godfather of surgery

Chapter 1182 Learning from Sanbo Hospital
"Thank you!"

Johannesson was very pleased to receive the recognition.

Actually, Yang Ping was just saying it casually. Sometimes, when Song Ziming and Xu Zhiliang asked him questions and he finally understood, Yang Ping would jokingly say this.

Johannesson had also heard the professor use this phrase to praise others. Although he didn't quite understand the meaning of the classical Chinese phrase, he knew it was a compliment, so he was very pleased.

“But why can’t we think of these things? What if we go to geneticists and embryologists? Could we find a breakthrough and use this method to find out the distribution of neural nuclei in the brainstem?” After being praised, Johannesson’s mind became very active, and he had many questions.

"As I just said, you lack knowledge in this area, so you wouldn't even think of using this knowledge to solve the problem. Just like if you don't have knowledge of vectors in mathematics, you wouldn't even think of using vectors to solve the problem, let alone ask others, because you simply don't know that you can use vector knowledge to solve this problem," Yang Ping explained to them.

That makes sense. Without this kind of knowledge, how could one think of using it to solve problems?

“Even if you have a little bit of knowledge and can think of using these to solve the problem, and then go to genetics and embryology experts, in the end, because your research in this area is not in-depth, and those experts lack clinical surgical knowledge, you will not be able to work together to find a solution. Even if you can, it will be a long time later,” Yang Ping added.

Johannesson nodded. This lesson had given him a lot of inspiration. As a surgeon, to be able to solve complex problems, it was far from enough to just have knowledge within one's own specialty. That would only lead to doing repetitive work every day. Instead, one needed to have a strong foundation of knowledge.

In the operating room, during the rest time after surgery, I can give everyone a lesson. It won't take much time, just a matter of ten minutes.

Song Ziming and Xu Zhiliang still have surgery to perform. The attending physicians from the other two operating rooms came over and said that the anesthesia for the next surgery had been administered and the surgery could begin.

Everyone dispersed again to continue with other surgeries. The surgery on the conjoined twins was just one of many surgeries performed every day.

"You guys finish the rest of the surgeries. I'm going to check on the lab; it's been a bit busy lately."

Yang Ping now spends most of his time in the laboratory and less time in clinical settings. When Yang Ping goes to the laboratory, Johannesson follows behind.

The researchers at the stem cell lab were delighted to hear that the surgery was successful, as they also contributed to its success; the skin and muscles they cloned played a crucial role in the operation.
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After the surgery, doctors all over the world were still reflecting on it. So many top experts had evaluated and concluded that the surgery was not feasible, but when Yang Ping was to perform the surgery, these people, without even understanding the facts, actually stirred up a wave of public criticism.

But now, Yang Ping has completed the surgery with such ease that it's unbelievable.

Those doctors who were making such a fuss back then are now ashamed.

After the surgery, Raymond sat in his chair for a long time, unable to get up. How ridiculous he was! He had almost missed one of the world's most advanced surgeries today. Surgical fundamentals, surgical thinking, the overall structure of the surgery—this surgery had demonstrated everything he could think of related to surgery to the fullest extent.

It's truly a living textbook!

However, there are still many aspects of this surgery that he hasn't figured out. For example, how exactly did he find the distribution of brainstem nuclei? At the time, he used some advanced equipment, such as functional magnetic resonance imaging, to search for them, but he just couldn't find them or distinguish the true location of these nuclei.

He never understood the problem.

"Massimo, you're saying he's an amateur neurosurgeon?"

"That's right. I only perform neurosurgery occasionally. I used to do more orthopedic surgeries, but I don't do those anymore. My energy is mainly focused on scientific research now."

Massimo's words were a heavy blow to Raymond. Although Massimo had mentioned it before, it was never as stimulating as it was now.

The fact that an amateur doctor who occasionally performs neurosurgery could surpass him, especially a Nobel laureate, is quite a blow, especially to one's self-confidence.

