Surgery Godfather

Chapter 267: Chapter 0251 Cheese

Zhang Lin was arranging Fang Xiaoyun’s emergency surgery, entering medical orders into the computer’s HIS system, getting the surgery approved, notifying the operating room, and contacting Huang Jiahui to prepare the equipment.

Huang Jiahui’s company mainly produces products in the field of sports medicine, but to support Yang Ping’s surgery, Huang Jiacai applied to represent several companies that produce supplies for trauma, spine, and joint procedures, to complete their product line.

Yang Ping told Zhang Lin to have Su Yixuan prepare general surgery’s cholangioscope and flexible endoscope, which were needed during the surgery. Zhang Lin didn’t know why he needed the general surgery equipment, and dared not ask further.

Fang Xiaoyunneeded to undergo an anterior thoracic spine surgery, in which an incision was made in the chest area to gain access to the 9th thoracic vertebra, then the tuErculosis-infected body of the 9th thoracic vertebra was removed, as well as the material compressing the spinal canal.

The area from the 4th to the 9th thoracic vertebra is dangerous, as the blood supply to the spinal cord is weak and easily disrupted. If the blood supply were disrupted, it could cause ischemic degeneration of the spinal cord, which could not only prevent recovery from paralysis, but could also exacerbate the condition, and the harm could be permanent.

In the system space, Yang Ping had undergone extensive anatomical training and spine trauma surgery training, but he hadn’t performed surgery on spinal tuberculosis before.

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He could easily perform the surgery using his experience from the trauma operations. However, to be safe, Yang Ping went to the system space and got training on 300 cases of spinal tuberculosis surgery, especially those involving the 4th to 9th thoracic vertebrae. During the procedure to remove the compressing material, he tried to disturb the spinal cord’s blood supply as little as possible.

Now that he had hundreds of thousands of points on hand, as long as he didn’t use them to simulate surgeries all the time, these points would last for a long time.

In treating spinal tuberculosis, some hospitals use minimally invasive techniques. For instance, a professor from 301 Hospital has accumulated extensive experience in minimally invasive procedures.

He believed that spinal tuberculosis treatment could use an internal medicine approach, specifically using CT-guided puncture to inject anti-tuberculosis drugs directly into the infected area for localized treatment. This treatment will be combined with systemic anti-tuberculosis therapy, until it is cured.

This method was sharply debated at academic conferences, but it cannot be denied that the professor has opened up a new perspective. In fact, it has been very effective for a certain number of not very serious cases.

Fang Xiaoyun couldn’t use this minimally invasive method and needed to undergo surgery because she had already developed paraplegia. The cause of her paraplegia was compression of the spinal cord by a mix of pus, granulation tissue, caseous necrosis tissue, and dead bone.

She had to undergo an open surgery, directly removing the compressing material in the spinal canal, thoroughly relieving the compression on the spinal cord, and allowing the spinal nerves to recover as quickly as possible. This satisfies the three main principles of spinal surgery–decompression, stability, and correction!

The Department of Orthopedics has its own independent operating room, which makes surgery scheduling very convenient. As long as the patient’s condition allows, the surgery can be performed at any time.

Less than half an hour later, everything was ready. Su Yixuan and Zhou Can prepared the surgical instruments, Huang Jiahui’s anterior spinal plate was already in place, sterilized, and ready to use at any time.

Yang Ping’s team was progressing quickly. Song Zimo, the first assistant, had extremely high talent and was full of passion for surgery. He was determined to be the best surgeon.

By now, he was able to assist Yang Ping in challenging Takahashi Sasaki, taking care of ten blood vessels when Takahashi fell into a predicament during the surgery at the academic conference.

In microsurgery, although his skills were still a significant distance from Yang Ping’s, he was already a high peak that others found difficult to overcome. With his current skills, he could cut off and anastomose the tail of a newborn mouse, ensuring smooth blood flow, even with his hands floating in the air.

He was extremely skilled in arthroscopy, thoracoscopy, laparoscopy, and foraminoscopy. Open surgery required no further explanation. Under Yang Ping’s guidance, he was far more proficient in dissection than the average person.

