After more than 20 years of surgery, Director Shi has never seen such a skin cut, this knife skill is not ordinary skill, it doesn't look like surgery, but a performance.

"One Knife Stream!"

Director Fang is knowledgeable, and he explained to his senior brother in a timely manner.

Just now, the senior brother came to the operating table alone to observe, and Director Fang naturally had to accompany him, how could Professor Yang's surgery be done without a qualified commentator, and he was afraid that it would be foggy and seriously affect the mood of the senior brother.

Lao Fang knew that Yang Ping's skin-cutting technique was known as a knife stream by everyone, and it had become his signature move.

Even Yang Ping's two big disciples, Song Zimo and Xu Zhiliang, have now mastered the first sword, but they are not so proficient, so they can only be regarded as so-so.

Even if it is so-so, I am afraid it is rare in the world, this kind of knife technique, it looks easy, but it is extremely difficult to do. The thickness of the skin of each person's different parts is not the same, and the toughness of the skin is not the same, so it is necessary to be able to finely feel what tissue the knife is in contact with, and to which layer, this information is fed back to the brain, and the brain directs the hand to control the strength of the knife.

"A one-size-fits-all? Why haven't you heard of this kind of incision? "Director Shi has never heard such a novel word.

Director Fang had no choice but to continue to explain patiently and deeply: "This is Professor Yang's signature skin incision, that is, no matter what kind of surgery, the incision is formed from the epidermis to the dermis and then to the subcutaneous, and there is no need for a supplementary knife, neither deep nor shallow, neither long nor short. ”

And this kind of play? Director Shi was so dry that he just cut the skin, and you still created your own genre.

"Young people have fun, this is still the beginning, wait for you to see what fairy surgery is." Director Fang was triumphant.

Shi Guosheng felt that when did his junior brother become so disgusting, and what kind of fairy surgery, this kind of licking dog vocabulary can be spoken, what level is called the level of immortals, and he actually said in front of himself that he had seen and understood, if it weren't for his junior brother, he would really scold him a few words, no big or small.

Because the best angle of view for each step of the operation is different, Director Shi has to adjust his position at any time, but fortunately, the operating table is empty, and it does not matter how he changes his position.

Wherever he goes, Director Fang will follow him, and he will be responsible for explaining the whole process.

The abdominal cavity has been opened, first of all, the abdominal cavity is explored, the exploration does not start from the pancreas, but from the organs around the pancreas and the peritoneal cavity to understand the approximate extent of the tumor invasion, the exploration slowly shrinks from the periphery to the center, and finally the tumor of the pancreas is explored.

After all, any preoperative imaging examination is indirect, and now intraoperative exploration is the real direct understanding of the tumor, and the scope of exploration is extremely wide.

the extent of tumor invasion of the liver; Metastasis of lymph nodes around the hilum and celiac arteries, the lymph nodes next to the aorta, especially the lymph nodes at the ligament of Treitz, the location and path of the small mesentery, mesenteric vessels, right hepatic artery, and the presence or absence of tumor implantation in the peritoneum and pelvis are all within the scope of exploration. Finally, the tumor of the pancreas was explored, and Yang Ping's movements were very gentle to protect the tumor tissue from being destroyed and leaked.

All the way to probe, all the way to gauze mating, the action is extremely fast, and the exploration is already preparing for the subsequent operation.

Exploration starts from the periphery, but isolation will start from the center, and the tumor originates from the pancreas, so anatomical isolation begins with the pancreas.

"Tissue scissors!"

The instrument in Yang Ping's hand has a soul, the scissors open and close, unobstructed, and any blood vessels blocking the separation path are either avoided or cut off by clamping and ligation in advance.

The peritoneal forceps clamped the peritoneum and connective tissue at the upper and lower margins of the pancreas, and handed the tail of the forceps to Song Zimo, who immediately flipped the pancreas and spleen to the right side until the upper edge reached the beginning of the splenic artery, and the lower edge went to the inferior mesenteric vein to join the splenic vein.

When the pancreas was revealed, everyone was stunned, because of the invasion of the tumor, the pancreas had been seriously deformed, and it was not clear where the tumor was and where was the pancreas.

Moreover, the mixture of pancreas and tumor is severely adhered to the surrounding area, and many people can't help but start shaking their heads.

"Sharp knives!"

The scissors in the hand are replaced with sharp knives, and the separation is upgraded.

There are two methods of separation, blunt dissociation, as the name suggests, using a relatively blunt instrument for separation, usually using a knife handle, the tip of a scissor, the tip of a vascular clamp or a finger, blunt dissociation must use natural boundaries and loose connective tissue gaps, equivalent to the explorer following an existing road.

