Chapter 608 Underwater Escape
Little Duke Gordon has been taken to the operating room, and Yang Ping is about to leave for the operating room.
All the big guys present woke up and remembered something extremely important.
Today's pre-operative discussion was an impromptu meeting, and one important person was not present. However, it seems that he has been out of touch every time he goes on vacation, and there is no way to contact him.
That is the legendary figure Maninstein of Charité Hospital. Although half of Germany’s Nobel Prize winners in medicine and physiology came from Charité Medical School and Hospital, and Nobel Prizes are not rare, this professor is indeed the best. , because of his arrogant character and frequent achievements in multiple fields, he is very dazzling at Charité Hospital.
"Professor Maninstein once proposed the classic over-consumption phenomenon regarding Goldenberg's condition. I think Professor Yang needs to listen to it."
Professor Lloyd was not provoking, but as a member of the team, it was his duty to remind the other party.
Yang Ping's surgical plan never mentioned the phenomenon of attrition from beginning to end. Perhaps he didn't even know there was such a fatal risk.
"Please speak quickly, time is a bit tight!"
August urged, because the little Duke had already entered the operating room, August wanted to take Yang Ping to the operating room.
Professor Lloyd cleared his throat: "The so-called overconsumption phenomenon means that Gordon's heart and great blood vessels have been in a state of compression for a long time. Because the heart is compressed, its contraction and relaxation are insufficient, and the blood vessels are compressed, causing the heart to recycle more blood. Insufficient, the output pressure is too high. In the long run, the heart is only suitable for this low-consumption state. Now the compression is suddenly released, the heart is liberated, and can contract and relax as much as it wants. The blood withdrawn suddenly increases, and the output load increases even more. Originally The poor reserve capacity is quickly exhausted in this high-consumption state, and the heart will suffer from fatigue arrest.”
This legendary figure's prediction of the disease is much deeper than that of the big guys here, because he can understand the disease as a whole from different angles.
The fact that he was able to bring up the phenomenon of overconsumption shows that he has grasped the key to this case, while others have not.
This is indeed the case. If Gordon's heart is not decompressed, it will be a dead end, and decompression will be a dead end.
Just like you will starve to death if you don't eat, you will die of bloating if you eat.
That's it.
Yang Ping had long considered this possibility, so he designed a gradually expanding artificial thoracic prosthesis. This exquisite prosthesis not only exists for skin expansion.
What's more important is that in order to overcome the overconsumption of the heart, the space created by the artificial thoracic prosthesis is not completed in one step, but automatically expands little by little, and the compression on the heart is relieved little by little.
This gradually expanding space gives the heart an adaptation process.
Moreover, this decompression process must be controlled properly, not too fast or too slow.
How fast or how slow it is can only be obtained through countless trial and error studies.
So Maninstein can raise questions, but cannot solve them, but Yang Ping can solve them.
"The thoracic prosthesis I designed can avoid over-wear, and the impact of over-wear on surgery can be ignored." Yang Ping tried to make the problem as straightforward as possible.
Now the patient is lying on the operating table waiting for help, and there is no time for a more in-depth academic communication.
Lloyd looked at Professor William, then at the others.
The cycle of life and death predicted by Professor Maninstein - the phenomenon of overconsumption, can he avoid it?
Even Maninstein himself couldn't find a way to avoid it, could he?
"Would you like to contact Professor Mainstein again?"
Someone suggested.
Although Maninstein is not the main person in charge of the little Duke's medical team, he is also an important consultant.
"No need!" August decided.
Why contact him at this time? The patient is already lying on the operating table. With the support of his mentor, August has the confidence to say no to this influential man.
August was the person in charge of the young duke's medical care. Since August said this, the matter was over and no one mentioned it again.
But everyone is still a little uneasy. Although this young Chinese professor looks really powerful, Maninstein is a Nobel Prize winner. Could the problem he mentioned be solved so easily by the Chinese? ——
In the operating room, Marcus has arrived early.
He worked with junior doctors and body posturers to position the little duke.
The little Duke could neither lie on his stomach nor his back, so he could only lie on his side.
Performing spinal orthopedic surgery in the lateral decubitus position is extremely difficult for doctors, especially osteotomy, which has no sense of spatial positioning.
No one performs spinal orthopedic surgery in the lateral decubitus position.
Besides, it is also very difficult to perform laparoscopy and thoracoscopy in the lateral decubitus position.
After general anesthesia, with the help of a special position fixator, the little Duke was placed in a lateral decubitus position. Even the anesthesiologist frowned. For patients with this kind of deformity, regardless of whether they are operated through the anterior, posterior, or lateral approach, The operation will be extremely difficult, and it will give you a headache just looking at it, making you feel a bit overwhelmed.
