The holidays are short and the Iris Clinic is back to normal business again.

Many customers who came to the clinic expressed their appreciation for the new look of the iris clinic!

After questioning Zhou Qiao, Rachel transferred a patient to Murphy, a 25-year-old breastfeeding mother, who was diagnosed with acute appendicitis.

If it is chronic, simple or mildly purulent, not too serious, and does not recur, as an internist, she can prescribe some medicine and just put pressure on it, but now it is acute, causing fever, nausea and vomiting, and severe pain in the lower abdomen, surgery is the fastest and most stable way!

Rachel's admiration for Zhou Qiao now naturally has nothing to say, she has never seen a 23-year-old visiting professor at the University of California in her life.

As for Murphy, after the last congenital diaphragmatic hernia surgery, Rachel also sincerely appreciated it!

She often feels lucky, fortunately she is an internist, and she is more qualified, for many years, if she is a surgeon and competes with Murphy on the same stage, it is estimated that she will be very stressed, and she will worry about being pressed by her when she sleeps!

Murphy cut her hair short, natural chestnut hair, no need to highlight it, like satin, with a white face and delicate facial features, Elena gave her a nickname, called "Iceberg Little Hepburn".

"Iceberg" means that she has a cold temperament, and her lonely look outside the world always rejects people.

Needless to say, "Little Hepburn" is beautiful, even if Elena likes it, I can't help but want to reach out and pinch it!

Even taking advantage of Murphy's inattention, Elena secretly kissed her, making Murphy, who was expressionless, very rare to show a little embarrassment!

Murphy rarely has this kind of intimacy with people.

Every time Elena teased Murphy, Zhou Qiao was hot!

The patient was given painkiller injections, and then a list was prescribed for the other party to go for a preoperative examination, and at the same time the other party was told to strictly abstain from food and water.

The mother was accompanied by her husband, but the child was not brought and sent to the grandmother to take care of her.

Because I had to have surgery and used a lot of drugs, I stopped breastfeeding and asked my grandmother to feed her formula.

Infant milk powder in the United States, Zhou Qiao also often pays attention to the price, it is indeed cheap, more than a dozen dollars a can, it will be sold in China for hundreds, and what you buy in China is not necessarily genuine.

It's not that he wants to eat it himself, but now that it's been a long time, everyone knows that he is in the United States, and he always sends him a message through various methods, some send him a message directly, some convey it through his old father, and some send a small contact through the same village, asking him to mail milk powder!

Zhou Qiao was very helpless, because these things took up a lot of his time, so he was a little unfamiliar, so he directly refused, but the kind that really couldn't be pushed, so he had to work hard by himself, what price to buy, plus the freight, and he didn't make much money from the other party.

His clinic is now very profitable, and he can't look down on the middleman price difference of this milk powder. And it's a relative, and the old father doesn't look good on his face.

After Murphy drew up the surgical plan, he came to Zhou Qiao and asked him to help take a look.

"Single-port transumbilical laparoscopic surgery...... Scar physique ......" Zhou Qiao carefully flipped through it and nodded.

In terms of the surgical plan alone, I can't find any major problems.

As for doing a single hole, it was because the patient took the initiative to ask for it, and the other party had a scar constitution, and as soon as he heard that he was going to have surgery, he immediately broke the defense, and begged Murphy if he could make the knife a little smaller, because the scar from her last caesarean section was still there, and it was very big, and it was a huge ugly!

She didn't want a few more hideous scars! A multi-hole laparoscope requires 3-5 holes, which she is completely unacceptable!

Murphy told her that she only needed to make a small hole of about 1.5 cm in the belly button, because there were already wrinkles there, and it was basically impossible to see that the knife had been used afterwards with cosmetic sewing!

Since Murphy had never practiced appendectomy before, while he had time, Zhou Qiao pulled her and rehearsed it several times with clay figurines until Murphy reached the specialization level.

When it was time for surgery, the group arrived at the community hospital.

Single-port laparoscopy is also a tertiary operation, and requires general anesthesia, and the operating room conditions of the iris clinic are not enough, so it is still borrowed from the community hospital.

Compared to the University of California Medical Center, the operating room rental fee in a community hospital is much cheaper, and for a minor illness such as appendicitis, it is naturally the first choice for community hospitals.

Andre with an appointment with an anesthesiologist, the patient is in a supine position, and the combined anesthesia is suctioned.

Time out, the surgery officially began.

The first song Ava chose this time was "Rolling Yangtze River East Passing Water", I have to say that every time Ava can surprise Zhou Qiao.

Andrei gave a thumbs up, this song is good! Although he doesn't understand! But he likes that kind of majestic and tragic style!

Murphy turned a deaf ear, his blue eyes turned lightly, the virtual 3D modeling was turned on instantly, the holographic 3D image was displayed, and the knife was moved!

The surgical instrument is a laparoscope, multi-functional laparoscopic puncture sheath produced by Stryker in the United States, and a single-hole laparoscopic instrument package from Cambridge (including a series of disposable rotatable wrist instruments, that is, in a straight state, enter the puncture sheath, enter the body cavity, and then rotate and bend into different angles or arcs as needed, and then lock, there are 7 degrees of freedom of operation can be switched at will).

