godfather of surgery

Chapter 1168 Brain Surgery Under Awake

In the corridor, the conjoined sisters had already come out; they were used to the curious stares of others.

Two conjoined twins, each with their own independent thoughts, but maintaining consistency in action is indeed a challenge, which is why they are always arguing. Yang Ping doesn't know if other conjoined twins are like this, but at least this pair of conjoined twins are. They live together in this symbiotic relationship.

However, having four legs did not give them greater speed; instead, it brought them more inconvenience in movement. Their two bodies looked somewhat distorted, so the correction during surgery was also a major challenge.

Morris gets a headache just thinking about this surgery. Back in the United States, a team of doctors had a serious discussion about it, but ultimately decided to abandon the surgery.

Orthopedic surgery involves cervical spine correction, which is also a very dangerous procedure. However, Yang Ping's focus is not on this. As an orthopedic surgeon, Yang Ping is skilled in scoliosis correction, which is not a problem for him. The unknown neural interface is the real challenge.

But for those American doctors, each problem is a problem, and a series of problems combined make it impossible.

But Professor Yang remained so calm, as if this case were just an ordinary one in his eyes. He did not convene a meeting with specialists to discuss it, but instead proceeded with the surgical plan step by step. Everything was so uneventful that Maurice felt a little uneasy. However, Yang Ping was a Nobel Prize winner, which made him have to trust him completely.

Using comprehensive gene testing technology, a large model can simulate how these two sisters differentiated from fertilized eggs into the conjoined twins they are today. They were originally supposed to be twins, but during the process of the fertilized eggs developing into fetuses, they encountered some unexpected factor, which caused their bodies to be joined together.

It is formed from the division of a single fertilized egg. Unlike the normal process of monozygotic twin pregnancy, the fertilized egg does not completely separate in the first two weeks. The partially separated fertilized egg continues to mature, resulting in the formation of a conjoined fetus.

This usually occurs in the first two weeks of pregnancy, when the two fetuses have the same chromosomal karyotype, the same sex, and the same blood type, hair color, fingerprints, etc.

It occurs in about one in 100,000 pregnancies, and most conjoined twins die in the embryonic stage, with a delivery success rate of only one in 200,000.

In terms of probability, these sisters are lucky; they seized a one in two hundred thousand chance of success.

Most conjoined twins do not choose to undergo surgery because the risks are too high. They choose to live in a unique way. The world's longest-lived conjoined twins are also a pair of sisters who lived to be 68 years old.

Johannesson immediately got to work after putting down his backpack. He worked as an ordinary doctor in the preparation for the surgery of the conjoined twins. Because his Chinese was very fluent, he was able to integrate into the team quickly.

Why do doctors at the research institute progress so quickly? Besides Yang Ping being an academic leader and having a scientifically advanced training system, there's also this open exchange mechanism. You can work alongside world-class experts at any time. In such a training environment, doctors are easily cultivated to be confident, possess the latest knowledge, and have extremely strong practical skills.

Dr. Li Min, who came from a township hospital, has not yet finished his advanced training. He is working with these world-class experts. He has the basic knowledge that Yang Ping gave him. In this environment, he is learning and growing, and his medical skills are improving day by day.

The Guandu Hospital, funded by Wang Changxin's donation, has already started construction. It is estimated that the Guandu Hospital will become the best township hospital in the country, not only in terms of buildings and equipment, but also in terms of technology and personnel.

After Li Min returns, he will likely succeed the old director as the young director. Under Li Min's leadership, Guandu Hospital will surely become an excellent township hospital.

Guandu Hospital is a township hospital, and Li Min is a village doctor, so Yang Ping's training program for him was designed to make him proficient in surgery, master the techniques, and get to know a group of people.

For all basic surgeries, regardless of specialty, one must be proficient and reach a high level of expertise. For some advanced surgeries, mainly emergency surgeries, one must master them and be able to safely complete the surgeries under conditions of limited equipment and a simple team. For some non-emergency advanced surgeries, one needs to have a comprehensive understanding of these surgeries, but does not need to master the practical aspects of the surgeries.

Under this training model, Li Min gradually became a master of basic general surgery.

