godfather of surgery

Chapter 1169 This is not a problem

Actually, it wasn't Yang Ping who proposed the idea of ​​awake craniotomy, nor was he the first to perform this type of surgery.

These doctors, including Song Ziming, Xu Zhiliang, Johannesson, and Morris, all knew this, and they were also familiar with some cases around the world.

In some surgeries involving functional areas of the brain, where patients have very high expectations for that function, doctors sometimes use this type of surgery, talking to the patient during the procedure to assess whether the operation has caused any damage to the functional area.

For example, a British musician was diagnosed with a brain tumor, and her doctors chose to perform an awake craniotomy to protect her ability to perform fine motor skills with her fingers.

The violinist suddenly fell ill while performing on stage in 2013 and was rushed to the hospital. After a series of examinations, doctors discovered a large tumor in her brain.

She then underwent radiation therapy, but the results were unsatisfactory, and the tumor continued to grow. In January 2020, she went to King's College Hospital in London for treatment.

Her tumor was located on her right frontal lobe, which is mainly responsible for controlling the movement of her left hand. Therefore, she was very worried that the surgery would damage this functional area and seriously affect her fine motor skills when playing the violin.

Therefore, her doctors and team studied her surgical plan, figuring out how to carefully protect the delicate brain tissue in this area so as not to affect her ability to continue playing the violin in the future.

Finally, the doctors decided to perform an awake craniotomy, opening her head while she was conscious to remove the tumor.

In order to carefully determine whether each step of the surgery would damage brain nerves, the doctors specially designed the operating table, with a transparent sterile drape to isolate her in this area, allowing her to play the violin.

During the nearly two-hour surgery, the musician played Gustav Mahler's Fifth Symphony and Giulio Iglesias's Besham Mucchio on the violin.

Fortunately, the surgeon was also a music lover. He listened to the violin playing while carefully performing the surgery. If the music changed, it meant that his surgical instruments had touched the brain tissue in the functional area. At this time, he had to be careful to avoid this dangerous area.

Guided by the violin, the doctors completely removed the tumor, perfectly preserving the functional brain tissue. The patient recovered well after the surgery, with no lasting effects, and the surgery did not impair her playing ability.

A neurosurgeon at a large, top-tier teaching hospital in my country performed a similar surgery on a teacher who was diagnosed with a left temporoparietal glioma located in the dominant hemisphere's language area.

Because he is a teacher, good language skills are the guarantee of his profession. Once he loses his language skills or his language skills are impaired, his career will come to an end.

To protect his language function, the doctors opted for awake craniotomy. After the surgery, the teacher's language function was well preserved and did not affect his career.

Awake craniotomy is often performed on functional areas of the brain. The purpose of this is to awaken the patient during the operation and engage in dialogue and interaction with them. This interaction is used to determine whether the functional areas are damaged. In fact, this interaction serves as an indicator and identification function.

With the development of medicine, our understanding of the anatomy and functions of the brain in controlling various parts of the body is becoming clearer. For example, the brain regions responsible for limb movement, emotions, and language are fixed. With the patient's cooperation, awake craniotomy can ensure that the patient's response is monitored while the lesion is removed, thus avoiding damage to the corresponding functions.

However, Yang Ping is about to undergo brainstem surgery. No doctor in the world has ever used this method to perform brainstem surgery, and no doctor dares to use awake craniotomy for brainstem surgery.

Craniotomy under conscious attention is usually performed under local anesthesia, which is generally used for minor surgeries. Why is it possible to perform such a major surgery under local anesthesia?

This is related to the distribution of pain nerves in the head. The fundamental function of anesthesia is to solve the problem of pain. It, along with hemostasis and disinfection, is known as one of the three cornerstones of modern surgery.

From the perspective of head surgery approach, pain nerves are mainly concentrated in the skin, periosteum, and meninges. The human brain tissue does not have pain sensation. Even without anesthesia, if surgery is performed on the brain tissue, the patient will not feel pain.

With only a small amount of anesthetic, layered local anesthesia can be used to block several layers of nerves that cause pain, allowing doctors to complete this type of surgery. This demonstrates the feasibility of craniotomy in an conscious state under anesthesia.

