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Today, in the operating room of the Second Affiliated Hospital, the atmosphere is slightly more tense than usual, and the doctors and nurses in hand-brushing clothes look busy, all doing their own things seriously and efficiently.

"If you can be in the operating room every day, you can be at least 20 percent more productive here!"

said to Dean Liu Ming with a cold smile.

Liu Ming smiled bitterly and shook his head: "I want to too, but is it possible?"

As the chief surgeon of general surgery, he now has at most one operation per week, and in many cases not even one. Since he sat on the throne of the dean, he has been getting farther and farther away from the operating table.

He smiled coldly, didn't say anything more about it, and asked, "Dean, do you want to go into the operating room to have a closer look?"

"No need!"

Liu Ming waved his hand and said with a smile: "Let's just look outside, I really don't know much about the surgery outside the gods, sometimes I am afraid that I need to let you explain it, I am afraid it will affect their work." ”

Nodding, Leng Yan didn't say more, and immediately turned on the TV hanging on the wall, and the situation in the operating room immediately appeared in front of the two of them.

Looking at Tian Lu, who was dominant in the operating room, Liu Ming couldn't help but sigh: "Old Leng, when you recruited Xiao Tian in at the beginning, I really didn't expect him to get the title of deputy high school so quickly! I'm afraid this is the youngest deputy chief physician of our Second Affiliated Hospital, right?"

"It should be. ”

nodded with a cold smile, with a faint hint of pride on his face: "Generally, it is thirty-three at the earliest." Thirty-four years old, anyway, in my impression, there seems to be a person in the history of our second academy who is a few months earlier than him!"

Speaking of this, he said with a cold smile: "And don't forget, Xiao Tian still has the title of an adjunct professor of neurobiology, hehe, if I hadn't followed closely at the beginning." That old boy can't wait to give him the title of official professor!"

Seeing Leng Yan's exaggeration, Liu Ming couldn't help but smile and said: "Doing basic research, professors who are less than thirty years old are not uncommon in China. But the deputy chief physician in clinical practice, there are very few in their early thirties, and you really picked up treasures this year!"

"Haha。。。。。。 ”

Leng Yan laughed very heartily. Over the years, his vision has been ridiculed by many people in private. This year, I finally came back with a sigh of relief.

"Then what kind of surgery is Oda going to do today?"

After being cold and proud for a while, Liu Ming asked with a smile. Today, he came to the operating room on purpose to see with his own eyes what the level of this young man who was recommended by Leng Yan was really high! Although he is not a neurosurgeon, those basic surgical things are also the same, and at least Liu Ming still has this kind of vision.

After listening to the dean's question, Leng Yan immediately replied: "Anterior communication aneurysm clipping." ”

Knowing that Liu Ming didn't know anything about this, he didn't wait for the other party to ask, so he continued to explain: "This is one of the representative surgeries of cerebrovascular surgery, and I dare not say that it is the most difficult. However, it is definitely not easy, and it is a test of the basic skills of a surgeon, especially the application of anatomical understanding of the relevant parts is very high! The blood vessels in the anterior communicating artery area are complex, and there are important perforating arteries, and the arteries related to the treatment of aneurysms may even reach as many as 14. In addition, the anterior communicating artery itself may have various mutations, so it is definitely not an easy task to do this surgery well!"

As soon as he said this, Liu Ming's expression became solemn, and he asked with some concern: "Then you don't plan to go to the stage to watch this operation?" And according to the regulations, Xiao Tian is now a junior deputy chief doctor, and he must be under the guidance of a senior doctor before he can perform this operation, right?"

"You can rest assured. Isn't that Li Qiang here!"

Leng Yan smiled and dispelled Liu Ming's doubts: "And I also absolutely believe in Xiao Tian, according to his own words, this kind of operation has been done at least seven or eight times。。。。。。 ”

That's right, if it is an anterior traffic aneurysm clipping, Tian Lu not only has seven or eight practical experience in reality, but he has also practiced dozens of times on the system's simulation training ground!

Therefore, even though he knew that the director and dean outside were watching the operation, Tian Lu still looked calm and calm, and led the entire operation process with ease.

At this point, the anesthesiologist has begun to anesthetize the patient.

Tian Lu nodded at Li Qiang first, and motioned to the other party to check the preparation of the surgical instruments again. In addition to the conventional craniotomy neurosurgery equipment and intracranial vascular micromanipulation instruments, there are also aneurysm clips and clamps, intraoperative blood flow detection equipment such as Doppler fluorescence imaging, temporary blocking clips, head frames and automatic traction devices. Out of prudence, as long as it is the operation of Tian Lu, he will ask the person he trusts the most to check again before each operation officially begins.

Tian Lu himself moved a few steps forward and stood behind the anesthesiologist.

