Surgery Godfather

Chapter 323: Chapter 0307: Too Handsome (Added More for the Silver League Wolf Pulling the Sleigh)

“On to the next segment, let’s cut a new entry!” Director Qin is the chief surgeon, naturally he would showcase his courage at critical moments.

The mistake can’t be too far off, it’s probably just by one segment, and if there is an error, it would not be upwards, it would be downward.

Removing the scope and working cannula, Director Qin cut a small opening on the left side of the next segment, puncturing a path, dilating the channel, inserting the working cannula, then inserting the scope, then the plasma knife began to clear the field of vision, gradually entering the spinal canal.

There was nothing, everything was so normal that it took one’s breath away!

Just now we could still see the ruptured annulus fibrosus, now the view was completely normal. Director Qin’s hope was extinguished like a soap bubble, one couldn’t possibly blindly puncture the patient’s back with two rows of holes.

In an urgent moment, Director Qin turned his attention to Xiao Yang, renowned as a prodigy, but unsure about his skills in spinal surgery. In trying circumstances, Director Qin asked, “Xiao Yang, what do you think? Still no sign of it, what should we do?”

At this point, for the sake of the patient, even if he had to devalue and bargain his prestige, Director Qin, though troubled, still resorted to asking.

Even though Director Qin knew all along that he had been waiting for this moment to ask for help, when it came to the asking, he was still a little uncomfortable.

Prestige is curious, though you know it’s nothing of value, yet you can’t help constantly trying to preserve it, fearing it will fall.

Xiao Yang earnestly studied the MRI scan: “Prepare a bottle of Omnipaque, intraoperative spinal angiography!”

A single sentence made them all enlightened, why didn’t they think of this? Since the popularization of MRIs, spinal angiography had almost faded from the minds of orthopedic doctors. In this era, who still performs spinal angiography.

However, at this time and place, spinal angiography was the best method, they had seen such a big thing on the MRI, could it have just vanished in thin air? After the angiography, would it not be clear, and then positioned accordingly.

“Wipe my sweat.” Director Qin moved his head away from the sterile area, and the patrolling nurse dabbed at his brow with a tissue.

No need to employ heavy hitters, these were all experts after all. One sentence pointed out the solution to the problem, this kid does have a handle on spinal surgery.

Director Qin was much more relaxed and regained his confidence: “Omnipaque, get me 100ml bottle, less than that is useless.”

Omnipaque, iodixanol injection fluid, which Director Qin was familiar with, is a type of iodine radiographic contrast agent often used in percutaneous vertebral kyphoplasty for vertebral body imaging, but he has not used this method for intraspinal angiography, so he did not think of it.

“Is it sterile?” a doctor below the stage asked.

Director Qin retorted bluntly: “Use your brains more during work. An injectable can enter human blood vessels, would it be sterile or not?”

The doctor who asked the question turned red in the face, indeed, an injectable that can enter human blood vessels, how could it be non-sterile? Such a dumb question, he must have been confused just now.

The patrolling nurse opened a 100 ml bottle of Omnipaque, the equipment nurse used a 50 ml large syringe to draw two full tubes, and placed them ready for use.

The patient was lying face down, slightly inclined at this time, Director Qin returned to the first entry point, established the working cannula, inserted the endoscope, and injected the Omnipaque into the spinal canal, waiting for it to spread evenly.

“Fluoroscope, let’s check the situation.”

The C-arm was pushed in, the sterile cover was put on both the emitter and receiver near the surgical area, and Dr. Wen directed the operator to adjust the position.

“Hurry up, move aside!” Dr. Wen rushed the people.

The operator stepped on the footswitch at the door, everyone lined up and went back in, the angiogram on the screen was clear, the intervertebral disc appeared at the right rear of the L4/5 gap.

“Today is such an unlucky day, I’ve been doing this kind of surgery for ten years and haven’t encountered something like this. The intervertebral disc moving in the spinal canal, during the exam, it moved to the L1/2 position, during the surgery, it ran to the right rear side of L4/5.” Director Qin was caught between laughter and tears.

If it wasn’t for Xiao Yang’s guidance today, Director Qin would definitely be trapped in a fixed mindset, and the surgery would end up a sham surgery. Attempts made to protect his pride all fell through.

“Dr. Yang, your thinking is broad, we were almost tricked by this thing.” Director Qin was also a straightforward person.

Yang Ping reminded him: “Indeed, this is quite rare, such a big thing can freely move inside, be careful, it may run again.”

His just relaxed nerves were suddenly tensed again by Yang Ping’s words, Director Qin was scared now, he felt like a frightened bird.

The patient’s upper body was not anesthetized and could move, the patient might have been lying down for a long time and moved slightly, the anesthesiologist immediately shouted: “Don’t move around, tell me if you feel uncomfortable.”

“Puncture from the right side of L4/5, this is not the high iliac crest, it should be easier to make a way.” Director Qin needed a break, he let Dr. Wen do the puncturing.

Thoughtfully, he decided to get his hands dirty, “Wait, I’d do it.” Director Qin proceeded to take over the puncture tool.

Fluoroscopic positioning, puncturing, multiple checks with fluoroscopy, no deviation in positioning, then way-making and hole-expanding, establishment of the working channel, insertion of the endoscope into the spinal canal.

Again, there was no trace of the free intervertebral disc! It was just seen in the spinal angiography.

