"The piggy-back orthotopic liver transplantation we performed this time was also improved on the basis of classic liver transplantation..."
Fang Le continued: "The biggest difference between piggyback orthotopic liver transplantation and classic liver transplantation is that piggyback liver transplantation does not require resection of the inferior vena cava..."
Ariro Tanabe: "..."
Without resection of the inferior vena cava?
Currently, many liver transplants performed in country r are all classic liver transplants, which require resection of the inferior vena cava. Now that Fang Le said that resection of the inferior vena cava is not needed, Tanabe Yuro fell into deep thought.
Having performed so many liver transplant surgeries, Ariro Tanabe must have a higher level of awareness than Chu Jianlin and others. This is the difference between those who have done so and those who have not.
While doing classic liver transplantation, some possibilities and considerations are not completely absent. After all, piggyback orthotopic liver transplantation is indeed based on classic liver transplantation.
It's just that even country r has not made any attempts in this area. For a while, Tanabe Yuro was a little at a loss.
Before coming here, Tanabe Yuro had prepared a lot of words. He had thought about all the difficulties in the technique and planned to target Fang Le. When the time came to question him on the spot, as long as Fang Le couldn't answer, it would make it impossible for Fang Le to come to Taiwan.
.
At that time, the success of an operation can only mean good luck and low difficulty.
But now Fang Le doesn’t even know about Tanabe Youlang, so how can he question this?
"Compared with classic liver transplantation, the most obvious advantage of piggyback liver transplantation is less intraoperative bleeding."
Fang Le continued: "This was reflected in the technique the day before yesterday."
"Especially for patients with portal hypertension, it can greatly reduce the massive bleeding from retroperitoneal collateral circulation caused by inferior vena cava resection..."
Many people nodded at this point.
Although most of the doctors present have never performed liver transplant surgery, as top extrahepatic experts, everyone is still aware of the impact of resection of the inferior vena cava.
Compared with classic orthotopic liver transplantation, piggyback orthotopic liver transplantation without resection of the inferior vena cava will definitely reduce massive retroperitoneal collateral circulation bleeding caused by resection of the inferior vena cava. This is beyond doubt.
"At the same time, piggyback liver transplantation can also avoid damage to the right adrenal gland during the resection of the inferior vena cava. Piggyback liver transplantation uses end-to-side anastomosis between the donor inferior vena cava and the recipient inferior vena cava.
, the method of ligating the subhepatic inferior vena cava of the donor liver..."
Fang Le continued to talk.
Liver transplantation is not as simple an operation as many people think. It just removes a liver. When the diseased liver is removed, the heart, kidneys and many other organs will be affected.
During the resection of the inferior vena cava, damage to the right adrenal gland is also often encountered during the operation. Piggyback orthotopic liver transplantation does not remove the inferior vena cava, thus avoiding damage to the right adrenal gland...
"During the operation...the main difficulty is..."
Fang Le continued to talk, Tanabe Yuro listened carefully, and then suddenly saw Zhang Ruihua beside him who had taken out a small notebook.
"Zhang Sang, lend it to me."
Tanabe Yuro said softly to Zhang Ruihua.
Zhang Ruihua: "......"
Fuck, I’m taking notes, and you want to borrow a notebook?
What record did you borrow from me?
The biggest difference between preoperative analysis and postoperative analysis is that preoperative analysis is just a plan, which is relatively vague, while postoperative analysis is meaningful. The difficulties and key points in this kind of postoperative analysis are very important to top doctors like Zhang Ruihua.
That is very useful for liver surgery experts.
It wasn't just Zhang Ruihua who was taking notes at this moment, Chu Jianlin and others were also taking notes.
"After I write it down, Zhang Sang can make a copy when I go back."
Tanabe Yuro whispered.
"All right."
Zhang Ruihua nodded, but reminded: "You must use Chinese characters."
Unlike Inoue Tomanobu, Tanabe Ariro can speak Chinese well, and he can also write it.
Zhang Ruihua doesn't want Yuro Tanabe to use ghost drawings to record it. What will he do when he is translating for himself during this short period of time?
The desire to harm others and the desire to guard against others are indispensable.
"All right."
Tanabe Yuro nodded.
Zhang Ruihua then handed his notebook to Tanabe Yuro. Relatively speaking, Tanabe Yuro was of higher standard and had better understanding, and his records were better than his.
