It's really embarrassing, if the two big directors even hand over the chest to the junior doctors, then they won't do anything, and they can't say anything.

If you write a paper in this case, the first author must be Director Wen, Director Wen is a sincere person, if he didn't do anything on the stage for this operation, he would definitely not be able to say it.

Therefore, Director Wen and Director Zhang honestly completed the last step of chest closing, but in fact, only the chest can be closed.

The scene is a bit funny, in the entire operating room, a group of doctors surrounded the two bigwigs to watch the two bigwigs close their chests and sew their skins, and the two bigwigs pretended not to be alarmed under the burning eyes of everyone, but in fact, there were already 10,000 horses galloping in their hearts.

"Let's drain it?"

"Let's go!"

Usually the work of placing drains, determining the length of the drainage tube, and trimming the side hole of the drainage tube are all done by junior doctors, but now they suddenly do it themselves, which is still a little strange.

Doctor Chu didn't squeak on the side, just quietly watched the two bigwigs operate.

Maybe it's because of the hand, or because the big guy has high requirements for the side hole of the drainage tube, Director Wen is still not satisfied with cutting the two drainage tubes, Director Zhang is still not satisfied with the acceptance to prune, and finally the fourth drainage tube is finally trimmed to satisfaction with the discussion and cooperation of the two big guys.

The doctors around the side are not good to leave now, for fear that the cold scene will lose the face of the two big guys, so everyone is still like observing coronary artery bypass, and do what an observer should be.

"That Xiao Chu?" After finishing the last stitches, Director Wen looked up and called his junior doctor.

Dr. Chu immediately responded: "Director! ”

"Why are you hiding here, what time is it?" Director Wen asked.

Dr. Chu said, "Nine:22. ”

I am a big living person, I have been standing here and pulling the hook, why am I hiding here, Doctor Chu thought in his heart, but a strange smile appeared on his face.

Director Wen glanced at the electronic clock on the wall, it took a few minutes for coronary artery bypass, but it took about half an hour for him to close his chest and sew the skin, as if he hadn't done this kind of work for a long time, and today can be regarded as an experience, but it should not be experienced in this kind of public eye.

"Dressing stickers!"

Director Wen took the nurse's dressing sticker, and then taught Dr. Chu while sticking it: "Every detail must be done well in the operation, and the dressing should be smooth and there should be no wrinkles." ”

I taught it this with my mouth, but as soon as I put the dressing and stroked my hand, there were a few wrinkles, and my hands were raw.

"Look, director, I didn't press it well, do you want to change it?" Dr. Chu took the blame in time.

Director Wen frowned: "Forget it, don't get in the way, pay attention next time." ”

After this operation, Director Wen and Director Zhang felt hazy in front of them, which was probably the most difficult operation that the big guy did.

In the operating room of the orthopedic department here, Song Yun has already exposed the back of the neck 4, 5, and 6, and the automatic retractor has also been placed, and the gauze place has also been padded.

After Yang Ping finished dealing with the matter of cardiac surgery, he brushed his hands back in, the time on both sides was very well controlled, and it did not affect the progress of his operation at all, Song Yun saw Yang Ping come back so quickly and said, "What? Do they do it themselves? Don't teach you on? ”

"Oh, we've just built two bridges for them, let's get started." Yang Ping stood up, and the operation here was ready to begin.

Has the bridging been completed? It won't be so fast, this is a coronary artery bypass in cardiac surgery, not a crack in the skin of the finger or a ruptured tendon, it can be done in a few minutes, it is a coronary bypass, Song Yun also wanted to ask about the specific situation, Yang Ping had already done it, and Song Yun had to keep up with the rhythm.

"It's just two bridges, it won't take much time, I guess the operation over there is almost over."

Yang Ping looked at the operation area, Song Yun had already performed subperiosteal separation on the vertebral plates on both sides, but further on both sides, the subperiosteal separation could not be advanced, because the two sides were articular processes, transverse processes, pedicles, etc., as well as the intervertebral foramen where nerve roots entered.

If the lamina is equivalent to a plain, then these structures are mountainous and easy to carry out in a flat subperiosteal separation of the lamina, but in the intricate protrusions, subperiosteal separation is simply not possible.

Before entering the spinal canal, an ordinary high-frequency electric knife is used, and before the knife, Yang Ping checks whether the various connections are appropriate, and the use of the electric knife is very particular and there are certain safety rules.

The fixed point of the electrosurgical wire on the sterile sheet cannot be used to wrap the instrument, and many doctors prefer to use the winding method.