He can perform a wide range of procedures, including neurosurgery to clear hematomas, emergency treatment of brain herniation, emergency interventional cardiac surgery, major blood vessel rupture surgery, and trauma surgery on major heart vessels. He is also very familiar with cesarean sections in obstetrics and gynecology.

Everyone gathered together and, under Song Ziming's direction, divided the work and cooperated to prepare for the surgery for the conjoined twins.

Almost all the successful conjoined twin surgeries reported in the literature involved twins without any major organ connections or organ sharing. In such cases, doctors would not choose surgery but rather maintain the status quo.

In 2009, a woman in Hubei Province gave birth to conjoined twins, the first case of conjoined twins in China. They were connected by their ischium, sharing a single umbilical cord and anus. They also shared internal systems, including digestion, urination, reproduction, and skeleton. This sharing involved two systems working together.

75% of conjoined twins in the world are joined at the chest and abdomen; it is very rare for them to be joined at other parts of their bodies.

The situation of conjoined twins, with their skull base and cervical spine connected, is extremely rare and has not been reported in the literature. The challenge this poses to Yang Ping is unimaginable.

Scientific research training has made Yang Ping not only a doctor who can treat patients and perform surgery, but also a doctor capable of solving unknown problems, because he is a scientist among doctors, not just a surgical craftsman.

In the past, when conjoined twins underwent surgery, the shared organs were not truly shared, but rather two sets of organs were used interchangeably. For example, the two stomachs were connected, and the surgery required separating the stomachs and then repairing the connection. The same applied to other solid organs. The so-called sharing meant that these organs were connected through blood circulation or other channels.

So these organs are not actually one, but two. They are not truly shared, but mixed. If there is only one vital organ, conjoined twins cannot separate. Who would get that organ?

This is also explained by genetics; conjoined twins are caused by developmental disorders in identical twins, so they generally have two sets of organs.

These conjoined twins have their brainstem and cervical spinal cord connected. Their problem lies in the fact that they are using the same set of brainstem and spinal cord. If they only had one set, Yang Ping would not have been able to perform surgery on them. Now they have two sets, which are being used interchangeably, with unclear boundaries and unknown developmental status.

This kind of mixing is different from mixing other organs. Apples and pears are easy to separate when they're in the same box. But if flour and rice flour are mixed together, it's difficult to separate them, and that's the kind of terrible situation Yang Ping is facing now.

Yang Ping sat in the doctor's office, opposite a dedicated image viewing screen, with other doctors surrounding him. Many pre-operative discussions were conducted in this way.

Thanks to Johannesson, Moslito blended into the crowd and went unnoticed. Given that he was Johannesson's friend, even if he were discovered, people would give him some face and not drive him away.

“Other areas are relatively easy to handle, but the anatomy in this region is extremely complex. Some nerve nuclei are very close together, while others may have merged into one. We must distinguish them precisely, otherwise the surgical consequences could be disastrous.”

Pointing to the images on the screen, Yang Ping said that for him, nothing else was a problem, only this was uncertain for the time being, but it was only temporary.

The nerve nuclei were all mixed together, making surgery much more difficult than operating on a tumor in this area, which worried Song Ziming. "The cervical spine seems to be a challenge as well," Johannesson commented.

Yang Ping said, "From the medulla oblongata downwards, the boundary between the cervical spinal cord and the spinal cord is relatively clear. We just need to be careful not to damage the nerve bundles and nerve nuclei during the operation. After the cervical spinal cord and cervical vertebrae are separated, some segments need to be fused for stability. As for the missing skin, we will use expanded skin to cover it."

Johannesson understood that these were problems for him, but not for Professor Yang.

"This is a large model from Director He's side depicting the location and boundaries of the neural nuclei, as well as the suggested surgical approach." Song Ziming then pulled up the three-dimensional brain image created from the large model.

Johannesson and Morris were both surprised, not expecting that China's artificial intelligence development had been so rapid, and that its application in medicine was already at the forefront. The United States also had similar artificial intelligence models, but it lacked a large-scale medical model like this because it did not have a digital human as a base.

