A set of transforaminal scope, a set of arthroscope, and two sets of endoscopic equipment are properly connected and can be used for surgery at any time.
This was neither an arthroscopic surgery nor a transforaminal surgery, but a cervical spine surgery above the skull base, but Yang Ping brought two sets of endoscopic equipment.
Not only August didn't understand, but Song Zimo and Xu Zhiliang didn't understand either, because the preoperative discussion only mentioned that the anterior approach through the mouth required endoscopic assistance. After all, there are natural cavities in the oral cavity and pharynx, and there is a certain operating space. Suitable for endoscopic or laparoscopic operations.
As for posterior surgery, there is no mention of using a laparoscope. There are no natural lacunae at all in the posterior approach, not even potential lacunae. How to insert the lens and how to operate under the microscope.
Yang Ping didn't notice everyone's doubts and just started the operation on his own.
When performing posterior surgery in a sitting position, both the surgical field of view and the operating space are very poor, especially when the skull base and cervical vertebrae have been fixed in the anterior approach, making it impossible to retract the interlaminar space by lowering the head during the posterior approach. These shortcomings are further exacerbated. Zoom in, but Yang Ping has his own way.
He combines two endoscopic systems, arthroscopy and transforaminal endoscope, as a tool to obtain the field of view. He wants to perform a laparoscopic surgery in an open surgery, abandoning the inertia of direct vision and using the thinking of laparoscopic surgery. Rely on skilled hand-eye separation to complete posterior surgery.
Yang Ping personally focused and dialogued the arthroscope and transforaminal mirror, and then the operation began. The scalpel made a vertical incision in the back of the neck and headrest.
This is a completely open surgery routine!
August wondered, and couldn't help but feel a little disappointed. He thought Yang Ping would use minimally invasive surgery to solve the posterior problem. But he thought about it again. At this moment, minimally invasive surgery was obviously unrealistic, so how could it be possible to use minimally invasive surgery.
How to implant such a large internal fixation device during laparoscopic minimally invasive surgery? How to graft bone? How to drive screws? These operations must be completed within the incision space, not to mention that all the instruments are also traditional instruments.
No matter how powerful a doctor is, he is a human being, not a god. Any operation must be completed within the limits of human power.
The skin, subcutaneous tissue, fascia, and muscles are incised layer by layer until they reach the base of the skull and the lamina of the cervical vertebrae. Then, the skin and soft tissue on both sides are attached to the base of the skull and the lamina of the cervical vertebrae are pushed apart.
"Place the screen symmetrically on the left and right, with the arthroscope on the right and the foraminal scope on the left. Prepare the retractor." Yang Ping ordered.
Originally, the two master retractors would be in place in time without Yang Ping opening his mouth. The sudden appearance of the endoscopic equipment also made the master retractors a little stunned. They turned their heads and thought about what was going on.
Xiao Su, the equipment nurse, immediately used the hemostatic forceps in her hand to point to the position of the retractor assistant. Only then did the two great retractors wake up from their shock and immediately rushed to the front line.
August is still thinking about this question. Since it is an open surgery, what is the use of arthroscopy and transforaminal scope?
Decoration? Does the surgery require decoration? Or is it some kind of ritual taught by the professor?
If it was free time now, August would definitely ask the question, but now that he was undergoing surgery, he couldn't ask questions and could only continue to observe the operation.
At this time, two master retractors came on stage. They lined up on the left and right, each holding a retractor, and steadily retracted the incision to reveal the surgical area.
This is no ordinary hook puller, but a world-class hook puller.
Their upcoming magnificent monograph "Surgical Retractors" will be an epoch-making monograph, filling the gaps in this type of monograph. Most importantly, it will introduce a variety of retractors, most of which are the first in the world.
The two retractors were calm and calm, breathing evenly, and the two retractors did not tremble at all. This is not something ordinary people can do. In order to achieve this effect, the two masters made great efforts.
They not only exercise their arm strength every day, but also exercise their breathing to coordinate their breathing with their movements.
