Oriental Hospital operating room.
Lin Sanqi was wearing full surgical clothing and a disposable cap and mask, and was preparing to watch Cai Yangxian perform a thoracoscopy surgery.
Cai Yang was also wearing a complete set of surgical attire, and while preparing the tools, he asked:
"Junior brother, the commonly used instruments and equipment for thoracoscopy, how to choose the surgical position, and preoperative preparations, You should have learned about the selection of incisions, right?”
“Yes, senior brother, I have learned these in school and during internship, you can omit them.”
"Okay, then there is only one question left about the basic operating techniques of thoracoscopic surgery. You have just read this patient's medical record. Although he underwent lobectomy for malignant lung tumors, it is not the same as your tuberculosis lobectomy. In fact, the principle is the same. Please read it through first."
Lin Sanqi nodded: "Okay, senior brother."
Cai Yang asked an additional question at this time: "When you learned it in school, how many holes did a thoracoscope make?"
Lin Sanqi recalled: "You learned it at that time. At that time, there were two holes and three holes, but during my internship I mainly learned the two-hole mode.”
Cai Yang said with a proud smile:
"Then our Dongfang Hospital is much more advanced than Huadu No. 1 Hospital. We use single-port video-assisted thoracoscopic surgery, which is called uVATS in English. This technology is currently the most advanced surgery in the world, and it is estimated that it will become mainstream in the future.
Single port offers a range of benefits compared to multiport approaches, such as direct view, better lung exposure, ergonomics It has the advantages of using more advanced equipment, less postoperative pain, faster postoperative recovery, and shorter hospitalization time.
Of course, the difficulty of the operation will also increase, but since you want to learn it, you must learn the most advanced technology. "You can't embarrass the teacher by saying that you are also Dean Wang's student."
Lin Sanqi was delighted when he heard this. This kind of pretentiousness was his favorite.
Think about it, when he goes back to 1961 and performs surgery on Japanese people, he does not need to open the chest or make a big incision, he only needs a small hole to solve the problem. How many foreigners will be shocked?
Ignorance and backwardness can be returned to the doctors of these developed countries in just four words.
“Okay, Brother Cai, I will learn the single-port technique.”
Cai Yang used a scalpel to make an incision of about 3cm in the fourth intercostal space between the patient’s mid-axillary line and anterior axillary line. The keyhole is kept on one side of the mouth:
“For other lobectomies, we all choose the 5th intercostal space to make the incision. This This position allows the surgeon to approach the hilum at a slight angle, which facilitates manipulation of hand instruments along the longitudinal axis.
If the incision is too high and the surgical axis is too close to the hilum, although the anatomy is not a problem, the lack of angle is not. This means that the hand instrument cannot bypass the blood vessels, but is pushed onto the posterior hilar structures
If the incision is too low, the shaft provides a good angle for the stapler, but the incision is far away from the hilum and the instrument operation path is very narrow, making instrument operation complicated.
When you are going to perform a right upper lobectomy, the routine is the fifth intercostal space. My personal suggestion is to use the fourth intercostal space because it allows better exposure and treatment. "
Lin Sanqi thought that this experience and technique is simple. Anyway, he is writing a proposition. Just remember that the incision is in the fourth rib space.
" Got it, senior brother. ”
Lin Sanqi is an audience today, not a surgeon, and does not need to be a mirror-holding assistant, as long as he looks at the display screen the whole time.
The process of lobectomy is actually very simple. On the TV screen, the surgeon Cai Yang retracts the upper lobe backwards, opens the mediastinal pleura, and exposes the hilar blood vessels of the upper lobe.
First, the tip branch and anterior branch of the pulmonary artery are freed, and then ligated and cut off respectively. The apical, anterior, and posterior branches of the superior pulmonary vein are then treated.
Then open the upper part of the horizontal crack and the oblique crack. The posterior branch of the superior lobe artery was found deep at the intersection of the two pulmonary fissures, and then cut off after ligation.
Finally, the upper lobe bronchus is freed, the bronchus is cut off after suturing a traction suture, and the stump is sutured.
Cai Yang was doing a teaching surgery, so he did the first step clearly, completely according to the textbook standards, and the surgery was done very slowly, so that the junior brother could see it clearly. Some.
