godfather of surgery

Chapter 1115 The Importance of the Town Hall

The operation was carried out in this strange position. With Yang Ping's support, Director He felt at ease. He decided to challenge this world-class surgery.

The graduate student supported the patient's body with his hands, but the head could not be fixed. The graduate student could not free his hands to fix the head, so another graduate student had to be assigned to fix the head specifically. In this way, the patient could maintain a 90-degree sitting position on his left side to minimize the pressure of the tumor on the heart.

The graduate student in charge of fixing the head was the one who had just backed out at the critical moment, but was still forced by Director He to fix the head with his eyes closed. If he had known he could not escape, why would he have been hesitant and made excuses to refuse?

With the help of two graduate students, the patient's position was finally fixed.

"Ice cap, give me an ice cap and put it on the patient." Director He called out with his back straight.

Now he feels very proud and confident.

I, He Xiangjun, will admit patients that others dare not to admit; I, He Xiangjun, will perform surgery that others dare not perform.

Everyone didn't understand why Director He used the ice cap, but they just did as he was told. Director He saw everyone's confusion, and in order to show off his superior skills, he said, "The patient will have insufficient blood supply to the brain during the operation. Using the ice cap will lower the temperature of the head, reduce brain metabolism, and thus reduce the brain's demand for oxygen, so as to protect the brain and prevent hypoxic damage to the brain. Otherwise, even if the operation is successful, the patient will suffer serious brain damage, so what's the point of the operation then?"

"Why does insufficient blood supply to the brain occur during surgery? You can analyze it yourself when you have time after surgery. You need to use your brain to study and conduct in-depth research on the patient's condition."

Director He took the opportunity to throw out the homework he had left for the graduate students. How could this world-class surgery be completed without saying a word? With so many graduate students, is he still the department director if he doesn't raise some profound questions?
The patient's position problem has been solved. Now the nurse is opening an infusion line for the patient. After some observation, the infusion line can only be implanted through femoral vein puncture. The anesthesiologist gives pressor and cardiopulmonary resuscitation drugs through this line. Relying on these drugs, the patient's vital signs are kept stable during the operation as much as possible to help him get through the operation. However, the anesthesiologist is not sure whether it will work. Since the doctor has decided to perform the operation as planned, he can only cooperate and devote his lifelong learning.

"Can we ask Brother Liang to come over for technical support?" The anesthesiologist suddenly had an idea and immediately asked Yang Ping.

Yang Ping said calmly, "Dr. Liang is busy right now and can't leave. The patient's airway is open and his vital signs are stable for the time being. There's no need to be so nervous. Once the tumor is removed, the pressure will be relieved and the risk will be much lower."

For Yang Ping, who has seen countless big scenes, this is nothing. When he was performing a brain stem tumor resection surgery on his mentor Academician Feng Tiancheng, the old academician suffered cardiac arrest several times during the operation. Yang Ping managed to pull him back from the hands of death. Compared with the old academician's surgery, this kind of surgery was just a small storm.

But for Director He and the anesthesiologist, this is a huge wave that could capsize at any time. Director He now has Professor Yang to see patients, and the anesthesiologist is all alone. His heart is beating fast and tense.

Although Director He was cheerful and cheerful on the surface, he was still a little nervous. As they chatted, the disinfection sheet was put on the operating table. Yang Ping was still standing in front of the reading light studying the patient's CT scan. A graduate student next to him also imitated him, standing in front of the reading light with his arms crossed, concentrating and squinting his eyes, as if he was also studying the patient's complex CT scan manifestations. For the first time, this graduate student felt that staring at the CT scan on the reading light in this posture and with this look was very cool and handsome.

The patient, Xu Songde, male, 30 years old, had been ill for one year. The tumor grew rapidly from a pea-sized lump to 1 cm × 60.1 cm × 54.6 cm in just one year. It was a very rare giant tumor that grew rapidly in the mediastinum.

How big is it? The graduate student next to me gestured with his arm. It is almost the same size as the large washbasin we usually use. The volume of the chest cavity is only this big. If you stuff a washbasin in there, it is no wonder that so many organs are squeezed.

It can be seen from the current medical history recorded in the medical records that this patient had undergone three chemotherapy sessions in other hospitals. Not only did these three chemotherapy sessions fail to achieve any effect, but the tumor actually grew rapidly after the chemotherapy.

