I, Tomoya Aki, am not a bootlicker

After noticing the look in Aki Tomoya's eyes, Yoshida Aoba almost couldn't help but want to slap him.

He was clearly the source, so why is he the one to take the blame?

Chapter 507 Learn to Walk First

"This surgery will be performed using a thoracoscopy."

After Tomoya Aki's first successful surgery, he usually decided the surgical procedures for the surgeries he performed.

However, this time, after Yoshida Aoba selected the patient for him, he did not give him any chance to refuse and decided to use a total thoracoscopic surgery.

"No, Dr. Yoshida, why did you suddenly ask me to use a thoracoscopy?"

Akitomo is no stranger to thoracoscopy. Although he has always performed surgeries using open chest surgery, he has practiced thoracoscopy.

After all, minimally invasive surgery is an important development in the future.

However, this time, thoracoscopy was to be used, and it was Yoshida Aoba who arranged it directly.

You should know that although Yoshida Aoba was involved in the previous operations he performed, Yoshida Aoba did not interfere too much in the surgical plan and only gave him some suggestions.

So An Yilun was also very curious why the other party directly chose the surgical method for him this time.

"I haven't done surgery with a thoracoscopy yet."

Akitomo also said it very bluntly.

I don’t know if he was reminding Yoshida Aoba or reminding himself to be careful.

Yoshida Aoba rolled his eyes at him and said, "You know you've never had a thoracoscopic surgery before!"

That’s right, it’s been less than half a year since Tomoya Aki started operating, and of course he has never used thoracoscopy.

Compared with traditional open-chest heart surgery, total thoracoscopic heart surgery is less invasive, requires less blood loss, has a faster recovery, and meets cosmetic requirements.

However, during total laparoscopic cardiac surgery, the heart and great blood vessels are poorly exposed, traditional vascular cannulation is difficult, and the mode of extracorporeal circulation must also be changed accordingly.

The surgical field and surgical method are not much different from traditional thoracotomy and need to be changed accordingly according to the specific situation.

"You still want to use a surgical robot? You haven't even used a thoracoscope yet. You're still far from being good at minimally invasive surgery, kid!"

Yoshida Aoba struck without mercy.

He didn't want to say that Aki Tomoya was too ambitious or anything like that.

But before surgical robots, at least you have to be good at using thoracoscopy.

Both are minimally invasive surgeries, but in terms of difficulty, thoracoscopy is simpler than robotic surgery.

"Been taught a lesson!"

Aki Tomoya accepted the criticism.

Yoshida Aoba is right, don’t think about surgical robots for now.

At least in terms of minimally invasive surgery, he has to be good at using the thoracoscope, which will show that he can go a step further and use surgical robots to perform more sophisticated operations.

Although Director Mononobe is still unsure whether he can get the job done, Yoshida Aoba is already making preparations for a rainy day.

In any case, let Aki Tomoya accumulate experience in minimally invasive surgery first.

"But Dr. Yoshida really trusts me."

"If I trusted you, I wouldn't have reminded you."

Yoshida Aoba shook his head and placed the patient report on Aki Tomoya's desk.

This is the patient he selected.

From now on, Akitomo will be the patient's primary surgeon.

"Male, 70 years old, weight kg, rheumatic heart disease, mitral stenosis, tricuspid regurgitation, left atrial thrombus..."

The electrocardiogram showed atrial fibrillation.

This is quite amazing.

Yoshida Aoba is really good at selecting patients for him.

This means that he has to solve all of the patient's symptoms at once and also find ways to deal with complications.

"This will require surgery soon. How did you arrange it, Dr. Yoshida?"

"If you can come up with a surgical plan as soon as possible, I will schedule him for surgery in the next few days."

"You really don't give me any time to prepare!"

Akitomo was also a little depressed.

Tomorrow, which means he only has two days to prepare the surgical plan, and in between there are also surgical instructions and the patient needs to sign an informed consent form.

"I hope you can come up with a preliminary plan for the seminar tomorrow afternoon."

Well, it really didn't give him any time to breathe.

I will be busy next time.

As for the surgical team, if nothing unexpected happens, it will probably still be just a few of them.

……

At the surgical seminar the next day, the patient that Yoshida Aoba arranged for Aki Tomoya was the second one.

Because Yoshida Aoba had already reminded Aki Tomoya, Aki Tomoya simply raised his hand and began to explain under the gaze of all his colleagues in the department.

"The surgery can be performed using a fully thoracoscopic approach."

"Doctor An Yi, are you going to be the lead surgeon?"

Sasaki Ichiru, who was standing next to Director Monobe, asked.

He also glanced at Yoshida Aoba who was sitting next to Aki Tomoya.

"Yes, if possible, please let me be the surgeon."

It was impossible for Akitomo to retreat at this time, although the gazes of Sasaki Ichiru and Director Mononobe were indeed quite stressful.

At this time, Sasaki Ichiru also signaled Aki Tomoya to continue.

