After being anesthetized, Jing Yunsong lay naked on the spinal prone frame.
The endotracheal intubation is connected to an anesthesia machine, and the anesthesia machine replaces Jing Yunsong's breathing with rhythmic mechanical ventilation.
Dr. Chen Shichao, the anesthesiologist, sat on the side of the patient's head and next to the anesthesia machine. From the time the patient came in to the time the anesthesia was completed, he only said one sentence: The anesthesia is complete and the operation can begin!"
Then he just sat there without saying a word, not participating in any small talk, and just being a tool man doing his duty.
The G-arm X-ray machine is on standby, but it is rarely used. It is only used when inserting pedicle screws.
Song Yun took Kong Weiquan and began to disinfect and spread the sheets. Qiu Ruo was already in place and the instrument table was unfolded. She began to arrange various instruments with her dexterous hands.
The circulating nurse is checking how much liquid is left on the infusion pole and whether the intravenous access is open. Nurse Xin is sitting in the corner, providing necessary support to the nurse at any time.
The other two doctors stood against the G-arm machine, so that they could stay as G-arm machine operators and help push the G-arm machine. This was considered as participating in the operation, which was also an honor.
The sterile packaged and ready-to-use artificial spinal prosthesis is placed separately on an equipment cart and can be unpacked and used at any time.
Yang Ping wore goggles and stood in a relatively empty corner of the operating room. With the help of the circulating nurse, Yang Ping put on surgical gown and gloves, then stepped aside and waited for Song Yun to complete the disinfection and draping.
After everything was ready, Yang Ping came on stage and stood in the position of the chief surgeon.
After a serious pre-operative check, Qiu Ruo handed over the scalpel.
Yang Ping took the scalpel and drew a vertical line on Jing Yunsong's lower back.
It was Yang Ping's habitual one-cut method. He only needed one cut to cut the skin, and the skin was cut through at once, neither deep nor shallow. The fat particles under the skin immediately burst out as the skin split.
Most of the entire operation was completed with a laser knife. The scalpel was only used for skin incision. After the skin incision, Yang Ping returned the scalpel to the instrument nurse.
Qiu Ruo was stunned for a moment, then took the scalpel with a curved disk and handed over the toothed forceps.
The opening movements were a bit hasty, Qiu Ruo never thought that Yang Ping would cut the skin with one knife.
There is no skin incision like this. Generally, the skin is incised slowly along the incision line, and then gradually deepened little by little. After repeated incisions many times, the skin can finally be incised to form the entire surgical incision.
The scalpel was just passed over, and within three seconds, the skin incision was completed. How could Qiu Ruo react?
However, Qiu Ruo quickly learned this lesson and never dared to be careless again. This young professor was indeed very fast and he might lose his rhythm if he was not careful.
According to the surgical procedures, she picked out the instruments to be used in advance, put them in a convenient place, and handed them over at any time. She also always paid attention to the progress of the operation and predicted which steps the operation would take and what instruments were needed.
The scalpel was replaced with a laser knife, and the incision continued. The laser knife was also very fast in Yang Ping's hand. First, he stopped the bleeding accurately, and then cut the lumbar fascia. As the lumbar fascia was cut, the red muscles of the lower back were exposed.
come out.
Currently, there are relatively few surgical instruments in use, and instrument switching is not very frequent. After Qiu Ruo made adjustments, he was able to handle it easily.
Starting from the midline, Yang Ping used a pair of toothed forceps and a laser knife to separate the muscles against the spinous process, peeling off the muscles on both sides from the spinous process and lamina, and then pushed them apart on both sides.
This kind of bone-to-bone dissection, also called subperiosteal separation, is more convenient to operate on the long bones of the limbs, because the long bones of the limbs are generally tubular bones with smooth surfaces and thick periosteum.
The vertebrae are irregular bones with various protrusions and depressions on the surface, and the periosteum is also very thin, so it is very difficult to perform subperiosteal dissection on the vertebrae.
But Yang Ping's operation was fast and steady. Soon, the muscles were separated from the periosteum, close to the spinous process and lamina, and almost no blood was visible in the surgical area.
Occasionally, the nutrient blood vessels that pass from the muscles to the vertebrae are also promptly killed by Yang Ping's laser knife.
Yang Ping's laser knife and toothed tweezers worked perfectly together, as if the muscles, tendons, and ligaments were all glued to the surface of the bone. Yang Ping was just carefully opening them now.
The lamina, spinous process, transverse process, upper and lower articular processes, these complex convex structures are not obstacles at all for Yang Ping. When the muscles are separated from the spinous process and lamina, they still carry the complete periosteum, anatomy
The layers are very clear.
