A brain of about 1,400 grams, with hundreds of billions of cells, transmits various electrochemical signals all the time. The conduction methods and routes are very complex, and the structure is far tens of millions of times more complex than our most advanced chips.
The thumb-sized brainstem is located deep in the human brain and controls the human body's heartbeat and breathing. It is densely packed with the most important nerve nuclei and conductive bundles, and the vertebrobasilar artery that supplies blood supply to the brain also passes here.
In such a dangerous and complex small area, the operating space is often within a few centimeters.
Mr. Feng's tumors were in the shape of complex tree roots, intertwined, and they snaked in the gaps between these nuclei and conductive bundles. Some of them adhered to the nerve nuclei, regardless of you or me.
Among them, the tumor has the tightest adhesion to the dorsal nucleus of the vagus nerve. If the scalpel is slightly deviated, breathing and heartbeat will stop.
Professor Feng's spontaneous breathing was suppressed by the anesthetic. The ventilator took over Professor Feng's breathing at a frequency of 20 times/min, while the heart rate was maintained at about 70 times/min under the control of the anesthesiologist.
Unlike spinal orthopedic surgery, this kind of surgery cannot be carried out at a fast speed. Yang Ping stops step by step, instructs the equipment nurse in advance to prepare the equipment for the next step, and tells the assistant to pay attention to the key points.
Under the microscope, various structures are magnified and appear clear and delicate. The laser knife cuts and separates accurately. The tiny thermal effect shrinks the small blood vessels and stops bleeding while cutting, without damaging the surrounding tissue.
The smart and sharp laser head will not cause pressure on the surrounding tissue compared to the blade scalpel, and is more suitable for operation in small spaces.
The knife cuts along the posterior median groove, extending from the medulla oblongata of the head to the cervical spinal cord of the upper cervical vertebrae. The arachnoid membrane is incised, the pia mater is incised, and the soft tofu-like gray brain tissue is slowly cut by the laser knife.
Split slowly and lengthwise.
Go deeper bit by bit, and the straight line repeated each time will not deviate in any way. The route always coincides with the anatomical gap. This kind of operation in the tissue gap is a guarantee of safety.
The bloodless operation was carried out to the end, and the tissue was protected to the utmost, and the tumor showed a trace of outline.
Yang Ping began to separate the tumors. The tumors grew intertwined with normal tissues. They had no capsule and no boundaries could be found.
But Yang Ping was able to find the boundary where they penetrated each other. With the separation of the laser knife with a precision of 0.1 mm, Professor Feng's vital signs temporarily remained stable, and the wavy lines of the ECG monitoring showed a normal curve.
"Fluorescence imaging was not used?" Johannessen was very surprised.
In order to confirm the boundary between the tumor and normal tissue, this kind of surgery routinely injects a special fluorescent imaging agent into the patient before surgery, and then turns on the fluorescence mode of the microscope during the surgery.
The surgeon can clearly distinguish tumors under fluorescence imaging from normal tissue without fluorescence imaging, and then perform precise resection under the navigation system.
Unfortunately, even if it has developed to this point, the success rate for tumors like Mr. Feng is still less than one percent.
"You didn't use navigation equipment either?" Johannessen couldn't understand.
Without the help of these two technologies, it would be impossible to complete this operation, let alone achieve a success rate.
Professor Fu from Moliu Neurosurgery was also surprised. When discussing the surgical plan, Yang Ping did not mention this. Everyone thought it was a routine thing and did not need to be mentioned. However, from the surgical field of view, no fluorescence was used.
What's going on?
This doctor who graduated from Tiantan Hospital was tutored by a top neurosurgery expert in the country. Under the careful guidance of his tutor, he also became a top neurosurgery expert in the country.
"We didn't use fluorescent imaging agents?" Wen Rentao also noticed and reminded.
Yang Ping replied while operating: "No, the fluorescence imaging under the microscope will interfere with my judgment. Although the navigation is accurate, the CT image as a guide is only an indirect image, which is of little significance to me."
For Yang Ping, he has performed countless surgeries and conducted countless anatomical studies in the system space to obtain real anatomical images of tumors, which are far more accurate than fluorescence imaging and navigation.
For ordinary people, even top experts like Johannesson, fluorescence imaging and navigation are necessary, but for Yang Ping, they will become a burden.
The weak flashing fluorescence will affect Yang Ping's visual judgment during the operation and cause interference when comparing the anatomy during the operation with the pictures of his brain.
