With Robert's help, Huang Jiacai went to inspect several American medical device companies.

Lao Cheng visited the New York Special Surgery Hospital, accompanied by an administrator who conducted an in-depth study of the hospital's culture, management, and structure.

Confirming that Yang Ping was not affected by the accident, Robert arranged the operation as originally planned, and the first operation was Andrew's Jr.

Robert had been planning this operation for two years, but he had not done it because he was uncertain.

If you are not sure, you can only wait, there is no turning back, once the surgery is broken, it is not only difficult to do revision surgery, but also the effect is poor.

So Robert has been researching and hoping to develop a new surgical method to solve the multi-ligament reconstruction of the knee joint in children.

The existing surgical methods cannot cope with even simple anterior and posterior cruciate ligament reconstruction, let alone this kind of multi-ligament reconstruction.

For two years, Robert racked his brains and did not make a breakthrough, until he met Yang Ping, and this matter did not see hope.

Everyone is looking forward to how Yang Ping will do this operation, and what level of mentor Robert is talking about.

New York's specialty surgery hospital has long been at the top of the world's orthopedic department, and these doctors are used to the feeling of being first, used to teaching others, and many doctors have never seen a hospital ask someone to do surgery in their careers.

Now that Robert has asked a Chinese professor to perform the operation, everyone is full of anticipation and curiosity.

Because of the existence of epiphysis, some people suggest surgery after adulthood, and some people design the method of extraosseous suspension, but the method of extraosseous suspension changes the anatomical center of the ligament, and the insertion point can not obtain firm tendon bone healing, which is a helpless choice.

In short, in order to operate like an adult, it is necessary to open the bone tunnel, as long as the bone tunnel is opened, the epiphysis will be damaged, and if the epiphysis is damaged, it will cause bone development deformity, and in severe cases, it will cause the epiphyseal plate to close and stagnate growth.

Knee multi-ligament reconstruction is already very difficult for adults, and it is even more difficult for children to operate.

In order to watch the surgery, except for the doctor on duty in the ward, the doctors of the entire sports medicine department are rested, and no other surgeries are scheduled on this day.

Doctors from other departments also came, and Professor Jung, who focuses on knee replacement, also deliberately took time out to take a look at Yang Ping's surgery.

Because sports medicine and joint replacement are the same as joint surgery, many hospitals are not detailed, and one doctor does both knee replacement and knee arthroscopic surgery.

There is a reason why Professor Jung is so interested in Yang Ping's arthroscopic surgery, because Yang Ping's surgery demonstrates that the ligament balance technique is more difficult than the soft tissue balance of joint replacement, and it is not at the same level at all.

Professor Jung wanted to see what the Chinese doctor, Robert's mentor, could do to adjust so many ligaments to a state of equilibrium.

OrthoPediatricS engineers also rushed over to see how the instruments were used and how they were used to accomplish the procedure, especially the drill bit that could drill in a curve.

This drill bit was manufactured by OrthoPediatricS according to Yang Ping's drawings, but they didn't know how to use it or where to use it, after all, they were not doctors.

Little Andrew was in the first place, and Robert himself was his assistant, taking Barrel to position himself and disinfect the sheets.

Yang Ping brushed his hands, put on a space surgical gown, put on gloves, and entered the position of the chief surgeon.

The first assistant, the second assistant, and the instrument nurse have already been in place, and there are already ten instrument boxes on the instrument table around them, which are fully reflected here.

Yang Ping visited the supply room of this hospital, which should be the most complex and advanced supply room in the world, using factory-based and assembly line management, with more than 100 surgeries per day, about ten instrument boxes for each operation, some surgeries have more than ten instrument boxes, and some doctors have their own exclusive surgical instrument boxes because of personal habits.

Every day, more than 1,000 instrument boxes are cleaned, collected, inspected, repaired, replaced, disinfected, and packaged after surgery, and the whole process is monitored and tracked using a special computer system.

When Yang Ping visited, he found that they were very serious about the inspection of the instruments, each instrument had to go through the standard procedure of inspection, the damaged ones were immediately picked out, and the new replacement instruments were added on the spot, which was very efficient.

