The length of the free optic nerve is sufficient, and the eyeball connected to the optic nerve is removed. The empty eye socket becomes the best safety door. Directly behind it is the tumor and the "shield". The "shield" is an important brain wrapping the tumor.
Organization, they leave a gap here, which is the best place to attack.
Entering through this gap can avoid damaging the surrounding important brain tissue, and also avoid damaging the dense blood vessels.
Surgery requires strategy. Facing the "Maginot Line", whether to attack frontally or by surprise, the latter is obviously better than the former.
Although entering through the eye socket requires taking a huge risk to remove an eyeball, this does bypass the danger zone. Compared with other approaches, it minimizes the risk of death and disability. In a sense,
It is the only way to success.
Yang Ping did not hesitate and decisively cut away layer by layer from here, all the way to the cranial cavity. The gap directly behind was clearly visible in the field of vision. From this gap, the tumor could be removed in one go.
When the "gap" scene appears on the video.
The Mayo doctors took a long breath, what a brilliant approach, the gap is just behind the safety door, and the blood vessels on the surface of the tumor can almost be seen through the gap!
This requires great courage and innovative spirit to remove a healthy eyeball to achieve a successful operation. No one has thought of it before, and no one dared to think so.
"Are they really behind?" Johannessen exclaimed.
Yang Ping's tone was very calm: "Both magnetic resonance imaging and CT show this, but you just didn't pay attention."
In fact, every doctor at Mayo Neurosurgery has seen the patient's MRI and CT images. The images are indeed clearly displayed, but the power of the mindset is so terrifying that they selectively avoid the orbital approach. According to the textbook
There has never been such an approach. All their plans and attempts are within a limited circle.
The distance from the safety door to the tumor is relatively long, and the operating space is different from usual. It is almost a tunnel.
Therefore, to remove tumors through tunnels, the length of surgical instruments used is much longer than ordinary instruments. The greater the distance below the holding point of the hand, the worse the stability of the end of the instrument.
This will bring a certain degree of difficulty to the operation under the microscope, especially when the upper limbs are suspended in the air.
Even if you switch to the stable mode of double elbow support, this situation is extremely difficult.
"Do I need to support my elbow?" Johannessen asked.
At this time, the first assistant had been replaced by Johannessen from the ophthalmologist. He was worried that his arms were hanging in the air and he would not be able to complete such a difficult operation.
"No! The support will reduce the dexterity of my hands."
Yang Ping's tone is always so calm. Although this calmness seems cold, it can make people feel his rationality and confidence.
Johannesson stopped talking because every judgment he made was based on completely different thinking from Yang Ping.
The long-handled micro-instrument has penetrated deep into the skull to peel off the tumor. Starting from the notch, the laser knife begins to peel off the tumor.
This kind of contact laser knife not only has very high precision, but also does not cause mechanical compression and traction damage to nerve tissue caused by conventional mechanical knives during cutting. It also does not have the high-frequency current of electrocoagulation and hemostasis equipment, making it ideal for intraoperative electrophysiological monitoring.
No electronic interference.
Therefore, Yang Ping likes to use this tool very much when performing neurosurgery.
The location is so deep, the blood supply of the tumor is extremely rich, and the operating tunnel space is not large, making the operation difficult.
Johannessen's job as an assistant can only be to take on the task of retracting the hook. Yang Ping completed the entire surgical operation himself. In order to shorten the ischemia time of the eyeball as much as possible, Yang Ping did not want to waste time. Johannessen would only slow him down.
, his efficiency in individual combat is the highest.
By changing the power density, changing the irradiation time, changing the cutter head of different shapes and changing the way the cutter head contacts the tissue, the contact laser knife can change the tissue temperature and control the shape and range of cutting. Its cutting accuracy is 0.1~0.2mm, and the surrounding area
There is no obvious change in the tissue. Yang Ping maximizes the advantages of laser knife and minimizes the shortcomings of thermal damage.
The tiny blade will appear between blood vessels in every operation, and then cut and coagulate, so so far, no bleeding in the surgical area has been seen.
Yang Ping stretched out his hand, but the instrument he wanted did not come. He stopped what he was doing and looked back at the instrument nurse.
The nurse looked confused.
"I need another round-head laser knife!"