Prepare two equipment nurses and two circulating nurses, both of whom are senior nurses in their forties.
The anesthesiologist is August's royal anesthetist.
The first assistant is August himself, and the second assistant is Marcus.
It can be said that August prepared the strongest lineup in Harlachen to assist Yang Ping.
Music, Marcus remembered August's confession.
The guzheng version of "High Mountains and Flowing Waters" was specially brought by August from China. He put the disc into the CD player, adjusted it, and then told the traveling nurse to start playing the music when the surgeon completed the pre-operative check.
Munich Orthopedic Hospital Harlachen has a history of more than a hundred years and is the world's leading orthopedic hospital.
At this point, they were running for this operation.
They never thought that the little Duke would be on the operating table so soon.
August and Yang Ping wore sterile caps, masks, and blue wash clothes and walked into the operating room. Yang Ping stood in front of the film reading light screen and performed the last film reading before surgery.
This is a habit. No matter how familiar he is with the case, Yang Ping must perform the last film reading in the operating room.
The operating room is very spacious, with several instrument tables spread out in an L shape, as well as ECMO, navigation equipment and many other equipment, so it does not look crowded.
The German nurse is tall and strong, and can move freely in the operating room.
August accompanies Yang Ping, but once he faces other people, he immediately returns to his former majesty and gives orders to everyone in the operating room. This is his territory and he has absolute authority.
The postures were arranged, everyone washed their hands and disinfected the sheets, and the operation began naturally.
——
This surgery was actually performed in the lateral decubitus position, which was something no one expected.
But after thinking about it carefully, it seemed that there was no other suitable position except the side-lying position, because the little Duke's deformed body could not assume any position other than the side-lying position.
The conference room in the operating room was full of people, with more than a dozen big guys gathered in front. They felt dark clouds in their hearts and felt suffocated.
How to perform surgery on a side-lying patient with a severely deformed body?
As if there is no time and space for the operation to unfold, this feeling makes people full of uneasiness, anxiety and dullness.
After the preoperative check, as the music of mountains and flowing water rang, Yang Ping began the operation. He incised the skin, subcutaneous tissue and fascia in the middle of the patient's lower back, and then used an electric knife to separate the muscles on both sides of the spinous process.
He was not in a hurry, and his first step was to perform posterior surgery to insert pedicle screws.
Even with the help of navigation, implanting screws in this spiral spine is still a high-risk task. Originally, everyone thought that it would be extremely difficult to implant screws in the lateral position, but they saw Yang Ping sitting on a stool, facing the little Duke's back, Marcus was doing nothing on the opposite side, and August was on the same side of Yang Ping. help.
An automatic retractor is used to expand the surgical field.
Even with a high-definition camera, the side-lying position surgery is a bit unclear.
Anyway, Yang Ping kept repeating the actions: opening the mouth and implanting the guide needle.
Dozens of guide pins were implanted before anyone knew it. Using the navigation equipment for fluoroscopy, the position was very good. Then the same operation was repeated: opening the channel and implanting the screws.
In just ten minutes, dozens of screws were successfully implanted.
This set of equipment was designed by Yang Ping himself and then contacted by Marcus for production.
After installing the screws, Yang Ping used the screws as connection points, installed a temporary external fixator, locked each connecting joint, and then started posterior osteotomy.
The ultrasonic osteotome started working amidst the noise. Osteotomy was originally a high-risk job, but it was extremely easy in Yang Ping's hands.
The nature of the entire operation seems to have changed, and the atmosphere at the scene has also changed from highly tense to relaxed, because everyone feels as if they are undergoing a minor operation, which is not so scary.
The main steps of the rear approach have been completed.
Now start the anterior release. The lateral decubitus position allows you to switch between anterior and posterior surgeries easily without changing positions.
The operation was too fast, and it was difficult for the two instrument nurses to keep up. Yang Ping and August moved to the other side.
After connecting the various lines and tubes of the thoracoscopic and laparoscopic devices, Yang Ping asked the anesthesiologist to alternately collapse both lungs to make room for the operation because of the support of ECMO.
The lens of the thoracoscope is inserted into the chest cavity, and there is no room in the narrow space inside. The lens is filled with something, leaving no room for visual operation.
Yang Ping's separation forceps pushed forward the tissue bit by bit, slowly reaching the front of the thoracic spine. Yang Ping handed the separation forceps to August. His job was to hold the separation forceps and remove the surrounding tissue. The tissue gets out of the way, creating a gap to complete the surgery.
This gap is really too forced.
Professor Lloyd watched the surgical operation on the screen, and his scalp tingled involuntarily, because this operation was like an underwater escape magic.
This magic trick is to trap a person's limbs tightly, put them into an iron cage, and then sink the iron cage and the person to the bottom of the water.
