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“…… Therefore, if the diagnosis is clear, the choice of this incision will be the most appropriate. ”

While waiting for Thomas and other assistants to finish the disinfection and towel laying work, John was also explaining everything about the McTon dot and McChuck incision for Dale and the others.

In the history of acute appendicitis surgery, there is a physician whose name cannot be left unmentioned, and that is the American physician Charles? McBurney. The surgeon, who now received his bachelor's degree from Harvard and later received his M.D. in New York, first discovered the tender point of acute appendicitis and later concluded the best surgical incision, the McStrid incision that bears his name.

The importance of the McTon point and the McCephalic incision is evident from the fact that it is still used by surgeons more than 100 years later.

For surgeons in 1885, it was very difficult to find the best surgical approach because of the lack of knowledge of anatomy, pathology, anesthesiology, etc......

The knowledge in John's mind was undoubtedly shocking to the physicians of this era!

Everyone listened and watched intently.

John's explanation, which involves the anatomical knowledge of the right lower quadrant and the pathological knowledge of acute appendicitis, is naturally of concern, and the operation of Thomas and others is also the focus of attention! John's disinfection method not only uses the latest disinfectant, but also the concept of circular disinfection centered on the incision is also innovative, and the spread of towels to protect the wound after disinfection is even more refreshing: during the operation, the patient is no longer exposed to the outside with his chest and abdomen exposed, but is covered by layers of disinfectant wipes. Only a small area of the surgical area was exposed!

Regardless of whether or not they were in favor of these measures before the surgery, when the surgery was really ready to begin, everyone's expressions were a little dumbfounded.

Coupled with the full set of equipment from John and others, this is almost a subversion of traditional surgery!

"That's it."

After completing his task, Paul nodded at John.

"Let's get started."

After bowing his head and whispering a few words to the sober Mr. Miller, John cried out without raising his head: "Scalpel!" ”

Robert, who had been prepared for a long time, immediately handed over a bright scalpel!

Just two or three seconds. John took the scalpel from Robert's hand, but it was such a simple action that made the eyes of the onlookers brighten! Robert didn't hold the plate and let John take it, but held the back of the knife with his thumb and four fingers, the blade downward, the tip of which was at his level, and John easily squeezed the scalpel!

"It's pleasing to the eye!"

Thinking of his usual operations on the operating table, Bergman couldn't help but shake his head.

He now had a deep understanding of why John had to train several people for so long, even if he did almost all the main operations alone, but if he wanted to practice these coordinated movements well. I'm afraid a month is the most basic!

While everyone was holding their breath and watching carefully, John's scalpel slashed down without hesitation......

Ordinary appendicitis surgery is one of the most basic procedures for a general surgeon in the 21st century, and John himself has done hundreds of cases, so he must be very familiar with it. However, in the eyes of others watching at this time, open surgery is undoubtedly the most complex and difficult operation to control at the moment, and its dangerous process is self-evident.

So imagine when John's surgery didn't match what others expected. What are the consequences?

Except for Thomas and the other three assistants, everyone stared blankly.

They stared blankly at John in the patient's lower right abdomen. An incision perpendicular to the line is made at the junction of the middle and outer thirds of the right anterior superior iliac spine with the umbilicus; Mu listened to John's voice that suddenly became erratic: "The skin is cut along the direction of the skin striae, which has less damage to blood vessels and nerves, and because the fibers of the three layers of abdominal wall muscles are in different directions, the postoperative incision heals firmly, and it is not easy to develop incisional hernia." It should be noted, though. Because this incision is not convenient for exploring other abdominal organs, it is only suitable for surgery with a definite diagnosis of appendicitis......"

After a brief introduction to the choice of incision, John stopped talking. And in the eyes of everyone, John's operation is so coherent and concise, as if he has done it countless times!

In silence. Bergman et al. watched John cut the skin and then cut the subcutaneous tissue, cut the aponeurosis of the external oblique muscle, and separated the internal oblique muscle and transverse abdominis muscle by blunt dilation with curved forceps, and retracted the muscle layer to expose the peritoneum; They watched John and Thomas work together to lift the peritoneum, cut and cut the peritoneum, protect it with wet gauze, and then use a retractor to open the incision and fully expose the surgical field......

"Pull the hook!"

"Scalpel!"

……

Barely a sound was heard in the entire operating room, except for John's orders. And when everyone saw that John stopped continuing to expand the incision, indicating that this step had been completed, everyone's breath was instantly held for a moment!

Oh, God!

With a pair of eyes wide, Bergman only felt that his mouth and throat were on fire, dry and maddening!