The picture in his mind far surpassed any fluorescent imaging.
The picture in his mind, composed of thousands of Professor Feng's pictures, is more accurate than any visualization and navigation.
Because, through countless anatomical studies, he can easily identify tumors and normal brain tissue with the naked eye.
Questioning is questioning. Both Johannessen and Professor Fu are guessing that Yang Ping can make such a rigorous surgical plan and take into account the several cardiac arrests that may occur when nerve nuclei are disturbed during the operation. It is impossible to have these basics.
Sexual things are not considered.
Yang Ping must have a better way to complete the operation before he abandons the technical means that ordinary people must have.
The fine gun-shaped double-stroke electrocoagulation forceps are reliable microscopic forceps when there is no need for hemostatic electrocoagulation. When combined with the laser scalpel, the outline gradually becomes clearer and the deeply buried tumor emerges.
Wen Rentao and Zeng Ran sat next to each other and retracted the hook. Wen Rentao was also responsible for suction, but the suction device in his hand did not work. So far, there is almost no blood visible during the operation.
Brain tissue is filled with blood vessels that intersect with each other. The laser tip can operate in the gaps between blood vessels, and even small blood vessels that need to be damaged are electrocoagulated in advance.
Double-click electrocoagulation can accurately clamp the ends of blood vessels and use minimal energy to perform electrocoagulation to stop bleeding.
The separation between the nerve nuclei and the gap was very fast. Soon, it approached the dorsal nucleus of the vagus nerve, and one root of the tumor almost surrounded it, forming a tight adhesion.
Yang Ping stopped, gently put down the equipment in his hand, and took a short rest.
The next step is to separate the adhesion between the nerve nuclei and the tumor. This adhesion is so tight that it is almost indistinguishable. This is the anatomical basis for the low success rate of the operation.
Yang Ping picked up the instruments again, adjusted the two instruments in his hands, and searched for the best feel again.
Which are tumor blood vessels and which are normal blood vessels, which are tumor tissues and which are normal tissues, where are their safety gaps, and where are the real boundaries of tumors.
Relying on the pictures in the brain for precise guidance, the pictures are turned into instructions from the brain, and the instructions are transmitted to the hands, which control the laser head.
Compared with ordinary scalpels, the slim laser blade is more capable in complex and narrow anatomical spaces.
Professor Zhang did not go to observe the conference room, but walked back and forth at the door of the operating room. Han Jiangong and Hong Zhigang were guarding the door of the operating room, and no one spoke.
Operations in other departments are also starting one after another. Some doctors specially come here and take a look and know that Professor Feng's operation is being performed inside.
The focus of the laser knife is 0.1 mm, there is no mechanical collision with the tissue, and it is very easy to use.
The instrument has an accuracy of 0.1 millimeter, but in the hands of a doctor, it is very difficult to achieve maximum accuracy throughout the entire process. This requires the hand to be very stable and not subject to any interference.
Because people's hands don't seem to be shaking, but they are actually shaking.
This is why the picture shakes when taking pictures at ultra-telephoto.
The trajectory of a 0.1 mm scalpel according to human will will inevitably deviate. Even if it is a simple straight line, it is impossible to maintain the accuracy of 0.1 mm when viewed with a magnifying glass.
"The separation of tumors is very precise. Does their microscope have some special function that can distinguish tumors and navigate?" Johannessen couldn't believe that this surgery was performed without the assistance of fluorescence imaging and navigation. p>
Griffin shook his head: "If there is such a device in the world, we shouldn't not know about it."
The operation entered the vicinity of the nerve nucleus. Based on his anatomical knowledge, Johannessen made a judgment, and the ballet on the tip of the knife officially began.
Judging from the images, this will be a delicate operation of life and death.
Under the naked eye, it is almost impossible to distinguish tumors from nerve nuclei.
But that scalpel did it and began to separate the tumor and the nerve nuclei. Even with an accuracy of 0.1 mm, weak thermal damage will cause interference.
If replaced by a mechanical scalpel, the interference and damage will be greater.
"This is writhing on the edge of a knife!" Griffin tightened his heart.
"Have you seen "Bad Thief"?" Johannesson's heart began to pound against the chest wall.
"See it!"
"When Johnny Utah was free climbing at Angel Falls, his partner fell and was shattered to pieces."
"Dr. Yang cannot make any mistakes, not even once."
"However, even if he doesn't make a single mistake, he will fall several times. Once he falls, he will have to grab a rock again during the fall and continue climbing."