However, this type of surgery has a major drawback: the loss of general anesthesia allows patients to interact with doctors, but also eliminates the need for restraint.

Under general anesthesia, patients lose consciousness and mobility. In addition, the head is fixed with a special fixator, which makes the head very stable during the operation. This stability is conducive to the surgeon's delicate operation.

During delicate intracranial surgeries, even the slightest movement of the patient's head can have serious consequences.

Currently, surgery is performed under local anesthesia while the patient is awake, meaning they have the ability to move. If, due to some accident, the patient breaks free from the restraints or the restraints become loose, their head may move involuntarily. If the doctor is performing a high-risk and delicate procedure at this time, it is very likely to cause misoperation and result in irreversible consequences.

Surgery on functional areas such as language and motor skills may cause impairments in those areas at most, but brainstem surgery is different; misoperation can lead to fatal consequences.

So when Yang Ping suggested performing surgery while the patient was conscious, everyone found it hard to believe and thought they had misheard.

Even Song Ziming was extremely surprised, so he wanted to confirm if there was any misunderstanding: "Professor, do you mean to perform craniotomy to separate the brainstem from the cervical spinal cord while the patient is awake?"

Yang Ping nodded calmly: "That's right. Although I think this dividing line is quite correct, in order to ensure that no mistakes will occur during the operation, we must perform the surgery while the patient is awake. With each step of the operation, we must observe the patient's spontaneous heartbeat, breathing, speech, movements, etc. while awake, to ensure the correctness of the operation throughout and give the surgery an extra layer of assurance. After all, this is the first time that we have used a large artificial intelligence model to analyze and judge such important parameters."

A master doctor is different; he can always think of things that others cannot and do things that others dare not do.

The professor still seems to be creating miracles, just like before. However, he has been away from clinical practice for so long that he can hardly perform a single surgery a week. This volume of surgeries is bound to make his hands rusty. It is already worrying to see rusty hands performing this kind of surgery. Now, he is performing a craniotomy while the patient is awake, which makes people's hearts skip a beat.

Despite the initial shock, experience told Song Ziming that the impossible was possible with the professor.

In Song Ziming's mind, Yang Ping had always been a pragmatic person. He was calmer, more rational and objective than anyone else. He was never boastful, never detached from reality, never pursued vanity, and never did anything to attract attention.

Since the professor says it's okay, then it's fine.

When would a professor say something is okay, but then turn out to be impossible? Never. As long as it's not a misunderstanding, it's fine. Anyway, you can't use ordinary thinking to understand a professor.

Upon hearing about this procedure, Johannesson couldn't help but break out in a cold sweat. Even with Yang Ping present, Johannesson would never dare to perform such surgery while fully conscious. He probably wouldn't dare to make any movement with his hand holding the scalpel. It would be like dancing on a tightrope without any protection, and the tightrope was exceptionally thin.

If Johannesson hadn't personally witnessed Yang Ping perform surgeries so many times, he would probably have jumped up and exclaimed, "That's ridiculous!"

As a doctor, Maurice was excited to see such groundbreaking surgeries. But now he was not a doctor, but a patient's family member. As a family member, he always hoped that the doctor would be more certain and not take reckless risks. He held a cautious and conservative attitude towards such groundbreaking surgeries.

This is because doctors and patients focus on different aspects of things from different perspectives. There's a saying: Doctors can't treat themselves or their loved ones.

Sometimes this statement makes sense, because both medicine and surgery are double-edged swords; while treating diseases, they also bring some unavoidable side effects.

When dealing with themselves or their loved ones, doctors who are usually decisive may hesitate and become indecisive due to the various side effects and complications of medications and surgeries. Under this mindset of worrying about gains and losses, it is impossible to cure the disease or perform the surgery well.

"If the patient is awake during craniotomy, wouldn't local anesthesia be necessary?" a PhD student asked, having seen case reports on this topic.

"Local anesthesia!" Yang Ping confirmed.

"Aren't you worried that the patient might move around during the operation?" Another PhD student asked with concern, even though everyone understands the basics.

