Back in 2002 as a doctor

Page 479

If this is the case, the operation cannot be done at all, it is impossible!

While Zhou Congwen was speaking, Liu Wei was already adjusting the double-lumen intubation and preparing to open the airway.

Soon, Liu Wei squeezed the ball, and the patient's left lung expanded.

"It's not bad, the spinnaker technology is very good." Huang Lao said lightly.

Director Miao jumped to see, but he couldn't see anything because there were four hands and four instruments on the small 6cm incision.

"It's okay." Zhou Congwen smiled, "Internal mammary artery suspension system."

This time the equipment nurse immediately handed over the equipment Zhou Congwen wanted.

Director Miao took advantage of Zhou Congwen's installation of the arterial suspension system and turned around to look for the footstool.

He was neither tall nor short, Director Miao originally thought that he should be able to see Shuye standing behind Huang Lao.But I didn't expect that the incision was so small that I couldn't see anything.

He was very eager to see what the spinnaker technique was, and why Zhou Congwen had to ventilate both lungs for such a large surgical incision.

After the left lung is inflated, it is said that there should be no surgical field, but Huang Lao said that this technique is not bad.

The wild fire of curiosity burned more and more vigorously in Director Miao's heart, and it has already started a prairie fire.

But after all, it wasn't his own operating room. Director Miao searched around but couldn't find a footstool, so he hurried to find the itinerant nurse.

When he came back with the footstool, Zhang You had already taken the best seat.

Director Miao was bitter, and he was used to it. He patted Zhang You on the shoulder and pushed Zhang You away.

Standing on the footstool, Director Miao saw in astonishment that Huang Lao and Zhou Congwen had already freed the left internal mammary artery.

And Shuno...

Standing tall, he could see...a little bit clearer.

As the ventilator assisted breathing, the patient's left lung expanded and contracted, but it did not affect the surgical field at all!

This!

Director Miao stared blankly at the operation area, turning a blind eye to Huang Lao and Zhou Congwen's delicate operation of freeing the left internal mammary artery, and recalling Zhou Congwen's centrifuge operation just now in his mind.

Between the four hands, Director Miao saw many details that were invisible before.

He soon determined that due to the obstruction of pericardial fat, the left lung would not enter the surgical field to interfere with the operation during ventilation.

The so-called spinnaker technique is to "turn over" the pericardial fat, suspend it, and block a surgical field out of thin air.

At the same time, the patient does not have to ventilate one lung all the time, but ventilates both lungs.

This is just a technical detail, and I can't say how important it is, but the patient is very old, 74 years old.

It is inevitable that the shorter the one-lung ventilation time of the elderly, the better.

Director Miao was stunned that such a small detail was not missed.

By the time he figured out a "simple" technical detail, Huang Lao and Zhou Congwen had already mobilized the left internal mammary artery.

As for this process, Director Miao didn't see how it was done at all.

The little monster in his heart kept scratching his hair and crying loudly. Director Miao was sad and regurgitated. He looked at it himself, but he didn't see anything.

How exactly does the Internal Mammary Artery Suspension System work?

Director Miao wanted to ask Mr. Huang to talk about it, but he didn't dare to say it, because he saw that Mr. Huang had already performed the anastomosis of the left internal mammary artery-anterior descending branch with Zhou Congwen.

How fast!

It's only been open for a few minutes?

Director Miao was in a trance, and glanced at Deng Ming and that Dean Xiao who were freeing the great saphenous vein of his left lower extremity as if he had been hit hard.

Deng Ming did it a little slowly, the left internal mammary artery-anterior descending artery anastomosis has already started on this side, and he has not yet completed the step of freeing the great saphenous vein.

Although the incision is relatively long, it is not enough. Director Miao felt a little contemptuous.

Could it be that Deng's level has regressed to this point when he is with Mr. Huang every day?

But he didn't think about Deng Ming, just a flash of thought, and then he concentrated on watching Huang Lao and Zhou Congwen do the left internal mammary artery-anterior descending branch anastomosis.

The heart keeps beating to build a bridge, this extremely difficult technique has become the most basic operation at this time.