Everyone watched with fear as the magician completed the impossible escape. The feeling of suffocation, despair and excitement was exactly the same as now.
With such a deformed chest, it is almost impossible to have a gap in the chest to operate the thoracoscope and instruments.
However, Yang Ping just used a pair of separation forceps to create a space close to the gap, and another type of electrosurgery under the microscope began to separate and release the soft components on the front side of the thoracic spine.
After release, a long microscopic ultrasonic osteotome is inserted from the sheath.
What is he going to do?
Professor Lloyd, Professor William, and Professor Rimbaud all widened their eyes at the same time. He wanted to use a microscopic ultrasonic osteotome to perform an anterior osteotomy.
Could it be? He fixed the spine with a temporary external fixator, performed an open posterior osteotomy, and a minimally invasive anterior osteotomy. After the combined anterior and posterior osteotomy was completed, the external fixator was used to adjust the spine, and finally a nail was installed. The rod system is locked, the temporary external fixator is withdrawn, and the surgery is completed!
Sure enough, the vertebral body was osteotomized from the front with an ultrasonic osteotome under thoracoscopic surgery.
As the ultrasonic osteotome trembles, a wedge-shaped incision is made on the vertebral body, and then the excess bone is chewed out.
The grumpy Professor Lloyd slapped his thigh. He was a genius. He could actually use the external fixator in this way.
In this way, the osteotomy can be done with confidence, without worrying about the stability of the spine, let alone the interference of the spine's own gravity on the osteotomy, which greatly simplifies the entire operation.
Moreover, he could actually use a thoracoscope in such a narrow space.
I'm afraid that as a heart surgeon, Constantine is also ashamed of himself.
What’s next? Remove the ribs!
Yes, he guessed it right. This operation is really interesting. An almost impossible and suffocating operation, it looks so easy.
The ribs were peeled off one by one, cut and extracted, and then artificial ribs were inserted.
Twelve pairs, twenty-four ribs, all were cut off and removed except for a few centimeters that were left to fix the artificial ribs.
The technique is delicate and clear. After the periosteum of each rib is incised, it is completely peeled off. The stripped ribs are smooth.
The artificial rib is placed into the periosteum and then sutured.
When replacing the titanium plate in the precordial area, August held the heart. Because the patient was in the lateral position and there was nothing blocking the heart, it might have rolled out of the chest due to gravity.
For every few ribs that were cut off, several artificial ribs were installed until all twenty-four ribs were completely replaced.
Twenty-four artificial ribs are connected to the remaining ribs at the front and back, and then connected to each other by bridges to form a strong artificial rib cage.
How brave is that? The patient relies on ECMO to continue his life, and he dares to undergo this kind of surgery.
The big guys watching the video were all dumbfounded when they saw the surgery on the screen. The Chinese professor was very courageous, but he had superb surgical skills to realize such a bold plan.
I’m afraid no one here can do the thoracoscopic soft tissue release and osteotomy just now.
After the thoracic and thoracic surgeries were completed, Yang Ping focused on the lumbar spine surgery, using laparoscopy to perform microscopic release and osteotomy like the thoracic spine.
In this way, the combined anterior and posterior osteotomy is completed, and the prosthetic replacement of the thorax is completed. The surgery is done here, and there is not much bleeding. Except for some inevitable bleeding from the cancellous bone osteotomy, there is very little other bleeding.
When everything was ready, Yang Ping took August to the waist and back surgery area.
He carefully adjusted the external fixator and rearranged the severed vertebrae. He stared at the screen of the somatosensory evoked potential monitor over and over while adjusting the external fixator with great care.
Slowly, little by little, the spine adjusts.
"Bonus!"
Yang Ping began to install the fixation rod, then locked it, and removed the temporary spinal external fixator.
This isn't over yet.
Yang Ping then turned to the front side of the patient and began to insert the thoracoscope and laparoscope. He made a small incision of three centimeters in the chest and abdomen. Using this small incision, he inserted the anterior steel plate under the microscope, and then placed the anterior plate under the microscope. Screw in the locking screw.
At each anterior osteotomy site, a clavicle compression plate is placed under the microscope to allow the new bone surfaces of the osteotomy to fit tightly together, which not only has the effect of stopping bleeding, but also prevents future fusion.
Tighten some screws here, Yang Ping then turned to the back, tightened the nut of the fixing rod, and repeatedly moved back and forth on the front and back of the patient, slowly, several steel plates in the front, and the entire pedicle screw in the back. The system is all tightened, and each osteotomy is tightly sutured together.
Combined anterior and posterior fixation makes the spine very firm.
"Perspective!"
The navigation device fluoroscopy can reconstruct the three-dimensional image of the spine, which is very satisfactory.
Professor Lloyd felt like he was watching an underwater escape magic. This Chinese professor really accomplished his escape!
(End of chapter)