With a brain of about 1,400 grams and hundreds of billions of cells, various electrochemical signals are transmitted all the time, and the conduction methods and routes are very complex, and the structure is far more complex than our most advanced chips.

The thumb-sized brainstem is located deep in the human brain and is responsible for the heartbeat and breathing, and is densely packed with the most important nerve nuclei and conduction tracts, through which the vertebrobasilar arteries that supply blood to the brain pass.

In such a dangerous and complex confined area, the surgical space is often in the middle of a fraction.

Feng Lao's tumors are complex roots-like and intertwined, and they meander in the crevices between these nuclei and conduction tracts, and some are adherent to nerve nuclei, regardless of you and me.

Among them, the tumor adheres to the dorsal nucleus of the vagus nerve the tightest, and the slightest deviation of the scalpel will stop breathing and heartbeat.

Professor Fung's spontaneous breathing was suppressed by anesthetics, and the ventilator took over Professor Feng's breathing at a rate of 20 beats, while the heart rate was maintained at about 70 beats per minute under the control of the anesthesiologist.

Unlike spinal orthopedic surgery, this kind of surgery can't go all the way to the end, Yang Ping stopped one step at a time, instructed the instrument nurse to prepare the next step of the instrument in advance, and explained the key points to the assistant.

Under the microscope, various structures are magnified to appear clear and delicate, and the laser knife accurately incises and separates, and the small thermal effect incises and stops the bleeding of the small blood vessels without damaging the surrounding tissues.

The delicate and slender laser head does not compress the surrounding tissues compared to a blade scalpel and is more suitable for working in tight spaces.

The knife is cut along the posterior median sulcus, extending from the medulla oblongata of the head to the cervical medulla of the upper cervical vertebrae, the arachnoid membrane is incised, the soft membrane is incised, and the gray brain tissue like tender tofu is slowly split longitudinally under the cutting of the laser knife.

Going deeper little by little, each repetition of the straight line does not deviate from it, and the route always coincides with the anatomical gap, which is a guarantee of safety in the tissue gap.

The bloodless operation was carried out to the end, and the care of the tissue was beyond measure, and the tumor showed a trace of contour.

Yang Ping began to isolate the tumor, and the tumor grew staggered with normal tissue, without an envelope, and there was no boundary at all.

However, Yang Ping could find the boundary of their interpenetration, and under the separation of the laser knife with an accuracy of 0.1 mm, Professor Feng's vital signs remained stable for the time being, and the wavy lines of ECG monitoring showed a normal curve.

"Didn't use fluorescence?" Johanneson was surprised.

In order to confirm the boundary between the tumor and normal tissue, the patient is routinely injected with a special fluorescence imaging agent before surgery, and then the microscope is turned on fluorescence mode during the operation.

The surgeon can clearly distinguish the tumor from the normal tissue without fluoroscintigraphy, and then perform a precise excision under the navigation system.

It's a pity that even if it develops to this point, in the face of a tumor like Feng Lao, the success rate is still less than one percent.

"Didn't use a navigation device either?" Johanneson couldn't understand.

Without the help of these two techniques, it would not have been possible to complete this surgery, let alone achieve a success rate.

Professor Fu of the Magic Six Neurosurgery Department was also surprised, when the surgical plan was discussed, Yang Ping did not mention this, everyone thought that this was a routine thing, and there was no need to mention it, but now from the surgical field of view, no fluorescence imaging was used, and no navigation equipment was used, what was going on.

This doctor, who graduated from Tiantan Hospital, is a top neurosurgeon in China, and under the careful guidance of his supervisor, he has also become a first-class neurosurgeon in China.

"We didn't use fluorescent imaging agents?" Wen Rentao also found out and reminded.

Yang Ping replied while operating: "No, the fluorescence imaging under the microscope will interfere with my judgment, although the navigation is accurate, but the CT image is only an indirect image, which means little to me." ”

For Yang Ping, he has performed countless surgeries and countless anatomical studies in the system space to obtain real anatomical images of tumors, which are far more accurate than fluorescence imaging and navigation.

For ordinary people, even for top experts like Johannathan, fluorescence imaging and navigation are necessary, but for Yang Ping, it will become a burden.

The faint flickering fluorescence will affect Yang Ping's visual judgment during the operation, and will interfere with the comparison of the anatomy during the operation with the pictures of his brain.

