The Godfather of Surgery

About 1400 grams of brain, hundreds of billions of cells, various electrochemical signals are transmitted at all times, the conduction mode and route are very complex, and the structure is far more complex than our most advanced chips.

The thumb-sized brain stem is located in the deep part of the human brain and controls the heartbeat and breathing of the human body. It is densely populated with the most important nerve nuclei and conduction tracts, and the vertebrobasilar artery that supplies blood to the brain also passes through here.

In such a dangerous and complicated narrow area, the surgical space is often within a minute.

On the other hand, Lao Feng's tumors are complex tree roots with intertwined roots. They meander in the cracks between these nuclei and conduction bundles. Some of them are adhered to the nerve nuclei, regardless of you or me.

Among them, the tumor is most closely adhered to the dorsal nucleus of the vagus nerve, and if the scalpel is slightly deviated, breathing and heartbeat will stop.

Professor Feng's spontaneous breathing was suppressed by anesthesia, and the ventilator took over Professor Feng's breathing at a frequency of 20 beats/min, while the heart rate was maintained at about 70 beats/min under the control of the anesthesiologist.

Unlike spinal orthopaedic surgery, this kind of surgery can’t be fast-tracked to the end. Yang Ping stopped one step at a time, instructed the equipment nurse to prepare the next equipment in advance, and explained the points for the assistant to pay attention to.

Under the microscope, various structures are magnified and appear clear and fine. The laser knife accurately cuts and separates, and the tiny thermal effect shrinks the tiny blood vessels to stop bleeding while cutting without damaging the surrounding tissue.

The dexterous and thin laser head, compared with the blade scalpel, will not cause compression to the surrounding tissue, and is more suitable for operation in a small space.

The knife incised along the posterior median sulcus, extending from the medulla oblongata of the head to the cervical spinal cord of the upper cervical vertebra, the arachnoid membrane was incised, the pia mater was incised, and the soft tofu-like gray-white brain tissue was incised slowly by the laser knife. Split slowly.

Go deeper little by little, the straight line of each repetition does not have any deviation, and the route is always coincident with the anatomical gap. This kind of operation in the tissue gap is a safety guarantee.

After the bloodless operation was carried out to the end, the love for the tissue was inexhaustible, and the tumor showed a trace of outline.

Yang Ping began to separate the tumor. The tumor and the normal tissue grow staggered, without a capsule, and there is no boundary at all.

However, Yang Ping could find the boundary of their mutual penetration. With the separation of the laser knife with a precision of 0.1 mm, Professor Feng's vital signs remained stable for the time being, and the wavy line of the ECG monitor showed a normal curve.

"Without using fluorescence imaging?" Johanneson was surprised.

In order to confirm the boundary between the tumor and normal tissue in this type of surgery, a special fluorescent imaging agent is routinely injected into the patient before the operation, and then the microscope is turned on in the fluorescence mode during the operation.

The surgeon can clearly distinguish tumors with fluorescence imaging from normal tissue without fluorescence imaging, and then perform precise resection under the navigation system.

It is a pity that even if it has developed to this point, the success rate is still less than 1% in the face of a tumor like Feng Lao.

"Not using a navigation device either?" Johanneson couldn't understand.

Without the help of these two techniques, this operation would not have been possible, let alone the success rate.

Professor Fu of Magic Six Neurosurgery was also very surprised. When discussing the surgical plan, Yang Ping did not mention this point. Everyone thought it was a routine thing and no need to mention it, but now from the perspective of surgery, no fluorescence was used. Visualization, and no navigation equipment, what's going on.

The doctor graduated from Tiantan Hospital, and his supervisor is a top neurosurgery expert in the country. Under the careful guidance of his supervisor, he has also become a first-class neurosurgery expert in the country.

"We didn't use fluorescent imaging agents?" Wen Rentao also noticed and reminded.

Yang Ping answered while operating: "No, the fluorescence imaging under the microscope will interfere with my judgment. Although the navigation is accurate, the CT image as a guide is only an indirect image, which is of little significance to me."

For Yang Ping, he has performed countless operations and anatomical studies in the system space to obtain real tumor anatomical images, which are far more accurate than fluorescence imaging and navigation.

For ordinary people, even top experts like Johanneson, fluorescence imaging and navigation are necessary, but for Yang Ping, it will become a burden.

The faint flickering fluorescence will affect Yang Ping's visual judgment during the operation, which will interfere with the comparison of the anatomy during the operation with the pictures of his brain.

