Chapter 125 High-precision puncture
When Tan Boyun shook hands with Professor Yu, Professor Yu said: "Director Tan is soaring to the sky now!"
Tan Boyun smiled heartily: "I must thank Director Yu for his hard work!"
The two of them were smiling on the surface. If you didn't know the inside story, you would think that they had a deep friendship and shook hands and exchanged greetings.
Those who knew the inside story understood that there was something behind each other's words and ridiculed each other.
The relationship between the two is so bad that they are no longer in the same hospital and have no relationship. They still compete with each other when they meet and shake hands.
When it comes to orthopedic robotic surgeries, Affiliated One is at the forefront, with more than 500 surgeries in operation. In terms of orthopedic robotic surgeries alone, there is no problem in ranking among the top three in the country.
However, Appendix II has not yet carried out orthopedic robotic surgery, but only carried out robotic surgery in thoracic surgery, general surgery, urology surgery and obstetrics and gynecology.
As soon as Tan Boyun arrived at Sanbo Hospital, with the strong support of Director Han, more than ten surgeries were performed in just one month. According to this pace of surgery volume, he has already become a catch-up with Fuyi.
If Sanbo buys a second robot and develops spine, joint and sports medicine, it will start a crazy catching up mode.
Tan Boyun is full of energy and ambition, and dares to enter the cutting-edge fields of the industry. He not only has the ambition to challenge the Department of Traumatology and Orthopedics in the First Department, but also vows to occupy a place in the country.
Under Director Han, he can now take advantage of the wind and rain, without any constraints, and can flex his muscles.
"Director Tan took the initiative and launched more than a dozen units in one month." Professor Su praised.
Although Tan Boyun was arrogant, he did not dare to be arrogant in front of Professor Su, not only because Professor Su's academic character was outstanding, but also because Professor Su had helped him.
"This robot is specially used in our Department of Microtrauma and Orthopedics, so it is used very intensively. There are surgeries tomorrow, and there are five machines lined up this week. We need to learn more from Affiliated One. Compared with Affiliated One, we are still just toddlers. ”
Tan Boyun introduced the current status of Sanbo robotic surgery as the host. Before the introduction, he looked at Director Han to show respect and gain approval.
"We are currently conducting more than a dozen surgeries involving the pelvis and limbs. Our goal is to use robots to perform all types of traumatic orthopedic surgeries." Tan Boyun introduced his blueprint.
These dozen surgeries are just a warm-up, the best part is yet to come.
Professor Su admired in his heart that Han Jiangong knew how to use people, and Tan Boyun, a fierce horse, could hardly move even two inches in front of him, but he made great strides in Sanbo. This man will definitely make extraordinary achievements in the future.
Mr. Ning, a patient in Huaqiao Building, has been sent to the operating room, which is next door to where Director Tan performed the surgery just now, because there is navigation equipment - a computer-assisted surgical navigation system.
Su Nanchen considered using a robot to complete the puncture, but gave up because this kind of puncture not only requires precision, but also requires an excellent feel when entering the guide wire. The direction of the guide wire can be adjusted according to the feel to successfully place the tube.
The accuracy of robotic surgery is very high, but the biggest shortcoming is the lack of feedback on instrument contact, that is, the lack of feel.
Su Nanchen completed the simulated puncture, mastered the best puncture point, puncture angle and depth from the simulated puncture, and had a clear understanding of the relationship between various anatomy.
Yang Ping took Su Nanchen to the operating room, followed by Song Zimo.
Su Nanchen and Wen Rentao are the goals in Song Zimo's heart. He has been secretly working hard to surpass these people who are known as the stars of tomorrow.
Song Zimo followed behind without saying a word. He was not unsociable, but too lazy to socialize. He always looked like it had nothing to do with him.
"The aunt I just met in the garden had a weak right knee joint. Did you perform the surgery on her?" Su Nanchen took the opportunity to ask.
Yang Ping nodded: "I just had an operation this morning and will be discharged from the hospital tomorrow. What, an acquaintance?"
Su Nanchen said: "My old patient had her second operation done here, but the effect was not good. I met her just now, and her symptoms were completely resolved this time."
Yang Ping did not expect that this patient was his. The patient mentioned that the second operation was performed by Dr. Su for him, but Yang Ping did not care: "This patient has a synovial band stuck in the popliteus tendon tear." Caused by pressure, I found the synovial membrane of the popliteus tendon tear and removed it, and the patient’s symptoms were relieved naturally.”
"Have you never heard of this disease?" Su Nanchen asked. With his profound knowledge, he didn't know about this disease.
Yang Ping smiled: "I have never heard of this disease and the abnormalities found on her MRI."
"Let's take a look at the MRI together when we have time?" Su Nanchen was eager to learn.
When you arrive at the operating room, change your shoes, clothes, and put on a mask and hat.
The patient has been positioned in the prone position. Zhang Lin and Xiao Wu have helped disinfect the bed sheets and prepare the instruments.
Professor Su, Professor Yu and Director Han had already put on lead clothes and were sitting inside chatting.
"Nan Chen, hurry up and brush your hands!" Professor Su urged.
"Xiao Yang, brush your hands and prepare a table for Dr. Su." Director Han ordered.