Some hospitals stock up on instruments that need to be supplemented by manufacturers, and they must be added before the instruments are packaged, so that there will be no lack of instruments for the next day's operation, and there will be no instruments that do not fit because of minor problems.

The instruments used in the operation, especially those designed by himself, Yang Ping looked at every piece and confirmed that there was no shortage, and Yang Ping officially opened the stage.

The glass shield that hangs slowly from the ceiling encloses the perimeter and isolates the operating table from the surrounding area to ensure maximum safety in the operating area.

Preoperative checking, opening, probe insertion, and examination of various anatomical structures in the knee joint is initiated.

The probe fits easily in the child's knee joint, always in the gap, and does not collide with the cartilage.

Each time you change the position of the knee joint, there is no need to wait, and the probe wanders almost simultaneously with the change of the knee position, and the two work together perfectly.

Stryker's latest naked-vision 3D arthroscopy equipment is very easy to use, and the image presented on the screen is clear 3D, not a two-dimensional plane.

If the probe should be palpated, it should be palpated carefully; What should be stopped and carefully observed, never roughly; The meniscus should be lifted up, and the steps should never be omitted.

Instead of wasting time, not a second is wasted, and the proficiency of surgery has entered a realm of enjoyment.

In the teaching room of the operating room, everyone watched the video, the arthroscopic operation was completed under the camera, and the chief surgeon also watched the real-time video to complete the operation, so the field of vision of the chief surgeon and the audience's field of vision were the same.

The atmosphere is delicate, fast but not impatient, elegant but not frivolous, and the operation has been made into an artistic appeal.

Professor Jung, an amateur musician and a professional violinist, has not only the ability to judge rationally but also emotionally about surgery.

Surgery can form sensual charm, that is, rationality has entered the extreme, and harmony and rhythm are invisibly produced, this level must be a master among masters, and it is definitely not something that ordinary people can do.

Professor Rong Ge sighed that from this Chinese operation, he saw a temperament --- broad, deep, simple, and sensitive, which was not derived from logical reasoning, but by perceptual imagination.

The examination within the knee joint has been completed, and the next step is the reconstruction of the anterior cruciate ligament, which requires the reconstruction of several ligaments.

The instrument nurse was a little overwhelmed and couldn't keep up with the rhythm, Robert had already counseled her many times about the surgical steps, and she was mentally prepared, but she still couldn't keep up.

However, the speed of the operation was beyond her imagination, and the sister-in-law began to be a little nervous, and Robert comforted her: "Don't worry, Dr. Yang will stop and wait for you." ”

Robert fears that she will collapse, but Barrell helps her leg and Robert assists in the delivery of the equipment, and the scene is stabilized.

To prepare the tunnel opening, according to Robert, Dr. Yang will use the curve drilling of the sagittal plane to bypass the epiphysis, and everyone is eager to see this step, how Yang Ping will dig the tunnel in a curve.

"Curve drilling, no need for a guide pin, at present can only drill by hand, we can use computer software to navigate, there are three ways to drill, sagittal curve drilling, coronal curve drilling, horizontal curve drilling. In order to avoid damage to the posterior nerves and blood vessels, the second curve requires a small incision on the anterior side of the knee, and reverse drilling is carried out from front to back; Horizontal curve drilling, postoperative stress will be concentrated below the epiphyseal line, which is easy to cause epiphyseal traction stress concentration, and in severe cases, epiphyseal separation; Coronal drilling is the safest, most convenient and most effective, which can avoid the shortcomings of the previous two drilling methods.

Yang Ping explained while doing it, Robert thought too simply, he thought that Yang Ping would drill the curve of the sagittal plane, and the way he guessed was exactly the first to be eliminated by Yang Ping.

The coronal surface is an imaginary surface that divides a person into two halves; the sagittal plane, which divides the person into two halves; A horizontal plane, a plane that divides a person into two halves.

The coronal curve is drilled, and the curve will be shaped on the coronal plane.

Coronal curve drilling is started, and the soft drill bit can change direction at will to drill directionally.

