The length of the optic nerve is free enough, the eyeball is connected to the optic nerve is removed, and the vacated eye socket becomes the best safe door, and directly behind it is the tumor and the "shield", which is the important brain tissue that surrounds the tumor, and they leave a gap here, which is the best place to attack.

Entering through this gap avoids damaging the vital brain tissue around it, and likewise, it avoids damaging the dense blood vessels.

Surgery requires strategy, and in the face of the "Maginot Line", whether it is a frontal attack or a surprise attack, the latter is clearly better than the former.

Entering through the eye socket, although it takes a huge risk to remove an eyeball, does bypass the danger zone, minimizes the risk of death and disability compared to other approaches, and in a sense, it is the only way to succeed.

Yang Ping did not hesitate, and decisively cut from here layer by layer, all the way to the cranial cavity, and the gap directly behind it was clearly displayed in the field of vision, from which the tumor could be turned into a pot.

When the "gap" appears on the video.

Mayo's doctors took a long breath, what a clever approach, the gap was just behind the safety door, and the gap could almost see the blood vessels on the surface of the tumor!

It takes a lot of courage and innovation to remove a healthy eyeball to achieve the success of the surgery, which no one had ever thought of before and no one dared to do.

"Are they really right behind?" Johanneson exclaimed.

Yang Ping's tone was very calm: "Whether it's magnetic resonance or CT, it's just that you didn't pay attention." ”

In fact, every doctor in Mayo Neurosurgery has seen the MRI and CT images of patients, and the images are indeed clearly displayed, but the power of mindset is very terrifying, allowing them to selectively avoid the eye socket approach, which has never been seen in textbooks, and all their plans and attempts are within a limited circle.

From the safety gate to the tumor, the distance is relatively long, and the operating space is different from usual, it is almost a tunnel.

Therefore, the length of surgical instruments used to remove tumors through tunnels is much longer than ordinary instruments, and the greater the distance below the grip point of the hand, the less stable the end of the instrument.

This can make it difficult to operate under the microscope, especially when the upper limbs are suspended in the air.

Even if you switch to the stability mode of elbow support, it is extremely difficult in this situation.

"Do you need elbow support?" Johanneson asked.

By this time, the first assistant had been replaced by an ophthalmologist to Johannesen, who was worried that his arms were hanging in the air and he would not be able to complete such a difficult operation.

"No, you don't! Bracing will reduce the dexterity of my hands. ”

Yang Ping's tone is always so calm, although this calmness seems cold, but it can make people feel his rationality and confidence.

Johanneson no longer speaks, because each of his judgments is based on a completely different thinking than Yang Ping.

The long-handled microscope has penetrated deep into the skull to peel away the tumor, starting with the notch, and the laser knife begins to peel away the tumor.

This kind of contact laser knife not only has a very high precision, but also does not cause mechanical extrusion and traction damage of the nerve tissue produced by conventional mechanical knives during cutting, and does not have the high-frequency current of electrocoagulation and hemostasis equipment, so it does not produce electronic interference for intraoperative electrophysiological monitoring.

Therefore, Yang Ping likes to use this tool very much when he is in charge of neurosurgery.

The location is so deep, the blood supply to the tumor is abundant, and the operation tunnel space is not large, which is destined to be difficult to operate.

Johannesen's job as an assistant can only be to undertake the task of pulling the hook, and the entire operation is completed by Yang Ping himself, in order to minimize the ischemia time of the eyeball, Yang Ping does not want to waste time, Johannesen will only slow down his speed, and his efficiency in individual combat is the highest.

By changing the power density, changing the irradiation time, changing the different shapes of the cutter head and changing the way the cutter head contacts with the tissue, the contact laser knife can change the tissue temperature, control the shape and range of cutting, and the cutting accuracy is 0.1~0.2mm, and the surrounding tissue has no obvious change. Yang Ping maximizes the advantages of the laser knife and minimizes the thermal damage of the disadvantages.

The small knife head appears between the blood vessels and then cuts off and coagulation with each operation, so so so far, no bleeding has been seen in the surgical area.

Yang Ping stretched out his hand, but the instrument he wanted did not come, he stopped what he was doing and looked back at the instrument nurse.

