After perfusion, the kidney has a pale appearance, and the transparent irrigation solution will make it easier to identify the bleeding caused by the peeling, etc., and after opening the gerotafascia in order, after removing the bilateral adrenal glands, the entire bilateral kidney can be removed along the distal abdominal aorta all the way up, and the ureters should be cut away from the renalpedicle.

After determining the anatomical positions of bilateral renalpedicles, Xiao Rin successfully amputated them, completed the removal operation, and handed over the kidney to Li Jingyi: "In this process, the farther away the renalpedicle is, the better, which can facilitate the selection of subsequent renal implantation surgery." ”

Li Jingyi nodded clearly, wiped the beads of sweat from Xiao Rin's head, and the latter raised his head and looked at the clock on the wall, which was already two o'clock in the morning: "Next, we will do a transplant." ”

"Need a break?"

"The sooner the surgery is over, the better it will be for Danqing, and her physical strength cannot withstand the time of the process." Xiao Rin shook his head, in fact, he didn't like the idea that there was a break in the middle of the operation, the perfect operation must be done in one go, and he did not object to or support the practice of developing a short break during a long operation, let alone follow suit.

The kidney pouch used to hold the kidney source is sewn into two layers of four layers of gauze, with the kidney in the middle and water between the two layers, and frozen at a temperature of about 0 to 4 °C. Li Jingyi took out the kidney pouch from the freezer, added water to the basin, and clamped it with pliers on the outer layer of gauze, which was to prevent the kidneys from being squeezed.

Because the renal veins are exposed and easy to adhere to the ice chips, wrapped in wet gauze in order to carry out renal vein anastomosis, Li Jingyi carefully sprayed the gauze with saline to separate the gauze until the artery and vein were completely open, she removed the kidney bag and soaked it in saline.

Such a process is slow and patient, Xiao Rin did not urge Li Jingyi, but in the process of waiting. Remove some small problems in Danqing together, time is a symbol of life for him, and he will not waste this precious time in vain to wait.

"Dr. Xiao can use it."

Li Jingyi put a single cloth under Danqing's side buttocks to raise the surgical vascular site. For Li Jingyi, who was gradually entering the state, Xiao Rin smiled at her with satisfaction.

The following abdominal L-shaped incision is made to cut the external oblique and transverse abdominis muscles, and the rectus abdominis muscle is not cut off, but the rectus abdominis muscle is cut in front of the pin. Li Jingyi is using electricity to stop bleeding and doing corresponding cooperation work.

Xiao Rin pushed the peritoneum inward to protect the lower arteries and veins of the abdominal wall. After the external iliac veins of the internal and external iliac arteries are exposed, they are retracted with an automatic retractor.

On the surface of the iliac vessels there is a layer of loose fibrous tissue. The lymphatic vessels are distributed in a network pattern, and the connective tissue on the blood vessels is carefully ligated one by one between the arteries and veins with a 0 line.

"Here, we have to pay attention to the direction of ligation, which should be along the direction of the blood vessels, up to the common iliac artery and down to the groin."

Li Jingyi stared at Xiao Rin's strange technique, a strange gesture she had never used before. Fast and accurate, she couldn't help but look up at the person who was bowing her head and speaking in a dedicated tone.

Why would a person with such superb medical skills come to a small school hospital? This question, which had been entangled in her heart from the beginning, was once again stirred up by memory at this moment. But these are not important, she sees hope in him for her son.

"If the lymphatic vessels are not treated carefully, lymphatic leakage or lymphatic cysts can occur after surgery, so we must pay attention to this to avoid a continuous flow of clear lymphatic fluid from the postoperative wound, which is difficult to distinguish from a urinary fistula or lymphatic leak."

Xiao Rin used a stripper to push away the loose connective tissue on the vein so that it could fully expose the external iliac vein about 4-5 cm, so that the atrial appendage forceps could smoothly clamp the iliac vein, so that the renal vein and the iliac vein could be anastomosed end-to-side.

"See this?" Xiao Rin pushed the external iliac artery: "Here is the anastomosis of the external iliac vein." ”…,

Li Jingyi glanced at it and said to Xiao Rin: "You can pull 2 stitches on the fibrous membrane of the external iliac artery and suture it with the lateral muscle, but you don't need to buckle it very tightly." This is not conducive to removal after surgery. ”

"Not bad." Xiao Rin handed the utensils in his hand to Li Jingyi: "You can complete this part." ”

Li Jingyi didn't expect Xiao Rin to make such a request, she stared at him stunned: "I can't do it!" It took a long time to find her voice, this is not child's play, she was a little timid to refuse Xiao Rin's kindness.

"No one is born with it, and if you can't even suture it so simply, how can you go under the knife for your son afterwards?" Xiao Rin's stern voice and his undeniable strength. Li Jingyi took the tool in his hand and began to finish her previous description.

When holding the surgical equipment with Xiao Rin's body temperature, the nervous heart calmed down, and Li Jingyi, who has been engaged in surgery for many years, carefully and properly stitched up the excess place, and exchanged the equipment to Xiao Rin.

"Very beautiful stitching technique."

Time was passing by a minute, and Xiao Rin didn't say anything more. Separation of the internal iliac artery begins outside the common iliac artery and separates along the internal iliac artery distally by 3-5 cm in length.

"Pay attention to the posterior branch of the internal iliac artery, where ligation and sutures need to be done once to prevent slippage. If the patient is older and often has arterial plaque formation, the intra-arterial plaque should be removed, the diameter of the renal artery should be enlarged, and the external iliac artery should be used for end-to-side anastomosis. The anastomosis of the renal artery and the lateral iliac artery is large enough, the position is shallow, the anastomosis is easier, and the anastomosis with the external iliac artery is shorter, and the separation of the side wall of the bladder can be performed during the ureter-bladder anastomosis. ”

After Xiao Rin completed this step, Li Jingyi handed over the heart-appendage forceps to him, clamping 3/4 of the external iliac vein. The vein was cut with vascular scissors, and Li Jingyi flushed the venous lumen with heparin water until the caliber was consistent with the renal vein.

"The supravenous incision is best placed outside the anterior side of the vein, because the kidney is placed in the iliac fossa, which is conducive to the smooth blood circulation of the kidney." Xiao Rin glanced at Li Jingyi: "You come to do venous anastomosis." ”

This time, Li Jingyi did not shirk.

Venous anastomosis generally uses two-point sutures, that is, sutures at the upper and lower ends of the iliac vein as a fixed point, and then continuous sutures are made from the medial and lateral sides.

Seeing that Li Jingyi's needle distance was kept at 1.5mm and about 1mm from the incision edge, so that the veins could be sutured with valgus and kept the intima well aligned, Xiao Rin couldn't help but admire Li Jingyi's suturing skills, maybe girls are always a little stronger than boys in this regard.

When the last stitch was reached, Li Jingyi could inject 5-8ml of heparin saline with a thin needle with an angled flat head, and the sutures were tightened, but there was no leakage, and the renal veins were filled with heparin saline, and she knotted the sutures. Then, she put on the horn forceps at the renal vein, loosened the heart-ear forceps to observe whether there was blood leakage at the anastomosis, and there was no leakage at the suture, before nodding at Xiao Rin. (Your support on this site is my biggest motivation.) )