If someone wanted to challenge Yang Ping, they had to overcome the obstacle that was Song Zimo first. But it was extremely difficult to do so.

It was not clear who was the gold or silver hook between Xiaowu Zhang Lin, and the two were evenly matched. It was hard to say who was superior, but there was no denying that they were the best second and third assistants.

Anesthesiologist Liang Fatty was as passionate about anesthesia as he was about food. He thoroughly enjoyed his role.

Nurse Su Yixuan needs no introduction. She was Yang Ping’s perfect companion. Their naturally seamless coordination enabled each surgery to be flawlessly conducted. @@novelbin@@

Zhou Can was the best circulating nurse, and if he went on stage, he would also be an excellent scrub nurse.

The most important thing was that they had been through one battle after another. Taking down the surgery that Takahashi failed to accomplish boosted the team’s confidence greatly. They firmly believed that they were the best team in the world.

Fang Xiaoyun’s important x-ray films were hung on the light board for easy consultation by the surgeon. There were also digital images available on the electronic screen which could be seen just by slightly raising one’s head.

She was given general anesthesia through endotracheal intubation, and positioned 90 degrees toward the left side with her right arm raised and placed on a support. Her scapula was externally rotated against the chest wall to expose the 5th and 6th intercostal spaces.

Positioning was very important to the surgery. Good positioning can provide ample exposure, while improper or incorrect positioning can make exposure difficult or even impossible.

Fang Xiaoyun had an endotracheal tube inserted in her mouth, which was connected to the anesthetic machine. A head holder was placed above her head, and the eyes were covered with protective tape to keep them shut. Silicone protective pads were used to protect all protruding parts of her bones, such as the sacrococcygeal area, to prevent ischemic necrosis due to pressure. The right upper chest and armpit had also been padded with thin pillows, to provide ample protection for the axillary artery, axillary vein, and the brachial plexus nerves.

Zhou Can checked Fang Xiaoyun’s upper limbs for pallor or cyanosis, venous congestion, and whether the radial artery pulse was normal. After confirming that there were no problems, Song Zimo started the disinfection and draping procedures. Everything was ready. Yang Ping wore his surgical gown and gloves, and stepped onto the surgical stage.

The sacred preoperative check. This was not only to prevent errors in the surgical site and approach but more importantly, it was a ritual that demonstrated the surgical team’s seriousness and dedication.

“Name, Sex, Age, Hospitalization Number, Position, Surgical Site, Surgical Method, Anesthetic Technique, Surgery Attention Points, Anesthesia Attention Points—”

Stop all work at hand, each task must be checked, and every member of the surgical team must participate. If anyone disagrees, they must voice their objection on the spot. If there are no objections, then it is officially announced: Surgery begins! Only then can the scalpel be wielded.

Entering the thoracic cavity, following the upper edge of the eighth rib, from the outer edge of the paraspinal muscle to the anterior axillary line, cut open the skin, subcutaneous tissue, and deep fascia. Continue to cut through the muscles: The first layer is the latissimus dorsi, the second layer includes the anterior serratus, the external oblique abdominis, and parts of the paraspinal muscle, the third layer involves the external intercostal muscle and the internal intercostal muscle, with protection of the intercostal nerve and the intercostal blood vessels beneath the lower edge of the rib.

The parietal pleura is exposed. Yang Ping makes a small incision on the parietal pleura with a knife, and air enters the thoracic cavity, instantly eliminating negative pressure. One of the lungs gradually collapses.

Adhesions exist between the lung and pleura. The tissue scissors are handed over and Yang Ping cuts off the band-like and membranous adhesion bands. The lung completely collapses and the thoracic wall is protected by saline gauze.

The thoracic retractor gradually opens the thoracic cage, presenting the throbbing heart and the pair of contracted lungs vividly before the eyes. Especially the vibrant, powerfully throbbing heart: its rhythmic pulsating sound signifies the driving force of life. From the moment of birth, until death, it beats ceaselessly in its rhythm.