Blunt separation uses the force of tearing to tear off the connecting tissue, if there is no natural boundary, there is no loose connective tissue gap, this separation is impossible to start, such as tumor and organ invasion and growth, how to blunt separation.

Sharp separation is different, it uses tissue scissors and scalpels to separate, it is the tissue that is cut off, the cutting is significantly finer than tearing, and the damage is less, but the skill required is higher and the risk of surgery is greater. This is equivalent to the explorer has no way out, and must find a way.

Tissue scissors are the basic tools for sharp separation, but sharp knives are finer than tissue scissors, but at the same time, they are also more risky, and few people use sharp knives to do sharp separation in this kind of surgery, because it is easy to cause accidental injury.

Faced with such a chaotic situation, Yang Ping felt that only a sharp knife was king, and this was a special weapon for masters.

In the face of all kinds of tissues without boundaries, Yang Ping's sharp knife began to show its might, and he tried to take a part of the surrounding normal tissue along the border of the tumor to cut it, so as to ensure the thoroughness of the resection.

At the confluence of the inferior mesenteric veins, the spleen veins clamped by two vascular clamps on both sides of the distance and near were almost clamped, and the tail of the forceps was immediately transferred to Song Zimo's hands.

Originally, the splenic vein should have been cut off at this time, but the splenic vein was not cut, but retained, just shook for a while, and I don't know what was going on, the unknown blood vessels around it had been cut by clamping.

In the hand of the chief knife, I don't know when it was again, and I put it out of the abdominal cavity, and the suture and ligation of the blood vessels have been completed, and the assistant's thread was cut and shaken, and the two vascular forceps were shaken out of the abdominal cavity.

Director Shi stared at the operation area, obviously feeling dizzy, he moved his neck, wondering if there was a problem with his cervical spine, some cervicogenic dizziness will also be like this, but it is not like, he turned his head and did not look at the operation, there was no such symptom at all, but as long as he stared at the operation again, the symptoms of dizziness and dizziness returned.

Hypoglycemia? No, breakfast was hearty.

Could it be blood sickness? Director Shi's mind flashed, he had been operated on for more than 20 years, and if he fainted blood, saying it would make people laugh and lose his big teeth.

After many attempts, Director Shi finally discovered the cause of vertigo.

It turned out that the operation was too fast, and the instruments were metal, which was more or less reflective, and the coming and going of the instruments made Director Shi dizzy.

Where can I see the details of the surgical steps clearly, I can't see it at all, it's like a magician performing a magic trick, and in a flash, a pigeon appears in his hand, and every movement feels like this.

Let's just say that this pliers with wire, why didn't I see the step action of ligating and loosening the pliers, just put it in and take it out, the pliers took off, and the knot was finished.

It feels like the action is not continuous at all, there is no transition from one action to another, as if the intermediate steps are completely cut off, so the action gives the impression that it is completed instantly, how did he do it? I insist on seeing the effect of surgery as magic, and I have to figure out how to make a simple action.

Lao Tzu came to see the operation, not the magic.

Professor Shi Guosheng is really angry, you said that this matter is completely unreasonable, and if you tie the knot, you will tie the knot, and you will take it out when you put the string inside, and the knot will be done.

The more Director Shi looked at it, the more dizzy he became, don't faint if it goes on like this, there is no way, Director Shi had to stop and rest for a while, and he has been driving a knife for more than 20 years.

Be careful, Director Shi took a few steps back, closed his eyes and rested for more than ten seconds.

"Professor, I'm a little dizzy!"

At this time, Xia Shu, who was helping on the stage, also felt that something was wrong, and found that he was dizzy and vomited when he looked at it.

It's not blood sickness, Xia Shu also thinks so, he has never had this problem, if he faints blood and falls here today, he will make a big joke, not only does he have no face, but even his face outside Fuwai is lost here.

It seems that surgeons sometimes think the same way.

"I'll take a break!" Xia Shu had to withdraw, but fortunately he was not in an important position, just a dispensable assistant without a number.

Xu Zhiliang said while doing surgery at this time: "It's okay-—— it's just the operation - too fast, the eyes are shaking, and in the future, the operation will be more -—— natural habit, I was like this -——at the beginning, and now there is nothing to do." ”

Professor Shi Guosheng finally balanced his heart, you see, it's not me who can't do it alone, your own doctor is also like this, dizzy.

After the discomfort was relieved, this time Director Shi didn't dare to stare at the operation area for the time being, so he had to come back to watch the synchronous video, but fortunately, everyone still gave face to the big guy, and the position he was standing in before was always empty, and no one filled it.

