If this operation is to be carried out step by step, then there are four major parts in total, the total resection of eight organs and tumors - the removal of tumors in vitro-—— the reconstruction of blood vessels and some structures - artificial vascular transplantation of the inferior vena cava, autologous transplantation of six organs.

The patient's vital signs remained stable, and Yang Ping began to speed up the operation and try to shorten the operation time.

The "golden team" was in place, Xu Zhiliang took Zhang Lin to remove the saphenous vein of the lower limbs, and Yang Ping took Song Zimo and Xiao Wu to start reconstructive surgery on various blood vessels and some structures.

Liang Fatzi crossed Erlang's legs, checked the data of the monitoring instrument from time to time, and then made a record and analyzed it in his heart.

Director Shi stood next to the sterile table to observe the operation, Director Fang switched back and forth between the LCD screen and the sterile table, and other doctors gathered in front of the LCD screen.

Xu Zhiliang cut two very long saphenous veins as the materials for vascular grafting, and according to Yang Ping's requirements, he cut the blood vessels into various lengths, soaked them in normal saline, and neatly spread them on the wet saline gauze for later use.

Director Shi was very puzzled by Xu Zhiliang's operation, Professor Yang did not calculate the number of blood vessels needed, nor did he measure the length of blood vessels, how could he trim all the blood vessels into various lengths in advance.

What if it doesn't fit? If they don't fit, all of these blood vessels will go to waste.

Director Shi himself also does ex vivo resection + autologous transplantation of pancreatic tumors, although the number of accumulated cases is not very large, but it is also ranked first in the country, so the experience is rich.

Not only him, but other experts are after the tumor is removed during the operation, whether a blood vessel transplant is needed, if transplantation is required, and then calculate the number, caliber and length of the transplanted blood vessels, and report the data to the assistant, so that the assistant can process the blood vessels according to these data.

How could it be that Professor Yang had already considered these factors and made accurate calculations before the operation?

With this question, Director Shi couldn't help but ask Yang Ping: "Professor Yang, have you measured the number and length of blood vessels through imaging pictures before the operation?" ”

Yang Ping said while doing the operation: "This is like building a house, there must be design drawings before the operation, what materials are used, the specifications of the materials, must be planned before the operation, and the amount of surplus of the prepared materials must be in the calculation, or the engineering concept I said, our surgery, especially this super large surgery, must have the concept of engineering, so that the operation can be done well, otherwise it is easy to take care of one or the other, and it will be a mess." ”

The application of the concept of engineering in surgery, Director Shi learned something new today, he pondered what Yang Ping said, it is indeed very meaningful, and he will also apply the concept of engineering to surgery in the future, so that the operation is more rigorous and precise.

Director Shi remembered this knowledge point, this is the core technology, without the guidance of this engineering concept, this complex operation is easy to fail.

The left kidney has been removed and does not require a transplant; gallbladder removal, and transplantation is also non-existent; inferior vena cava is grafted using artificial blood vessels; For the remaining five organs, Yang Ping has already transplanted the blood vessels, and now he wants to put them back into his body and let them return to their respective places.

The artificial vascular graft of the inferior vena cava is completed first, so that the subsequent surgery can be done.

Artificial vascular grafting of the inferior vena cava was completed, and the five organs were put in place.

After homing, their suspensory ligaments and mesangium are anastomosed first, so that the organs can be fixed in the body to a certain extent, avoiding wandering around, and it is very dangerous once there is torsion or herniation.

The organs were fixed to a certain extent, and Yang Ping began to anastomoses their arteriovenous vessels, as well as some necessary nerves that could be anastomosed.

The pancreas is first anastomosed, the pancreatic duct is reconstructed, and then the blood vessels of the liver, including the hepatic arteriovenous and portal vein, are anastomosed to reconstruct the biliary tract.

The reconstruction of the functional pipeline in these two steps is very important, once the reconstruction quality is not high, it is easy to cause bile leakage and pancreatic leakage, resulting in chemical peritonitis, infection, etc., and causing serious complications.

Because the small intestine has been removed, the pancreatic duct needs to be connected to the jejunum, and Yang Ping uses Blumgart anastomosis, that is, the modified pancreatic and intestinal duct mucosal anastomosis, that is, this anastomosis requires the surgeon to have a high level of anastomosis of the small tubes, which is nothing at all for Yang Ping, who is good at anastomosis of small blood vessels.

