godfather of surgery

Chapter 1177 Talent and Diligence

After the surgical verification was completed, the procedure officially began, and the chief surgeon, Yang Ping, began to inject local anesthetic into the scalp of the two patients.

He will perform awake craniotomy under layered local anesthesia, anesthetizing the scalp, periosteum, and the meninges of the brain tissue layer by layer. The brain tissue does not need anesthesia because it has no pain receptors and does not feel pain.

Even when lying face down, the sisters kept chattering away, discussing how to celebrate after the surgery, what to do after they went their separate ways, and occasionally arguing, but mostly making wonderful plans for life after the surgery.

These two nine-year-old girls clearly had no awareness of the risks of the surgery; their minds were filled with positive thoughts, and the concepts of risk and failure simply did not exist in their minds.

Local anesthesia? Or a conscious craniotomy, or brainstem surgery?

Some neurosurgeons realized that the surgery was intended to be performed under local anesthesia, and their anger was immediately ignited. They claimed that the surgeon was simply ignorant, arrogant, and lacked even the most basic respect for life.

Some doctors, who had already sided with Yang Ping after being educated by Einstein, are now turning against him because of the anesthesia method.

How could this surgery possibly be performed under local anesthesia? Can such a high-risk surgery, requiring such high precision, be performed under local anesthesia? Even if it were possible, how long would a single local anesthesia session last? With such a large surgical area and such a long surgical duration, how many doses of local anesthetic would be needed? Could the patient withstand it? Wouldn't there be a risk of local anesthetic poisoning?
This is utterly absurd. No one in the world would dare to perform this kind of surgery under local anesthesia unless they are insane and have no regard for the patient's life or death.

The surgery has only just begun, and the method of anesthesia alone has already caused a huge uproar among neurosurgeons worldwide.

Some people even started searching for literature on the spot, but couldn't find a single article about brainstem surgery under local anesthesia, not even a single sentence.

In the teaching and research office of the research institute's operating room, everyone stared at the huge, high-definition, soft-focus screen. A pair of extremely nimble hands were using a syringe to administer local anesthesia to the scalp. It was just a simple local anesthesia, and the surgeon's skill level was not yet apparent.

“He really intends to use local anesthesia, he’s not just saying it,” Maurice muttered to himself, worried about whether his daughters could tolerate it.

Thinking of this, Morris's heart skipped a beat. Just like a doctor cutting into his head without anesthesia, the imagined, raw pain instantly spread throughout his body.

"Don't worry, Professor Yang's local anesthesia isn't what you're thinking," Johannesson said.

Local anesthesia is local anesthesia, what's the difference between high and low level? Morris smiled bitterly to himself. Johannesson's worship of Professor Yang had reached the point of irrationality. What technical skill could a simple local anesthesia possibly have? Injecting a bunch of local anesthetics into the skin and subcutaneous tissue around the scalp, this wide-net approach could theoretically block all nerves coming to this area from all directions.

In a broad sense, anesthesia only includes general anesthesia and local anesthesia. General anesthesia causes loss of consciousness, essentially anesthetizing the central nervous system. Local anesthesia, in a broader sense, includes local anesthesia in a narrower sense, nerve blocks, spinal anesthesia, epidural blocks, etc., because all these methods target the peripheral nerves. Local anesthesia in a narrower sense involves a general intradermal or subcutaneous injection of anesthetic to block small branches or nerve endings. Nerve blocks use a more precise method to block the trunk of a peripheral nerve. Spinal anesthesia and epidural anesthesia both block the spinal nerve roots.

Therefore, all anesthesia except general anesthesia is based on the same principle—nerve block, which targets peripheral nerves. These are all local anesthesia, only the scope of "local" is different.

The observant Morris noticed that Yang Ping was indeed using a different local anesthesia technique. Instead of injecting in a circular motion, he was injecting several small, scattered, and irregular spots. Would that work? Would it be effective?
"Shall I explain Professor Yang's local anesthesia to you? Actually, Professor Yang can perform almost all surgeries under local anesthesia. His local anesthesia isn't just simple local anesthesia; it's a precise blockage of the nerves upstream of the surgical area. Even when anesthetizing the scalp, he doesn't just give a random injection; he's very familiar with the nerve distribution on that area of ​​the scalp. These few injections have completely sealed off that area, so there won't be any pain." Johannesson reluctantly acted as the explainer, otherwise Morris wouldn't understand and would just be watching the show.

