Professor Feng lay on his back on the operating table, and the itinerant nurse connected the indwelling needle of the left radial artery to maintain venous access.

Professor Ma, the anesthesiologist of Moliu, placed a right subclavian vein under local anesthesia, connected to various monitors, and dynamically monitored electrocardiogram, heart rate, arterial blood pressure, central venous pressure, pulse, and blood oxygen saturation.

Professor Ma injected 0.2mg of intravenous fentanyl, 100mg of propofol and 50mg of rocuronium, and after the successful induction of anesthesia, a spring stent endotracheal tube was inserted and connected to the anesthesia machine for mechanical ventilation.

The breath sounds of both lungs were clear and symmetrical, and Professor Ma adjusted the respiratory parameters to maintain the partial pressure of end-respiratory carbon dioxide at 35-45mmHg, inhaled isoflurane, maintained the end-respiratory concentration of 1%, and planned to add 2mg of vecuronium bromide every 40 minutes.

After the anesthesia was satisfied, everyone worked together to change Professor Feng to the prone position, various positional pads and restraint belts were standardized, and Professor Feng's eyes were also fixed in the closed position with protective tape.

The head is fixed on the Mayfield fixer, Yang Ping personally installed the fixation, and each screw was checked several times, especially the three skull nails, to ensure that they were installed at the maximum diameter of the head, completely pierced the outer plate of the skull, and used the outer plate of the skull to firmly hold the head.

If it is not installed properly, the bone entering the apical vertebrae is not enough, and the head slips during the operation, which will be fatal for Feng Lao.

Not only should the head and neck be fixed, but the angle of fixation should also be optimal, and after adjusting these well, Yang Ping checked the defibrillator again.

Even the sandbag used for prone cardiopulmonary resuscitation, Yang Ping also personally checked, this sandbag is stuffed in the lower sternum, so that when the heart compresses, the back is pressed, and the lower sternum is squeezed and sunk by the sandbag, forming a squeeze on the heart, which has the same effect as supine compression.

Sandbags can not be squeezed on the abdomen, can only be in the lower part of the sternum, according to the principle of position, this position can not be placed sandbags, easy to cause pressure ulcers, but in order to save rescue time, it can not be taken care of so much.

Somatosensory evoked potentials and motor evoked potential monitoring instruments in the brainstem and spinal cord are working properly.

So after these details were checked, some precautions were repeatedly emphasized, and Yang Ping took everyone to brush their hands with satisfaction.

Disinfection sheet, preoperative check, anesthesiologist reported vital signs: heart rate 75 times, breathing (mechanical ventilation) 20 minutes, blood pressure 12065mmHg, blood oxygen saturation (low-flow oxygen) 100%.

Yang Ping wore protective glasses and held a laser knife with a sapphire head to start the operation.

The laser knife fiddled with the hand a few times, looking for a feel, and began to cut the skin.

According to the two-point positioning principle, Yang Ping chose the posterior approach of the upper cervical vertebra to connect with the median occipital transmembranous medullary sail approach to form a joint approach.

There are 14 safety areas for brainstem surgery, and six for the medulla oblongata, and the median occipital transmembranous medullary sail approach is one of the six.

The tumor, which involves the upper cervical spinal cord and medulla oblongata, was supposed to be a collaboration between a spine surgeon and a neurosurgeon, but now Yang Ping has to do it alone.

Yang Ping's study of anatomy has gone far beyond these rough concepts of safe zones, and in the brainstem region, he already has a mature and complex safety map in his mind, and even in the most dangerous areas, he knows how to smoothly carry out traversals.

The skin is cut open, the scalp clip is neatly clamped to the edges, and the laser scalpel is advanced layer by layer.

Drill two holes on the lateral side of the lateral occipital carina, at the lower edge of the transverse sinus,

The skull of the hind of the head is uncovered by a manhole cover, and the annular spinal canal of the upper cervical vertebrae, fully opened from the posterior side, revealing the entire rhombic fossa.

In this delicate craniotomy, the skull can be covered back like a lid after surgery, and the closed cervical vertebrae are firmly fixed with internal fixation plate screws.

The spinal canal and cranial cavity are opened, and the pulsating dura appears in the field of vision, enclosing the superior cervical and medulla oblongata.

The whole brainstem is no bigger than a thumb, the medulla oblongata is only a part of it, one-third the size of a thumb, and the upper cervical spinal cord is about the size of a finger.

