(Thanks to the 20,000 yuan reward from [Feiyanren] book friends, thank you!)

The burnt day is finally over.

Since most of the surgeons in the emergency department are at work today, Director Qian took the initiative to sit on the night shift tonight. After all, there are still too few people.

It is said that Vice President Lin is currently poaching some experts from other hospitals to come to their emergency department, but there is no good news yet.

An experienced and highly skilled emergency physician is not so easy to find.

The next day, he went to work as usual, and when he had just finished checking the room with Jiang Yurong, he was notified by Dr. Chen that the general surgery department was looking for him to come for a consultation!

"Looking for me?" Ruan Bin was slightly stunned. There are so many talented people in general surgery, how could they consult him with a resident doctor. Generally speaking, it is usually their emergency department that asks them for general surgery.

Even if you look for their emergency department, you should find Director Qian's level Jiang Yurong.

"It is said that an elderly patient with obstructive jaundice and acute pancreatitis caused by gallstones is a complicated and difficult situation. Dr. Chan didn't know much about the situation.

"Isn't this disease just a secondary and tertiary surgery, it shouldn't be too difficult. Ruan Bin frowned.

"I don't know, but I guess your laparoscopic surgery is so good, maybe they really have a tough problem?" Dr. Chan laughs.

"Okay, I'll take a trip. Ruan Bin walked towards the general surgery department.

Speaking of general surgery, the emergency department is the closest relative.

Surgeons in the emergency department are generally from general surgery.

Consultation room.

"Director, do you think this Ruan Bin can help us? I guess he hasn't encountered this kind of case before, right?" asked Qiu Huahui. The other party and he are both resident doctors, no matter how good the operation is, he must have never seen this kind of case, right?

"I think so, too. Hu Changmao agreed. He had been meditating for an hour, but he still hadn't come up with a good solution.

"Okay, maybe he'll be able to bypass it!" Dai Yaowen said as he glanced at the two of them. He didn't know what these two guys were thinking, he just thought that Ruan Bin might not have that ability at all?

Soon, it was time for the consultation room.

Ruan Bin saw three doctors waiting for him in the consultation room.

They are Dai Yaowen, deputy director of the Department of General Surgery, Hu Changmao, an attending officer, and Qiu Huahui, who is hospitalized.

"Hello Director Dai. Ruan Bin greeted him as soon as he came in.

He knew this director and chatted a few words, but he didn't know the other two.

"Dr. Ruan, I'm looking forward to you. I know your emergency department is always the busiest, so I'm sorry to let you take the time to come over. Dai Yaowen said apologetically.

"It's nothing, it's all about the health of the patient. Ruan Bin smiled.

"Okay, then I won't gossip, this time we came to you because we met a tricky patient, the patient male, 78 years old, transferred from a lower hospital. ”

"The patient had a herniated lumbar disc for many years, which caused his spine to be deformed, severe kyphotic scoliosis, and his hunched back was nearly 90 degrees, so he could only walk bent over and could not lie flat when he slept. Because of the deformation of the spine, the internal organs are also squeezed to varying degrees, and the abdominal space is folded, compressed, and deeply concave into the body. ”

Last week, he suffered from obstructive jaundice and acute pancreatitis due to gallstones, and he had abdominal pain and vomiting. The trouble is that the operation needs to lie flat, but his abdomen is very different from ordinary people, it was a routine operation, because his special physical condition has become more difficult, he ran several hospitals in his local city hospital, but was politely refused treatment, so he was transferred to our hospital. ”

"Although we only performed laparoscopic cholecystectomy and choledocholitomy and other secondary and tertiary surgeries, the difficulty was not as simple as ordinary secondary and tertiary surgeries. I heard that Dr. Nguyen is very accomplished in laparoscopic surgery, especially after completing a 19-minute cholecystectomy, so I thought about asking you if there are any good solutions and suggestions. Dai Yaowen said.

He's embarrassed to say that they don't have any good surgery options yet. So I can only ask Ruan Bin to come over and see if there is any advice and help.

"It's rare to see such examples. After hearing this, Ruan Bin was immediately relieved and asked Mao General Surgery to consult him. Such patients are indeed rare.

It's not just that the patient can't lie flat and can't be operated, but there are many other factors involved.

"Can you take me to see the patient?" asked Ruan Bin.

This has to go to the scene to see the specific situation of the patient, so that he can make a judgment and think of a way.

"Of course!"

A group of people came to the ward in a hurry, and Ruan Bin saw this old man in his 70s.

I saw that his spine was seriously deformed, his hunchback was nearly 90 degrees, and his abdomen seemed to disappear into his body, and he couldn't lie flat, so he could only lie on his side.

"The patient's entire abdomen is deeply concave into the body, the groove can be stuffed into an adult's palm, and there is only three horizontal finger space for adults from the front, and only two horizontal finger space on the side, so there is no need to consider laparotomy. Ruan Bin said.

"That's right, but although it is only an ordinary laparoscopic surgery, because the surgical position is difficult to place, the surgical instruments can be used in a small space, but it is more difficult than single-port laparoscopic surgery, which is simply "survival in the cracks". Hu Changmao said with a headache.

"Well, first of all, it is difficult to intubate anesthesia, he belongs to a difficult airway, because of the deformation of the spine, one of his lungs must have been severely squeezed, and the trachea is seriously deviated. Ruan Bin pointed out one of the difficulties.

The trachea is severely deviated, and the anesthesia intubation step is difficult to operate.

There is also a normal operation that the patient is lying down, the doctor is standing up, and the laparoscope is operated from the front of the abdomen.

"Have you ever thought about having a patient sit for surgery?" asked Ruan Bin. He has a world-class laparoscopic cholecystectomy. I have tens of thousands of surgeries in my mind.

What type of cholecystitis patients have not seen?

In this case, he has exactly dozens of cases in his mind.

"Sitting? We have also thought about it, but even if the patient is sitting, his abdomen is not visible at all, as if he has disappeared into the body. Director Dai said with a headache.

It's also the only headache they have!

"I didn't say that the laparoscopic operation hole should be made from the abdomen, we should find another way! From the left lower abdominal slit to the right upper abdomen, the surgeon and the patient will be "sitting" for the operation!" Ruan Bin said lightly.

"This ...... It looks feasible!" Dai Yaowen's eyes lit up after hearing this, and he was suddenly awakened by Ruan Bin's train of thought, and he felt like he was empowered.

In order to avoid lung damage affecting postoperative recovery, the amount of gas injected into the abdominal cavity is very limited, and the surgical field is not well exposed. We've never tried to do it from the left lower quadrant space to the right upper quadrant, Dr. Ruan, can you give us a little guidance later?" Dai Yaowen asked, looking at Ruan Bin with blank eyes. I want to talk about "Krypton Doctor" with more like-minded people, pay attention to "excellent reading literature" on WeChat, talk about life, and find confidants~