While operating, he also kept explaining some clinical experiences:
"When reaching this step, you must follow the 'flexed arm rule', tilt the stapler to the left, and begin to dissect the upper lobe veins. Before identifying the middle lobe vein, fully dissect the upper lobe vein to optimize the passage of the stapler. ”
“When there is no suitable angle for inserting the stapler to disconnect the vein, separate the bronchial vein if it remains. Difficult to divide, there are two unusual options
Especially for a beginner like you, it is necessary to rotate the upper lobe longitudinally and orient the stapler caudally or to cut it with 2 regular thoracoabdominal staplers. Dissection. ”
“When we want to dissect the pleura above the middle bronchus, we need to identify the bronchial artery, and if it is cancer, we need to dissect the lymph nodes so that the stapler can be inserted from the front. ”
"Gently dissect the A2 region, as excessive traction without bronchial support may cause avulsion of this branch leading to massive bleeding." To identify pulmonary fissures. Usually, there is a contour crack between the lobes, but if there is no such mark, the middle lobe vein is an important sign of dividing the horizontal fissure.”
Lin Sanqi is an undergraduate student at a top medical university. , there is no shortage of theoretical knowledge, but experience.
Now that a chief physician is teaching him step by step, teaching him all his surgical skills and clinical experience without concealing or retaining, Lin Sanqi's level is improving in a straight line.
At least he thinks so.
With this teaching model, let alone an undergraduate, even a technical secondary school graduate who graduated from a health school can become a high-level doctor performing lobectomy in the shortest possible time.
After three consecutive lobectomies in the morning, Cai Yang took advantage of the break and asked:
“How is it, little junior brother, you should already understand the steps and essentials of thoracoscopic surgery, right? ?”
Lin Sanqi was a little excited:
“Senior Brother Cai, I’m not bragging. Now I feel that I am terrifyingly strong. If you dare to let me go, I can perform an operation right away. Let me show you.”
Cai Yang had a playful expression on his face:
"Oh, right? We surgeons don't like to brag, and you don't want to be like those PPT doctors who talk about one thing after another. If you actually perform the operation, you will only be blind. . In this way, since you are confident, you can hold the mirror in a moment. ”
Lin Sanqi was eager to try: "Okay, it's so simple to hold the mirror. I think all freshmen can do it." Micro-instruments are used to perform the main surgical operation, and a surgical assistant is required to hold the endoscope next to it.
Scope assistants play a very critical role in surgery. A well-trained scope assistant can allow the surgeon to have a very good view when performing surgery, making the operation safer.
Obviously Lin Sanqi thought too simply.
The fourth operation started, and the atmosphere in the operating room immediately began to drop to freezing point. From time to time, Cai Yang’s scolding could be heard:
“The mirror is crooked!”
"You need to observe the fluid in the abdominal cavity, such as effusion, flushing water or even blood, as a marker of the plane."
"Put my operating point in the middle!"
"The brightness of the central field of view of the laparoscopic lens is often higher. If the operation moves out of the field of view, there is a risk of accidental injury, and it may not be discovered and lead to serious consequences. Do you understand?"
"Don't shake the lens!"< br>
“You should hold the lens slowly and steadily, and try to avoid violent shaking of the lens. At the same time, in order to expand or focus It is also taboo to move the camera back and forth too quickly to avoid making the surgeon dizzy! "
"How can I see clearly if the mirror is blurred?"
Lin Sanqi! Sweat was dripping from his eyes. At this time, he had already discovered that he was far from qualified to be a mirror holder, let alone a chief surgeon.
Because he couldn't keep up with Brother Cai's operation progress and didn't know what to do next. It was either too slow or too fast, and the surgical field of view could never be fully displayed on the monitor.
During the operation, the surgeon was the biggest surgeon in the world. Even though Cai Yang had endured it, his tone had begun to become more and more severe.
That is to say, Lin Sanqi has a special status. If it were another resident doctor or a regular training doctor, Cai Yang would have scolded him long ago.
Few surgeons have good tempers.
In the operating room, the other assistants and nurses all covered their mouths and chuckled. It’s fun to see the newcomers in a hurry, isn’t it?
Just when Lin Sanqi was sweating profusely, Dean Wang leisurely wandered into the operating room.
Head nurse Kong in the operating room received the news and immediately rushed out: "Ah, Dean, why are you here to inspect the work?"
Of course Dean Wang must be cool in front of his subordinates ’s:
“I came to see how the new apprentice’s surgery went, By the way, which operating room is Cai Yang from the Department of Thoracic Surgery?”
“Director Cai, he is in operating room 11. When I was patrolling just now, I found that he seemed to be teaching students, but this student He must be quite stupid, Director Cai kept scolding, haha~~~"
While reporting the situation, Head Nurse Kong quickly took out a brand new surgical gown from a compartment in the changing room and helped the director put it on.
Whoever can be a head nurse is not a well-rounded person, and must observe carefully and understand every detail that happens in the operating room.