As the first assistant, Song Yun has the best view to directly observe the operation.
He had never seen such clear separation technology.
"The preoperative images showed that only the lamina of the lumbar 2 was intact and not invaded by the tumor. I opened the opening through the lamina. The opening of the lamina must be larger than at least 1.5 centimeters before I can open the loop. If it is larger than 2 centimeters, it can be very easily removed.
Open the loop and get rid of the trap!"
Yang Ping explained to the assistant while continuing the operation. The explanation in advance could help the assistant understand the surgeon's intention.
After all, the number of times my assistant cooperates with me now is very rare.
After the muscles were separated, the back of the lamina was smooth without a trace of soft tissue on it. The energy of the laser knife was upgraded and switched to a mode that can cut bones.
The energy level of the laser knife can be adjusted at any time to adapt to the cutting object. For example, when cutting bones, the energy level is higher than cutting soft tissue.
As the focused laser cuts bit by bit, a square bone piece is removed from the normal lamina from behind, and then the orthopedic piece is taken out.
The annular vertebrae form a defect at the rear. This defect opens the closed ring of the spinal canal. When the vertebrae are removed, the spinal cord and cauda equina can be freed from this gap. Otherwise, the spinal cord and cauda equina will be trapped by the vertebrae and the vertebrae cannot be removed.
Yang Ping's basic surgical idea is very clear. He opens the spinal canal from the back side to completely unravel the vertebrae, then removes the tumor along the border of the tumor, and finally removes the vertebrae and the tumor together.
As for whether to remove the entire tumor from the front or from the back, it depends on the direction of tumor invasion. Whichever is more convenient is used.
After the square vertebral bone fragment was removed, the posterior surgery of waist 2 was temporarily completed, and Yang Ping filled the surgical area with imaging gauze.
This chapter is not over yet, please click on the next page to continue reading! Next is the surgery on the posterior side of lumbar 3. In this vertebra, Yang Ping will demonstrate the tumor separation technology at the pedicle and intervertebral foramen.
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The beginning was a bit unacceptable to Cheney.
He is the world's top spinal tumor expert, so he can certainly understand the level of demonstration surgery.
First of all, this separation method is very novel. It boldly takes full advantage of the advantages of the laser knife and truly achieves subperiosteal separation of the bones. It is already one step ahead of Cheney in concept.
Secondly, this surgeon is very familiar with the anatomy of the spine and tumors. He knows where the natural boundaries of the tumors are, so he always separates the tumors along the boundaries of the tumors from the normal tissue near the boundaries.
In addition, the surgeon's surgical skills are indeed very high. For example, the soft tissue is separated from the spinous process and lamina with intact periosteum throughout the process. After separation, the lamina in the surgical area is simply smooth without any soft tissue attachment.
Tumors are not like potatoes in the soil. They are completely different from the surrounding soil and have clear natural boundaries.
The tumor grows invasively to the surrounding tissue, and the boundary between it and the surrounding tissue is very blurred, and the so-called boundary and pseudomembrane are difficult to find.
However, the surgeon found it easily, which shows that he has studied a large number of such tumors and is very familiar with its boundaries.
Finally, there is very little bleeding during the entire operation.
Cheney stared at the surgical operation on the huge screen, his whole body in a state of high tension. The tension was not due to other reasons, but because of some kind of oppressive force covering himself, making it impossible to breathe.
He had never seen such an operation, or he never knew that it could be done like this.
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Blood vessel clamp!
Blood vessel clamp with wire!
needle!
Thread cutter!
Toothed tweezers!
Laminar retractor!
Nerve peeler!
Nerve retractor!
As the operation continues, more and more types of instruments are required, and the frequency of switching of surgical instruments becomes higher and higher.
Yang Ping was completely immersed in the operation and did not pay attention to whether others could keep up.
As I was doing it, I stretched out my hand for a long time, but there was no feeling of tapping with an instrument in my palm.
Yang Ping turned around, and the equipment nurse looked at him with timid eyes, and carefully patted Yang Ping's palm with the belated equipment.
The equipment nurse failed to keep up and had lost the rhythm.
Because Xiaosu is a device nurse, Yang Ping is particularly kind to the device nurse.
Some professors were throwing knives outside and getting angry at assistants and nurses at every turn. Yang Ping would never do this.
Seeing the guilty and uneasy look in Qiu Ruo's eyes, Yang Ping immediately realized that she was moving too fast. She had not kept up with the rhythm at all. It was allowed to go slower and it would not affect the operation, so just go slower.