The two of them put on lead clothes and began to brush their hands. Yang Ping had a very good chat with Su Nanchen. He didn't like Song Zimo, who was aloof and arrogant at all times, and kept people away from him thousands of miles away.
Yang Ping is different. He has a strong self-confidence, but he is not arrogant or aggressive.
Masters are often lonely, and it is a blessing to be able to find an opponent.
The sympathy between young talents made Su Nanchen hate Yang Ping for meeting him so late. When they were brushing their hands, the two kept chatting, from the patient with popliteal tendon tear hole synovial strip compression to the puncture of this patient, it was like brushing his hands. The time is too short for two people to chat.
Everything was ready. The surgeon checked again, opened the table, administered local anesthesia, and percutaneously implanted a spatial reference positioning needle in the spinous process to provide coordinates for navigation.
Dr. Su's posture on stage is very good, with different sitting postures, standing postures, walking postures, and eating postures.
There are different postures for surgery. Some people have standard postures and look very beautiful; some people lower their heads and hold their chests, and sometimes get close to the surgical area to see; some people twist their bodies, which is not only unsightly, but also easy to contaminate the surgical area; and some people have a simple fracture. , in a very awkward kneeling position. I don’t know if it’s a special need or it’s the first time I’m having surgery.
From Dr. Su's surgical style, we can see that Professor Su has strict requirements on him. The wrinkles of large orders are smoothed out, and the operating instruments are required to be placed neatly and arranged according to the frequency of use.
Keep your chest high and your head down, your hands should be at a suitable distance from the operating table, and your movements should be controlled within a limited range. If it can be limited to the fingers, try to control it on the fingers; if it requires assistance from the wrist joint, control it at the wrist joint; even if it requires assistance from the elbow joint, it is a very small movement.
Every step is standard and looks very beautiful. The surgical rhythm is clear and progresses step by step.
The image on the navigation screen presents a three-dimensional anatomical structure. The reference points accurately display the coordinate relationship between the instrument and the anatomical structure. The navigation pointer instructs the puncture needle with the sheath to accurately advance toward the target.
Simulated puncture and precise navigation, coupled with Dr. Su's talent and experience, the puncture is in place at one time, passing through the pedicle, breaking through the cortex at the best position, and after completing the bony channel, the target is the nerve root sheath in front.
One step at a time, no mistakes.
Su Qingyun's son really lived up to his reputation. Professor Yu paid close attention to the entire puncture process and had to admire him for raising his son to be outstanding.
Even without Su Qingyun's help, Su Nanchen was fully qualified to enter the 1st Secondary School of Peking Union Medical College, which is the eight-year academic qualification for studying medicine in the country.
What's more, Su Nanchen was the top scorer in the science college entrance examination in Nandu Province and entered the Union Medical College as the top scorer. Professor Yu felt ashamed of Su Qingyun, both in terms of the department's academic status and his personal success.
The puncture needle is pulled out, leaving the sheath inside. The thin hollow puncture needle passes through the puncture sheath, and the needle tip touches the nerve root sheath. Even with navigation, this is an extremely difficult operation.
The future life is terrible! Everyone agreed.
The needle tip is ready to pierce the nerve sheath and enter the sheath. Navigation cannot help with this step. It must be done by hand. Song Zimo sat next to him. Su Nanchen was indeed a rising star as famous as Wen Rentao, and had nothing to do with his father.
The needle tip pierced the thoracic 2 nerve root sheath, and the microcatheter with an elastic guidewire entered the sheath from the hollow needle tube, revealing a little bit, but it was difficult to move forward.
The puncture was blocked at the last step of cannulation.
Su Nanchen frowned. Due to the invasion of tumor tissue and the adhesion between the sheath and the perineurium, the guidewire that needs to enter the sheath is elastic. The original intention of the design is to fit the natural gap between the sheath and the nerve, but now this The gap no longer exists due to adhesion.
When advanced again, the guidewire appeared curved on the image and could not break through the adhesions.
Professor Su stood up and looked at the navigation picture on the screen. The puncture process was perfect, but the last step was blocked.
He believed that Su Nanchen could handle it, and Su Nanchen did not panic. He stopped operating and thought about a solution.
Before the operation, he had considered adhesions. To solve this problem, he had to adjust the angle of the puncture needle.
The puncture needle now enters almost perpendicular to the direction of the nerve. It is necessary to adjust the angle of the needle tip so that the needle and the direction of the nerve present a certain angle, so that the guide wire can break through adhesions in a better direction.
Just like splitting wood, splitting it horizontally is very laborious; splitting it vertically can be split in half with just one axe.
It would be good if the missile hits the teacup, but it also requires hitting the teacup from a specific direction, which is even more difficult.
The range that can be adjusted is very small. The diameter of the bony tunnel is inherently thin. The finer puncture needle has an adjustment range, but it is very small.
Withdraw the guidewire catheter and puncture the nerve root sheath again.
Su Nanchen is very skilled in the anatomy of the spine. At such a young age, just thirty years old, he has accumulated experience in hundreds of scoliosis surgeries, which is very rare.
He had a good touch and adjusted the needle tip slightly to reveal the angle. However, as soon as the needle tip touched the nerve root, it slipped away as soon as it was pushed forward.
"The angle is not correct, just adjust it fifteen degrees."
Yang Ping reminded.
(End of chapter)