“Actually, you don’t need to be upset. I’m in a worse situation than you. Professor Yang rarely performs interventional surgeries, yet he’s better at them than I am. There’s something called talent in this world, and there’s nothing you can do about it. It’s like how you can study math your whole life but still not be as good as Gauss in your student days,” Massimo comforted Raymond.

“I wish I could go to China right now to apologize to Professor Yang and learn brainstem surgery from him. I was one of the people who criticized him before,” Raymond said with shame.

Massimo smiled and said, "Practice your Chinese first. I've always wanted to go there, but I can't learn Chinese well. It's a pity. I never thought Chinese was so important, but I just can't learn it well. I'm in their group, and all the chat is in Chinese. I can only barely manage by using translation software every day. If I hadn't been working hard, they would have kicked me out of the group long ago."

It's unbelievable that the usually proud Massimo, this interventional genius, would have such an experience; it's truly pitiful.

"Those Chinese characters are so troublesome, like a picture. I can never remember them, and even if I do remember some, I forget them again. When will I be able to learn Chinese well? My dream is to go to China to study for a period of time."

"Can you recommend me to join a group on that social media app?"

"You need two existing members to refer you. I can refer you, but you can't find a second one. See if Johannesson can be your referrer."

"Although I haven't gone for further studies, I can learn a lot just by watching them chat in the group every day. I'm sure it's the best online medical community in the world, where you can access the world's most cutting-edge medical knowledge anytime, which you can't learn from literature. For example, soon they will have a surgical case of conjoined twins to share and learn from."

Raymond was now itching to get in, and he couldn't contain himself: "How can I get into that community? What can I do? Just tell me, I'm willing to do anything, even donate!" "As I just said, there are two conditions: two members as recommenders and passing the CET-4 (College Chinese Test Level 4). I went through a fast track because I was short of a moderator for the interventional section at the time, so I needed four recommenders, and then I passed the CET-4 later. But you don't have that opportunity now because the neurosurgery moderator position has been taken over by Johannesson."

Why isn't it open?

"Because we are discussing knowledge that is not found in existing literature and textbooks, it can easily mislead members who do not meet the standards. If everyone imitates it indiscriminately, it can easily bring disaster to patients."

“I’m very curious. During the surgery, I only focused on the separation of the brainstem. After the two patients were separated, I saw that they had so much missing skin and muscle. I saw that they had all been repaired with some skin and muscle. Where did this skin and muscle come from?”

Raymond suddenly remembered another problem. He hadn't figured out the first one yet, and now there was another.

"They implement a systematic approach to research and clinical practice. They have several laboratories, one of which is a stem cell laboratory. They can use patients' stem cells to clone large amounts of skin and muscle using local cloning technology."

"Local cloning technology?"

As a neurosurgeon, Raymond wasn't really concerned about advancements in basic medical science; he didn't know what local cloning technology was.

"In a laboratory setting, a single organ or a piece of tissue is cloned using special techniques."

Massimo explained.

"This kind of technology exists?"

"Professor Yang's Nobel Prize-winning academic achievement is spatial guidance genes. These are genes responsible for the spatial construction of cells. Professor Yang has mastered the activation methods of spatial guidance genes in some organs. Using these factors, the skin and muscles of the whole body can be cultivated in a laboratory environment."

Raymond was like listening to a science fiction story. He was amazed that such technology existed in the world. He knew that a recent award-winning academic achievement was in the field of genetics, but he thought it was still in the theoretical stage and would take twenty or thirty years to be applied in practice. He never expected that it would already be applied in practice. It was truly amazing.

If this surgery were performed by other doctors, even if they could separate the brainstem, it would be impossible to continue. Skin could be covered with skin grafts, but what about muscles and bone tissue? Muscles and bone tissue are simply unavailable. Without muscles and bone tissue to fill the gaps, there is no way to reconstruct the spinal canal after separating the cervical vertebrae, and it is even more impossible to obtain a stable cervical spine.

