At the 3rd lumbar vertebra, Yang Ping began to demonstrate the technique of separating tumors from the pedicle and intervertebral foramen.
This site is complex and the operating space is narrow, so it requires very high surgical skills.
The intervertebral foramen surrounded by the upper and lower vertebral pedicles is the space for the nerve roots to enter and exit. When separated, the nerves can easily be damaged.
Moreover, in such a deep and narrow space, it is difficult to deploy the instrument, so when faced with this situation, the average doctor can only do the next best thing, incise the tumor under the protection of gauze, and then cut off the vertebral pedicle.
But Yang Ping didn't want to do this. Once the tumor was cut open, no matter how well it was protected with gauze, leakage would inevitably occur. This violated the principle of no leakage.
Yang Ping decided to conduct precise separation of this area, also starting from the spinous process, because spinal tumors rarely invade the spinous process.
Start with normal tissue and separate it in a scientific order. This is the principle of leak-free resection.
Only by starting with normal tissue is it possible to operate within the normal tissue at the outer border of the tumor.
As the separation progresses, from the spinous process to the lamina, when separating the pedicles and the intervertebral foramen, a layer of bone cortex is actually separated together. Only laser and knife can achieve this easily.
, ordinary scalpels cannot do this. To separate the bone cortex with ordinary instruments, only sharp bone knives can be used.
Not only does it carry the bone cortex, it also carries the dura mater and the outer membrane of the nerve near the dural sac and nerve roots. These unrelated tissue layers are regarded as the pseudomembrane of the tumor, and the entire layer is completely destroyed in this way.
Opened with damage.
Yang Ping adjusted the speed of the operation several times to adapt to the speed of instrument nurse Qiu Ruo and assistant Song Yun.
Surgery is a team effort, and jumping in on your own can easily cause some problems.
Qiu Ruo could understand that the young professor had slowed down several times to accommodate himself, and he was very moved.
How can the surgeon accommodate the nurse during surgery, but this is the case now. The surgeon is obviously accommodating to her. She is like a favored princess. She feels very sweet in her heart. At the same time, she is more focused and hopes to go as quickly as possible.
After the cortex is lifted up, the laser knife easily completes the osteotomy at the pedicle.
The pedicles on both sides are separated using this wonderful method.
"This is because the periosteum has been violated, but the bone cortex is fine. With the soft tissue as the pseudomembrane, we have no way to start, so we can only use this extreme method. This method is called subosseous separation. When there is no laser knife, the sharp small bones
The separation can also be done with a knife, but it is very difficult. It will be much easier to use a laser knife to separate."
"As for the boundary of the tumor, I rely on the image of the tumor to judge, and then use the images in my brain and surgical experience to find the boundary during surgery."
"I am researching a more reliable staining method. I use dyes to dye the junction area of tumor, normal tissue and tumor-normal tissue into three different colors. With special research, I can see the boundary directly during the operation, and I can design the staining in the future.
The agent has a cutter head with recognition ability and will alarm if it crosses the boundary."
Yang Ping explained to Song Yun while performing the operation.
Subosseous separation was the first time Song Yun had heard of this separation method. However, if subosseous separation is not used in this vertebra, tumor cells will definitely leak out.
Once separated from the bone, the problem is solved, which is indeed a wonderful idea.
The dyeing method and induction method proposed by Yang Ping are also new ideas and are very promising for research.
"The surgical method is very important, just like racing without restrictions on transportation. No matter how good you run, you can't beat a racing car."
Yang Ping used a metaphor to explain: Without the concept and method of subosseous separation, and still stuck in the habit of thinking that soft tissue is a pseudomembrane, the tumor in waist 3 will definitely rupture and leak.
Lumbar 3 successfully cut off the vertebral pedicles on both sides and completed the open loop.
Total vertebra resection, no matter what method is used, must open the ring, just like a closed iron ring on a pillar. It cannot be removed from the top or bottom of the pillar, either by breaking the pillar or breaking the iron ring.
Obviously the patient's spinal cord and nerves cannot be interrupted, so only the rings of the vertebrae can be opened.
The scope of lumbar 4 tumor invasion is much smaller, and the vertebral pedicles are not invaded. Conventional separation methods can be used to cut off the vertebral pedicles on both sides.
In this way, the separation of the posterior tumor and the opening of the three posterior vertebrae were all completed. This step took about an hour, but it was slowed down to take care of the assistants and nurses.
In fact, the quality of doctors and nurses in Xiehe is very high, absolutely world-class, but Yang Ping is too strong!
"Do you want everyone to take a break?"
Of course Yang Ping wants to complete the operation in one go, but I don’t know what everyone else thinks. If you really can’t keep up, it’s better to take a rest.
"It's okay, you can continue!"