Biliary reconstruction of the liver is also very tricky, this patient is a biliary reconstruction close to the hilum of the liver, which requires multiple bile duct openings to be formed, and then the biliary-intestinal Roux-en-Y anastomosis.

Among these organs, autologous transplantation of pancreas and liver is the most difficult, as it requires complex reconstruction of blood vessels and functional ducts.

Director Shi watched it with relish, because any step of this step is the top surgery of hepatobiliary surgery and pancreatic surgery, and now it is integrated in one operation, and it is impossible to see such a complex reconstruction at all.

"Professor Yang, isn't the level of general surgery ordinarily high?" Director Shi sighed to himself that the gap was not a little bit.

In particular, the engineering concept of this major surgery is much ahead of him in concept, and he is still at the level of making a vague plan before the operation and doing step by step during the operation, and there is no such detailed engineering concept at all.

A major operation includes many minor surgeries, and of course, these so-called minor surgeries are all major surgeries if they are taken out individually.

These surgeries are independent of each other and form a module, but they also have to be coordinated with other surgeries, and each module forms an organic whole.

For this kind of complex surgery, the doctor must have a basic knowledge of engineering, the whole operation as a big project, each step as a component module, the masterpiece in the history of human surgery, the Fontan operation, embodies this engineering thinking, in order to achieve the goal, it is necessary to consider many factors rigorously, rather than thinking about the problem in a disorderly and chaotic way.

"Or else? I'll just say that Professor Yang did all the immortal surgery, you don't believe it. ”

Director Fang said triumphantly, after all, this kind of god is the brother of his own hospital, so he has to follow the bull no matter what.

Director Shi said unhappily: "I don't believe it." ”

The liver and pancreas have been transplanted autologously, and now the spleen needs to be transplanted autologously, and the spleen only needs to reconstruct the arteriovenous vessels, and there is no need to reconstruct the functional pipes, so it is much easier than the liver and pancreas.

But the spleen is a bit weird, and its implantation can be confined to any location in the cavity or in solid organs, such as the liver, pelvis, thoracium, pericardium, subcutaneous tissue, etc.

That is, if a little spleen tissue is accidentally scattered on these parts due to trauma or surgery, it can survive like a seed.

Therefore, in order to prevent this accidental spleen implantation, Yang Ping is very careful, just like treating a tumor, and protects the surgical perimeter very tightly, so as to prevent the small spleen tissue from falling off and causing accidental implantation.

Director Shi was sweating profusely, holding a tissue in his hand, and pressed a few times on his forehead from time to time.

Director Fang is pondering, next time is to do an autologous liver transplant to try, if you can do a good job of autologous liver transplantation, it is also good, after all, it is also a difficult operation, there are not many hospitals in the country that can carry out autologous liver transplantation, eat bite by bite, and do the surgery one by one.

And if you do a non-ischemic autologous liver transplant yourself, it will be the second case in the world.

In the Institute of Surgery, the world's first is not valuable, but for the other director, let alone the world's second, it is tenth, and it is all unwanted.

Thinking about it this way, Director Fang had a stirring in his mind, in the Institute of Surgery, the world's first case of two ends in three days, isn't the recent minimally invasive myocardial rotary resection technology also the world's first?

A bold idea arose in Director Fang's heart, and in the future, he followed the pace of the Institute of Surgery, focusing on his general surgery, as long as they do the first case, they will do the second case, like this kind of super large surgery, they can't take it at all, it doesn't matter, shrink the operation, try to make it smaller.

For example, Professor Yang engaged in ex vivo resection + autologous transplantation of eight organs, and he engaged in ex vivo resection + autologous transplantation of one organ.

In this way, he is the second in the world every time, the second in the world!

Director Fang was excited when he thought about it, happy for his enlightenment, and insisted on this concept in the future to complete the "academic class leap" in his life.

"Wait a minute, copy the surgery video back!"

Director Fang told his graduate students in a dignified tone that in the future, all the general surgery videos of the Institute of Surgery should be copied back and studied slowly, and then asked Professor Yang to "lead" him to do the operation, and he would naturally become familiar with the way.