The nurse looked dazed.

"I need another round-tipped laser cutter!"

Yang Ping reminded that he found that the instrument nurse was just a strange American girl, and suddenly woke up, so he reminded.

Now Yang Ping is holding a microscopic tweezers in his left hand and a laser knife with a pointed head in his right hand.

Therefore, he wants to replace the microscopic tweezers in his left hand with a laser knife with a round head, so that he can cut with his right hand and stop bleeding with his left hand, and the two can be separated to improve the speed.

“OK！”

The instrument nurse responded, answering with a sharp answer, but her heart was already very flustered, the dullness just now was just the result of accumulation, she had worked hard, but she still couldn't catch up with the rhythm, just at that moment, her tense nerves finally broke, and she couldn't keep up with the rhythm anymore.

But Yang Ping has already taken care of the nurse's speed, and the early operation is obviously very slow, of course, this is just his usual speed, in the eyes of everyone, the speed is very fast.

Now it is necessary to think about reducing the ischemia time of the eyeball as much as possible, so it is necessary to speed up, and the speed of the instrument nurse finally collapses, like a speeding car burning out its engine.

"I—I -——"

The instrument nurse was flustered, and after answering "OK", she completely lost her rhythm, she didn't know what to do next, her brain was blank, and she didn't know which instrument to reach for with her hands.

Johanneson was extremely embarrassed to see this scene, this is Mayo, the number one hospital in the United States.

"It's okay, don't be nervous, take a break."

Yang Ping stopped what he was doing and comforted the nurse, he had always been gentle with the nurse.

Johanneson followed Yang Ping's attitude and encouraged the nurses: "You may be too tired, take a rest." ”

At this time, Yang Ping remembered something and said to Johannathan: "I forgot to tell you an important thing yesterday, if the conditions allow, my operation should be equipped with two skilled instrument nurses, which is the standard for my main surgery." ”

Just been an instrument nurse, even if she slowed down, because she was already very embarrassed by this poor American girl.

Two instrument nurses?

Johanneson didn't know what to do after hearing this, and he didn't know why Yang Ping would say such a thing, but looking at the tired instrument nurse, he confirmed that Yang Ping's meaning was very simple, that is, two nurses were needed.

The instrument nurse next to him nodded honestly: "Yes, it should be better to have another nurse." ”

She very much agrees with Yang Ping's suggestion, because she really can't hold on to it in her current state, and the whole process just now can only be maintained by highly tense nerves, and she has mobilized all the potential of her body, which is not a normal way of working, and will collapse sooner or later.

Johanneson called the itinerant nurse: "Let Daisy go on stage!" ”

Daisy is also a specialist neurosurgery nurse in the operating room, she is older than the current instrument nurse, Daisy and the instrument nurse on the stage, are the best neurosurgical nurses in Mayo.

The anesthesiologist, who had been silent beside him, looked at the screen of the monitoring device again, and at this moment, he felt a huge pressure.

"Johannathan? Do I need to add more staff here? The anesthesiologist offered to do so.

Because surgery is a serious and sacred matter, there is absolutely no room for mistakes, and it is better to take the initiative than passively find the shortcomings.

Johannathan's eyes were on Yang Ping, who was also unsure if he needed two anesthesiologists.

Yang Ping shook his head: "No, one is enough." ”

At this time, the anesthesiologist was relieved, but he was obviously more nervous and focused than just now.

"I will tell you what equipment to deliver in this step, what equipment to prepare in the next step, the two of you divide the labor, one person is responsible for preparation, one person is responsible for delivery, don't mess up the rhythm, the ischemia time of the eyeball needs to be shortened as much as possible, so I have to speed up, take a deep breath, and we will continue now." Yang Ping encouraged instrument nurses.

After a few deep breaths, the instrument nurse finally found her state, and the operation continued, while Daisy began to wash her hands and go on stage.

——

What's going on?

How does the video pause?

Is the surgery difficult?

The sudden pause of the video screen caused a series of questions to arise among the doctors who were observing the operation in the classroom.

This operation is inherently difficult, and the bizarre anatomy of the hemisphere brain makes the outcome of the operation even more unpredictable, and Yang Ping's use of such an unconventional surgical approach makes every step a trap and risk in the eyes of these doctors.