This incision ......

At most, a few centimeters, is this the passage that John thinks can be removed from the appendix?

Although he had looked through the information written by John countless times, and knew that this kid was fully prepared, Bergman still felt a little unbelievable when he saw John's actual operation! In his opinion, such a small incision, let alone the removal of the appendix, is probably an impossible task to find it, right?

"Mr. Miller, how are you feeling?"

After the field was fully exposed, John suddenly turned his head sideways and asked softly.

"It's okay, it's okay."

It's still a simple sentence, but it's relative to the fear at the beginning. Mr. Miller seemed to be much calmer at this time, but there was a slight trill, indicating that there was still tension in his heart.

"Sizzle......"

After hearing John's answer, everyone gasped at the same time again!

Everyone's attention was focused on John's operation just now, and it was only when he heard Miller's voice that he suddenly remembered: John had opened the patient's abdominal cavity, and this Mr. Miller was still conscious. You can even talk to the surgeon who is in charge of the surgery!

Even Bergman's heart was pounding violently at this time.

In fact, the use of local anesthetics is still limited to one hospital in Charlotte, but Bergman usually uses surface anesthesia or local infiltration anesthesia, and has never used neuraxial anesthesia, this is the first time he has seen a demonstration of the effect in surgery!

However, at this time, John had already focused all his attention on the operation, and had no time to care about the reaction of the others, and said softly: "Mr. Miller, some of my next operations may cause you discomfort, such as nausea and vomiting. If you're uncomfortable, sue me, okay? ”

"Yes, sir."

After swallowing a mouthful of saliva, Mr. Miller answered.

After nodding at Paul, John proceeded with the operation. After finding the appendix, it is necessary to pull it out of the abdominal cavity for operation, and the traction of the mesangium may cause Miller's epigastric discomfort, such as nausea and vomiting, so John naturally needs to prepare in advance.

Until John started the operation. Others are coming back to their senses.

Watching John's careful but coherent movements, Bergman frowned and pondered. If you compare it to the movements of other surgeons. John's operation seemed to be a little slow, as Bergman always had with him, but now Bergman didn't dare to look at him with ideas such as not working hard enough, not having enough talent, etc. Looking at his coherent and cautious operations just now, and looking at the position and order of the knife he deliberately chose, Bergman understood one thing at this point: John didn't say that he couldn't be fast, he just didn't want to be fast. Because he does not perform surgery as simply and crudely as other surgeons, but considers the process of minimizing the harm to the patient!

My own evaluation of John's surgical operation may have to be postponed to a new one!

It was at this moment that John's voice finally sounded again: "Gentlemen, I think perhaps you will have some doubts. How do you find an appendix with such a small incision? In fact, it is not very difficult, some patients have an appendix that is under the incision, which is very easy to find, we can find the cecum first, and then look along the three colonic belts to the top of the cecum to find the appendix. Of course, if we can't find it, we should consider the possibility of a posterior cecal appendix, and we can use our fingers to explore the posterior cecum, or cut the lateral posterior peritoneum, and turn the cecum inverted to find the appendix...... Hehe, found it. ”

"So fast?!"

Everyone was shocked, and hurriedly tiptoed to look, and sure enough, a section of the appendix was pulled out of the incut by John!

After carefully observing the situation of the appendix, John breathed a sigh of relief.

There was no obvious hyperemia and edema when the peritoneum was examined just now, and although the swelling of the appendix was now more obvious, the mesangium was congested, and there was discharge on the surface, but there was no gangrene or perforation, and Mr. Miller's condition was not bad overall. After examining the ileocecal bowel for no abnormalities, diverticula and masses, John was reassured. Of course, John must also be glad that this Mr. Miller has made up his mind so quickly, otherwise it would be difficult to say without antibiotics if it dragged on for a few more days......

Looking at the little things that he hadn't seen for more than ten years, John said before proceeding with the next operation: "Gentlemen, the next step is the final treatment, including the treatment of the mesangenal membrane, the removal of the appendix, the embedding of the appendix stump, and the cleaning and closure of the abdomen......

"Buzz ......"

Before John had finished speaking, there was a slight commotion among the crowd.

There were so many questions to ask about this operation, but John's words blocked them all. Because of what happened before, everyone, including Professor Bergman, had to suppress the doubts in their hearts and quietly watch John proceed with the next operation...... (The novel "Doctor 1879" will have more fresh content on the official WeChat platform, and there will also be a 100% lottery gift for everyone!) Open WeChat now, click on the "+" sign in the upper right corner to "add friends", search for the official account "qdread" and follow, hurry up! (To be continued......)