In fact, Song Yun also struggled to keep up with the rhythm. Several operations were originally performed by his assistant, but because Song Yun failed to keep up, Yang Ping replaced the assistant and completed the operations himself.
Slow down!
"No hurry, slow down!"
Yang Ping gently comforted Qiu Ruo, took the equipment, and then consciously slowed down.
Qiu Ruo usually reacts and moves very quickly, and he has never been unable to keep up with the speed like this.
It's just that Professor Yang's speed was indeed too fast, beyond Qiu Ruo's understanding. Qiu Ruo had never seen anyone perform surgery so fast.
And since this is a spinal tumor, shouldn’t we be cautious?
Some professors still do one step and look at the other, but Professor Yang does the whole process at high speed, which is completely different from other professors' approach.
After Qiu Ruo lost his rhythm just now, he was afraid of being scolded, but Yang Ping's eyes were not reproachful, but comforting. Later, he slowed down completely to accommodate himself. Qiu Ruo felt warm in his heart. He did not expect Professor Yang to have such a good temper.
Even if he deliberately slowed down, Yang Ping was still very fast.
Nurse Xin was standing by and saw the entire scene. The young professor's operation speed was indeed ridiculously fast. Qiu Ruo couldn't keep up with the speed at all. If he hadn't given him face just now, he would have had to arrange a temporary equipment nurse.
If you go on stage, you might be embarrassed.
Fortunately, this young man gave me face and could slow down a bit to take care of the nurse on the table.
Nurse Xin was very grateful. Although it would be possible to add nurses temporarily, it would mean that her arrangement was wrong. The doctor had reminded her, and Professor Yang himself had mentioned this matter, but he had vetoed it.
This matter was blamed by Professor Liang, and he was inevitably criticized.
Qiu Ruo felt that she was not doing her job well and looked at the head nurse. The head nurse didn't say anything, which made her feel much better.
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As the operation progressed, Professor Cheney became more and more focused.
This kind of surgical technique is more advanced and mature than my own method in terms of concept and operation. How is it possible?
They asked to learn my new skills before, but how could they surpass me so easily now?
Did they steal their own technology through other means and then improve it?
It's impossible. I haven't included the technical details in my paper. At present, except for my assistants and the few doctors I personally mentor, no one has really mastered it.
Moreover, this surgical method is completely in two directions from concept to operation and our own new technology.
This Chinese-style total spondylectomy completely surpasses my own total spondylectomy method and truly achieves border-based resection!
Where did this technology come from? Cheney never believed that it was created by the Chinese themselves.
This requires time and a lot of energy, and it does not mean that it can be surpassed.
Take a look first!
After the surgeon has processed the back side of the 1st lumbar vertebra, he completely separates the spinous process, lamina, transverse process, and the muscles and ligaments attached to the upper and lower articular processes, and then opens the ring on the lamina. After opening the ring, he starts to treat the 3rd lumbar vertebrae.
Cheney vaguely felt that the surgeon was just opening the vertebrae from the back to separate the tumor, and later would take out the three vertebrae and the tumor at one time from the front instead of taking them out in three parts like he did.
When the surgeon separates the tumor, he is completely centered on the tumor and has been operating within the surrounding normal tissue. After being separated for so long, the tumor has been wrapped within its own boundaries.
Looking at it, Cheney was almost certain that the surgeon's purpose was to remove the tumor and three vertebrae from the front at one time.
The posterior approach is used to open the loop, the front and rear are combined to separate the tumor at 360 degrees, the tumor is taken out through the anterior approach, and then the spine is fixed and stabilized through the posterior approach.
This complex tumor requires only three steps. It is clear that this is a true en bloc resection. The entire operation is within the normal tissue surrounding the tumor, and the tumor as a whole is wrapped and sealed by the normal tissue, so there will be no leakage when taken out.
Is this difficult to do?
No, it's not difficult, basically impossible to do.
Because Yang Ping did not allow Director Hu to be his assistant, it was pointless for Director Hu to stay in the operating room. He returned to the orthopedic conference room and observed the operation with everyone, accompanying the American guests who came from afar.
"Professor Hu! Is this plan to open the loop posteriorly, separate posteriorly, and then separate anteriorly? The entire tumor and three vertebrae will be taken out at one time through the anterior approach?" Cheney couldn't help but ask Professor Hu next to him.
Professor Hu nodded: "Watch carefully and ask if you have any questions after the surgery."
Cheney was embarrassed by Professor Hu's words. Like a student who was not paying attention in class and was being scolded by a serious teacher, Cheney retracted his seat and continued to stare at the screen.