After Dean Wang changed his clothes, he walked towards operating room 11 and said leisurely as he walked:
"This stupid student is my new graduate student... ..."
Mr. Kong hurriedly paused. She really wanted to give herself a slap in the face, but this flattery hit the horse's feet.
Outside the operating room, through the glass, Dean Wang saw Cai Yang operating while teaching the details of the operation, so he nodded slightly.
"Xiao Cai's skills are incredible. He is indeed young and promising."
The head nurse also took a look and asked cautiously:
"Dean "Your student came to the operating room on his first day. He studied very seriously, and you can see that he is holding the mirror right after he arrived. He is very talented." Dean Wang was very happy when he heard this:
"In the next month, I, a student, will be staying in the operating room. Please take more care of me."
The head nurse understood immediately and immediately expressed her loyalty: "Don't worry, dean, I will make everyone Pay attention. "
The doctors, nurses, and anesthesiologists in the operating room are all amiable in front of the director, but in front of the interns or trainees, they are fierce and absolutely difficult to talk to.
Especially those who can become head nurses are basically strong women. They can yell and scold the junior doctors at will. Even if the chief physician has something to do, he can only discuss it with the head nurse.
Dean Wang came here specially to hang out. In fact, he was warning the medical staff in the operating room not to bully his precious apprentice.
In the locker room after get off work at noon.
While changing clothes, Cai Yang kept urging:
“If the small blood vessels do not pass through the angle of the stapler, my personal suggestion is to use a polymer blood vessel clamp...
“The 450 angle clip applicator allows the clip to go around the entire circumference of the vessel before closure, avoiding any vessel damage…”
“Two clips are placed at the proximal end of the vessel and the energy device seals and separates remote. A clamp on the distal stump may be displaced when handling specimens or dividing fissures..."
"Junior brother, why are you..."
Cai Yang said as he walked. Halfway through, he realized why the junior brother didn't answer. Then he turned around and saw that the corridor behind was empty?
So Cai Yang hurried to the locker room and found Lin Sanqi holding her waist with one hand while moving slowly.
Cai Yang frowned:
“Junior brother, your waist and physical strength are not good enough. Our old dean was still able to go to the operating table at the age of 80 and performed 10 operations a day. Your hands are still steady after you get down, and you will be..."
Lin Sanqi also didn't know whether to laugh or cry. She thought, "You have to deal with two wives and pay two public rations. Can you try to see if your waist can handle it?"
The key point is that Cai Yang is different from other doctors. Other doctors’ assistants stand behind the surgeon, on the same side.
Cai Yang's habit is to ask his assistant to stand on the opposite side to hold the mirror, so that the assistant has to bend down and turn sideways when holding the mirror, so that he can see the display screen clearly and continue to follow the action.
During the entire process of holding the mirror, the assistant's hand must be balanced. If the hand shakes a little, the long front lens will shake very badly.
The feedback on the display screen is a blur, making it impossible to operate at all.
Let alone Lin Sanqi. With such awkward postures, bending over, leaning forward, and turning sideways, an operation can take half an hour faster or an hour or two slower. Who can tolerate it?
Every assistant has been specially trained, but Lin Sanqi has not.
This caused his waist to almost break after a long time, and the usual "excessive amount of exercise" made it even worse.
"Senior Brother Cai, it's okay. I, I just twisted my waist a few days ago and haven't fully recovered yet. Don't worry, I can persevere!"
Cai Ying was helpless, but also I know not to push too hard, there is still time anyway.
"Okay, okay, you should continue to observe the operation in the afternoon, and leave the mirror-holding work to others. Again, when you want to operate on someone else, try to be as slow as possible. You would rather wait for the mirror-holding assistant to make sure you don't make any mistakes. "
At the end of the day, when Lin Sanqi returned to his lounge, he was already tired and lay down on the bed motionless.
It is said to be a lounge, but it is actually the VIP ward on the top floor of the hospital.
The wards here are all per person. In addition to normal medical equipment, the rooms are fully equipped with large beds, large sofas, and household appliances. They are completely decorated according to the design of a five-star hotel.
Of course, the bed fee per day is not a small amount, 2800 per day.
Those who can stay in the VIP ward are only high-ranking officials or entrepreneurs, or those gods who don't work all day but have endless money...
Although Lin Sanqi is a close disciple of the dean, He spent a lot of money in the thoracic surgery department, but he didn't want to take advantage, so he still paid for the room fee.
Anyway, he is not short of this little money, and there is no need to embarrass his mentor and senior brother.
In the elevator room, the elevator door opened with a ding, and Yin Lianyi walked out with a few lunch boxes in her hands, and then walked to the VIP ward.
