The liver is very close to the pancreas, living next to each other, so the tumor of the pancreas has many ways to invade it, and now the metastases of the liver are particularly complex, and it actually grows around the hilar arteries and veins and various ducts.

If the tumor is to be removed, the blood vessels must be cut off together and then reconstructed, of course, this kind of delicate tumor cannot be removed in the body, so there is such a surgical method as ex vivo resection.

Now Yang Ping regards the liver and tumor as a whole, and does not want to separate them, leaving the isolation of the tumor to be done outside the body, what Yang Ping currently wants to do is to separate the whole of "organ + tumor" from the surrounding normal tissue.

But even then, it was not so easy, because the tumor eventually crawled around the blood vessels towards the inferior vena cava.

The sharp knife is the best tool for sharp separation, compared to the various "knives" that are now available, such as laser knives, ultrasonic knives, and water jets - the sharp knives are still as powerful as they are in the hands of masters, and they are the easiest weapons to obtain, and any hospital has them.

Now the anatomy of the liver and tumor on the video is no longer described, and I don't know what it is.

Yang Ping and his assistants have put on fluorescent navigation glasses, through which the tumors stained with indocyanine green emit a faint green fluorescence, while normal tissues will not transmit this light, so the tumor tissue or the tissue invaded by the tumor is divided into two obvious camps with the surrounding normal tissues, and the sharp knife is swimming between the two camps, in order to ensure the thoroughness of the resection, it is necessary to cross the dividing line and remove a part of the surrounding normal tissue.

Excision first, then reconstruction, this is a reluctant choice for surgery, once important structures are violated, they will be ruthlessly killed, and these structures will be rebuilt afterwards.

Now the sharp knife wanders in the dangerous area: the blood flow outlet of the liver-—— which is the "crossing" of the three hepatic veins into the inferior vena cava, and all the blood that has passed through the liver "detoxification" has to come out from here and return to the inferior vena cava.

These blood vessels have been seriously invaded, so they cannot be retained, of course, before the entire surgical goal is taken out of the body, Yang Ping is temporarily retaining their existence, so that they can ensure that the blood circulation of the liver is still normal.

If the entire surgical target is taken out of the body, the blood vessels will be cut at a normal site, and then the blood vessels will be cut off along with the tumor, and after the tumor is removed outside the body, these blood vessels must be rebuilt by transplanting the blood vessels.

Director Shi's heart is under tremendous pressure, if there is no matter of those seven organs, if there is only this one organ, only the liver and tumor that we see so far, it is actually a super large operation.

This surgery is called ex vivo liver resection + autologous liver transplantation.

Liver transplantation, which is usually referred to as allogeneic liver transplantation, is also implanted with someone else's liver, but now it is your own liver transplanted, and it seems that transplanting your own liver should be easy.

On the contrary, autologous liver transplantation is much more difficult than conventional allogeneic liver transplantation and is known as the Everest of hepatobiliary surgery.

Because there are two difficulties in autologous liver transplantation, firstly, after the patient's liver is taken out, the patient has a liverless period, and during the period when the patient has no liver, the surgical team must ensure that he is alive and well.

Secondly, after the liver is taken out, it must be put back after some careful repair, and it must be ensured that the liver is repaired without fail, once it is repaired, the patient lying on the operating table will definitely not be saved.

Allogeneic liver transplantation is different, it uses someone else's liver, the patient has his own liver in his body, when preparing the allogeneic liver, the patient has a liver, although this liver is not good, but it is better than nothing, in case the allogeneic liver has a problem and cannot be implanted, the patient does not have much problem for the time being.

In both cases, it's the equivalent of swapping CPUs on a running computer.

Autologous liver transplantation, take out the original CPU, repair it and put it back, in this process, to ensure that the computer can not be shut down, can still run normally, once the CPU is repaired, can not be reinstalled, the computer can only be scrapped. Allogeneic liver transplantation, buy a new CPU to replace the original CPU, although it is also a requirement that the computer can not be shut down, but when dealing with the new CPU, doesn't the computer still have its own CPU, who is more difficult to keep the computer without CPU and without CPU, obviously, if the new CPU is accidentally broken at this time, it doesn't matter, at most this time it fails, wait for the next time to change, isn't there a piece in it to make do with.