The first one to respond was Qiu Ruo. She felt even more regretful after taking a rest. She had already received special care from Professor Yang.
"Professor Yang, would you like to add a device nurse?" Nurse Xin now took the initiative.
Nurse Xin has been working at Peking Union Medical College since she graduated from Peking Union Medical College. She has never seen any kind of professor, but she has never seen a professor like Yang Ping.
The surgery was ridiculously fast and the job was done so well. Such skill can really be described as a stunt!
"No need, Nurse Qiu is very cooperative. It's the first time she's so cooperative. It's rare. Xiehe is Xiehe."
Yang Ping gave enough face to the equipment nurse today and gave enough face to Xiehe.
He is an alien, so he cannot ask others to be an alien too. Yang Ping is still self-aware.
Hearing this, Qiu Ruo felt warm in her heart and was very grateful.
---
Cheney's eyes never left the screen as he watched every detail of the operation intently.
Three vertebrae, posterior surgery only took one hour.
My usual posterior separation is much rougher than this. With this kind of tumor, it is absolutely impossible to complete the posterior separation within five hours, but now Xiehe's surgeon only takes one hour to complete the separation.
The speed is so fast, but what about the quality?
As long as you are a serious expert, you will definitely be able to see the god-level quality of this kind of surgery.
This chapter is not over yet, please click on the next page to continue reading! The surgeon uses a variety of techniques during surgery, some of which are traditional, such as subperiosteal separation. Even with these traditional methods, the surgeon has taken them to a new level.
, the entire subperiosteal separation, no part of the periosteum was damaged, and the surface of the bone was smooth.
Some were methods that Cheney had never seen before, such as the novel subosseous dissection, which expanded the understanding of the tumor boundary, and with the help of a laser knife, the periosteal dissection was extended under the bone.
This is not only an improvement in operations, but also an update of concepts.
With the Chinese-style total spondylectomy in full swing, Cheney's self-esteem was severely hit, no, seriously crushed.
Chinese-style total spondylectomy is far superior to Cheney's surgical method.
The mineral water bottle was in Cheney's hand. He was squeezing it and rubbing it, but it no longer had a normal position.
He had many questions in his mind to ask Director Hu, but Director Hu kept staring at the screen without looking away, and Cheney did not dare to speak.
"Where's the bathroom?"
Cheney's bladder was a little tense and he couldn't hold it in any longer, so he asked Director Hu.
"Watch carefully! If you have any questions, ask after the surgery!" Director Hu replied again.
"Yes, I see!"
Cheney sat upright again. It should be okay if he endures it for a while. His bladder has the ability to reabsorb. Let's wait and see.
Professor Lu Donglai, the director of the medical department, has a background in oncology surgery. Seeing this level of surgery, he finally understood why Professor Liang spent so much money on Yang Ping.
When it comes to selecting people, Mr. Liang puts Xiehe first, and no one dares to say second.
Zhang Chunquan, who was mediocre at that time, was attracted by him and put a lot of effort into it. Although this kid has now gone to the United States, it is undeniable that his abilities are definitely among the best in the world. The stem cell project of the MIT Baitou Laboratory in the United States has current results.
Zhang Chunquan takes the greatest credit, and I heard that he is expected to win a Nobel Prize in the future.
Unfortunately, Zhang Chunquan went to the United States and never came back. He also became an American citizen. Not long ago, Professor Liang was entrusted by the Union Medical College to contact Zhang Chunquan, hoping to bring him back to the country. Zhang Chunquan decisively refused. Even if he did not return to the country, he would become a visiting professor and do something for the Union Medical College.
Contribution is fine, but this Zhang Chunquan even refused to be a visiting professor, and he refused so resolutely that Mr. Liang was sad for a long time.
Professor Lu thought of this and looked at Professor Liang sideways. Wasn't he sick in bed? The day before yesterday, he and the dean visited his home. Yesterday, he called Professor Liang's wife to inquire about his condition and see if he could persuade Professor Liang to go to Union Hospital.
Hospitalization for several days.
Why are you so lively today? You are sitting here attending a meeting and observing surgeries. You don't look sick at all. You have been in bed for several days and still have a fever. How can you recover so quickly?
While Professor Lu was questioning, Professor Liang grabbed the mineral water bottle and drank a few sips. Almost the entire bottle of mineral water was gone.
With this appetite, I drink a whole bottle of water at a time.
"Mr. Liang, your student's surgical skills are a bit exaggerated. I would say, Mr. Liang, that the talent you are looking for is definitely one in a million, so I, Lu Donglai, signed without batting an eye." Professor Lu said it as if it was true.
.
Professor Liang did not buy the blame of him, the director of the medical department: "Of course you didn't blink, because you signed with your eyes closed under my coercion and inducement, and you didn't sleep well for three days after signing, right?