The picture in his mind far surpassed any fluorescence imaging.

The picture in his mind, which was condensed by thousands of Professor Feng's pictures, was more accurate than any visualization and navigation.

Because, countless anatomical studies have allowed him to easily identify tumors and normal brain tissue with the naked eye.

Doubts are turned into doubts. Both Johanneson and Professor Fu are guessing that Yang Ping can make such a strict surgical plan, and several cardiac arrests will be taken into account when he interferes with the nerve nucleus during the operation. It is impossible for these foundations Sexual things are not considered.

Yang Ping must have a better way to complete the operation, and then he will abandon the technical means necessary for ordinary people.

The fine gun-shaped double-click electrocoagulation forceps are reliable microscopic forceps when there is no need for hemostasis and electrocoagulation. When combined with the laser scalpel, the outline gradually becomes clear, and the deeply buried tumor emerges.

Wen Rentao and Zeng Ran were sitting next to the hook. Wen Rentao was also in charge of suction, but the suction device in his hand did not work. So far, there has been almost no blood in the operation.

The blood vessels in the brain tissue are clustered and interlaced. The laser tip can operate in the space between the blood vessels. Even the small blood vessels that must be damaged are coagulated in advance.

Double-click coagulation can precisely hold the end of the blood vessel, and perform coagulation to stop bleeding with minimal energy.

The separation of the nucleus and the space is very fast, very fast, approaching the vicinity of the dorsal nucleus of the vagus nerve, a root of the tumor, almost surrounding it, forming a tight adhesion.

Yang Ping stopped, gently put down the equipment in his hand, and rested for a while.

The next step is to separate the adhesions between the nerve nuclei and the tumor. This adhesion is so tight that it is almost indistinguishable. This is the anatomical basis for such a low surgical success rate.

Yang Ping picked up the instruments again, adjusted the two instruments in his hands, and rediscovered the best feel.

Which are tumor blood vessels, which are normal blood vessels, which are tumor tissues, which are normal tissues, where are their safety gaps, and where are the true boundaries of tumors.

Relying on the pictures in the brain, precise guidance is carried out, the pictures are turned into instructions of the brain, the instructions are transmitted to the hand, and the hand controls the laser head.

Compared with ordinary scalpels, the slender laser head is more efficient in complex and narrow anatomical spaces.

Professor Zhang did not go to observe the conference room, but walked back and forth at the door of the operating room. Han Jiangong and Hong Zhigang stood at the door of the operating room, and no one spoke.

Operations in other departments were also started one after another, and some doctors came over on purpose to take a look here and know that Professor Feng's operation was being performed inside.

The 0.1mm focal point of the laser knife has no mechanical collision with the tissue, and it is very easy to use.

The instrument has an accuracy of 0.1 mm, but in the hands of the doctor, it is very difficult to maximize the accuracy of the whole process, which requires the hand to be very stable and not subject to any interference.

Because the human hand does not appear to be shaking, there is actually shaking.

This is the reason why the picture shakes when taking pictures with super long-range telephoto.

The trajectory of a 0.1mm scalpel in accordance with human will will inevitably deviate. Even if a simple straight line is viewed with a magnifying glass, there is no way to maintain an accuracy of 0.1mm all the time.

"The separation of tumors is very precise. Does their microscope have some special function that can distinguish tumors and navigate?" Johanneson couldn't believe that this was performed without the aid of fluorescence imaging and navigation.

Griffin shook his head: "If there is such a device in the world, it shouldn't be that we don't know."

The operation went into the vicinity of the nerve nucleus. From the knowledge of anatomy, Johannesson made a judgment, and the ballet on the tip of the knife officially began.

Judging from the images, it will be a delicate operation of life and death.

To the naked eye, it is almost impossible to distinguish tumors from nerve nuclei.

But the scalpel did, and began to separate between the tumor and the nerve nuclei, with even 0.1-millimeter precision, even the slightest thermal damage would interfere.

If you switch to a mechanical scalpel, the interference and damage will be greater.

"It's tossing on the tip of a knife!" Griffin tightened his heart.

"Have you seen The Thief?" Johanneson's heart began to beat against his chest wall.

"Seen!"

"Johnny Utah was free climbing at Angel Falls when his partner fell and shattered."

"Dr. Yang can't make mistakes, not even once."

"However, even if he doesn't make a single mistake, there will be several falls, and once he falls, he has to grab a stone again in the fall and continue to climb."