In this case, even if all the steps of ex vivo liver resection + autologous liver transplantation are successful, there are still complex pipeline reconstructions such as: hepatic artery, common bile duct, portal vein, superior and inferior hepatic vena cava, and inferior hepatic vena cava-

If any step is not done well, if the human body is replanted, for example, the blood vessels are not rebuilt, causing massive bleeding, there is no salvation at all, and if the common bile duct leaks, causing bile leakage, it is life-threatening.

Director Shi Guosheng is one of the few professors who carry out this kind of surgery in China, and there are not many cases accumulated at present, and it basically takes him about ten hours for ex vivo liver resection + autologous liver transplantation.

Not long ago, Pengcheng carried out a case of ex vivo liver resection + autologous liver transplantation, which is said to be the first case in the history of Pengcheng medicine, and the operation took more than 20 hours, which shows the difficulty of this operation.

This is just ex vivo liver resection + autologous liver transplantation is so difficult, and now Yang Ping's surgery is eight organs, this difficulty is simply Mount Everest on Mount Everest, and it is the tower of Babel for general surgery.

This operation must take a long time, Director Shi pinched his fingers and couldn't help but shiver, don't you do this for a few days and nights?

An ex vivo liver resection + autologous liver transplantation is fast for more than ten hours, the resection of these eight organs + autologous transplantation, and the cleaning of various lymph nodes, so it is not more than 100 hours, that is not five or six days, day and night, in order to complete the operation, even if some organs are not as difficult as the liver and pancreas, shorten the time, two or three days.

I didn't calculate the time before, I just rushed to see the operation, but now I feel like I'm broken, what kind of surgery is this, why do you do it for a few days and nights?

Professor Shi had to turn his head to stand a few young people in the stand, just these few guns, and he insisted on it for a few days and nights, wouldn't it?

Look at the junior brother and the other doctors, they are watching with relish, don't they realize the problem of time? Still in the dark? The ignorant are fearless.

For a few days and nights, even the people who saw the operation themselves were now afraid, let alone the doctors who stood on the stage to perform the surgery.

The operation in the video is still continuing, and the operation has always adhered to the principle that the arteries and veins are temporarily retained, and the other connecting parts are gradually disconnected, and the tumor is not decomposed, and the tumor and these eight organs are removed as a whole, as a "large organ".

Don't these people know anything about this operation, looking at dioramas?

"Just a team? Is there a relay team? Director Shi Guosheng asked Director Fang.

Usually, this kind of super major surgery, if it takes a long time, requires several teams to take over each other and play relay races or wheel battles.

Director Fang was suddenly asked and his brain short-circuited: "Relay? What force? Professor Yang still has to relay for surgery? ”

Director Shi was blocked by the tone of his junior brother's speech, which is obviously the truth, but it is easy to be regarded as "scolding", if it weren't for the close relationship between the senior brothers, Director Shi would have criticized him again, how could he talk like this, but the other director, Director Shi has been used to it, he knew from the time he was studying, this product is like this, he is forced to speak bluntly, he was a second product when he was studying, and it is still now, and it has not changed at all.

Speaking of the relay, Director Fang suddenly had a string plucked in his head, and felt as if something was wrong, but he didn't know what was wrong for a while, he looked at the operating table, then at the table, then at others, and finally at himself.

Why did you think the scene was weird just now, what was wrong?

"What's wrong with you?"

Director Shi felt that his junior brother's eyes were wrong and asked.

Director Fang didn't answer, the two eyeballs rolled around, what was wrong?

No way!

Am I not Ichisuke? How to be offstage? Why are they all on stage?

Didn't I say yes, I'm a suke?

How am I offstage, how am I offstage-

Song Zimo, Xu Zhiliang, you two are not authentic, why are you standing on the stage, that is my position, I am a helper who said yes, why didn't anyone remind me today.

This thing is done, I accompany my brother and forget that I am a helper, and now that the operation has been opened, what should I do?

This incisor tooth that I lost and swallowed in my stomach? No way.

Director Fang immediately walked to the edge of the operating table, first pretending to be a probe to observe the operation, and then said coldly: "Dr. Song, it's a little hard, why don't I help you take over?" ”

When Song Zimo heard it, Director Fang's voice didn't understand what he meant for a while, so he said, "It's okay, it's okay." ”

Director Fang circled around the operating table, anxious, how could he let go of such a good opportunity, not to mention that he could learn a lot, just this operation, although he is just a helper, he can take it out in the future to brag, you can also start with "we", this operation can be blown for a lifetime.