Because of the coupling phenomenon, the working cable or the electric knife will transmit energy to the adjacent cable or metal instrument, if the electric knife pen is wound on the fluorescent lamp tube and the electric knife is started, it can light up the fluorescent lamp that requires 220V voltage, so if the electric knife cable is wound around the vascular clamp or other instruments to fix, it is easy to cause the vascular clamp to heat up and cause danger.

"Anesthesiologist, the concentration of oxygen for the patient?"

“30%！“

It seems that anesthesiologists also have knowledge in this area and are very aware that if the oxygen concentration is higher than 40%, there is a risk of burning the patient with the use of electric knife.

Once everything is settled, the operation begins.

The tip of the electrosurgical unit begins to extend outward from the lamina, and begins to perform subperiosteal separation on the complex transverse process, upper and lower articular processes, and pedicles, which is a real subperiosteal dissection.

A real subperiosteal dissection with an electric knife is complete and does not bleed, and the operation looks very comfortable.

Soon, from neck 4 to neck 6, the posterior vertebral plate, transverse process, and articular process have been completely revealed, and the attached muscles are covered with gauze, and then pulled to both sides by the hook.

The next step is to open the window, the vertebral plates of the three vertebrae must be opened, because only by opening the window can the tumors, spinal cord and nerve roots in the spinal canal be exposed from the back side through the window, and the tumors around the nerve roots can be removed, and the cleaning of the intervertebral foramen also needs to be carried out from this window.

In surgery, revealing is a profound science, and doctors who don't know how to reveal it will bury their heads in it for a long time and can't see where the target of the operation is, or even if they can see the target of the operation, they will feel very aggrieved by the operation.

This is the same surgery, why some people do it easily, others do it so difficult, and exposure can also be an important factor.

There are more and more people in the operating room who are unconsciously observing, these people are all from the heart surgery department, just now Yang Ping came gently, walked gently, and when they woke up from their confusion, they knew how superb the level of surgery was shown in these few minutes.

The operating room of the orthopedic department is different, and a screen that can be broadcast live has been installed, which is for teaching, so that the doctors in the audience can see the details of the operation at any time, otherwise they are all gathered around the operating table, which increases the risk of contamination to the operation, but nothing can be seen.

It's different with an LCD screen connected to the camera on the surgical light, every detail of the operation is transmitted to the screen by the camera.

At this time, a faint wisp of smoke drifted across the screen, which was captured and carried away by the attractor.

The smoke produced by these electric knives has a good name - aerosols, scorching smoke or diathermic plumes, this layer of smoke not only interferes with the vision, but also poses a threat to the health of the doctor, so it must be removed in time, generally using a suction device, and a more advanced method is a special smoke trap.

Liang Fatzi once did a study, the average daily smoke produced in the operating room is equivalent to the smoke produced by the combustion of 27~30 cigarettes, which contains a large number of ultrafine particles, the particle concentration can reach more than 3×108/m3, and 95% of the particles are aerosols with a particle size of less than 5μm, which are difficult to remove after entering the alveoli, and long-term inhalation can cause bronchiolitis, emphysema and pulmonary fibrosis and other diseases.

This is not the most important thing, the most harmful is that surgical smoke contains more than 600 harmful chemicals, which are mainly divided into three categories: polycyclic aromatic hydrocarbons, volatile chemicals and volatile organic compounds.

Polycyclic aromatic hydrocarbons (PAHs), including benzopyrene and anthracene, are a class of carcinogenic and teratogenic substances and are genotoxic.

So as a surgeon, you must know that exposure to smoke is a harmful thing to your health, and try to find ways to reduce your exposure.

Entering the spinal canal, the electric knife was replaced with a sharp knife, and the forceps in the hand were also replaced with bipolar electrocoagulation.

Separation within the spinal canal will be performed against the nerve root, and the heat of the electric knife can easily cause thermal damage to the nerve root, but the sharp knife will not.

The sharp knife is in Yang Ping's hand, in different postures, and the tip of the knife can remove the tumor around the nerve root from any angle.

It's just that the tumor has completely wrapped the nerve root, how to liberate the nerve root from the compression of the tumor, when everyone is thinking about this problem, in the surgical field, the nerve root has been revealed.

Under the squeeze and ravages of the abominable tumor, the nerve roots have lost their original luster and elasticity, and the original fullness and roundness have long since ceased to exist, and have been replaced by flat concaves.