An arc-shaped incision of about 1.5 cm on the right side of the umbilicus was placed, and a multi-functional puncture sheath was inserted, and the pneumoperitoneum was established through the puncture sheath pneumoperitoneal tube.

Pneumoperitoneum, simply understood as inflating, usually carbon dioxide, blows the stomach up to make room inside.

Carbon dioxide is an inert gas, and if oxygen is used, there may be sparks during surgery and it will explode~

In addition, if carbon dioxide is used, the human body can absorb it, it is easy to be excreted through the lungs, and hypercapnia is not easy to occur.

If oxygen or nitrogen is used, it is not easy to absorb and discharge, and if the pressure is too high, the gas enters the broken blood vessel and there is a risk of gas embolism!

Zhou Qiao, with the assistance of the mirror bracket, can operate five holes with one hand, although Murphy is not as high as Zhou Qiao's realm, but it is not a problem to operate this single-port laparoscope with both hands.

Zhou Qiao is not so much an assistant as a guide to prevent accidents from happening.

Murphy moved his hand lightly, adjusted the pneumoperitoneum pressure to about 12mmHg, maintained it, and placed the laparoscopic lens through the 10mm hole (this is not an incision, but a hole in the multi-functional puncture sheath), and explored around the circumference to change the position of the head down and the right side of the body elevated.

The appendix is a very special part, some people are large, some people are small, some people still look strange, and some people have double appendixes.

Murphy followed the colon to find the confluence of the three colonic bands of the cecum, and then gently lifted the cecum upwards!

"Huh~" Murphy couldn't help but sigh.

Because, according to what she has learned, as well as Zhou Qiao's teaching, it is usually at this time that the appendix will appear!

Now, everything is ready, and I also carry the ultrasonic knife to kill the "appendicle" lair, but the "appendice" is not in the "lair"!

Murphy probed again, searching, but after several searches, there was no appendix.

She couldn't help but wonder if she had misdiagnosed? After all, this patient was transferred to her by Rachel.

However, she looked at the patient's examination report and confirmed that it was acute appendicitis.

"Could it be that the other party has a previous medical history and the appendix has been removed? However, if it is removed, how can it be diagnosed with appendicitis? ”

"Or is it a congenital loss of the appendix?"

Even a genius like Murphy can't help but be a little confused.

Zhou Qiao slapped his thigh slightly, this was his negligence, because this situation was rare, and he didn't expect the patient to be in this situation, so he forgot to tell Murphy.

"Fei Fei, the appendix is wrapped inside." Zhou Qiao said softly.

Murphy was stunned: "What the hell is Fei Fei?" Is it my new nickname? ”

Somehow, her heart was slightly sweet, she nodded, and she manipulated the ultrasonic knife to gently slash on the serous membrane!

Suddenly, an inflamed and swollen appendix hiding inside popped out weakly and helplessly!

Not only Murphy breathed a sigh of relief, but even Elena and Ava breathed a sigh of relief.

The three little ones looked over with adoring eyes.

System: "Murphy's opinion +1, Murphy's current friendship is 89!" ”

Ava pursed her lips and said in her heart that although Murphy is powerful, he still needs Joe's guidance from time to time! Hmph, she's nothing without Joe.

She has a lot of opinions about Murphy recently, because Murphy cut her hair short, and after her sister's dress, she became more and more beautiful, and Zhou Qiao peeked at Murphy more often, but what made Ava depressed was that her sister didn't realize it at all, and she was so familiar with Murphy all day long.

In fact, even if she leaves Zhou Qiao, if there is a good platform and Murphy is given a few years to grow, her achievements are absolutely amazing! It's just that she doesn't have a better platform now. It is impossible to have a platform that can be better than Zhou Qiao's side!

There are so many surgeries, and you can also perform the main surgery, and there are master-level or ceiling-level technical guidance!

Once you've found the "Appendicle", it's a lot easier!

The biggest advantage of this "appendix monster" is that it is hidden, and if it is discovered, it is nothing!

Murphy's level of specialization is more than enough to deal with it!

The appendix is carefully peeled out, its adhesions to the surrounding tissues are completely separated, the avascular area of the base of the appendix is penetrated, the root of the appendix is clamped with ligation nails, the appendix artery is separated, and the ligation nail is ligated.

After that, the hand is raised and lowered, the appendix is cut and removed, the hole is sutured, and the operation is over.

Murphy thinks that this ultrasound knife is weirdly easy to use!

In fact, in the previous traditional laparoscopic surgery, high-frequency electric knife was used for separation, cutting, hemostasis, etc., but ultrasonic knife obviously has more advantages, so it is now more and more widely used, and the surgical efficiency is also greatly improved.

Although the whole operation was delayed for a while, the total length of the operation did not exceed 20 minutes. It's fast.

After observing many times, the average novice does this for the first time, because he is not skilled, at least more than forty minutes, and some clumsy ones even need sixty minutes.

Thanks to the "Devil Pillar" for sending Luo Ya's chicken legs and blades.

(End of chapter)