“The nerve distribution on the scalp is so small, the distribution of nerves varies greatly from person to person, how could it be possible to achieve precise blockage?” Morris was very skeptical.

Johannesson laughed and said, "You haven't taken any specialized scalp nerve anatomy classes, have you? You also haven't learned how to use CT, MRI, or color Doppler ultrasound to understand the nerve distribution in the scalp, have you? This is the foundation for achieving the best results in scalp local anesthesia."

There are courses like this? It's just the scalp, right? How can there be so much information about its nerve distribution?

Morris turned to look at Johannesson: "No, I didn't even know there was such a specialized course."

"So, you don't understand the technical complexity of local anesthesia," Johannesson said, shaking his head.
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At Johns Hopkins Hospital, the surgery had just begun, and the conference room was already in complete chaos.

"Are they planning to perform the surgery under local anesthesia? It's absurd! Now I understand why so many people oppose this surgery. It's a disregard for life and a serious violation of medical ethics. Two living children are lying there, and they're using local anesthesia to open their skulls and operate on their brain tissue. Can you imagine the pain these children are going through? I can't bear to watch anymore. This isn't surgery; it's torture!"

The head of neurosurgery, Raymond, was the first to speak up, his voice filled with anger. He felt that paclitaxel was driven by a doctor's conscience.

Massimo reassured him, "Calm down, let's talk after the surgery. Being arbitrary isn't your style, Raymond!"

"Is he going to have brain surgery while he's awake? Brainstem surgery while awake? Is there anything more absurd than that? Does he even understand neurosurgery? Has he read any literature? Does he have any basic neurosurgical knowledge? Maurice is a complete bastard, blinded by greed, desperately seeking any treatment, actually sending a bunch of his daughters to this charlatan for surgery. We've discussed it with him many times, telling him not to have surgery, not to have surgery! Not to have surgery! But he just wouldn't listen. Well, now look what's happened, letting others stage a medical tragedy here!" Raymond pointed and gestured, and if it weren't for the public setting, he would have already started cursing.

“He’s a Nobel laureate, not a charlatan. He’s my teacher, not a charlatan!” Massimo reminded him seriously.

"He only won the award in the field of genetics, not neurosurgery. In the field of neurosurgery, he is an outsider. Just like being a neurosurgeon doesn't mean I can perform heart surgery, let alone fix a car or play basketball in the NBA," Raymond insisted.

Massimo scoffed, “Sit down quietly, shut your mouth, and watch the surgery carefully. I believe you’ll change your mind. So please watch the whole surgery quietly; it won’t take you too much time. Judgment should be based on full understanding, not hysterical shouting. What are you yelling about?” “Fine, I’ll give him two hours for your sake. If those two girls scream even once, I’ll fly to China tomorrow and smash eggs in his face.” Raymond was panting, still furious.

In the video, the surgeon personally administers local anesthesia to the patient. His technique is extremely skillful, and the local anesthesia of the scalp is completed very quickly.

After the local anesthesia was completed, a short pause was allowed for the anesthetic to take effect before the surgery continued. The steps of the surgery were connected very smoothly and rhythmically.

The scalp incision technique was so familiar that it took the eyes almost to react, and the assistant's cooperation was also quite tacit. The surgeon gently lifted the scalp with forceps, and the scalp clamp immediately took place where the surgery was performed, giving the scalp no chance to bleed.

The scalpel, like a deft, automated tool, drew a beautiful arc, and by the end of the surgery, the scalp clips were all in place.

The scalp was cut open but there was hardly any bleeding. The gauze for stopping the bleeding was waiting nearby but was never used. What happened?

and……

Throughout the entire process of cutting open their scalps, the two sisters continued to chat and laugh, and their voices could be clearly heard in the video without any change.

Clearly, despite being local anesthesia, the anesthesia was very thorough and effective; the two sisters felt no pain at all.

Dr. Raymond's eyes were fixed on the screen. His skin-cutting technique was so skillful that it was as if he could draw perfect circles, straight lines, and images of any shape with a single hand.