Today is full of bad luck, Director Qin’s hand was a bit stiff: “There’s still contrast agent inside, fluoroscope it again!”

Yang Ping was very calm, familiar with these things, and used to it. Director Qin may have performed a few thousand conventional spinal endoscope surgeries. But he has fifty thousand training points, and isn’t interested in wasteful surgeries, he only does simulation surgeries. Now he can do anything without going broke, he often strolls around in the system space, doing all kinds of strange surgeries, so he’s never unnerved.

It’s like going to war, the constant battles make a big difference. With bombs exploding all around and bullets whizzing past your head, you can still calmly take a puff of a cigarette.

“More contrast agent, fluoroscope!” With people backing him up, Director Qin was confidently incisive.

At first glance through the fluoroscope, everyone just wanted to laugh, the intervertebral disc was now on the left rear side of the L4/5 gap, could they go to the left side of this segment and cut another hole?

Director Qin turned his head to seek help from Yang Ping, “What’s the solution to this difficult problem?”

“Just pull it over from the other side, the spinal canal isn’t that large anyway?” Yang Ping felt the task was simple.

Blind operation? Absolutely forbidden under foraminoscopy.

“What if you accidentally pull the cauda equina and yank it out, that would pose a big problem.” Director Qin put forward his concern.

Is it impossible to differentiate between the cauda equina and the nucleus pulposus of an intervertebral disc by touch?

Yang Ping was somewhat puzzled, then realized. Only he could do this, not others. Thanks to years of surgical training in his system space, he is more experienced than anyone else.

“If the mobility is so high, it means the pressure is not heavy. Then why are the symptoms so severe?” A doctor in the audience questioned.

Dr. Wen took the time to explain, “Some people have been trying for years to get pregnant without success, while others can conceive after just one attempt. Can you explain why?”

“Don’t move, mate! Anesthesiologist, give him a sedative!”

The patient moved again, as Dr. Wen called out.

“How about I do it?”

Yang Ping volunteered to take over. If he continued like this, the patient would be exposed to unnecessary radiation, every time his position had to be redefined via fluoroscopy, let alone the risk of the intervertebral disc getting stuck in a corner.

Director Qin decided to let go at this point. It seemed he was not having luck with this surgery, so it would be helpful if an expert could step in to save the situation.

If the surgery can’t proceed, what dignity do I have left to lose?

“How about this? Doctor Yang, you take over.” Director Qin consented.

“Should I get on the operation table?” Xiao Su spoke in a moderate tone.

“Just wait for me here, it will only take a few minutes.”

At this moment, to Xiao Su, Yang Ping was the most attractive man in the world. Regardless of how tough the surgery was, he always appeared calm and composed, making it look easy.

Scrub up, gown up, step up.

This type of procedure could be completed by one person. Even an assistant was unnecessary.

Yang Ping adjusted the working channel and the lens slightly once he was on the operating table.

He inserted a neurodissector and delicately prodded around. For some unknown reason, the separated intervertebral disc appeared in his field of vision. He then smoothly replaced the neurodissector with disc forceps, and he unbelievably managed to extract the entire piece in one attempt. He placed it in the saline gauze handed to him by the nurse for washing. Once the bleeding stopped, he removed the instruments and the working sheath.

He positioned the sheath in the path on the left side of the L1/2, extended the disc forceps from the broken posterior L1/2 annulus fibrosus, bit by bit he removed a portion of the intervertebral disc, shaping the annulus fibrosus, and ultimately, with the dura and nerve root as the center, carried out a thorough decompression on the head side, tail side, ventral side, dorsal side, and the opposite side.

Watching this, Director Qin was dazzled. Yang Ping’s skill with the foraminoscope was not just proficient, it was leagues ahead of his own.

With the surgical instruments inside the spinal canal, he could manipulate them as he pleased. At this level, all spinal canal issues can be solved under the foraminoscope. Paired with percutaneous pedicle screws, and interbody fusion devices inserted under the microscope, there would be no need for open spinal surgery in the future.

“It’s done!”

Yang Ping put down the instruments, having solved the problem in just a few minutes.

Director Qin had to admit, indeed a master is a master. For him to become a legend of the hospital, he certainly had his unique skills. One would not be proficient with the foraminoscope without at least a decade or so of surgical experience. As a young man, where would he get so much surgical practice from?

As Director Qin was pondering, Yang Ping had already started to take off his gown and gloves, with Xiao Su assisting.

So cool!

Each time he was on the operating table, Yang Ping evidenced an invincible mode which was just too cool to ignore.

“Rinse it once more, then you can close it up.” Yang Ping advised.

Director Qin looked at the extracted intervertebral disc and the adequately decompressed nerve root. The surgery was impeccable. He could regard him as his own teacher. This was not trauma orthopedics anymore, it was spinal surgery, a field Director Qin had been practicing in for ten years.

“Dr. Yang— Thank you for your hard work—”

Director Qin was thankful from the bottom of his heart. Had he let Yang Ping take over earlier, he could have avoided all the hassle—vanity could lead to disastrous consequences!

His handling was not the work of a novice, it was indeed quite mature.

“I’ll be going back to the department now—”

“Thank you!”

“I’ll get in touch with you later, we should hang out sometime.”

Yang Ping stepped down from the operating table, left the operating room, with Xiao Su following him.

“Every time I see how invincible you are in the operating room, it’s too cool!” Xiao Su secretly murmured.