The patient's heart was pounding, the lungs rose and fell, and there were countless disturbances.

When the heart is bypassed under normal extracorporeal circulation, the chest cavity is almost static, but at this moment, every organ seems to be interfering with the operation.

But the needle holder in Mr. Huang's hand was very stable, as if he didn't notice the disturbance at all, the needle was routed, and the left internal mammary artery-anterior descending anastomosis was completed in a very short time.

Director Miao was speechless, silently watching the operation in front of him.

Not to mention one-stop, just the left internal mammary artery-anterior descending artery anastomosis is enough to make me look up.

Chapter 0823

Director Miao stared blankly at the operation area. He didn't have time to regret it now. There was only one thing on his mind—how did Lao Huang and Zhou Congwen plan to take out the right internal mammary artery? !

The patient's diagnosis was clear, with three-vessel disease.

The incision in the left fifth intercostal space plus the jib technique and strange equipment can indeed take the left internal mammary artery as a graft vessel.

However, thorough coronary artery bypass grafting requires three blood vessels to be transplanted!

Director Miao is also a veteran of coronary artery bypass surgery, and usually one side of the internal mammary artery + great saphenous vein is taken.

What will Mr. Huang do next?

Did he take the right internal mammary artery?

Bilateral internal mammary artery + great saphenous vein, which is quite reasonable.But how does the small 6cm incision on the left bypass the mediastinum and free the right internal mammary artery?

The question popped up in other minds at the same time.

Or……

"Prepare for left-sided one-lung ventilation."

Just when Director Miao and others were thinking wildly, Zhou Congwen's voice interrupted their thoughts.

Left side one lung ventilation? !

To take the right internal mammary artery!

Numerous exclamation marks and question marks emerged, a small incision of 6cm, what Huang Lao and Zhou Congwen had to do to make it.

Director Miao had no answer in mind.

"Knife." Huang Lao stretched out his hand and said lightly.

A sharp knife was slapped in Huang Lao's hand.

Under the xiphoid process, a small incision of 1.5cm was made, which stunned everyone present.

"Retractor." Zhou Congwen pointed to another set of sterilized equipment and said.

The thing the boss made is very similar to the Rultract Skyhook retractor system used in the previous life. Zhou Congwen had already tested the usability of the device before disinfection.

He guessed that the boss had also tried it, and it was somewhat different from the conventional equipment in the future, but as long as this non-standard equipment can be used, Zhou Congwen is not picky.

Huang Lao stopped the bleeding after incision, and blunt dissection. Zhou Congwen installed a device similar to the Rultract Skyhook retractor system, and pulled the lower sternum upward from the subxiphoid incision to provide a better view.

Two people hold long forceps and walk between the 1.5cm incision.

Seeing this, Director Miao had a sore nose and almost cried.

I came to see the surgery, but there is no surgical field here for me to see!

In desperation, Director Miao got off the footstool, walked to the side of the patient's leg, squatted down about 15cm away from the instrument table, and looked intently along the narrow gap between the traction xiphoid process and the lower end of the sternum.

Director Miao is relatively tall, but he dare not approach the equipment table, so the position is particularly awkward.

But nothing could suppress his exuberant curiosity and devotion like worshiping gods.

Director Miao was riding a horse in a squatting position, with his head turned sideways, looking along the narrow surgical field in an extremely awkward posture.

Originally, he just wanted to watch for a few seconds, as long as he knew what Huang Lao and Zhou Congwen were doing.

However, at a glance, it seems that thousands of years have passed.

Three long-handled pliers, Huang Lao took one, Zhou Congwen held both hands, and the long electric knife in Huang Lao's hand, with a power of 30J, was bluntly separating the right internal mammary artery in an orderly manner.

The narrow and cramped incisions, piles of long forceps and long electric knives should be troublesome in Director Miao's imagination.

This operation is just a gimmick, just like the small 1.5cm incision in appendectomy, the inner peritoneum is opened by at least 3cm, and some even pull the skin hard, and the peritoneum is opened by at least 5-8cm.

