki Fujiwara looked at Yang Ping who was concentrating on the surgery and admired her heartily.
At the end of the operation, if nothing else, Yu Shuilian's stump was absolutely symmetrical, which only Yang Ping could achieve.
To achieve left-right symmetry, care should be taken to grind the remaining iliac bone, add muscle padding, and adjust skin suturing.
This is not a requirement of the surgery, but it reflects the precision of the surgeon, which is so precise that it cannot be improved.
"The operation is over. The three of you will start practicing peeling grape skins under a microscope tomorrow. Only by dissecting the grape skin into three complete layers will you be considered qualified."
Yang Ping is talking about Song Zimo, Gao Qiao and Xu Zhiliang.
"Do you have any questions?" Yang Ping asked Xu Zhiliang.
Because his microsurgery skills were probably the weakest, Xu Zhiliang nodded: "No problem."
"What about us?" Zhang Lin asked.
"If you can peel off two layers without any big holes, it will be considered qualified."
"Also, you still need to practice hook-drawing. Only when you pull the hook with one hand without shaking your hands for an hour will you be considered qualified."
Yang Ping moved away from the position of the surgeon, and Song Zimo, Gao Qiao and Xu Zhiliang bandaged Yu Shuilian's stump. This kind of bandaging is not casual and requires superb bandaging skills.
First put a layer of Vaseline gauze, then dry sterile gauze. Some places should be loose and some places should be tight. Separate when necessary, and thicken where necessary.
The last step is to wrap it with a cotton pad and bandage. Wrap the stump well, not tight but not loose, so that the gauze bandage will not fall off easily.
"What about me, Dr. Yang, you haven't assigned me any homework yet?" Fujiwara Miyuki took the initiative.
Yang Ping almost forgot about her. She also came here to study. Yang Ping thought about it. She majored in sports medicine, so she couldn't be as comprehensive as Takahashi.
"You use the olive nucleus to carve out a model of the knee joint under arthroscopy. The contours of the distal femur, tibial plateau and patella should be close to the anatomical shape. The basic internal structures of the anterior and posterior cruciate ligaments, medial and lateral collateral ligaments and menisci should be present.