Yang Ping reminded that he discovered that the equipment nurse was just a strange American girl, and suddenly realized that he reminded her.
Now Yang Ping is holding microscopic tweezers in his left hand and a sharp-edged laser knife in his right hand. He uses this laser knife at the same time to stop bleeding and cut, which affects his speed.
Therefore, he wants to replace the microscopic tweezers in his left hand with a laser knife with a round blade, so that he can cut with his right hand and stop bleeding with his left hand. The two can be separated together to increase the speed.
"OK!"
The equipment nurse responded, answering eloquently, but she was already very flustered in her heart. The sluggishness just now was just the result of accumulation. She had tried very hard, but she still couldn't keep up with the rhythm. At that moment, her tense nerves finally broke and she could no longer keep up.
Up the rhythm.
But Yang Ping was already very fast in taking care of the nurses, and the early surgeries were obviously very slow. Of course, this was just for his usual speed. In the eyes of everyone, the speed was very fast.
Now we have to consider shortening the ischemia time of the eyeball as much as possible, so we must speed up. The speed of the instrument nurse finally collapsed, just like a speeding car burning out its engine.
"I---I---"
Because the equipment nurse was in a panic, after answering "OK", she completely lost her rhythm. She didn't know what to do next, her mind went blank, and she didn't know which equipment to reach for with her hands.
Johnathan was extremely embarrassed to see this scene. This is Mayo, the number one hospital in the United States.
"It's okay, don't be nervous, just take a rest."
This chapter is not over yet, please click on the next page to continue reading!
Yang Ping stopped what he was doing and comforted the nurse. He was always gentle to the nurse.
Johannesson followed Yang Ping's attitude and also encouraged the nurse: "You may be too tired, take a rest."
At this time, Yang Ping thought of something and said to Johannesson: "I forgot to tell you something important yesterday. If conditions permit, it is best for my surgery to be equipped with two skilled instrument nurses. This is the standard configuration for my surgery.
."
I have been an instrument nurse just now, even if I slow down, it is already very difficult for this poor American girl.
Two instrument nurses?
Johannesson didn't know what to do after hearing this, and he didn't know why Yang Ping would say such a thing. However, looking at the tired equipment nurse, he confirmed that what Yang Ping meant was very simple, that is, two nurses are needed.
The equipment nurse next to her nodded honestly: "Yes, it would be better to have another nurse."
She very much agrees with Yang Ping's suggestion, because she really can't hold on in her current state. The whole process just now was maintained by highly tense nerves, and all the potential of the body has been mobilized. This is not a normal way of working, and sooner or later it will collapse.<
/p>
Johannesson called the traveling nurse: "Let Daisy come on stage!"
Daisy is also a neurosurgery specialist nurse in the operating room. She is older than the current instrument nurses. Daisy and the instrument nurses on the stage are the best neurosurgery nurses at Mayo.
The anesthesiologist who had been silent next to him looked at the screen of the monitoring equipment again. At this moment, he felt tremendous pressure.
"Johnathan? Do I need more manpower here?" the anesthesiologist volunteered.
Because surgery is a serious and sacred matter, mistakes are absolutely not allowed. Instead of passively discovering shortcomings, it is better to take the initiative to propose them.
Johannesson turned his attention to Yang Ping, and he was not sure whether two anesthesiologists were needed.
Yang Ping shook his head: "No need, one is enough."
The anesthesiologist was relieved at this time, but he was obviously more nervous and more focused than before.
"I will tell you what equipment to deliver in this step and what equipment to prepare in the next step. The two of you will divide the work and work together. One person is responsible for preparation and the other is responsible for delivery. Don't mess up the rhythm. The ischemia time of the eyeball needs to be shortened as much as possible, so
I have to speed up, take a deep breath, let's continue now." Yang Ping encouraged the equipment nurse.
The instrument nurse took several deep breaths and finally found the state. The operation continued here, and Daisy also began to wash her hands and get on the stage.
---
What's going on?
Why is the video paused?
Is there any difficulty in the operation?
The video screen suddenly paused, causing the doctors who were observing the surgery in the classroom to have a series of questions in their minds.
This surgery is inherently difficult. The bizarre anatomy of the hemispheres of the brain makes the outcome of the surgery even more unpredictable. Yang Ping used such an unconventional surgical approach. In the eyes of these doctors, every step is a trap and risk.