At present, Mr. Huang is not likely to prolong his mouth, but Director Miao's prediction is that the operation will be awkward.

But when he saw the surgery area, Director Miao was stunned.

Three extremely difficult-to-manipulate long pliers and a long electric knife went in along the 1.5cm incision, doing blunt separation in an orderly manner, that feeling...

It's like a person has four hands, and the cooperation is perfect. There is almost no collision between the pliers, the pliers, and the electric knife.

There is no "fight" between the forceps and electric cautery, and there is not even a useless collision. It is just a step-by-step operation.

Director Miao understands the principle, and all thoracic surgeons understand it—after a small incision, it is like a thoracoscope, and the space inside is very spacious.

But this cooperation is too tacit. Director Miao watched in a daze as the two of them manipulated three long pliers and an electric knife, moving away in a steady and orderly manner.

After finding a position and viewing angle by myself, the right internal mammary artery has been freed by 1/3 of the distance.

This fits!

Absolutely!

Director Miao knew the goods, but it was precisely because of his knowledge that he couldn't understand why he could see this scene.

Zhou Congwen held both hands, like arms and fingers, and the long pliers seemed to come alive.This level is more than one grade higher than his own, Director Miao knows very well.

But it was Huang Lao who surprised Director Miao and couldn't figure it out.

Huang Lao and Zhou Congwen stood shoulder to shoulder, and their vision seemed to be unable to fully see what was going on inside.

But he held a pair of long pliers and a long electric knife, and under the tacit cooperation of Zhou Congwen, he carefully moved from the fat-free muscle coverage area in the middle section of the internal mammary artery to the lower part of the first rib to the bifurcation of the internal mammary vessel of the fifth or sixth rib. free.

Sometimes Director Miao struggled to distinguish which pliers belonged to Mr. Huang and which belonged to Zhou Congwen.

The usually difficult part of freeing the right internal mammary artery became extremely simple. With the cooperation of two super-class surgeons, there was no difficulty at all.

After an unknown amount of time, the right internal mammary artery was freed. Watching Zhou Congwen take out a section of the freed artery, Director Miao subconsciously let out a long breath, and then straightened his waist.

"Ouch~"

With a sore waist, Director Miao couldn't stand up straight, but fell down all at once.

As a surgeon, the idea of ​​sterility is as indelible as the branding iron on a donkey.

In an instant, Director Miao forced himself to the side, and fell to the ground with a thump like a wooden stake.

"Director Miao, what's the matter with you?" Zhang You hurried over.

"Director Miao, you are..." Deng Ming was freeing the saphenous vein with Xiao Kai, and he glanced helplessly at Director Miao sideways.

"It's probably because I squatted for too long." Zhou Congwen said lightly, "Boss, we are not slow in doing this. Why are you still like this?"

"I'm getting older, so I need to put more effort into it." Huang Lao said, "Help me out and lie down for a while. If it doesn't work, take a picture. If you're not in a hurry, wait until I get off the stage to have a medical checkup."

Zhang You tried, but he didn't dare to help Director Miao stand up forcibly. Instead, he comforted him while letting Director Miao lie flat on the ground.

If you do have a spinal injury, lying down is obviously the best course of action.If you use force, it may increase the damage.

"Director Zhang, I'm fine." Director Miao kept moving his mask, probably grinning bitterly.

"Look...how do you say this? Are you okay, how is your waist?" Zhang You couldn't laugh or cry.

"Oh, I was so engrossed in watching it." Director Miao supported his waist, his mind was full of the operation scene he had just seen.

Chapter 0824 guessed wrong from the beginning

Zhang You didn't see anything, but he knew how well Huang Lao and Zhou Congwen performed the operation, and how tacitly they cooperated.

Freeing the right internal mammary artery is inherently difficult, and Zhang You hardly moves that side during surgery.Even if it is moving, it will take at least half an hour or so, which is not to mention.

However, starting from Huang Lao’s small incision of 1.5 cm, it took only 10 minutes to complete the operation, which is estimated to be less than [-] minutes.

He squatted beside Director Miao, sighed with emotion in his heart, and said nothing.