But just now, the operation has been completed and the ligation has been completed to cut off the superior and inferior pancreaticoduodenal veins and the venulous branches that drain into the portal vein and superior mesenteric vein.

The pancreatic head, duodenum, stomach and bile ducts are free, watching the video is a little better than looking directly at the operation area, after all, there is no reflection and dazzling eyes, but what, a new problem has appeared, the sharp knife in the video is scary to look at, the sharp knife is doing sharp separation, this kind of place uses a sharp knife, it really makes people worry and feel frightened.

The operation video is actually more clear and comprehensive than looking at the operation area directly, especially the details, which are more delicate, so every detail is meticulous, Professor Shi Guosheng was dizzy just now, and now his heart is tight.

Your sharp knife is operating in such a dangerous area, which makes everyone's heart tremble.

In fact, looking at the operation, the more high-level people are, the more dedicated, because he knows where the danger is, so he has a full sense of substitution, but he is a rookie who is ignorant, and he is very relieved, and he doesn't understand very well, and he doesn't understand what steps are dangerous, so he just looks at it.

Among the audience present, Director Shi has the strongest sense of substitution, so he is the hardest.

Oops, there's an artery there, it's going to spurt blood and retract, slow down!

Just worried about the artery, people have completed the arterial exposure and separation, and then a breath, the artery has been clamped and ligated and cut off, this level of surgery is really the first time to see, how many surgeries do it take to do this, how familiar this anatomical knowledge must be, where to practice.

The level of young doctors under the age of thirty is so high, this is simply a hanging, Professor Shi Guosheng suddenly ran out of words, and he could only think of this popular word to express what he saw.

The sharp knife is easy to navigate in the complex ravines, and so far it has not removed a small blood vessel without mistakes, and has not injured any non-target tissues, and the entire surgical area is clean and pleasing to the eye.

The external embodiment of the basic skills of surgery is followed by two aspects, anatomy and hemostasis.

The anatomical hierarchy of the master surgery is clear, the hemostasis is very thorough, the operation is neat and clean, and there is hardly too much bleeding.

The upper jejunum and the mesangium of the uncinate process have been severed, and the spleen, pancreas, and duodenum can now be removed, but the tumor tissue is still connected to the liver and other organs, so Yang Ping has no intention of taking these tissues out for the time being.

Now these organs except for the arteries that supply blood and the veins that flow back, there is no tissue connected to the body, once these blood vessels are cut off, these organs can be separated from the body with tumors, but the other organs have not been separated, so Yang Ping plans to keep these blood vessels for the time being, so that they can get a normal blood supply.

Instrument dealer Huang Jiahui came in at this time and began to set up the table, what instruments are needed for this operation?

Stapler? Titanium clips?

It seems that there is nothing else needed for this operation, nothing more than these things.

Director Shi wanted to go and see it, but he was afraid of walking away and missing the key steps.

"You go and ask, what kind of equipment is that prepared?" Director Shi's elbow stabbed his junior brother.

Director Fang reluctantly moved over there and asked Huang Jiahui, "What kind of equipment are you preparing here?" ”

"Artificial blood vessels!" Huang Jiahui said while setting up the stage.

Artificial blood vessels?

Director Fang didn't want to waste too much time here, if it weren't for Senior Brother commanding him, he wouldn't want to ask about this.

Asked a few words hastily, Director Fang immediately returned to his position, the majesty of the director was still there, no one dared to occupy the vacant position, seeing Director Fang come back, Director Shi asked: "What is it?" ”

"Artificial blood vessels!"

"What are artificial blood vessels for?"

"This -——"

Director Fang didn't ask just now.

"Let's find out."

Director Shi said.

Director Fang was extremely disgusted in his heart, now he looks more energetic when he sees the operation, you always command me to do something else, can you not do this, although we are brothers, but I also have pursuits.

"She doesn't know." Director Fang casually said something to deal with.

Why don't device dealers know what their devices are for? Director Shi felt so strange, and Director Fang said indiscriminately: "Professor Yang's surgery is like this, it's like playing magic, the instrument dealer only supplies according to the order, what is it for, I won't know until I get on the stage." ”

, there are times when people are rude, Director Shi blurted out with a groove, but the voice was too small, and the doctors around him focused on watching the operation and didn't hear it.

The sharp knife on the screen is separating the location of the liver hila, which is the place where the tumor is entangled, which is very complex and dangerous.

But the sharp knife was like playing, almost clinging to the veins and winding around little by little.

Is this surgery or magic, can you come to someone to explain to Lao Tzu that this place can use sharp knives? And the sharp knife is played with such an exaggerated!