At least Zhang Ruihua breathed a long sigh of relief at this moment.
At this point, Tanabe Yuro probably doesn’t have the ability to stir up trouble, mmp, wasn’t he quite arrogant just now?
"Okay, these are the key points of the surgery. Does anyone else have anything to ask?"
Fang Le talked for a while, took a drink of water, and then asked.
Ariro Tanabe was the first to stand up.
As Tanabe Yuro stood up, many people at the scene became interested.
Ariro Tanabe was sitting in the front row. Many people couldn't see what he had done just now. Some people thought that Ariro Tanabe was going to cause trouble.
Zhang Ruihua was also shocked and paralyzed. You were taking notes just now and now you want to ask questions?
"Excuse me, Professor Tanabe."
Fang Le said politely.
"Dr. Fang, what are the selection criteria between classic orthotopic liver transplantation and piggyback liver transplantation?"
Tanabe Yuro asked politely.
Just now Fang Le talked about the differences and advantages between the two, but a little more surgery does not necessarily mean it is better. There is also a suitable one. Only when the right surgery is used on the right patient is it most appropriate.
Hearing Tanabe Yuro's inquiry, many people were shocked.
"That's it?"
I stood up and asked this when I was young?
No, are you really not embarrassed?
Although many people are disgusted by Tanabe Yuro's arrival, most people have the mentality of watching the excitement.
As a result, Tanabe Yuro is like this?
"Based on the points I just mentioned, Professor Tanabe should be able to see that compared with classic liver transplantation, piggyback liver transplantation has one less vascular anastomosis, thereby reducing the complexity of the operation and shortening the operation time. At the same time, in
In the piggy-back surgery, since the donor-recipient inferior vena cava anastomosis is relatively well exposed, the anastomosis is less difficult than the suprahepatic inferior vena cava anastomosis in the classic surgery."
Fang Le said.
There is actually nothing to hide about this kind of thing. Technical transcendence means continuous transcendence, making it difficult for the other party to catch up. It is not about such small details. Fang Le knows very well that even if he does not do piggyback style, foreign piggyback style
It will be discovered soon.
Judging from the time, it should actually be within this year, and Fang Le himself can be regarded as taking another step ahead.
"Yes."
Tanabe Yuro nodded, he knew this very well.
The piggyback liver transplantation procedure has one less vascular anastomosis than the classic procedure, making the operation much less difficult. This is what Ariro Tanabe attaches great importance to.
The procedure that reduces the difficulty of liver transplant surgery is quite remarkable.
"But the disadvantages of piggyback style are also obvious."
Fang Le continued: "Piggy liver transplantation only requires partial or no blocking of the inferior amine vein during the operation. The recipient's hemodynamics are stable during the operation, and there is basically no postoperative renal failure.
, intraoperative cardiovascular parameter instability and other common complications of classic surgeries are particularly suitable for recipients with preoperative cardiopulmonary insufficiency.”
“The risk factors of piggyback liver transplantation mainly exist in the fact that the common opening of the donor liver’s subhepatic inferior vena cava and the recipient’s hepatic vein anastomoses. In a few cases, problems such as anastomotic stenosis and torsion may occur, resulting in the transplanted hepatic vein.
Reflux obstruction; in addition, the process of diseased liver resection during piggyback liver transplantation requires extremely high liver surgical skills and experience. Bleeding caused by damage to the hepatic vein, short hepatic vein, and inferior vena cava during diseased liver resection is a serious problem during the operation.
The most common complication.”
"In comparison, there is no clear distinction between piggyback liver transplantation and classic liver transplantation. However, piggyback liver transplantation requires very high standards of the surgeon, while classic orthotopic liver transplantation is relatively more challenging for the team.
The overall level."
Ariro Tanabe: "..."
Fang Le’s meaning is obvious. In terms of complications, intraoperative difficulties, etc., piggyback surgery has higher requirements for the surgeon. As Fang Le said, during liver resection, extremely high liver surgical skills and skills are required.
experience.
Of course, this is one of the reasons why Fang Le chose the piggyback approach this time. After all, as far as the team is concerned, they are all novices, so Fang Le can only rely on himself to solve the difficulties.
This is also true.
But why does Yuro Tanabe feel so uncomfortable?
Is Fang Le's words deliberately aimed at him?
(I have memorized all the chapters I owe and will make them up later. I didn’t mention it because I was too embarrassed to say it. Let’s talk about it later.)