"It should be a break to adjust the surgical position, the surgical position is relatively deep, and the use of long-handled surgical instruments, the elbows are definitely not supported." The muscular guy knows what's going on at a glance.

Muscular Man is the technical stream of Mayo Neurosurgery, and he is known as the king of micro-manipulation.

In the training stage of neurosurgery, this high-achieving student of Harvard Medical School, who operated under the microscope, frantically trained the operation under the microscope, and he refined each operation action, so he was called the king of micromanipulation.

Even he sweats in the gym just to have a strong body, in order to increase the balance and endurance of his hands, he uses homemade resistance training methods for ten years.

As the king of micro-manipulation, he deeply understands that in the current situation, it is impossible to complete the operation with both arms in the air.

However, the suspension operation just now is already very powerful, and judging from the operation under the mirror, Johannathan's mentor is indeed a world-class master.

The white-haired doctor has his own opinion, and he thinks that even if he adjusts his posture, it will not take so long, whether there is some accident during the operation.

The other doctors at Mayo sat quietly in the second row with both the muscular man and the white-haired man, quietly waiting for the continuation of the operation, it was normal for a little accident to have a difficult operation, and they had experienced a lot.

Only Robert knew what was going on in the operating room, and he guessed that it must be the instrument nurse who was stuck and needed to adjust the pace now.

Robert knew his professor best, and the problem could not have been with the professor, who he had never seen a miss so far.

"Having trouble with surgery?"

Woodhead asked.

Obviously unfamiliar with the professor, Robert shook his head and said disdainfully, "This operation is nothing to the professor. ”

"Nothing? What is that? Woodhead wondered.

"There's nothing but reason why your level four is there." Robert expressed helplessness.

Nothing? Woodhead pondered this sentence in his heart, but still couldn't figure out what it meant, this operation was also an operation for the professor, how could it be nothing.

"How do you pause the video?"

Woodhead continued to ask, since there was no difficulty, just continue with the operation.

"The professor is waiting for another instrument nurse to come to the stage, he is the main surgeon outside the main department, and it is always two instrument nurses with a table, otherwise the instrument nurse will definitely not be able to keep up with the speed." Robert was confident of his own speculation.

Massimo tilted his head and asked, "The professor is from orthopedic surgery, is neurosurgery also his amateur?" ”

Robert nodded: "The professor was originally an orthopedic surgeon, but he can do all the surgeries, and they are all at the top level, you see, the eyeball replantation of this operation was originally an eye surgery, and the professor is not still able to operate, he is definitely better than Mayo's ophthalmologist." ”

Massimo fell silent, when Yang Ping left Houston after relieving NASA, Massimo went to the airport to see him off, and asked Yang Ping if he had done a lot of interventional surgery when he was leaving, Yang Ping just replied: Usually rarely do interventional surgery.

At that time, Massimo was messy in the wind, and he rarely performed interventional surgery, but his skills were far above him.

It was at that time that Massimo recognized Yang Ping as his mentor, although he has not been recognized by Yang Ping now and has not officially joined the WeChat group, but in Massimo's heart, Yang Ping has long been his mentor.

The muscular man thought it strange when he heard that the Americans were actually chatting in Chinese, and felt that they seemed to know something inside, so he asked Robert if he knew what was going on in the operating room.

Robert told him truthfully: "Your instrument nurse can't keep up with the rhythm and is now waiting for the second instrument nurse to wash his hands and come to the stage." ”

"Two instrument nurses?"

The muscular man in the back row heard Robert's exaggerated words and felt unbelievable.

After all, the instrument nurse only delivers the instruments, and the brain tumor surgery is generally a dangerous operation, which is relatively slow, and the speed should be slower when operating under the microscope.

"That's right, two instrument nurses, whether the two nurses can keep up with the rhythm depends on the professionalism of your Mayo instrument nurses." Robert makes no secret that he's that simple and direct.

After hearing this, several Mayo men around were also very puzzled, how could they say that Mayo is also a world-class hospital, and they have never seen such a thing.

One chief surgeon, two instrument nurses?

(End of chapter)