Song Yun, as an assistant, was a little dazzled by the sharp knife in Yang Ping's hand, if it weren't for the tumor removal in this machine today, Song Yun still didn't know that an ordinary sharp knife that could no longer be ordinary can be played like this, how flexible this instrument is.

"Professor, do you have a name for how you hold a knife? How come I've never seen it in a book? Song Yun couldn't help but ask.

In fact, if it weren't for this special surgery, Yang Ping would not have been forced to use this kind of self-created technology outside of textbooks.

When he practiced this knife technique at that time, Yang Ping didn't think about choosing a name, so he casually took a name: "Flower knife!" The tip of the knife is at an optimal angle at all times, especially for complex anatomical areas. ”

Flower knife, a knife flow has not been mastered, and now there is a flower knife stunt, which is to live to learn from the old.

Song Yun remembered the name, and he didn't have time to see how the scalpel was transformed in Yang Ping's hands, because he had to concentrate on being a good assistant.

"True subperiosteal dissection is easy to do in the long bones of the limbs, but it is difficult to do it in complex vertebrae, only the vertebral plate is relatively flat, and it is easy to do subperiosteal dissection, and the complex anatomical site of the intervertebral foramen is almost impossible to do, but subperiosteal dissection is the safest, so you must master the all-terrain subperiosteal dissection for orthopedic surgery."

The sharp knife continues to go along the nerve root, and begins to come to the intervertebral foramen, the tip of the knife is attached to the bone separation, and the complete periosteum is constantly opened, the so-called subperiosteal dissection is actually to remove the tendons and meat from the bones, and to remove the tendons and meat as a whole, and the bones are not sticky to a little tendon and meat, which is the qualified subperiosteal separation, that is, from the periosteum and the bone to separate them completely.

The tip of the knife actually circles in the elliptical foramen of the intervertebral foramen, wraps it in little by little, and then continues to separate on the exit side.

"Professor Yang is busy."

"I'll just take a look."

The operation of cardiac surgery has ended, and in the interval between the receptions, Director Wen took Director Zhang over to see Yang Ping, the guy who completed the coronary artery bypass in a few minutes is actually an orthopedic surgeon.

There are also a lot of people in the operating room, and the two bigwigs did not find a suitable position, so they could only observe the screen from a distance.

The young doctors were so focused on the operation that no one noticed anyone coming in.

Several intervertebral foramina, each of which was peeled off in this way, and then began to peel off the extradural tumor, except for the tumor inside the spinal cord, Yang Ping planned to clean up the tumor in the spinal canal, and only by cleaning it up could the effect of complete decompression be achieved.

There is no obvious dividing line between the tumor and the dura, but Yang Ping still found a potentially invisible dividing line.

The tumor in the spinal cord has not moved, and the tumor outside the dural sac, especially the nerve root tumor responsible for pain, has been peeled clean, and even the intervertebral foramen has been peeled clean, and the nerve root access appears to be very loose.

Theoretically, the nerve roots have been liberated from the compression of the tumor, and the pain will be relieved, but no one knows exactly what the effect will be, and there are too many uncertain things in medicine.

As long as Yang Ping is willing, the tumor in the spinal cord in this case can also be cleanly cut off, but it is completely meaningless to do so, and it is useless to increase the possibility of high-risk paralysis.

Surgery is a means, definitely not an end!

"You go for surgery, I'll take a look over here."

"Then I'll call you again at dinner?"

Director Zhang was attracted by the operation and planned to stay and see the operation again, but Director Wen couldn't get out of his body and had to return to his operating room.

The scalpel on the screen is so flexible that it can be peeled off from different angles, as if the hand holding the knife can move 360 degrees, just like the robotic arm of a surgical robot.

Director Zhang couldn't help but be curious and turned to the operating table to take a look, this knife was dazzling, and he couldn't see how to hold it, how it was so flexible.

What kind of knife grip is this, and how have you never seen it?

As a senior doctor, what posture of holding the knife is perfect, holding the pen, holding the bow, grasping, and reversing, I have never seen this posture of holding the knife, which can be reversed or smooth, left or right, up and down, this young man is really unusual, and even holding the knife is different.

Director Zhang was very careful, he stared at Yang Ping's hand, and then went to the shelf to take a pen, held it as it was, and experimented with it, it's really like that, flexible when it should be flexible, stable when it should be stable.

The anesthesiologist stared at Director Zhang, who was a little embarrassed and smiled.

The anesthesiologist pointed to the pen in his hand: "This is my pen, I want to record something, can you give it back to me?" ”

PS: I'm a little busy today, and I've sent a little less, forgive me!