The huge tumor exerts obvious pressure on the nearby trachea, bronchi, heart and large blood vessels. The pressure on the trachea can cause breathing difficulties, and the pressure on the heart can restrict the heartbeat, both of which are fatal.

In order to use body position to relieve this pressure, the patient can only sit sideways at nearly 90 degrees to barely maintain heartbeat and breathing since the onset of the disease. He can only sit like this 24 hours a day, leaning against the back of the chair or the quilt on the bed with the left side of his body. He can't lie down at all. Once he lies down, the trachea and bronchi are flattened, oxygen cannot be inhaled, and carbon dioxide cannot be exhaled. And because of the pressure, the diastole of the heart is restricted, and this restriction can cause cardiac arrest at any time.

At this point, the only treatment is surgery, which must relieve the compression of the tumor on the surrounding organs to relieve or eliminate the current symptoms. However, the patient went to many hospitals during this period, and all the doctors told him: "If you have surgery, you will definitely not be able to get off the operating table and will die. The huge tumor is located in the center of the mediastinum in the chest cavity, and has widely invaded and compressed important organs such as the heart and blood vessels, trachea, bilateral lungs, left and right main bronchi and bilateral lungs. It is impossible to remove it. The removal process is very likely to damage these organs, resulting in impaired respiratory and heart functions, and cardiac and respiratory arrest. Moreover, even if you risk death and go to the operating table, there is no suitable position to complete this operation."

When the patient was in despair, a doctor recommended Xu Songde to Sanbo Hospital, saying that Sanbo Hospital had been very famous in the past two years, and its various departments had frequently completed the world's top surgical cases, so the thoracic surgery department must not be bad either. After hearing this, the patient immediately came to Sanbo Hospital.

Look, the patient was sent to the operating room, and his heart and respiratory arrest occurred just after he passed the bed. If it weren't for the timely and effective rescue, there would be no chance for surgery. Therefore, the doctors who were afraid to perform surgery on the patient before were correct.

In fact, the patient's situation is very simple. Even if the patient is sent to the ICU immediately, the patient can survive for a few days with the help of drugs and various instruments and equipment. However, as long as the tumor's pressure on the surrounding organs is not relieved, no drug can solve the problem of mechanical compression, so the patient is unlikely to survive after a few days. If the doctor can seize the opportunity and take the risk to complete the operation now, once the patient can survive the operation, the probability of survival will be very high.

Compression is the root problem, and removing the tumor is the only way to solve the root problem.

The operation began. Director He used the handle of the scalpel to indicate the center of the sternum. This operation could only be performed using a wide-open median sternal approach, as only this approach could reveal such a huge tumor.

"Anesthesiologist, I'm having surgery!"

On the surface, Director He was reminding the anesthesiologist to report the patient's current vital signs, but in fact he was reminding Professor Yang that he was really going to perform surgery and asked him to help keep an eye on it.

After reporting the vital signs, the anesthesiologist stared at the monitor screen carefully.

“I’ve officially started cutting skin!”

Director He repeated.

"Well! Cut it!" Yang Ping responded. After hearing the reply, Director He finally began to cut the skin of the chest with the scalpel that he had been practicing for dozens of times, making a long vertical incision in the middle of the sternum.

After the skin was cut open, the scalpel was replaced with an electric knife. As the squeaking sound of the electric knife and the smell of burning human tissue spread, the skin was cut open.

"Chainsaw! Open the chest!"

Director He would call out the name of each step, and his voice was loud and clear.

Yang Ping was still analyzing the CT scans, facing the film review screen with his back to the operating table.

"Anesthesiologist, what are the patient's vital signs?"

The anesthesiologist immediately reported: "Stable."

Yang Ping then turned around, facing the operating table, and looked at the operating area from a safe distance, signaling him to boldly open the chest: "Hurry up and open the chest, and make a quick decision, but stay calm, don't panic or get confused."

Director He immediately took the electric saw, and as a cloud of blood mist rose, the sternum was sawed in half along the midline. The glasses of the assistant deputy chief physician next to him were covered with tiny blood drops. He quickly turned his head away, and the circulating nurse took off his glasses, wiped them clean, and then put them back on.

"Why don't you wear goggles?" Director He muttered.

"Chest opener!" Director He shouted.

As the thoracotomy expanded, the split sternum was stretched open, the chest cavity opened, and the huge tumor wrapped in the pericardium was exposed. The surface was covered with densely curved blood vessels, the blue veins were bulging, and the red arteries were pulsating. Because of the beating of the heart, the huge tumor also pulsated along with it.

