The Godfather of Surgery

David Hawley got out of the cabin, checked the MDM, couldn't fix it, just replaced it.

Fortunately, Russia's Soyuz rocket is extremely powerful and unambiguous. It completed the docking in three hours and forty minutes and completed a space express mission.

Finally, David Hawley and the Russian astronauts, relying on the safety rope, completed the spacewalk, replaced the electrical components, and the power system was guaranteed.

The whole process took a full five hours.

The stable voltage makes the control of the robotic arm without the worry of downtime.

The operation can continue, but there is not much time left for Yang Ping.

On the angiogram of the whole cerebral blood vessel, the microaneurysm has expanded to its limit and burst at any time. The second one has begun to expand rapidly, and the third one is also looming.

IBM's Wall is not wrong, there is indeed a second aneurysm, Yang Ping is even more right, the third is already looming.

"According to the speed at which he entered the vascular network in the brain for the first time, it took at least half an hour to solve an aneurysm. Now there are three, and the time is not enough." Johanneson was also worried. After all, there are three now and need to be solved at one time.

Left femoral artery, right femoral artery, left radial artery, three arteries at the same time puncture! Yang Ping ordered Susan to change the equipment.

Puncture at the same time? Is this going to put three guide wires in at the same time? how can that be possible.

Massimo looked at the screen and then looked around the hall, surprised that he was not alone.

But Yang Ping's voice on the radio is like this: puncture from three parts, and put three micro guide wires at the same time.

At the same time, the three guide wires shuttle through the human blood vessels, enter the intracranial vascular network, and finally reach the target arterioles.

This requires the operator to be very familiar with the patient's intracranial vascular access, tens of thousands, hundreds of thousands, millions of blood vessels, how to intertwine, how to bifurcate, and how to make a circuit. No one's anatomical knowledge can do this.

The surgical robot has four robotic arms, and only two robotic arms are needed to complete the intervention.

If the three robotic arms operate at the same time, the operation time is short, and the operation risk is minimized in a sense.

But three guide wires enter at the same time, which is a fabulous operation.

In interventional surgery, there are also two guide wires, such as the double guide wire technology for cardiac intervention, but it is completely different from the current three-pronged approach.

In cardiac intervention, there is a double guide wire technology. For example, during percutaneous coronary intervention, a 0.36 mm coronary guide wire is placed along the first coronary guide wire, which can stably guide the catheter. , to help the balloon and stent pass through the lesion, which is the companion wire technique.

In the process of percutaneous coronary therapy for bifurcation lesions, in order to protect the coronary branch vessels, a coronary guide wire is placed. After the stent is released, the guide wire between the vessel wall and the stent is withdrawn. This is called the protection guide wire technique.

In percutaneous coronary therapy for chronic total occlusive disease, when the first guide wire enters the subintimal space, it remains in situ as a false lumen marker, and then a second, stiffer guide wire is sent to the true lumen, which is parallelism. Guidewire technology.

Regardless of the dual guidewire technique, the other is an adjunct, not three guidewires that treat different targets independently.

But Yang Ping seems to be doing this now!

It is already difficult for a guide wire to be safely sent to the arterioles in the brainstem. Now three wires are required to be sent together, and they cannot be repeated, crossed, or touched on the path they pass. This kind of route planning ability is already artificial intelligence. Level, not human.

Professor Eugene took a seat with someone else and sat with Johanneson and Massimo.

"Are you sure he set off at the same time for the three puncture points and operated at the same time?" Massimo asked.

"It shouldn't be possible. The two guide wires should be the same as our double guide wire technology, and they should play an auxiliary role?" Eugene judged.

"No, Dr. Yang said just now that three guide wires are required to operate independently at the same time, each with its own goals. He wants to solve three aneurysms at one time." Although Johanneson didn't believe it, he just heard Yang Ping saying this. said.

He's about to embolize three aneurysms at the same time, and yes, at the same time, which will be a world first.

The three manipulators operate independently, and the remaining manipulator acts as an auxiliary, making some international jokes.

When everyone is puzzled, all speculation is unnecessary.

The three guide wires, under the control of the robotic arm, have begun to enter along the blood vessels at the same time, over the mountains and mountains, traveling long distances, step by step toward the intracranial blood vessel network. They start from different paths and have nothing to do with each other.

All roads lead to Rome!

The same is true for the blood vessels of the human body, and the true meaning of intervention has been grasped by Yang Ping.

In the ink-like whole-brain angiography image, the three guide wires are scrambling for each other, like a race, advancing along the blood vessels.

This extremely smooth loach guide wire is very handy in Yang Ping's hands. Every time a bifurcation is encountered, no matter whether the angle of the bifurcation is obtuse, acute or right, the magical guide wire can easily cross.

The three guide wires are like flexible snakes, each super selection is so magical and wonderful.

However, the three filamentous snakes entered the depths of the human brain and continued to penetrate the complex network of blood vessels.

The operation demonstrated on the entire screen is like a game. The greedy snake moves dexterously, which makes the audience extremely uncomfortable. Some people feel that the three tiny things are swimming in their body, causing bursts of pore spasm and scalp numbness.

The largest aneurysm may be approaching its limit, and GG's artificial intelligence keeps flashing red lights to remind the blood vessel that it may explode at any time.

And the second one has also swelled up, and the third prototype has emerged, and the speed of expansion is faster than the first two.

There is a limit for the guide wire to enter the blood vessel. This limit is not only related to the thickness of the diameter, but also to the accuracy of the doctor's control of the guide wire. The guide wire cannot enter a blood vessel thinner than it, and it cannot arbitrarily cross the bifurcation and reach the target blood vessel. There are insurmountable forks.