The picture in his mind far surpassed any fluorescent image.

The picture in his mind, with thousands of condensed drawings of Professor Feng, was more accurate than any visualization and navigation.

Doubts are doubts, and both Johanneson and Professor Fu are speculating that Yang Ping can make such a rigorous surgical plan, and several cardiac arrests will occur when the nerve nuclei are interfered with during the operation, and it is impossible not to consider these basic things.

Yang Ping must have a better way to complete the operation, so he will abandon the technical means necessary for ordinary people.

The fine gun-shaped double-click electrocoagulation forceps, when there is no need for hemostatic electrocoagulation, are reliable microscopic forceps, and with the laser scalpel, the outline is gradually clear, and the deeply buried tumor emerges.

Wen Rentao and Zeng Ran sat next to him and pulled the hook, Wen Rentao was also responsible for suction, but the suction device in his hand did not work, and so far in the operation, there is almost no blood.

The brain tissue is full of blood vessels that are intertwined with each other, and the laser tip can operate in the space between the blood vessels, and even the small blood vessels that must be damaged are electrocoagulated in advance.

Double-click electrocoagulation precisely clamps the end of the blood vessel and uses minimal energy to stop bleeding.

The separation of the nucleus and the space is very rapid, and soon, near the dorsal nucleus of the vagus nerve, one root of the tumor, almost encircling it, forms a tight adhesion.

Yang Ping stopped, gently put down the instrument in his hand, and took a break.

The next step is to separate the adhesions of the nuclei from the tumor, which are so tight that they are almost indistinguishable from the anatomical basis for such a low success rate of surgery.

Yang Ping picked up the instrument again, adjusted the two instruments in his hand, and looked for the best feel again.

Which are the tumor blood vessels, which are the normal blood vessels, which are the tumor tissues, which are the normal tissues, where are their safe gaps, and where are the true boundaries of the tumors.

Relying on the drawings in the brain, precise guidance is carried out, and the drawings are turned into instructions from the brain, and the instructions are transmitted to the hand, and the hand controls the laser cutter head.

Compared with ordinary scalpels, the slender laser head is more comfortable in complex and narrow dissecting spaces.

Professor Zhang did not go to observe the conference room, but walked back and forth at the door of the operating room, Han Jiangong and Hong Zhigang stood at the door of the operating room, and everyone did not speak.

Surgeries in other departments were also held one after another, and some doctors came over to take a look here, knowing that Professor Feng's surgery was being performed inside.

The laser knife has a 0.1 mm focal point, and there is no mechanical collision with the tissue, so it is very light to use.

The instrument has an accuracy of 0.1 mm, but in the hands of the doctor, it is very difficult to achieve maximum accuracy throughout the whole process, which requires the hand to be very stable and not be disturbed in any way.

Because the human hand does not look shaky, there is actually shaking.

This is the reason why the image shakes when taking pictures with super telephoto.

The trajectory of a 0.1 mm scalpel according to the will of the person will definitely deviate, and even if it is a simple straight line, it is impossible to maintain the accuracy of 0.1 mm all the time when viewed with a magnifying glass.

"The separation of tumors is very precise, does their microscope have some special function to distinguish between tumors and navigate?" Johanneson could not believe that the surgery was performed without the aid of fluorescence imaging and navigation.

Griffin shook his head: "If there is such a device in the world, it shouldn't be unknown to us. ”

The operation went into the vicinity of the nucleus, and from the knowledge of the anatomy, Johanneson made a judgment, and the tip of the ballet officially began.

Judging from the images, this will be a delicate operation of life and death.

With the naked eye, it is almost impossible to distinguish a tumor from a nerve nucleus.

But the scalpel did it, and began to separate between the tumor and the nerve nucleus, and even with an accuracy of 0.1 mm, a slight thermal injury could cause interference.

If you switch to a mechanical scalpel, the interference and damage will be greater.

"It's churning on the tip of a knife!" Griffin tightens the heart.

"Have you watched Extreme Thieves?" Johannathan's heart began to pound against the chest wall.

"I've seen it!"

"Johnny Utah was climbing with his bare hands at Angel Falls, and his partner fell and fell to pieces."

"Dr. Yang can't afford to make mistakes, not once."

"However, even if he doesn't make a single mistake, he will fall several times, and once he falls, he has to regain a rock in the fall and continue climbing."