But now Song Zimo is a helper, and he is doing a good job on stage, if he forcibly pulls him down, he seems to be very unqualified.

At that time, it was not someone else who grabbed the operation, it was that he stupidly didn't brush his hands, and he had been accompanying his senior brother offstage, which was likely to make young people misunderstand that he was going to accompany the guests, and he gave up this opportunity to go on stage.

If the operation has not started, the old party will definitely go straight, please do me a favor, I will help, but now that people are on the stage, it is reasonable, they should not pull people off the stage, and it is impossible to always disturb others, which affects the safety of the operation, and the old party still has this awareness.

How can this be done?

Director Fang was like an ant on a hot pot, so anxious that he was in a hurry.

"Professor! Is it worse than you think? ”

Song Zimo saw that the dissection inside was simply a mess, and all the dissections in the textbook were invalid here.

"Calm down!"

Yang Ping reminded that the work at hand did not stop.

Song Zimo glanced up at the professor, his confident eyes were simply gods, no wonder August said that the professor was "a man from the earth." ”

"I'm calm."

Song Zimo cheered up and followed the rhythm of the professor, but where is this dissection, it is clearly a bad dough, this is still a hell level at the beginning, and there are many steps in the back that are far more difficult than this.

"Dr. Song, do you want to rest for a while?, it's okay, you come down to rest, I'll help you for a while."

Director Fang finally seized the opportunity.

"It's okay, where is this, the operation has just begun, and I am full of energy." Song Zimo replied.

Director Fang sighed in his heart, walked around a few more times, just delayed for a while, now the liver has been almost separated, except for a few arteries and veins, the liver is close to free, and now it is being separated from the inferior vena cava, which is the most difficult separation step, and the slightest carelessness will cause heavy bleeding.

"I'm sorry, brothers, I'm really embarrassed that you said that you caused this today, and you forgot that you were a helper, and I want you to help replace you."

This person from the old side is really straightforward and frank.

But at this time, everyone didn't hear it, especially Song Zimo didn't hear it at all, because everyone was focused on the operation, not pretending not to hear, but really not to hear.

Tragedy, I didn't hear my own words, so it's impossible to say this sentence all the time, obviously disturbing other people's operations.

Lao Fang has no choice but to stay on the edge of the operating table and wait for the opportunity.

Cut the peritoneum and loose tissue in front of the common hepatic artery, separate the common hepatic artery, the hepatic propria artery, and the gastroduodenal artery above the head of the pancreas, and the gastroduodenal artery is also separated, and continue to separate to the distal end with silk thread traction until it reaches a satisfactory length, and then separate along the common hepatic artery upward until it meets the celiac artery, and begin to separate the inferior vena cava in this direction.

The lymph nodes at the upper edge of the pancreatic head have been invaded by metastases, and they have separated as part of the "big whole", waiting for the last uprooting.

The lymphatic and connective tissues on the right side of the gallbladder are cut open in normal areas.

Yang Ping's hands sometimes cooperate, sometimes operate independently, one hand is separating a blood vessel, and the instrument of the other hand is actually separating the other part, and the two hands are operating independently separately.

What kind of riotous operation is this, I don't know if I don't look carefully, I was shocked when I looked carefully, and I thought it was two people's hands operating separately, especially if one person has two hands that can be operated completely independently.

This is really a fairy operation, which is equivalent to two independent people doing surgery, and the speed is doubled all of a sudden.

It is completely unreasonable to be reasonable, how can a person operate independently with two hands, and do his own work, but now it is obviously like this.

Now Director Shi Guosheng can understand that there are two assistants on the stage, and he said why these two people, one assistant and two assistants, work so vaguely.

These are two Ichisuke, one with his left hand and one with his right hand.

There are also these retractors, which are really well pulled, and they are revealed all the way down the steps of the operation, so that the two hands in the operation do not have to worry about other things at all, just do the work of the main knife.

I'm going to go, I can still do the surgery, is this still a person?

Director Shi Guosheng really can't figure it out, he really can't figure it out, he is also a big bull in oncology surgery, how can he feel that he has never seen anything now, and he will be shocked by everything.

"Left and right?"

There is a general surgeon who is a fan of Yang Ping, and when he saw the current operation, he immediately called out the name of the move.

It's another knife stream, it's fighting left and right, a serious operation, how to make it look like martial arts.