"If you are not proficient, you must use a C-arm machine for fluoroscopic monitoring, or use navigation equipment to assist in preventing damage to the epiphysis."

Of course, Yang Ping doesn't need such a complex assistive technique to drill holes with his bare hands, he is too familiar with dissection.

Yang Ping explained Robert's words, but it was just a reminder: dangerous shots, don't follow them.

The drill bit starts drilling from the lateral wall of the femoral intercondylar fossa, the anatomical center of the anterior fork ligament, towards the lateral side, without which the drill bit can be turned, and this curve tunnel cannot be drilled in any way.

Along the safe zone below the epiphysis, the drill bit follows a preset curve and drills out on the lateral side of the lateral femoral condyle, which can then be inserted with a soft protective sheath that can be turned to prevent the drill bit from twisting the soft tissue in the next drill.

Under the protection of the sheath, the drill bit turns, crosses the epiphyseal line, and above the exit just now, another safe zone, the drill bit drills, which is in the opposite direction from before, from the outside to the inside, through half of the entire lower end of the femur sufficiently, without the need for a drill bit.

This operation is hidden in the bone tissue and cannot be seen on the screen, in order to confirm that the tunnel does not damage the epiphysis, Yang Ping decided to perform a C-arm machine fluoroscopy.

The glass shield is raised, everyone evades, and the C-arm operator makes a perspective.

The drill bit is still in the tunnel, and the metal shadow is the direction of the tunnel, and above and below the epiphyseal line, the two curved metal shadows are very beautiful, and there is no damage to the epiphyseal plate.

Curve drilling, nice curve drilling! Professor Jung exclaimed.

Soft drilling, orthopedics often use, especially in a small space for drilling, in some operating dead angles, hard straight drill pipes because they will be pinned, can not be drilled, just like bullets have a dead angle for shooting.

As a result, soft drills are widely used, because the drill pipe is flexible, and can apply stress to change the direction of the drill bit to complete almost any angle of drilling.

However, it is only possible to determine any drilling point, and it is impossible to control the route of the tunnel through which the drilling passes.

Now this Chinese doctor has designed this set of instruments, which can skillfully drill holes in any path.

No wonder Robert worshipped him as a teacher and secretly went to China to study, the Chinese are too smart.

This doctor is not only highly skilled in surgery, but also advanced in concept.

The tibial tunnel follows the same approach, with curvilinear segmented drilling of the coronal plane.

The tendon is inserted into the bone tunnel, and the tendon fixation method in which the bone tunnel is buried at both ends is not fixed by the usual micro-flip steel plate suspension. Instead, a novel barb anchor technology is employed.

From drilling to fixing, it's a novel anchor technology.

Yang Ping successfully avoided some approval requirements for these new technologies, which are within the scope of the FDA's permission.

Anterior cruciate ligament, posterior cruciate ligament, medial and posterior structure, medial and lateral structure, many ligaments are inserted in the way of curve drilling, barb anchor fixation, so that children can operate as mature as adults.

The combination of new instruments and advanced surgical techniques makes this world-class surgery simple and straightforward.

"How did Robert meet this Chinese doctor?" Jung's heart itched.

A sports medicine doctor next to him shook his head: "I don't know." ”

"Does Dr. Yang only focus on sports medicine?" Professor Jung asked.

"I heard that no, spine, joints, trauma, sports medicine, all good at it!" The attending physician replied.

Professor Jung was very dissatisfied that Robert, a guy who had found such a good teacher, had never mentioned it to him.

Stingy, mean, selfish, narrow-minded!

Professor Jung was squirming, he could think of every word in his mind, and afterwards, he had to settle accounts with Robert and settle accounts well.

Why, there is such a mentor who never reveals the slightest bit of information.

If you only focus on sports medicine and a few arthroscopic surgeries, it is understandable that this mentor is also good at joint replacement!

The last time he went out for a week, he actually said vaguely that he would go to China to attend an academic conference.

This dishonest man, dishonest man!

"The next one is ready to start." Someone reminded Professor Jung.

The second operation is in another operating room, ready to begin.