Sometimes during cardiac massage within the chest, it is necessary to hold the heart in your hand. At this moment, you feel the miracle of life, as it rests in your palm.

Yang Ping stops his operation: “Everyone, come take a look!”

Standardized training students and interns observing the procedure climb onto stools, peeping into the thoracic cavity from a meter away from the operating table. The heart and the lungs are presented alive before them.

Such a sight easily elicits a spontaneous sense of sacredness, nobility, and responsibility within people.

Revere and respect life! The impact on the heart is more significant than reciting the medical student pledge a thousand times.

Life is presented to you in the form of a pulsating image. If it stops, life as we know it ceases and doesn’t bear any relation to this world. If it keeps beating, one can laugh, cry, love, hate, and experience all the joys and sorrows of the world.

The dissection has already progressed to an intuitive and proficient level, with saline gauze covering the lung tissues. Gently shifting them towards the midline, the anterolateral border of the thoracic vertebra and the posterior mediastinum come to view.

The whole procedure goes on in silence, with each move known to the assistant, including the positioning of the retractor, the direction, and strength without needing a reminder. The scrub nurse has a very thorough grasp of the procedure.

Even without exchanging glances, the scrub nurse passes the knife at the right time. Doing surgery with this synergy feels wonderful, it’s a heart-to-heart interaction.

The mediastinal pleura is longitudinally incised, exposing the left thoracic aorta, the azygous vein, hemiazygos vein, and the intercostal blood vessels on the right side.

These blood vessels need to be partially cut and ligated to get a full view, but the intercostal artery is one of the main arteries supplying the spinal cord. The number of sections cannot exceed three, otherwise, it could cause disruption to the blood supply of the spinal cord.

A true master surgeon adheres to the concept of minimally invasive procedures throughout, protecting blood circulation and tissues as much as possible. Yang Ping does not intend to cut and ligate these blood vessels, indeed he plans to protect each blood vessel that supplies the spinal cord.

Entering between the blood vessels, the space formed by the blood vessels will create several operation windows. This will make the operation seem very difficult. However, for Yang Ping, this is not a problem.

Entering between the vessels, a pleural separator is used to gently push open the aorta at the front of the vertebral body from the outside of the pleura, protected by saline gauze, a retractor is gently inserted.

Saline gauze protects the surroundings, revealing the operation space. The front side of the thoracic vertebra, the intervertebral disc, and the anterior longitudinal ligament are about to appear in view, but what is revealed is a fluctuating cystic object.

This is an abscess. Xiao Su hands Yang Ping a 50ml syringe. Yang Ping punctures the abscess with a small incision using a scalpel, and tenacious whitish-yellow “cheese” seeps from the tip of the syringe, rushing into the syringe tube. The syringe quickly fills up, another syringe replaces it, and the suction continues.

The collected specimens are preserved for bacterial culture and pathologic examination. Five consecutive aspirations are made for aerobic, anaerobic, tuberculin cultures, smears for acid-fast bacilli, and pathologic testing.

The assistant’s aspirator then is introduced, gently placed through the small incision, removing the remaining “cheese”. This aspiration device is specifically used to aspirate “cheese”. The patrolling nurse begins to calculate the volume of the “cheese”, which totals 1000 milliliters.

Yang Ping completely opens the abscess wall, repeatedly rinses the area with saline, and continues with the operation once the surgical site is clean.

“Nice!” praises Zhang Lin.

Little Five looks up at him and replies: “Indeed, just a pity we can’t smell it.”

“Could it be a sweet scent?”

“I’ve heard it’s sour.”

Unexpectedly, the cheesy material from a cold abscess could elicit such a vivid image, both Zhang and Little Five exclaim in unison. However, the retractor in their hands remain motionless and are used with appropriate strength for optimal exposure.

Being labelled as a golden or silver hook operator is not overrated, it’s earned by displaying excellent retracting skills through countless operations.

“Congratulations, you’re one step closer to being an exceptional surgeon,”

Yang Ping exposes the front of the ninth thoracic vertebra and begins to ligate the surrounding blood vessels.