"It should be a short rest to adjust the surgical posture. The surgical position is relatively deep and long-handled surgical instruments are used. It will definitely not work without supporting both elbows." The muscular man knew what was going on at a glance.
Muscular Man is a technical expert in Mayo Neurosurgery, and he is known as the King of Micromanipulation.
During his training as a neurosurgery specialist, this top student at Harvard Medical School, who viewed operations under the microscope as something extraterrestrial, trained frantically on operations under the microscope. He refined every operation, so he was called the King of Micromanipulation. Even if he sweats in the gym, it is just to have a strong body. In order to increase the balance and endurance of his hands, he uses homemade resistance training methods, which he has done for ten years.
As the king of micro-operation, he deeply understands that in this situation, it is impossible to complete the operation with both arms hanging in the air.
However, the hanging operation just now was already very powerful. The muscular man judged from the operation under the mirror that Johannesson's instructor was indeed one of the world's top masters.
Dr. Baifa has his own opinion. He thinks that even if the posture is adjusted, it won't take so long. Is there any accident during the operation?
The other doctors at Mayo sat quietly in the second row with the muscular man and the white-haired man, waiting quietly to continue. It is normal for a few accidents to occur in difficult surgeries, and they have experienced a lot.
Only Robert knew what happened in the operating room. He guessed that the instrument nurse must have got stuck and needed to adjust her rhythm now.
Robert knows his professor best, so the problem cannot be with the professor. So far, he has never seen the professor make a mistake.
"Having difficulties with the operation?"
Woodhead asked.
Obviously unfamiliar with the professor, Robert shook his head and said disdainfully: "This surgery is nothing to the professor."
"It's nothing? What is that?" Woodhead was very confused.
"Your Level 4 is just for a reason." Robert expressed helplessness.
Nothing? Woodhead thought about this sentence in his mind, but still couldn't figure out what it meant. This operation is still an operation for the professor, so how could it be nothing.
"Why is the video paused?"
Woodhead continued to ask, since there is no difficulty, just continue the operation.
"The professor is waiting for another instrument nurse to come on stage. He performs surgeries outside the headquarters. There are always two instrument nurses manning the table, otherwise the instrument nurses will definitely not be able to keep up." Robert guessed to himself that he was confident.
Massimo turned his head and asked: "The professor was born in orthopedic surgery, is neurosurgery also part of his hobby?"
Robert nodded: "The professor was originally an orthopedic surgeon, but he can do all operations, and they are all at the top level. You see, the eyeball re-implantation in this operation was originally an eye surgery. The professor can still perform the surgery. He is absolutely
Better than the eye doctor at Mayo."
Massimo fell into silence. When Yang Ping left Houston after rescuing NASA from crisis, Massimo went to the airport to say goodbye. When leaving, he asked Yang Ping if he had done a lot of interventional surgeries. Yang Ping just replied: Usually very
Do less interventional surgery.
At that time, Massimo was in a mess. He rarely performed interventional surgeries, but his skills were far superior to his.
It was at that time that Massimo recognized Yang Ping as his mentor. Although he has not been recognized by Yang Ping and has not officially joined the WeChat group, in Massimo's heart, Yang Ping has long been his mentor.
The muscular man felt strange when he heard that these Americans were actually chatting in Chinese. He felt that they seemed to know something about the inside story, so he asked Robert if he knew what happened in the operating room.
Robert told him truthfully: "Your equipment nurse can't keep up with the pace. Now we are waiting for the second equipment nurse to wash her hands and come on stage."
"Two instrument nurses?"
The muscular man in the back row felt incredible when he heard Robert's exaggerated words.
How fast the surgeon should operate can make it difficult for the instrument nurse to keep up with the rhythm. After all, the instrument nurse only hands out instruments, and brain tumor surgery is generally a dangerous operation, and the speed is relatively slow. When operating under a microscope, the speed
It should be slower.
"Yes, there are two equipment nurses. Whether the two nurses can keep up with the pace depends on the professionalism of your Mayo equipment nurses." Robert made no secret of it. He is that simple and direct.
After hearing this, several Mayo men around them were also extremely confused. How could it be said that Mayo is also a world-class hospital, but they had never seen such a thing.