The more Raymond thought about it, the more complex the surgery seemed, a massive undertaking, but Professor Yang had resolved it all with ease, solving many problems that others couldn't.
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Charité Hospital in Germany.

It's morning in China now, but in Germany the sun hasn't risen yet.

However, the doctors had not yet left the conference room. They would not leave the conference room all day because, under Professor Mainstein's guidance, they were conducting their first collective learning session, using slow-motion replays of surgical videos.

"As you can see from today's surgery, basic medical knowledge is crucial for solving clinical problems. Of course, this knowledge isn't necessary for solving ordinary clinical problems, but we must possess it to creatively solve complex clinical problems."

"Did you all notice that the biggest challenge of this surgery is that the brainstem of conjoined twins is also connected, and their neural nuclei are mixed together in a very disordered way, and no one can find their precise location. This is why other doctors in the world have given up on this task. But Professor Yang is different. He found the distribution of the neural nuclei."

"Does anyone know how he found it? I thought about it for a long time but couldn't figure it out. But now I understand. I just confirmed with Professor Yang that the method he used is consistent with my speculation."

"What exactly is the method? I've also handled this case; the Americans sent it to me, but even now I haven't been able to pinpoint their precise distribution. I've considered and used every imaging modality, including some of the latest cell marker tracking techniques, but unfortunately, I haven't been able to achieve it," said Felix, the head of neurosurgery.

"They used an extremely ingenious method, utilizing knowledge of genetics and embryology, to simulate the entire process of a fertilized egg differentiating into two identical twins," Mannstein said. "Then they found the moment when the division stopped, obtained the fetal anatomy at that moment, and continued to use the fetus at that moment to simulate how conjoined sisters would form after the division stopped. In this way, they obtained the precise distribution of neural nuclei."

Felix pondered for a while, then suddenly realized: "What a clever method! They abandoned all the methods of simply using images to find the interface, and instead adopted a more thorough and direct approach. How come I didn't think of that? If you hadn't told me now, even if time could be reversed, I still wouldn't have thought of it."

Professor Mannstein said, "Therefore, we need to deeply reflect on our medical education curriculum. While we focus on clinical education, we have neglected basic medical education, which has led to problems in doctors' knowledge structure."

August immediately spoke up: "Actually, I think that compared to the way American doctors are trained, we pay a pretty good amount of attention to basic medical science. But you're right, it's far from enough. We must pay more attention to training doctors in basic medical knowledge in the future."

"Therefore, everyone, we must establish a research project as soon as possible to study our physician training curriculum and come up with a reform plan. We must reform in order to revitalize medical education."

“This is one problem we’ve discovered, and there’s another very big problem that we’re missing, which you haven’t noticed,” Professor Mainstein asked seriously.

A young doctor raised his hand: "After observing the entire surgery, I found that in addition to the surgeon's superb surgical skills, the success of this surgery was also supported by a research system. For example, they knew where the skin, muscle and bone tissue they needed came from. It certainly wasn't filled using the patient's own skin flaps and muscle flaps. I didn't see the steps of harvesting skin and muscle flaps. There must be another technique involved."

“You have a keen eye for observation and have seen the root of the problem. Yes, that’s what I’m trying to say. All the muscles and skin come from their stem cell laboratory. Their stem cell experiments and operating rooms are in the same building, integrated as one. They are a hybrid of scientific research and clinical practice. This kind of model is very rare in the world, so we can draw inspiration from it. We must take this path of integrating scientific research and clinical practice. This is the model for the hospital of the future,” Professor Mainstein said.

He not only saw the technical gap from this surgery, but also the systemic gap. He decided to learn from Sanbo Hospital's strengths and make up for his weaknesses, reform the hospital, and implement integrated scientific research and clinical practice.

P.S.: I'm a bit busy today, so I'll just post the draft first. I'll revise it later when I have time. Thank you everyone.