The anesthesia was effective, and the operation finally began!

Due to the complexity of this operation, if laparoscopy is used, the surgical field is greatly insufficient, so the traditional laparotomy is used!

After Director Qian and Director Wu opened their abdomen, they completely lifted the right half of the colon from the retroperitoneal approach, and that scene was definitely a picture that could make you unable to eat.

In the next moment, the whole process of the inferior vena cava was completely revealed, and they placed blocking bands at the distal and proximal ends and major branches!

"Ruan Bin, it's your turn to play!" Director Qian said to Ruan Bin.

Because the next step is to isolate the tumor from the duodenum, pancreas, and hepatic caudate adhesions. This step was previously agreed to let Ruan Bin go up and separate, and the requirement was to be fast, accurate and stable!

The tumor is separated from the duodenum, pancreas, and hepatic caudate lobe adhesions as quickly as possible to shorten the operation time.

"Okay!" Ruan Bin nodded, and replaced the position of the chief knife with Director Qian.

With innovative debridement and suturing, he has absolutely no worries about his basic surgical skills. It also has a world-class pancreaticoduodenectomy, and is absolutely familiar with the structure of the duodenum, pancreas, and caudate lobes of the liver.

Pick up the electric knife and start separating!

The first knife went down, very slow, unremarkable.

But from the second knife, the third knife, one knife is faster than the other.

Half a minute later, his hands flew up and down as if they had turned into dancing elves, and the tumor adhesions in the duodenum were separated by him little by little.

Dazzling operation!

Zero mistakes!

It's as if he's like a delicate instrument, and there's no mistake at all.

Especially for the duodenum and pancreas structure as if it were an automatic radar, there can be touched, there can not be touched.

The strength and precision of the knife in his hand are also controlled to the point that it is amazing!

One knife down, just right, no need for a second knife!

"Shhh...... The operation is as fierce as a tiger, and I look like two hundred and five, how did he do it?"

"This hand speed, it's a waste not to play professional e-sports!"

When the experts of the eight departments saw Ruan Bin's sharp operation, the expressions on their faces were all wonderful.

As directors or experts, they know very well that the structure of places such as the duodenum and pancreas is complex, not to mention the adhesion of tumors.

It's scary to separate the difficulty!

But when you look at the person in front of you, it seems like a quick knife to cut through the mess.

After 35 minutes.

"The separation is over, director, let's see if there is any problem?" Ruan Bin breathed a sigh of relief, his forehead was sweating slightly, this highly concentrated and continuous operation made him a little tired.

A group of people came over and examined it carefully.

This is not to be sloppy!

"The duodenum was very clean, and there was not a trace of tumor tissue left. ”

"The pancreatic part is also very cleanly separated. ”

"There is almost no problem, the next step should be to isolate the tumor of the right renal vein, this step also has to be very careful, the speed can be slower, I am afraid of hurting the venous network." Director Wu of the Department of Urology said solemnly.

The main reason is that the right renal vein and the tumor are adhesed too widely, and more than half of the branch blood vessels of the right renal vein are adhesion to the tumor, and it is even more difficult to separate it at that time than the separation just now.

"I understand. Ruan Bin nodded.

The right renal vein separated, began. Ruan Bin first separated the tumor from the right kidney and the right renal vein, and fully freed the right renal vein, right renal artery, right upper ureter, right kidney and left renal vein......

Ruan Bin's operation is completely dancing on the tip of the knife and treading the waves in the sea!

His scalpels of various models were free on top of the veins, separating and removing the tumor tissue.

It's almost crazy on the verge of death!

If you're not careful, you might cut through any tiny vein, but Ruan Bin still made zero mistakes!

After 25 minutes, the separation is complete!

The separation of the two waves took a total of 60 minutes! It was done in exactly an hour.

At this time, everyone was already shocked to numbness.

If this operation is successful, Ruan Bin will be indispensable.

"It's my turn next!" said Director Wu of the Department of Urology.

After Director Wu took over the position of Ruan Bin's chief surgeon, he first severed the left renal vein, then cut off the right renal artery, and perfused the hypothermic renal protective solution through the right renal artery, and after the clear perfusate flowed out of the right renal vein, the right kidney and the upper ureters were removed. Then, with the assistance of other experts, the cold perfusion of the right kidney removed from the stage was quickly and smoothly completed, and the renal vascular trimming and cryopreservation were quickly and smoothly completed.

Finally, the inferior vena cava and tumor can be removed!

Then, the director of vascular surgery came on the field, only to see him block the inferior vena cava above and below the tumor, cut the branches of the inferior vena cava one by one, and then remove the inferior vena cava invaded by the tumor, and the diameter of 22

mm, about 15 long

The artificial blood vessel of CM is anastomosed with the upper and lower severed ends of the vena cava, and the anastomosis process is smooth, and there is no obvious blood leakage at the anastomosis!

After the vascular surgery operation was completed, Director Qian and Director Wu performed autologous kidney transplantation of the patient's free right kidney together. After a thorough evaluation, they decided to anastomosis the right renal vein to the lower segment of the inferior vena cava, the right renal artery to the right common iliac artery, and the right uretera to the lower end of the right ureter. After the successful completion of the venous and arterial anastomosis, the transplanted right kidney quickly recovered its redness and tension, and after about 1 minute, there was clear urine outflow from the broken end of the right ureter, and the autologous kidney transplantation was successful!

Seeing this step, all the experts were originally very tired, but they were all refreshed when they saw this.

They know that the operation is half done at this point!

Subsequently, Director Qian trimmed the omentum and made a "J" shaped omentum flap, which wrapped the inferior vena cava, the transplanted kidney and the iliac vessel from the right side downward, using the strong blood supply and absorption function of the omentum to provide safety for the artificial vascular anastomosis and the transplanted kidney.

At this point, 7 hours have passed since the start of the operation!

It was mainly vascular anastomosis, and it took three or four hours for an autologous kidney transplant, and an hour for the inferior vena cava to be removed.

"The operation is over!" Director Qian and the others were greatly relieved.

This surgery took a total of 7 hours!

Median specialists basically perform surgical operations in the 'forbidden area' of surgery.

Whether it is Ruan Bin's two-wave separation, or the venous and arterial vascular anastomosis of Director Qian and others, or the resection of tumors or autologous kidney transplantation.

In the unlikely event that the vein and arterial anastomosis fail, or the kidney is found to be unable to circulate after an autologous kidney transplant. It's basically a waste of all the work.

Luckily, it worked!

Next, the patient is transferred to the intensive care unit for treatment. Although the operation was successfully completed, there were still many difficulties waiting for him after the operation. Because after such a complicated operation, postoperative complications will definitely break out! The next step is to leave it to the ICU and the peritoneal tumor surgery to take over.

：。 : 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~