Can you have a good sleep tonight?"
Professor Lu's sarcasm towards Professor Liang was without changing his face or heartbeat: "After I signed the contract, I really didn't sleep well for a few days, I was so excited!"
Lu Donglai was the only one in Xiehe who had a thicker skin than the city walls.
Thanks to Professor Tuoliang and now thanks to the introduction of Yang Ping, Professor Liang is first and Lu Donglai is second.
After a while, Lu Donglai may become the first and Professor Liang the second.
With Lu Donglai's eloquence, it can be done.
---
After the posterior surgery is completed, the posterior surgical area should be temporarily closed, the special position should be filled with gauze, the incision should be temporarily closed with leather staples, and then a sterile medical film should be applied.
Turn the patient over to the supine position, re-sterilize the drapes, and then perform anterior surgery.
Yang opened the abdomen in parallel and cut it layer by layer. All the blood vessels he encountered along the way that needed to be ligated were ligated in advance. No bleeding occurred because any one was missed.
This preemptive hemostasis technology makes the surgical area very clean and makes people look very comfortable.
Soon the vertebral bodies and tumors from waist 2 to waist 4 in the retroperitoneum were revealed.
The tumors in waist 2 and waist 3 invaded the abdominal cavity forward and were severely adhered to the abdominal aorta and inferior vena cava. The walls of the large blood vessels had been invaded and degenerated. After Yang Ping's exploration, he believed that if left alone, the risk of aortic dissection would be extremely high in the future.
So Song Yun was asked to ask for vascular surgery support and implant artificial blood vessels as a precaution.
This was also the situation estimated before the operation, and the vascular surgery department was also prepared. When they were notified, they were already in the operating room.
If it were at Sanbo Hospital, Yang Ping wouldn't need to hire a vascular surgeon at all. He would insert the artificial blood vessel himself and do the whole thing himself.
At Sanbo Hospital, he has full surgical authority. Among all surgeons in the country, he is probably the only one who can have such special treatment.
Of course, his assistants also receive this special treatment.
But that was not the case at Xiehe, as his authority was only within the scope of his original practice - orthopedics.
Even if the abdominal aorta and inferior vena cava are explored and the subsequent separation of the aorta and inferior vena cava is done, it is still a side project. If Director Hu were to do it, this step would also require a collaborative operation between basic surgery and vascular surgery.
If it is an emergency life-saving situation, Yang Ping will make an exception. Now is not the time for emergency life-saving. We can only act in accordance with medical regulations.
Yang Ping always believes that doctors should be rational rather than emotional.
Director Zuo Ruiting of the Union Medical College Vascular Surgery Department came with two assistants to provide support. The Union Medical College Vascular Surgery Department receives many emergency surgeries for aortic dissection tears every year, so Director Zuo basically has no concept of Saturdays and Sundays.
In his own words, Wangfujing Pedestrian Street is near Xiehe. You can see the lively scene from the window, but he rarely goes there. Sometimes he just takes a look through the window. After getting addicted, he basically spends a year
There was little rest, and there were too many surgeries to handle.
Called by the Department of Orthopedics to cooperate, Director Zuo had no complaints. He had already familiarized himself with the condition in advance. This time he took his assistant and just looked at the images: "This patient needs to have an artificial blood vessel inserted in advance, otherwise 90% of the time he will have serious complications after the operation."
Arterial dissection and tearing. We had such an operation not long ago. After abdominal tumor surgery, the tumor was adherent to the aorta. Three months after the operation in an external hospital, the aorta was dissected and torn more than 20 centimeters from top to bottom.
, Fortunately, it was delivered in time and he was saved."
Director Zuo has rich experience and has rescued many patients with aortic dissection. He snatches people from the Lord of Hell every day.
"Brush your hands!"
Director Zuo was a forthright person. He gave the order and took two assistants to the stage.
Surgeon, just do the surgery.
---
Yang Ping temporarily withdrew and hid his hands in the gauntlet pockets on his chest to rest.
"Professor Yang---"
While Director Zuo was washing his hands and the operation was paused, Qiu Ruo whispered.
Yang Ping turned his head when he heard Qiu Ruo's voice. The equipment nurse was smiling at him: "Thank you!"
"You're welcome!"
"You---look at the equipment I prepared, right? You will use it later."
Yang Ping took a look and saw, yes, these are the instruments.
In fact, Qiu Ruo is really an excellent device nurse, worthy of being a graduate student of the Union Medical College, but she is still a little behind Xiao Su at home.
"That's right, these are the instruments. Keep your speed steady and don't rush."
"Well, thank you!"
She didn't expect that the professor would respond to her and chat with her for a few words. She thought that Yang Ping could only respond with a few words of hum.