The situation was more complicated than expected, and Director He's back felt slightly wet.

After entering the chest cavity, Director He immediately sewed several No. 10 silk threads in several dense connective tissue areas around the tumor, and clamped the tails of these silk threads with vascular clamps. The function of these silk threads is to pull and suspend the tumor. The vascular clamps at the tails of the silk threads are handed over to the assistant, who uses these silk threads to suspend the tumor. The pulling force of the silk threads forms a balance with the gravity of the tumor, so that the tumor will not continue to fall and compress the heart, organs and left and right bronchi due to the opening of the chest cavity, avoiding such compression to pose a serious threat to the patient's cardiopulmonary function.

In the past, Director He had performed many heart, lung and large blood vessel surgeries with Yang Ping and had accumulated rich experience. These valuable experiences are now beginning to play a role.

Although he was inevitably nervous and unsure about the procedure when facing such a complicated tumor, the surgical procedures were still very clear in his mind. He knew exactly how to proceed with each step, what the purpose was, and what to pay attention to.

After completing the suspension of the tumor, he began to insert a catheter into the patient's internal jugular vein, connected it to the femoral vein sheath through a connecting tube, and performed blood diversion in the superior vena cava and inferior vena cava systems to ensure the normal return of blood to the head and prevent insufficient blood vessels or ischemia in the head during the operation.

This step is very important. Without this step, the patient is very likely to suffer from cerebral ischemia during the operation. Even if the operation is successful in the end, the brain will be damaged due to ischemia and hypoxia, and the patient may even become a vegetative state.

It was a good start. Director He turned his head and glanced at Yang Ping next to him. Yang Ping encouraged him, saying, "Just do it this way. Stay steady and take it one step at a time."

The entire operation consists of two parts: resection and reconstruction. The tumor and some organs invaded by the tumor are removed, and then the removed organs are reconstructed. The entire process is very complicated and the project is relatively large. Without sufficient surgical experience, it is difficult to perform this complex and high-risk operation.

For ease of operation, Director He performed the surgery while sitting, with several assistants standing on both sides to assist. Limited by body position and operating space, Director He's movements were very awkward, but there was no other way, as this type of surgery could only be performed based on the body position, and the body position could not be used to accommodate the surgery.

Next, Director He conducted an investigation. After finding out the enemy's situation, Director He briefly recounted the general surgical process and asked Yang Ping to help verify whether there were any errors or omissions.

Tumor resection, most of the pericardiectomy, ascending aortic sheath resection, aortic arch sheath resection, right innominate artery resection, right subclavian artery sheath resection, right common carotid artery sheath resection, left common carotid artery sheath resection, left subclavian artery sheath resection, superior vena cava resection, left and right innominate vein resection, left and right internal jugular vein cancer thrombus, thrombus removal, left upper lobe anterior segment resection, right upper lobe anterior segment resection.

The resection of this operation includes fifteen specific operations. Most people would get a tingling sensation on their scalp just thinking about it. The former Director He would also get a tingling sensation on his scalp and tremble in his hands. However, the current Director He is no longer the same as before. He has gone through all kinds of bloody battles with Professor Yang.

After talking about the fifteen resection operations, Director He swallowed and continued.

Innominate vein-right atrium artificial blood vessel replacement and reconstruction, right innominate vein-right atrium artificial blood vessel replacement + artificial material pericardial reconstruction...

Finally, the name of the planned surgery was announced. Director He's forehead was covered with sweat. He turned his head from time to time to ask the nurse next to him to help wipe the sweat off his face, fearing that Yang Ping was not paying attention to his surgery. He looked at Yang Ping from time to time, and seeing Yang Ping standing there, he felt much more at ease.

At first, when Director He saw such a complicated tumor and the patient was in such a very uncomfortable position, his hands were very stiff. But as time went on, he became very used to it. Although he did not dare to move very fast, at least he was not stiff and shaking.

"Or, Professor Yang, you wash your hands, get dressed, and sit here to rest. I'll feel more at ease then." Director He said with a forced smile.

Yang Ping thought so too. If anything really happened, he could go on stage to save the situation immediately. Standing on the stage like this now, he would have to wash his hands and get dressed in case of an emergency, which would be a waste of time.

With the help of highly skilled and experienced teachers, the doctor's surgical skills will improve very rapidly. Otherwise, the doctor's surgical skills will improve very slowly. This is the importance of supervision.