Several falls are the several cardiac arrests that will occur during the operation.
"I am now preparing to enter the first death area. Professor Ma, please pay attention to ECG monitoring and evoked potential monitoring, and report to me at any time. Once ventricular fibrillation waves occur, cover the surgical area with sterile drape, and lift the sterile drape on the trunk.
Shoulders, remove the ECG monitoring electrodes from the back, and complete the defibrillation as quickly as possible. Remember, we only have five seconds, do you understand?"
"Understood!" Everyone knows their position and has repeatedly explained and rehearsed it before the operation.
Doctor Wu sent from the ICU is the instructor of the entire Magic City emergency technology training. He is responsible for electric defibrillation and pushes the defibrillator near the operating table.
Yang Ping took a deep breath, and the laser knife began to separate the adhering tumors and nerve nuclei. The cruel devil training made Yang Ping like a powerful machine in both his mental quality and the stability of his hands.
But Yang Ping has human tactile feedback and thinking adaptability that machines do not have.
The laser knife begins to enter the verge of death. The accuracy of 0.1 mm cannot be deviated. If the deviation is even a little bit, the nerve nuclei will be damaged, which will lead to cardiac arrest that cannot be revived.
The atmosphere in the entire operating room was extremely condensed, with everyone concentrating and focusing all their energy on a tiny point.
The tip of the knife goes deeper bit by bit, separating along the 0.1 mm life-and-death curve on the edge of death.
"1 mg of epinephrine, intravenous administration, withdraw surgical instruments, cover the surgical area, and prepare for defibrillation!"
Rescue drugs were injected from the intravenous channel, and the folded sterile drape immediately covered the surgical area of the head and neck. The sterile drape on the torso was lifted, exposing Mr. Feng's entire back, all the way to his shoulders.
Everyone performed their duties and the team cooperated seamlessly. The anesthesiologist finished pushing the medicine and stared at the monitoring screen.
After the normal ECG wave, suddenly, a ventricular fibrillation wave appeared, and then filled the entire screen.
Ventricular fibrillation---fatal arrhythmia, a type of cardiac arrest.
"Cardiac arrest---ventricular fibrillation wave!"
"Trans defibrillation!"
The wires and electrode pads connected to the ECG monitoring were quickly removed by the circulating nurse. Almost at the same time, the cathode of the electrode plate of Dr. Wu's right hand in the ICU pressed against the lower back of the right scapula, and the anode plate in his left hand pressed against the mid-axillary line of the fifth intercostal space on the left side.
Perform electric defibrillation at 200J.
"Leave!"
Everyone is out of contact with the operating bed.
Discharge, the only straw of life was grasped, a defibrillation was successful, and a familiar wavy line appeared on the defibrillator screen.
This is the wavy line of sinus rhythm, the wavy line of life.
The hearts in everyone's throats slowly dropped, but the hearts in the chest were still beating violently.
If a cardiac arrest occurs during the operation, no one is sure that it can be rescued, not to mention that it is caused by interference with the nerve nuclei. Medical research on the brain is still very rudimentary.
Only Yang Ping took his time and looked at the restored electrocardiogram: "Reconnect the electrocardiogram monitoring!"
"Sinus rhythm, heart rate 50 beats/min, blood pressure 90/45mmHg." The anesthesiologist reported that 1 mg of epinephrine was administered intravenously again. Later, the heart rate was 60 beats/min, and the blood pressure was 100/60mmHg.
Yang Ping observed for a few minutes and confirmed that he was out of danger: "Additional disinfection, additional sterile sheets, replacement of surgical gowns and gloves, be careful not to contaminate the surgical area, and continue the surgery---"
Wen Rentao looked at Yang Ping's calmness and was filled with admiration. At this time, the chief surgeon was the belief of the team members.
"One can never step into the same river twice."
Yang Ping has studied and simulated countless times in the system space, but the state of the patient and the simulation in the system space cannot be exactly the same.
Therefore, Yang Ping did not dare to relax at all, and could analyze and judge based on the current situation at any time to make the most favorable decision.
"The heartbeat center is disturbed and the regulation is disordered. The rhythm must be restored within five seconds. Each time, we only have five seconds."
Because the sterile drape on the torso was lifted just now, someone has been contaminated, and the stage needs to be re-brushed, and the sterile drape on the stage needs to be spread again.
Everyone, please take your place and continue the operation.