That's strange, does local anesthesia really have such a good effect? ​​Could the voice in the video be dubbed?
The incision was performed so quickly, and the hemostasis technique was so good, yet there's hardly any scalp showing. How is that possible?
The atmosphere in the conference room at Mayo Clinic was very tense. The doctors who came to observe were all there to learn. The surgery had just begun, and this simple anesthesia had already taught them a lesson.

This is the world's first brainstem surgery performed under local anesthesia, and it will make history in neurosurgery.

Yang Ping has performed surgeries at Mayo Clinic many times and has become a spiritual mentor to these doctors. In their hearts, Yang Ping is the embodiment of the world's pinnacle of medical skills.

There are no arguments, no doubts, only pairs of focused eyes. They dare not overlook any detail, for every detail may contain superb medical skills they are unaware of.

When they saw the awake craniotomy under local anesthesia, their eyes widened. The local anesthesia used by Professor Yang was not ordinary local anesthesia, but a precise nerve block technique. He relied on his extremely familiarity with anatomy to block each nerve upstream, requiring only a small amount of anesthetic to maintain the effect for a long time.

This meticulous surgical approach, conceptually superior to that of other doctors, is something every doctor should learn from.

The entire conference room was unusually quiet; you could hear your colleague breathing.
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After the scalp is cut open, the periosteum is cut open, and then the bone flap is lifted, exposing the brain tissue along with the membrane. The pulsation of cerebrospinal fluid can be clearly seen. After opening this membrane, the brain tissue is inside. This part is the core area of ​​the brain tissue, which controls human life and is called the life center.

This area was previously known as a no-go zone because brainstem lesions, due to their deep location and proximity to important neurovascular structures, posed a significant challenge to surgical treatment.

The presence of important neurovascular structures nearby means that to access the brainstem, it is necessary to avoid these important nerves, and in this process, the safety of these neurovascular structures must be ensured.

The brainstem contains a large number of nerve nuclei, which are located deep within the brain. To reach the target area, surgery must pass through many nerve nuclei. These nerve nuclei control vital functions, so surgery must not damage these nerve nuclei and must enter through the gaps between them.

With the continuous advancement of neurosurgical techniques, the correct selection of surgical approaches for brainstem surgery has become crucial for improving surgical outcomes and reducing complications. These safe surgical approaches rely on in-depth research into brainstem anatomy.

Today, Yang Ping used an approach known as the suboccipital transmembranous veil approach. The patient was placed in a prone position, and a posterior midline incision was made. The suboccipital region was exposed downwards to the posterior arch of the first cervical vertebra. The dura mater was Y-shaped and the cerebellar tonsils were exposed. The cerebellar tonsils and the posterior inferior cerebellar artery were pulled to the sides. After dissecting the choroidal tissue and the inferior veil, the rhomboid fossa and the lateral recess were exposed. This allowed the safe surgical operation area near the facial hillock to be placed within the surgical field of view.

This is just an approach close to the brainstem. To get inside the brainstem, the approach Yang Ping used is not one of any existing approaches. If it must be named, it can only be called Yang's No. 1 approach. It is called No. 1 because there are many similar new brainstem approaches, such as No. 2, No. 3, and so on.

From incision to exposure of the brainstem, the procedure was performed seamlessly, using layered local anesthesia—anesthetizing one layer and then incising it—the whole process was as smooth as flowing water.

So far, the pace of the surgery has been excellent and very comfortable to watch. Any surgeon, whether neurosurgeon or otherwise, would have to admit that this level of surgical skill is unmatched.

The rhythm of the surgery gives it an artistic beauty; there is no superfluous movement, no repetitive action.

Song Ziming was the first assistant, and Xu Zhiliang was the second assistant. They were surprised to see that the professor, who hadn't performed surgery in a long time, still had such good skills. There was no sense of rustiness at all. He didn't look like someone who hadn't performed surgery in a long time. He looked like someone who performed more than a dozen surgeries every day.

The worries before the surgery were completely unnecessary. The professor's confidence was well-founded. It seems that the professor's surgical talent is innate, a gift from the gods. No wonder, he hasn't performed surgery in so long, yet he is more skilled than the two of them. They perform surgery every day from morning to night, and they have also done a lot of individual training for this surgery.

It seems that hard work cannot make up for a lack of talent.