The anaesthesiologist's job is also extremely important throughout the operation.

Intravenous combined anesthesia with endotracheal intubation requires rapid and stable induction; during the anesthesia process, it is necessary to detect changes in blood pressure to avoid excessive partial pressure of carbon dioxide; anesthesia should be deep enough to avoid stimulation such as pain, and abnormal fluctuations in blood pressure and intracranial pressure caused by coughing; after anesthesia, deep venipuncture should be routinely performed to establish venous access to prevent emergency treatment when aneurysm rupture and bleeding occurs during surgery.

When the aneurysm is clamped, the controlled lowering of blood pressure is beneficial to prevent the rupture of the aneurysm, but long-term hypotension will lead to a decrease in cerebral perfusion, which may lead to cerebral ischemia.

After surgery, the patient should be awakened as soon as possible so that the neurological condition can be observed.

These are all anesthesiologists' jobs.

It can be said that although Tian Lu is the chief surgeon, the anesthesiologist is an indispensable figure in the entire operation process. It is inconspicuous in comparison, but it is the key to ensuring the smooth progress of the operation!

Watching the anesthesiologist finish all the work seriously, Tian Lu breathed a sigh of relief, and nodded at the two assistants, Li Qiang and Qian Yue: Next, it will be their turn to play!

The incision marker has been done a long time ago, and Tianlu is ready to take the classic Yasagir pterygoid point approach, that is, the frontotemporal approach, which makes clever use of the natural gap between the human brain, so as to avoid the damage to the brain tissue by surgery, and can be said to be one of the most commonly used surgical approaches in clinical practice.

Their first job is to position the patient on the operating table.

"What is he doing?"

After a while, seeing Tian Lu busy on the screen, constantly adjusting the posture of the patient on the operating table, and raising the patient's shoulder at this time, Liu Ming couldn't help but ask with some curiosity.

Glancing at Tian Lu's movements, he explained casually: "If the neck is twisted excessively, the trachea and jugular veins can be compressed, and then the venous return will be blocked, resulting in increased intracranial pressure and increasing the difficulty of surgical exposure. This can be effectively prevented by properly raising the ipsilateral shoulder in advance. ”

"I'm not asking you about the meaning of Tian Lu's action!"

The cold string of explanations made Liu Ming suddenly cry and laugh, and shook his head: "What I want to ask is, why does Xiao Tian attach so much importance to the placement of the position, is it necessary to be so meticulous?"

"This 。。。。。。 ”

For a while, Leng Yan frowned a little embarrassed, indeed, Leng Yan had also discovered this habit of Tian Lu. As long as it is his main surgery, it will inevitably take a lot of time to adjust the patient's position, especially the head position!

Admittedly, for the frontotemporal approach, exposing the base of the skull is crucial to facilitate the natural drooping of the frontal lobes away from the orbital roof and keeping the sphenoid crest perpendicular to the surgical field of view for direct visualization of the anterior bed process and parasellar tissue. So in this regard, the placement and fixation of the head position is of course extremely important.

But the problem is that the preparation of Tian Lu is also too meticulous!

The angle of inclination of the patient's skull, the height level, and even the position of the zygomatic process are exactly at the highest point, these details are constantly adjusted by Tian Lu, and the kind of preoccupied thinking, sometimes only adjusting a few centimeters, a few millimeters of slight changes, so that all onlookers can't help but have an illusion: as if Tian Lu's eyes can penetrate the patient's scalp and skull, directly see the inside of the dura, and then fine-tune according to the situation inside!

"Actually, I don't know what the basis and standard for Oda to do this is. ”

Leng Yan shook his head helplessly and said, "But after watching many of his operation videos, I found that all surgeries will go through a long period of body and head position adjustment, which takes a lot more time than other doctors." But after the operation begins, the exposure of the surgical field is unusually clear, and the chance of pulling and touching the brain tissue during the operation will be reduced to a surprising point!"

"Oh?"

His eyes flickered rapidly, and Liu Ming became more and more curious about Tian Lu's movements on the screen. Even if he doesn't know anything about neurosurgery, Liu Ming is also a surgeon after all, and he knows very well how difficult it is for Tian Lu to do this!

As for the approximate position and angle of the body position and head position, as long as you have prepared in advance, you will naturally know it, but the question is what judgment does this Oda rely on to fine-tune?

Without any aids, is it purely based on experience?

Or could it be that he had an ultra-miniature perspective in his eyes?

Liu Ming was thinking rapidly in his heart, and in the operating room, Tian Lu finally fixed the patient's head position with a head frame, and then began the final preparations such as disinfection and towel laying.

The real surgery is just getting started!

。。。。。。。。。。。。。。。。 ！~！

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