Thinking of this, Director Fang couldn't help but reminisce about the pleasure of being led for surgery just now, it was really cool, when would he be able to be led again.

At this time, Director Shi was also thinking about preparing to be the second in the world, worthy of being a senior brother, and thinking of going together, Director Shi saw an opportunity: "Professor Yang, I have time to go to our cancer hospital to guide the operation, there are many such patients there." ”

Director Shi also said to the other director's students: "Help me copy a copy too." ”

"Can I make a copy of the surgery video back?" After all, Director Shi is from the outer courtyard, and he still has to ask for the opinion of the master when copying other people's things.

Yang Ping has no opinion on these, as long as you are willing to learn, you can copy as you like, the more people copy, the better.

"Attention! Look at the tips next to the host, don't use your own U disk, the drawer next to it is full of new U disks, free, you can take it casually, you must not use your own U disk copy, once found, it is forbidden to enter the operating room. Zhang Lin reminded the person who wanted to copy the video of the operation.

If these messy USB flash drives have viruses and damage the computer host in the operating room, it will not be a big trouble.

Autologous liver transplantation is known as the ceiling of hepatobiliary surgery, but now autologous transplantation of five organs is required, so for a five-story house, the original ceiling is only the ceiling of the first and second floors.

Multi-organ transplantation of the abdominal cavity began with the transplantation of multiple organ clusters in the abdominal cavity, and was first pioneered in 1960 by Professor Starzl, who is known as the father of modern organ transplantation.

Intraperitoneal multi-organ cluster transplantation is the transplantation of 3 or more anatomically and functionally related organs in the abdominal cavity or outside the peritoneum in an en-bloc and in a series of organ clusters.

The basic principle of surgery is that the transplanted whole abdominal cavity needs to have a common arterial blood supply and venous outflow as a whole.

But Yang Ping's surgery today is obviously bigger than the abdominal multi-organ cluster transplant, because the organs involved are not arteries and veins that share a common blood supply, nor are they functionally completely related.

The operation continues, steady and meticulous, the entire sequence is carefully arranged, and engineering thought permeates every detail of this major surgery.

In the end, even the remaining part of the stomach was transplanted, and the whole operation was completed in one go, just like an old dilapidated house was completely demolished, and the dismantled materials were sorted, and the unusable materials were thrown away, and those that could be used were left, and then the remaining materials were used to rebuild a strong and solid new house.

Now that the new house has been completed, everyone is very excited.

Whether they participated in the operation on the stage or watched the operation offstage, they were all excited.

The blood vessels are all open, there is no blood leakage at all anastomosis points, and the transplanted organs are ruddy in color, indicating that the blood vessels are unobstructed and the operation is complete.

The roving nurses took blood tests for blood routine, biochemistry, liver and kidney function, and there were no obvious changes, indicating that the functions of various organs were also good.

Director Fang on a whim: "Wait for everyone to take a photo, commemorate this historical moment, I will invite guests to dinner in the evening, choose the location at will, and those who see it will have a share." ”

"Oh, by the way, Professor Yang, I also have a patient with liver cancer over there, the tumor invades the bile duct, hepatic arteriovenous and portal vein, and it is also entangled and growing, it seems that it must be done ex vivo resection and autologous liver transplantation, please help me take me to do it-—— oh, help guide me to do it."

Director Fang was a little excited, and whatever he thought in his heart, he said it all at once.

It means that, but you can't say that you are doing surgery in front of so many doctors, and it makes it so ugly.

"I have a pancreatic cancer patient who has invaded several organs, and he must have an ex vivo resection and autologous transplantation, so please ask Professor Yang for guidance."

Director Shi did not let go of such a good opportunity, although he is already well-known in the country, there is still a lot of room for improvement.

After seeing Professor Yang's surgery today, Director Shi and Director Fang's thinking was completely opened, and the surgery that I thought was very tricky before now feels nothing.

Moreover, once Professor Yang's ex vivo resection surgery is mastered, many abdominal tumor surgeries that could not be taken in the future can be safely taken down.

PS: About the details of the operation, I don't know if it's appropriate to write like this, I think it's too deep and too detailed, but because I don't understand it, it's easy to cause boredom, about the details of the operation, I think it can be roughly restored, everyone can understand and think it's interesting, I don't know your opinion, thank you!