To become a retractor master, this is not enough. They study anatomy carefully. Every time a retractor is inserted, they must be familiar with the local anatomy of the location where the retractor is located, and they must also understand the characteristics of these tissues. They need to understand the science of vision and find the best way to reveal the visual field of the retractor. Therefore, the two masters devoted their efforts to the monograph, which has extremely high depth and breadth - retractor anatomy, retractor visual field, retractor positioning -
Two retractors exposed the surgical area. Yang Ping placed the arthroscope and foraminal scope into the surgical area, one up and one down, with the foraminal mirror at the top and the arthroscope at the bottom. The two screens immediately displayed images of the surgical area, left. The side is up and the right side is down.
Yang Ping placed two lenses, and the two retractor masters held one lens with their other hand. In this way, their hands were free, holding the retractor in one hand and the lens in the other.
Looking at this posture, these two endoscopic mirrors are really going to be put to use?
August turned his head to full speed. What was he planning to do? It's obviously an open surgery, but there are two lenses inside. It's like a minimally invasive surgery. The incision has obviously been opened. It's obviously an open incision. Why are there two lenses inside?
Could it be that the lens is just for decoration? Or some kind of ritual?
August turned to look at Robert, hoping that this guy could give an explanation, but this guy was clearly looking at August with doubts in his eyes.
Forget it, how could a sports medicine doctor know the spine better than himself? August gave up asking Robert for advice. He planned to ask, but Yang Ping was so preoccupied at this time that even Song Zimo didn't dare to ask, so August had to give up. , continue to observe.
Anyway, at least the professor is awake now and all his actions are rational. If you continue to look at it, there will always be an answer.
The next operation made everyone have to stare wide-eyed.
Conventional open surgery is difficult to expose and operate, so using endoscopic assistance, Yang Ping does not need to look at the surgical area at all, but looks at the image on the screen, and uses hand-eye separation technology to complete this upper skull base cervical spine surgery.
Damn it!
Robert couldn't find the right words, so he could only use this irregular and rough word to describe his mood at this time.
Damn it!
August, who was at a loss for words, could only follow Robert.
It’s really unique. You can do this kind of surgery, and you can also use endoscopic surgery like this. This endoscopic operation technique of separating hand and eye is simply the pinnacle.
With the help of laparoscopy, the difficulties in surgical field of view and operating space are easily solved. From any corner, as long as the lens can see it, you can get a clear field of view, which is many times better than the field of view of the human eye.
Yang usually looks at the screen on the left, and sometimes looks at the screen on the right, because the left side shows the upper half of the surgical area, and the right side shows the lower half of the surgical area. The combination of the two parts forms a complete surgical area.
Under the guidance of this split real-time image, Yang Ping began to skillfully operate the hand-eye separation under the microscope.
The posterior arch of the atlas and the second half of the lateral masses on both sides are removed, the hematoma in the spinal canal is removed, the capsule of the spinal cord is incised, and the blood under the capsule is removed, so that the spinal cord can be fully decompressed. All the steps of the original open surgery are completed. Finished in front of the mirror today.
As assistants, Song Zimo and Xu Zhiliang were naturally left aside and became close observers on the stage. Because they could not achieve such skillful hand-eye separation and could not rely on the screen to complete the entire operation, the operation could only be Become Yang Ping's personal unique show. At this time, the two retractor masters concentrated their energy. They did not need to watch the surgical operation. They relied on two ordinary retractors to maintain the entire surgical field like sculptures. The two lenses also remained motionless.
Looking further back, August discovered that surgery performed in this way was much more precise than surgery performed under the naked eye, because the surgical site was magnified many times by the camera, and the entire surgical field of view was under the microscope, so there was no blind spot in the field of vision. There is no need to adjust the hook or adjust the position to get a view of a certain corner.
August was in trouble again. Yang Ping did not complete the operation under one screen, but completed the hand-eye separation operation under two fields of view split in half. In addition to superb hand-eye separation technology, he also needed to mentally integrate the two screens. into one piece.
August could no longer describe the difficulty of the hand-eye-brain coordination.