It also connects various intricate vascular nerves, such as vertebral arteries, cranial nerves, and spinal nerves.

Now the surgery has to perform a complex and precise incision in this finger-sized space to separate and stop the bleeding, and there can be no mistakes, a small mistake will cause the death of the patient.

Because the tumor involves only the medulla oblongata and the upper cervical medulla, the approach does not need to be used in its entirety.

Yang Ping held a laser scalpel in his right hand and a spear-shaped bipolar electrocoagulation tweezers with a light source on his left and right.

With extreme anatomical skill, all obstacles to the surgical target are removed.

From the scalp to the entire upper cervical cord and the posterior part of the brainstem, it is safely exposed in the field of vision, and almost no bleeding is seen.

The accuracy of the gun-shaped double-click electrocoagulation tweezers is amazing, and each bleeding point is solved in advance by double-click electrocoagulation before it appears red, and the hemostasis is completed at one time, and the action is never repeated.

"Microscope!"

The Carl Zeiss neurosurgery microscope is pushed to the surgical area.

Yang Ping changed the gloves, personally adjusted the focal interpupillary distance until he was satisfied, and then replaced with new sterile gloves.

The laser knife is slightly bright, and the dura mater is cut open in a Y-shaped shape.

The median foramen of the four ventricles is open, and the choroidal tissue, cerebellar tonsils, and posterior inferior cerebellar artery are lateral to the periphery.

A gentle nerve pull hook pulls the cerebellar tonsils and posterior inferior cerebellar artery to the sides.

Separate the choroidal tissue and the inferior medullary sail, exposing the entire rhomboid fossa.

At this point, the dorsal area of the brainstem exposed by the transmembranous medullary sail approach appeared in the visual field, and the surgical safety operation area near the facial mounds was placed in the surgical field of view.

The whole reveal was actually completed in a few minutes, and the movements were smooth, steady and brisk.

The master didn't want to waste time on revealing this step by step.

Wen Rentao and Zeng Ran's work is just to pull the hook to attract and revve.

The whole process was bloodless, and the suction device in Wen Rentao's hand did not play much role, and he seemed very lazy.

"It's so fast, it's a real bloodless operation, it's beautiful!" Johanneson lamented that it deserves to be at the level of 80 percent success.

The operation has just been revealed, and Johannesen has been impressed by his superb surgical skills, clean and clear surgical vision, and extremely skilled anatomy.

As the world's top neurosurgeon, he has a deeper understanding than others.

It's just that he had a hard time believing that it was an orthopedic surgeon doing surgery.

"It's like he knows every possible bleeding point in advance, and this bloodless operation, I've seen it for the first time." As an oncologist, Griffin is particularly sensitive to hemostasis.

Woodhead never looked away, as a spine surgeon often extended his scope to the medulla oblongata, and in the United States, spine surgery is not a branch of orthopedics, but is considered a branch of neurosurgery.

At this time, he was very appreciative of this bold and bright revelation, and at the same time, he felt that this unboxing technique, which was very particular about bone treatment, was difficult to replicate.

"I'm afraid it's hard to replicate this kind of fineness?" Woodhead was both envious and helpless.

He was thinking about how Yang Ping received surgical training to acquire such fine and skilled anatomical knowledge and surgical ability.

Under the microscope, the laser knife, the spear-shaped double-click electrocoagulation forceps are in front of the aspirator with a light source in the surgical field.

The first revelation is just a foreshadowing, and the later surgery is the real step.

This scalpel moves the center of life through errors.

"Guys, focus." Johanneson reminded.

All three sat upright, focused, and began to watch the video of the field under the microscope.

The entire conference room was silent, and the breathing of the next seat could almost be heard.

"Anesthesiologist, I'm going to prepare to cut the upper cervical cord and medulla oblongata, start separating the tumor, and keep an eye on vital signs."

"The defibrillator starts to prepare, remember that as soon as ventricular fibrillation occurs, the anesthesiologist will report it immediately, and the defibrillator must complete the defibrillation within five seconds."

Yang Ping reminded everyone, but the danger is not so fast for the time being, and it is very necessary to let them enter the state in advance.

The laser knife begins to make an incision along the posterior median sulcus of the medulla oblongata, which is one of the safe areas of the medulla.

The knife line is straight, like a ruler drawn.