Yang Ping carefully examined the boundaries depicted by the artificial intelligence. They roughly matched the boundaries he had drawn himself. The key was the mixed and disordered areas, which even the artificial intelligence would find difficult to depict accurately, since it also relied on the input data to make judgments, and the input data might be insufficient or distorted.

"So, is this dividing line accurate?" Song Ziming asked.

All eyes turned to Yang Ping, because although artificial intelligence is powerful, this was the first time it had been used in such a scenario, and there was no practical experience before, so it was uncertain whether it would work.

Other things can be tried, and if they don't work, we can always start over. But surgery is something we can't try. We only have one chance. Even if the dividing line is correct, there must be a way to verify it.

Surgery is not absolutely necessary for these conjoined twins. They can continue living as they are without surgery. However, if surgery were to endanger the lives of both of them, it would be a net loss and would not conform to the basic principles of surgery.

"It matches my own description quite well, but even so, we can't guarantee it's correct, because both my description and the analysis of the large model are the first of their kind, without a large number of samples to corroborate them. Such cases can't possibly have a large number of samples to corroborate them," Yang Ping said thoughtfully.

“What should we do then?” Johannesson said.

"This kind of surgery, we either don't do it at all, or we make sure it's foolproof," Yang Ping said firmly.

“But there’s no way to verify this kind of thing,” Song Ziming said, also at a loss.

Morris stood in the back of the crowd, feeling a little uneasy. This was indeed a problem, and a very dangerous one at that. This was why no doctor in the United States recommended surgery; no one could figure out the boundary between the nervous system and the cervical spine, so separating the base of the skull from the cervical spine was an impossible task.

"Actually, I think this dividing line is very precise, but that's just my opinion and lacks objectivity. We need an objective method to verify it."

The pencil in Yang Ping's hand was spinning.

Johannesson looked at the pencil in his hand and thought to himself that he had also mastered this pencil-spinning technique. Yang Ping used to have a pencil spinning in his hand every time he explained the surgery to him at the Mayo Clinic. Johannesson thought it was cool, so he followed suit and learned it.

Song Ziming looked at the pencil in Yang Ping's hand. He already had a wealth of experience. If the pencil was still, it meant that Professor Yang was thinking, and the problem was not yet solved or he did not have a good grasp of it.

If the pencil starts spinning and dancing, it means that the problem has been solved, and there is a high degree of certainty, which is what Professor Yang often refers to as an 80% certainty.

So, judging from this pencil, the problem has been solved?
"Are we still going to do the surgery?" Johannesson asked, leaning close and resting his chin on his hand.

"I'll do it... I'll definitely do it, or I won't..." Xu Zhiliang suddenly became a little anxious, feeling that Johannesson's words were unnecessary.

“Why would we all be sitting here discussing this if we weren’t going to do it? We’re definitely going to do it,” Song Ziming added, completing Xu Zhiliang’s sentence.

That's exactly what I meant, Xu Zhiliang said with a grateful look.

Professor Yang never does anything futile. He would admit a patient, arrange surgery, and then cancel the surgery because it couldn't be done. There is no precedent for this in the research institute.

Yang Ping didn't speak. The pencil in his hand seemed to have a soul, nimbly spinning and alternating between his fingers, which was very magical.

Morris was also fascinated by the pencil magic trick; it was so cool and showed a high degree of finger dexterity.

"Actually, there is another very basic method, but people have not thought of it. They have focused on high-end knowledge and ignored the application of basic methods. Sometimes, simple and crude basic methods can also have unexpected results."

Yang Ping was silent for a moment before speaking.

Is there another way?

The disheartened group rekindled their hope.

"Of course there is. This dividing line is actually quite precise, but there are still two problems. First, we cannot verify whether it is truly precise. Second, even if it is precise, it is only on the image. During surgery, when we enter the skull and operate on the brain tissue, can we completely match this dividing line?"

"Therefore, we only need to use a basic neurosurgical method."

"A conscious brain surgery!"

A conscious craniotomy? Under local anesthesia? Brainstem surgery?

Everyone was incredibly surprised.

Of course, the most surprised were Johannesson and Morris. As world-leading neurosurgeons, they had never heard of any doctor daring to perform brainstem surgery on a patient while the patient was awake.