I, Aki Tomoya, will not be a simp.

The project was led by Tomoya Aki, with Maki Nishikino providing assistance.

As for why Yoshida Aoba wasn't chosen to assist, it's because he's an experienced surgeon, while the other three members of the surgical team, including the lead surgeon, needed more practical experience.

With everyone focused on the laparoscopic view, compared to open-chest surgery, the surgical field of laparoscopy is limited, requiring the surgeon to concentrate more and perform more meticulous operations.

Exposing the mitral valve with a retractor and confirming the indication for valve replacement, the large valve is sutured with thick silk thread as a traction suture. The traction suture is then clamped with right-angle clamps to unfold the large valve.

Make a small incision about 3 mm from the valve ring, and cut the large valve forward and backward along the valve ring 3 mm from the valve ring. At the same time, cut the papillary muscle at the tip of the papillary muscle.

"Pay attention to the left ventricular wall..."

Aki Tomoya muttered to himself, his eyes slightly narrowed, watching his movements to prevent any damage during the excision.

After completing this step, he continued to remove the small flap in the same way.

Finally, a valve annulus size is measured using a valve measuring device to determine the required artificial heart valve number.

"Sent for pathological examination."

The removed lesion tissue was handed over to the nurse for pathological examination, and new instruments were installed in the operating port under Aki Tomoya's subsequent instructions.

"Mechanical flap... Dr. Majima, please cooperate with me to perform the suturing..."

"As ordered."

That's a great word, as you wish!

Aki Tomoya raised an eyebrow; Majima's "Yes, sir!" gave him a strange feeling.

Being the lead surgeon is definitely different; the feeling of being in control of the overall situation is as fulfilling as ever.

"2-0 line".

For the suturing method, Aki Tomoya uses interrupted mattress sutures.

The needle is inserted from the atrial side of the valve annulus and exited from the ventricular side. Immediately afterward, the artificial heart valve suture ring is sewn from the ventricular side to the atrial side.

Under Aki Tomoya's guidance, the position where the stitches come out of the sewing circle should be as close to the edge as possible.

"Insert an artificial flap."

After straightening all the sutures, the artificial flap is inserted into the flap ring.

Once implantation is confirmed, ligations are performed one by one.

"Cut the thread."

After the mitral valve replacement was completed, atrial fibrillation was treated with the Medtronic Cardioblate irrigation surgical radiofrequency ablation system.

When left atrial thrombosis occurs, it should be thoroughly removed and the left atrial appendage ligated.

There's basically no problem; it's a normal procedure. Just pay attention to the patient's condition.

The procedures were performed according to the surgical plan, with suturing done last.

Finally, there's the tricuspid valve.

"Prepare to perform DeVega shaping technique."

The surgery took a long time, not only because it was not a traditional open-heart surgery, but also because the patient needed more than just a mitral valve replacement.

The patient also had tricuspid regurgitation on top of mitral valve disease.

All of these can be done at once.

Because DeVega flap surgery often leads to anterior flap shrinkage and a reduction in flap area, Tomoya Aki decided to adopt a phased DeVega flap surgery.

This means that the valve annulus is folded only on the anterior and posterior septal sides. This can both reduce the size of the valve annulus to eliminate tricuspid regurgitation and preserve the leaflet area of ​​the anterior valve annulus of the tricuspid valve as much as possible.

The surgery lasted nearly three hours.

The surgery officially started around 9:30 in the morning and has now progressed to noon.

After the DeVega shaping technique was completed, Tomoya Aki immediately breathed a sigh of relief.

The total thoracoscopic surgery was not only a mitral valve replacement to remove thrombi and atrial fibrillation, but also included a DeVega plasty.

Not only did it save a critically ill patient, but the success of the surgery also brought a great sense of accomplishment to the surgeon, Tomoya Aki.

In short, once it's done, it boils down to one word—

Cool!

"Open the ascending aorta."

With the ascending aorta open, the patient's heart will automatically resume beating.

The surgery has reached its final stage.

"Ventricular fibrillation has occurred!"