I stopped for a moment when passing the nurse station:
"Hello, which way to go to room 28?"
One of the little nurses nodded: "Just go this way and turn right."
" Thank you. "
The nurses in the VIP ward were all selected from the whole hospital. They were all selected with the best figures and best looks, but these nurses were still far behind Yin Lianyi.
After Yin Lianyi left, several young nurses quickly gathered together and started gossiping.
"Hey, did you feel that the girl just now looked familiar?"
"Yes, yes, I felt the same just now. Do you think she is a fairy sister?"
"Ah yes. , when you said that, I also felt that it was her. Please check it out quickly. Who lives in bed 28? "
"Bed 28 is a hanging bed. Isn't it a young and handsome guy who is the target of Liu Tianxian's scandal?"
A few young nurses started chirping. After chatting about gossip, Yin Lianyi had already walked to the door of the ward and knocked on the door.
"Come in!" The voice said weakly.
After Yin Lianyi walked into the ward, she was extremely surprised to see the luxurious facilities inside:
"Okay, Lin Sanqi, no wonder you don't go home to live. It turns out that the hospital has such a five-star rating. In the hospital room? My dear, poverty really limits my imagination."
Lin. Sanqiyi raised his head and felt much better when he saw his girlfriend coming:
“Well, starting from Dongfang Hospital and returning to Yide Mansion, we have to go through almost half of Huadu, plus there is a traffic jam. Not more than an hour? You see, I have been standing all day, how can I go home?”
After Yin Lianyi visited around, he placed the lunch boxes one by one on the table:
“Come on, Master Lin, you don’t want to travel half of Huadu yourself, so let me, a little girl, run half of Huadu. Why don't you come here to deliver the food? Hurry up and eat, I cooked these myself!"
Lin Sanqi sat up and looked at her girlfriend with a strange look when she saw the dishes on the table:
“If I hadn’t been to Beiyuan, otherwise I would really think that this honey-glazed barbecued pork and roasted pork You made the squab yourself.”
Yin Lianyi’s face turned red when she heard this:
"No matter, I personally brought it anyway. You can eat the love dinner whether you like it or not. If not, I will take it home. Hum! You know how busy I am at work during the day. How can I be a hands-off shopkeeper like you?"
“Eat, eat, eat, even the farts of Miss Yin are delicious, let alone this delicious food. Sit down and eat together. By the way, do you think I should hire some assistants?”
As Lingnan Tang Company began to expand, it now has a Chinese medicinal materials sales company, a Chinese medicine clinic, A southern pharmaceutical company, three branches, and a pharmaceutical research laboratory are also in preparation.
The beach is getting bigger and bigger, and Yin Lianyi, as the financial director, is getting busier and busier at work.
Because of Lin Sanqi's time travel, he has to purchase these things today and collect information tomorrow, which are all very tedious and detailed tasks. It is definitely inappropriate to let Yin Lianyi do it.
In the company, mutual supervision and checks and balances between Lin Tianhua and Yin Lianyi are essential.
Just like in historical dramas, it is not a good thing for the prime minister to be dominant, or for the queen to be dominant.
The turnover of Lingnan Tang Company this year will definitely exceed 10 billion. It is obviously very scary to test human nature with such a huge number.
“Recruiting assistants?”
Yin Lianyi reported the report while eating:
"I have personally checked and initially selected my two junior sisters, both of whom will graduate in June this year and are now in the internship stage. One is majoring in administration and the other is majoring in financial management. Both of them are She’s a great beauty.”
Lin Sanqi rolled her eyes and said dissatisfied:
“Rather than being my assistant, I might as well say she is your eyeliner, your junior sister. Not all listening Yours? Humph, I don’t know if you are too confident about your man, or are you too worried about me with two pretty beauties around?”
Yin Lianyi pinched her. Lin Sanqi's waist fat:
"Thirteen o'clock, don't forget, I kicked a boy to death in school and made him a father-in-law. Do you want to join the palace too?" Huh?”
"If you don't want to, just let it go, you damn bitch. Also, I'm warning you, the employees you've hired recently are all girls. It's not a good thing to have too many women in a company. I won't be able to bear the punches.
I don’t care about other things. Anyway, you can recruit more male employees for me in the future. I don’t care whether they are your old classmates or old lovers. Just don't let me find out about the adultery."
When Yin Lianyi heard this, he kicked Lin Sanqi directly to the hospital bed next to him:
"Asshole, you are the one. I have an old lover, you..."
Yin Lianyi was about to tame her husband when she suddenly heard a fierce quarrel coming from outside, and one of the voices was particularly familiar. (End of chapter)