A few falls are the few cardiac arrests that will occur during the operation.

"I'm ready to enter the first death zone separation now, Professor Ma, please pay attention to ECG monitoring and evoked potential monitoring, report to me at any time, once there is ventricular fibrillation, the sterile single covers the surgical area, the trunk sterile single lifts to both shoulders, removes the back ECG monitoring electrodes, and completes the electrical defibrillation as quickly as possible, remember, we only have five seconds, do you understand?"

"Understood!" Everyone knows their position, and they have repeatedly explained and practiced before the operation.

Dr. Wu, who was sent by the ICU, was the instructor of the emergency technical training in the entire magic capital, and he was specifically responsible for electric defibrillation, pushing the defibrillator near the operating table.

Yang Ping took a deep breath, and the laser knife began to separate the adherent tumors and nerve nuclei, and the cruel devil training made Yang Ping feel like a powerful machine in terms of both psychological quality and the stability of his hands.

But Yang Ping has the ability to respond to human tactile feedback and thinking that machines don't have.

The laser knife begins to enter the brink of death, with an accuracy of 0.1 mm, there can be no deviation, a little deviation, damage to the nerve nucleus, even a little, will bring cardiac arrest that cannot be resuscitated.

The atmosphere of the entire operating room was condensed to the extreme, and everyone was engrossed in gathering all their energy to a subtle point.

Little by little, the tip of the knife went deeper, separating along the edge of death, the 0.1 mm curve of life and death.

"Sudden drop in heart rate, 30 beats, blood pressure 4020mmHg---"

"Epinephrine 1 mg, intravenous push, withdrawal of surgical instruments, coverage of the surgical area, preparation for defibrillation!"

The rescue drug was injected from the intravenous channel, and the folded sterile sheet immediately covered the operating area of the head and neck, and the trunk sterile sheet was lifted, and Feng Lao's entire back was exposed, all the way to his shoulders.

Everyone performed their duties, the team worked together seamlessly, and the anesthesiologist finished pushing the medication and stared at the monitoring screen.

After the normal waves of the heart, suddenly, there is ventricular fibrillation, followed by the entire screen.

Ventricular fibrillation --- fatal arrhythmia, a type of cardiac arrest.

"Cardiac arrest--- ventricular fibrillation!"

"Trans defibrillation!"

Almost at the same time, the cathode plate of Dr. Wu's right hand pressed against the lower back of the right scapula, and the anode plate of the left hand pressed against the midaxillary line of the fifth costal space on the left side to perform electrical defibrillation at 200J.

"Leave!"

Everyone is out of contact with the operating table.

Discharged, the only straw of life was caught, and once defibrillation was successful, a familiar wavy line appeared on the defibrillator screen.

This is the wavy line of sinus rhythm, the wavy line of life.

Everyone mentioned the heart of the throat and slowly put it down, but the heart in the chest was still beating violently.

Cardiac arrest during the operation, no one is sure that it can be saved, not to mention the interference of the nerve nucleus, and the medical research on the brain is still very rudimentary.

Only Yang Ping was calm and looked at the recovered ECG: "Reconnect the ECG monitoring!" ”

"Sinus rhythm, heart rate 50 beats, blood pressure 9045mmHg." The anesthesiologist reported that epinephrine 1 mg was pushed intravenously again. Later, the heart rate was 60 beats and the blood pressure was 10,060 mmHg.

Yang Ping observed for a few minutes and confirmed that he was out of danger: "Supplement disinfection, add sterile sheets, change surgical gowns and gloves, be careful not to contaminate the operation area, and continue the operation ---"

Wen Rentao looked at Yang Ping's calmness and calmness, and admired it in his heart, at this time, the main knife is the belief of the team members.

"One can never step into the same river twice."

Yang Ping has studied and simulated countless times in the system space, but the state of the patient and the system space simulation cannot be exactly the same.

Therefore, Yang Ping did not dare to relax at all, and made the most favorable decision based on the state of the moment at any time.

"The heartbeat center is disturbed, the regulation is disordered, and it has to be cardioverted in five seconds, and each time, we only have five seconds."

Because the sterile sheet on the trunk was lifted just now, someone has been contaminated and needs to brush their hands again on the stage, and the sterile sheet on the table must also be spread again.

Everyone took their positions and proceeded with the operation.