Start as an Emergency Physician

The removal of the omentum is relatively easy, but it is a test of strength, especially when it comes to separation, as a failure of separation can lead to rupture of blood vessels or tissues.

After easily separating the omentum from the transverse colon, Zhou Yuan began to separate the transverse mesocolon.

It is important to note here that the transverse mesocolon is easily detached.

"Electric knife, blunt separation. Zhou Yuandao.

Blunt separation?

Everyone, including Jiang Xiaoqi, frowned.

However, because Zhou Yuan was concentrating on separation, everyone did not express the doubts in their hearts.

I saw Zhou Yuan pick up the uncharged electric knife head, carefully cut the transverse mesocolon left and right, and then put down the electric knife, separated the gastrointestinal ligaments in turn, and performed gastric omentectomy in parallel.

After all this was done, Jiang Xiaoqi coughed lightly.

"What's the matter?" Zhou Yuan guessed.

"Why did you choose to use an uncharged electric cutter head for blunt separation? Jiang Xiaoqi asked.

He Jianyi was also a little curious: "Sharp separation has the least damage to tissues, why did blunt separation be chosen?".

Zhou Yuan explained: "The uncharged electric cutter head is not sharp, and using it for separation can save time, and in addition, it can ensure that the separation plane is advanced in parallel, avoiding tearing the mesangium due to uneven force." Many doctors choose to use a sharp scalpel to separate, which is naturally prone to problems. "

He Jianyi and Jiang Xiaoqi glanced at each other, and they both saw the shock in their eyes.

"Stunned... What are you doing in a daze, Ocean, write it down in a notebook!" He Jianyi shouted.

Haiyang hurriedly took out a small notebook with "Senior Brother Zhou Yuan's Special Experience Book for Surgery" written on it, and brushed it up.

Several people present were extremely excited.

That's the benefit of having surgery done with a specialist.

In textbooks, you can only learn that the uncharged electric cutter head is blunt and not sharp, and what are the advantages and disadvantages of mixed cutting and pure cutting.

But, with an expert, he will be able to let you know when to do what to do, when to go high and when to turn up the output power.

"Next is pyloric vascular ligation. "

Zhou Yuan cut the peritoneum at the lower edge of the duodenum, exposing the pancreas.

In the surgical field, it is clearly visible that there is an upward bulge on the surface of the pancreas, and the tip of the bulge is the root of the right omentum blood vessel.

This is a marker used to tell the arteries and veins, and some experienced doctors often use it to distinguish between them. It is the artery that walks up along the bulge and the vein that goes down.

At the top of the bulge, the right omentum vein and the right colonic vein converged into a trunk, and Zhou Yuan carefully ligated it with a seventh-wire line.

"Scalpels, scissors. "

Hearing the apparatus, the ocean asked curiously, "This time you want to be sharply separated?".

Zhou Yuan nodded: "The separation is the subpyloric lymph node, which needs to be carefully cut here, otherwise it will be difficult to separate successfully." "

Zhou Yuan slowed down his movements, increased his force slightly, pulled the tissue to the sides to make it tense, and then used a scalpel to make a vertical and short cut along the tissue gap.

In some places where the tissue gap is very small, Zhou Yuan replaced it with surgical scissors, and used the tip of the scissor to penetrate deep into the tissue gap, open the scissor handle, separate the tissue, and then cut it open.

He Jianyi and the others widened their eyes.

Whether it is separated or cut, Zhou Yuan's movements are textbook-level, they are simply art!

"In the future, can I often come to be the second assistant?" Jiang Xiaoqi swallowed and said.

Sun Meng's big eyes refused to blink: "I want to come too, I'll just be a fourth assistant." "

Zhou Yuan did not notice the conversation between the two, and after completing the separation, he found the lower edge of the duodenum, stretched the duodenal wall to the right, and ligated the right omentum artery at the root.

"Damn... And still like this!".

At this time, Haiyang finally understood why Zhou Yuan wanted to separate the duodenum, instead of cutting it off directly.

In doing so, the dense subpyloric vein is directly avoided, reducing the risk of surgery!

"The next step is to cut off the duodenum. Zhou Yuan said.

Without waiting for Zhou Yuan to speak, Haiyang immediately handed over the non-traumatic intestinal forceps.

Zhou Yuan smiled, it seems that the ocean has kept up with the rhythm.

Zhou Yuan moved his stiff neck and re-engaged in the operation.

About 2.5 cm from the prepyloric vein, Zhou Yuan clamped the duodenum with an atraumatic intestine.

"Kocher pliers. "

Kocher forceps are toothed vascular forceps, and their use is as the name suggests.

After Zhou Yuan took it, he clamped the Kocher forceps on the proximal end of the duodenum.

Next, the duodenum was easily cut between the two forceps.

Zhou Yuan was just about to stretch out his hand, and Haiyang immediately handed over the hemostat with a smile on his face: "You want this, right?

Zhou Yuan's face froze, "Yes." "

After receiving the hemostat, Zhou Yuan began to separate the fibrous tissue between the posterior wall of the duodenum and the head of the pancreas.

"Zhou Yuan, how do you choose now?" He Jianyi couldn't help but ask.

The time to choose which gastrointestinal reconstruction to use, in the case of jejunal gastric replacement, then the duodenal stump should be sealed. In the case of interlinear jejunum-duodenal anastomosis, the duodenal end should be preserved for later anastomosis.

The choices made will directly affect the patient's digestion and quality of life.

Everyone, including He Jianyi, focused on Zhou Yuan.

———

The eighth shift is sent, and the ninth shift begins!

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