A few falls are the several cardiac arrests that will occur during the operation.

"I am now preparing to enter the first death zone for separation, Professor Ma, please pay attention to the ECG monitoring and evoked potential monitoring, and report to me at any time. Once ventricular fibrillation occurs, the sterile sheet covers the surgical area, and the torso is lifted to the Shoulders, remove the back ECG monitoring electrodes, and complete the electrical defibrillation as quickly as possible, remember, we only have five seconds, do you understand?"

"Understood!" Everyone knew their position and explained the drill repeatedly before the operation.

Dr. Wu sent from the ICU, the instructor of emergency technical training in the entire Magic Capital, is responsible for electrical defibrillation and pushes the defibrillator near the operating table.

Yang Ping took a deep breath, and the laser knife began to separate the adhering tumors and nerve nuclei. The brutal training of the devil made Yang Ping's psychological quality and the stability of his hands like a powerful machine.

But Yang Ping has human tactile feedback and mental adaptability that machines don't have.

The laser knife began to enter the brink of death, with an accuracy of 0.1 mm, there should be no deviation, a little deviation, damage to the nerve nucleus, even a little bit, will bring about cardiac arrest that cannot be resuscitated.

The atmosphere of the entire operating room was condensed to the extreme, everyone was concentrating on it, and all the energy was concentrated to a subtle point.

The tip of the knife goes deep little by little, along the edge of death, the 0.1 mm life and death curve is separated.

"Sudden drop in heart rate, 30 beats/min, blood pressure 40/20mmHg—"

"1 mg of epinephrine, static push, withdraw the surgical instruments, cover the surgical area, and prepare for defibrillation!"

The rescue medicine was injected through the intravenous channel, the folded sterile sheet immediately covered the operation area of ​​the head and neck, the sterile sheet of the trunk was lifted, and Feng Lao's entire back was exposed, all the way to his shoulders.

Everyone performed their duties, and the team cooperated seamlessly. After the anesthesiologist pushed the medicine, he stared at the monitoring screen.

After the normal ECG wave, suddenly, a ventricular fibrillation wave appeared, and then covered the entire screen.

Ventricular fibrillation - a fatal arrhythmia, a type of cardiac arrest.

"Cardiac arrest - ventricular fibrillation!"

"Trans Defibrillation!"

The lead and electrode pads connected to the ECG monitor were quickly removed by the circuit nurse. Almost at the same time, the cathode of the electrode pad in the right hand of the ICU doctor was pressing against the lower back of the right scapula, and the anode pad of the left hand was pressing against the midaxillary line of the fifth intercostal space on the left. Defibrillation was performed at 200J.

"leave!"

Everyone is out of contact with the operating table.

Discharge, the only straw in life was caught, a defibrillation was successful, and a familiar wavy line appeared on the screen of the defibrillator.

This is the wavy line of sinus rhythm, the wavy line of life.

Everyone mentioned the heart in the throat and slowly put it down, but the heart in the chest was still beating violently.

In case of cardiac arrest during the operation, no one is sure that it can be rescued, not to mention that the nerve nucleus is disturbed, and medical research on the brain is still very shallow.

Only Yang Ping calmly looked at the recovered ECG: "Reconnect the ECG monitor!"

"Sinus rhythm, heart rate 50 beats/min, blood pressure 90/45mmHg." The anesthesiologist reported that 1 mg of epinephrine was intravenously pushed again. Later, heart rate 60 beats/min, blood pressure 100/60mmHg.

Yang Ping observed for a few minutes and confirmed that he was out of danger: "Add disinfection, add sterile sheets, change surgical gowns and gloves, be careful not to contaminate the operation area, and continue the operation—"

Wen Rentao admired Yang Ping's calmness and calmness. At this time, the main sword is the belief of the team members.

"One can never step into the same river twice."

Yang Ping has studied and simulated countless times in the system space. However, the state of the patient and the system space cannot be exactly the same.

Therefore, Yang Ping did not dare to relax at all, and made analysis and judgment based on the current state at any time to make the most favorable decision.

"The heartbeat center is disturbed and the regulation is disordered. It must be cardioverted within five seconds. Each time, we only have five seconds."

Because the sterile sheet on the torso was opened just now, someone has been contaminated and needs to be re-swiped to go to the stage, and the sterile sheet on the stage must be re-applied once.

Let's all sit down and proceed with the operation.

There are three chapters today, more than 10,000 words, and there are two more chapters to come.