Not all target vessels are accessible, and not all aneurysms are amenable to intervention.

"Three guide wires entered the skull at the same time? Pointing to three different aneurysms." Massimo finally believed that this was a high-dimensional creature, and he couldn't match it.

Three guide wires go in at the same time, no doctor in the world dares to do it, and no doctor can do it, but Steven needs to do it now, this is the only hope.

If it weren't for an accident, Dr. Yang would have enough time to solve the aneurysms one by one, but an accident took more than five hours, leaving him only one hour, maybe not even an hour.

Apart from the three-pronged approach, he has nothing else to do.

The natural advantages of the robotic arm are brought to the extreme in Yang Ping's hands, just like any other equipment in his hands, it will inevitably exert its limit.

The deeper the blood vessels are, the thinner the inner diameter of the blood vessels, the more complicated the mutual traffic, and the more difficult the paths are to identify.

For some well-known blood vessels, the subsidence level is very simple, and now the blood vessel Yang Ping is going to enter is already the innominate artery, and the subsidence level is unknown.

This kind of intervention can clearly find the target blood vessel without getting lost. There are only a handful of them in the world. Massimo is one of them, but he just touched the door handle.

The operation at this time requires the surgeon to study the blood vessels of the cranial brain, especially the brainstem, higher than all existing anatomical studies.

No doctor can do this level of anatomy. Neither surgery, interventional, or internal medicine doctors can do it, nor can a professor of human anatomy in a medical school do it. This requires researchers to have a large number of "general teachers" to study. this condition.

The total length of blood vessels in the brain, arteries, veins and capillaries, the entire blood vessel network is 1.6 million kilometers in a straight line, and a circle of the earth is only 40,000 kilometers. What a complex network this is.

People's research on this vascular network is far from enough, and it still stays on some main roads.

From the centimeter level, to the millimeter level, and then to the submillimeter level, the three guide wires are constantly sinking, and it has to reach the target within the last half hour to complete the task.

This is its only chance, and its last chance.

Massimo was curled up. In the warm hall, he was like a patient with a high fever. The cold came in waves and quickly spread throughout the body. If possible, he wanted to wrap a thick quilt.

High tension not only consumes adrenaline, but also consumes a lot of calories due to excessive and continuous muscle contraction due to the evaporation of sweat and water.

"He really solved three aneurysms at once, he really manipulated three guide wires at once!" Massimo murmured.

Johanneson saw Massimo's eyes. This was his own eyes, empty and empty, as if all the glory and glory of the past had vanished.

"I said that he is one dimension higher than us." Johanneson is relatively calm, he has already experienced a temper.

Dr. Eugene is not much better than Massimo: "He controls four robotic arms with two hands, three main knife robotic arms, and one assistant robotic arm."

Dr. Eugene's words reminded everyone that the four robotic arms were controlled by Yang Ping's two hands.

But there is no rhythm out of line. Every time, one guide wire slows down and stops when it wants to cross the bifurcation, and the other two rush forward at high speed. fork.

Just like an acrobat, throwing several balls at the same time, Yang Ping manipulates four robotic arms with two hands, two robotic arms are always moving, two are resting, rest is not rest, but every high-risk super selection Pause and turn.

The robotic arm that rotates at any angle makes the guide wire more flexible than manual manipulation.

The guide wire is getting slower and slower, but never loses the flexibility and precision it deserves.

Because the blood vessels are getting thinner and thinner, any rough operation will be fatal, and any rapid and large amplitude will make the guide wire difficult to control due to inertia, so it must be slow now.

At the same time, the longer the guide wire is released, the more difficult it is to control the direction of the tip.

The blood vessels are getting thinner and thinner, and the guide wire is constantly sinking, just like a submarine sinking deeper and deeper, and it has to sink to the deepest seabed.

The deeper, the finer, the more dangerous and the harder it is to control.

This kind of in-depth, this kind of sinking, there is no turning back, either success or fatality.

This is why Yang Ping is reluctant to operate when the voltage is unstable. He must kill with one blow, without any chance of turning back, and without any possibility of recovery.

Success or failure, this time, life and death, just this chance, the blood vessels that have sunk deep into the brainstem level, there is no chance to quickly withdraw the guide wire.

"He's still not lost, in a labyrinth of blood vessels, each following the closest route."

Massimo didn't even dare to breathe too big or too fast. This was the most critical moment. He once used the thinnest guide wire and with the help of various auxiliary equipment to intervene in the central blood vessels of the monkey's cranial brain stem. , Here, I don't know how many monkeys were killed.

On the huge and clear screen, three filaments snake, winding and twisting.

Everyone held their breath, they had already penetrated so much.

At this point, don't have any problems!

Originally it was a break last Sunday, and I wanted to have an update, but the work task was postponed, and the rest was naturally gone. I haven't had a rest since I came back. The promise of more than 10,000 words to make up for the update has not been fulfilled, so I am powerless, brothers! I will make up for it when I have a rest day. Regarding the case of the International Space Station, inspiration came from a real event. An astronaut found a left internal jugular vein thrombosis during a routine self-examination on the space station. On Earth, this disease is also very difficult. 10.3% of patients will develop pulmonary Embolism, the 44% mortality rate is chilling, the doctors on the ground are terrified, and Dr. Stephan Moll of the University of North Carolina at Chapel Hill School of Medicine is invited to help diagnose and treat. This doctor is a thrombosis expert, careful planning, and NASA emergency rocket After a thrilling treatment, the astronaut returned to Earth safely. The ISS medical emergency was written as a case report and published in the New England Journal of Medicine (NEJM).