Yang Ping shook his head: "Don't worry. First, we use a fixator to secure the head. Second, we communicate with the patient continuously during the operation. Also, we must have extremely skilled surgical techniques and extremely sensitive reactions to perform this operation. Don't follow my example. You can do this for some functional areas such as speech and movement during future surgeries, but never do this for brainstem surgery. Remember that."

"Don't follow my example." Every time Yang Ping performs a surgery, it has a very strong personal touch and is not replicable. He would emphasize this point to avoid misleading others.

Others might see Yang Pingxing and think they can do it too, which could lead to serious consequences.

This kind of thing has happened before in the medical industry, and there are many examples. People see others doing it and think they can do it too, only to end up making a complete mess of things.

For this type of surgery, Yang Ping can only be a pioneer. Once the boundary line he uses during the operation matches the boundary line predicted by the artificial intelligence, and the accumulated number of cases reaches a certain level, the accuracy of the artificial intelligence in this area can be evaluated. If it is unsatisfactory, the algorithm of the artificial intelligence will be improved, or more data will be fed in. If it is satisfactory, other doctors can boldly use the prediction of the artificial intelligence when performing this type of surgery in the future, which can ensure the success rate of the surgery.

"This type of surgery usually takes a long time, and local anesthetic is administered multiple times during the procedure to ensure that there is no pain at each level of the incision. An overdose of local anesthetic can cause death."

Johannesson had to raise a serious question: local anesthetic drugs must not be overdosed.

“We can keep the time within the range covered by a single dose of local anesthetic,” Yang Ping reassured him.

My God, how is it possible to perform this kind of surgery with just one local anesthesia? But why is it impossible? He is the hand of God.

Johannesson had witnessed Yang Ping perform surgeries he considered impossible, so quickly and skillfully, his movements were practically fast-forwarded. He couldn't believe it, but he had to, because it was Professor Yang, not someone else.

"You plan to use a single dose of local anesthetic to cover the duration of this surgery? How is that possible?" Morris couldn't hold back any longer.

Johannesson glanced at Morris, a look Morris perceived as one of disdain, as if to say: You're so unsophisticated.

But Morris is a doctor, and he will question what he believes needs to be questioned, especially since this question concerns the lives of his two daughters, so he still hopes that Professor Yang can answer his question.

Yang Ping said slowly, "Of course, this surgery can be completed within one local anesthesia session, and we have quite a bit of time. Of course, this is just an estimate, so we need to have a contingency plan. If it cannot be completed under local anesthesia, we should use general anesthesia as a backup."

Professor Yang was so determined that he was able to complete the surgery within the time limit of a single local anesthesia. Although Morris couldn't believe it, he had no choice but to believe it.

“Of course, the probability of using the backup plan is extremely low, but that doesn’t mean we shouldn’t do it.” Yang Ping knew Morris was worried, and given that he was a patient’s family member, Yang Ping had to dispel his unnecessary doubts.

"Go prepare for the surgery. It seems the plan to have the surgery next week remains unchanged. Let me know immediately if there are any other changes."

"Does anyone have any other questions? If so, please ask now. If not, let's settle this and prepare to schedule the surgery."

Yang Ping didn't want to waste any more time on this issue, because the question he was most worried about had already been answered, and dwelling on it further would only be a waste of time.

“And you, Mr. Morris, do you have any more questions? You are a family member of the patient, and you must clarify all your questions before the surgery so that we can establish sufficient mutual trust, which is the foundation of the surgery,” Yang Ping asked.

Indeed, Morris had many questions, but he didn't know where to begin.

“I…” Maurice didn’t know what to say for a moment.

Yang Ping knew what he was worried about: "You don't need to worry about the surgery time. It can be completed within one local anesthesia session without any problem. You may be limited by your own experience and find it hard to believe what I'm saying, but please believe me. This kind of surgical speed may seem impossible to you, but it's a very normal speed for me. In short, the surgery time is not a problem."

Americans won't understand unless you put it bluntly, so don't worry about their feelings. Just be direct and say what you mean.

He was always so confident, so confident that it was impossible not to believe him.

Seeing Yang Ping's consistently confident tone, Song Ziming felt a deep sense of admiration. This kind of confidence could not be found in anyone else, only in Yang Ping, and even if he wanted to imitate it, he could not.