“I will perform a transseptal approach to expose the diseased mitral valve, remove the diseased valve tissue, and replace the valve with a mechanical mitral valve.”

"What about atrial fibrillation elimination?"

"Treatment of Atrial Fibrillation with the Medtronic Cardioblate Irrigated Surgical Radiofrequency Ablation System."

Sasaki nodded, turned his head to look at the treatment on the projection screen, and asked him to continue speaking without stopping.

"The left atrial thrombus was completely removed and the left atrial appendage was ligated. Because the patient also had tricuspid regurgitation, DeVega angioplasty was performed at the same time."

"Extracorporeal circulation. According to the advice of Dr. Aoki from the Department of Anesthesiology, peripheral extracorporeal circulation was used. The right femoral artery was mostly selected for arterial perfusion. Ultrasound examination was performed before the operation to exclude the presence of severe aortic sclerosis or aortic dissecting aneurysm, so as to avoid serious complications such as cerebral embolism."

By explaining this, Aki Tomoya actually wanted to tell Sasaki Ichiru that he also knew that the surgery would be performed using a thoracoscopic approach, so the more traditional thoracotomy, including the extracorporeal circulation method, would have to be changed accordingly.

So there is no need to worry that he doesn't know how to perform thoracoscopic surgery.

After entering, Sasaki asked a few more questions, and Aki Tomoya responded to them one by one.

A complete surgical plan requires further discussion and research. After the surgical team is decided, it will be discussed together with the anesthesiologist and the extracorporeal perfusionist.

There were basically no surprises and Tomoya Aki passed the surgical seminar smoothly.

For the surgical team, this is also the default arrangement.

The surgeon was Tomoya Aki, with Yoshida Aoba as the first assistant, Majima as the second assistant, Nishikino as the third assistant, and Dr. Aoki from the anesthesiology department.

"Come up with a complete surgical plan as soon as possible and have the patient sign a consent form."

After the seminar, Yoshida Aoba patted Aki Tomoya on the shoulder and reminded him.

"Dr. Yoshida, can you come and help me?"

"I'm giving you this opportunity to practice, so don't forget to cherish it."

Chapter 508 Success?

What you said makes a lot of sense, and Aki Tomoya is speechless!

He couldn't even say "no".

But fortunately, Majima, Nishikino and the others are still there.

This was my first time performing a thoracoscopy. Although I didn’t have enough experience, I still had some experience.

After discussion, they came up with a complete surgical plan as quickly as possible, and then Tomoya Aki and Aoba Yoshida successfully got the patient to sign an informed consent form.

At 9:11 am on May 21st, the patient was pushed into the operating room for preparation.

At 9:32, anesthesia began.

Anesthesiologist Aoki used intravenous combined anesthesia and double-lumen endotracheal intubation.

Three 3-1 cm small holes were made on the right chest wall of the patient.

The first hole is located at the third intercostal space beside the right sternum, and the second hole is located at the fourth intercostal space at the right midaxillary line. Those locations have been marked in advance.

"I will now begin the fully thoracoscopic mitral valve replacement. Please advise me."

The surgeon in charge, An Yilun, also nodded slightly.

"Please give me more advice."

The operation officially begins.

"…The condition is stable."

"Open the hole."

The first hole is located in the third intercostal space beside the right sternum.

The second hole is at the fourth intercostal space on the right midaxillary line.

The third hole is located at the fifth intercostal space on the right anterior axillary line.

The holes are opened one by one. The first and second holes are operation holes, and the third hole is the laparoscope insertion hole.

……

"Perfuse."

Extracorporeal circulation was started.

Tomoya Aki stared at the surgical field on the display screen and began performing surgery on the operating hole.

"Watch it carefully and get used to it as soon as possible. Thoracoscopic surgery is different from the feeling of using a knife yourself."

Yoshida Aoba reminded quietly from the side.

Operating a thoracoscope and directly opening the chest with your own hands are two different operations, and the feel is different.

Since this is the first time using this technique, Aki Tomoya may have some difficulties in adapting.

But he is the chief surgeon, and Yoshida Aoba hopes that Aki Tomoya can adapt as soon as possible.

"Dr. Yoshida, please give my surgeon some face."

Tomoya Aki's eyes were fixed on the display screen, and his hands were slowly operating the operation hole.

In the operating room, the surgeon has the highest authority.

As the first assistant, Yoshida Aoba's words now are completely disrespectful to him and make him lose all his prestige.

In the operating room, challenging the authority of the surgeon as a surgical assistant is a very serious matter.

Of course, the specific situation is not that serious.

When Aki Tomoya said this, it seemed more like he was trying to relax the atmosphere.

Although the patient's condition was somewhat complicated and it was his first time to perform thoracoscopy, in fact, this operation was not so serious as to cause a botched operation.

The fact that he is still able to fight back shows that he has confidence and the situation is under control.

"Expose the diseased mitral valve and prepare for resection. Dr. Nishikino, you will assist me."

As planned, the diseased mitral valve was exposed through the atrial septum and then the resection of the diseased valve tissue began.