Surgery Godfather-Chapter 315 - 0299

Chapter 315: Chapter 0299

Before the surgery, Yang Ping needed to conduct a brief conversation with Guo Jingyao, with both Dr. Huang and Dr. Lin accompanying him by the patient’s side.

In the eyes of Yang Ping, Guo Jingyao was just one of his many patients.

Doctors have to go into surgery clear-headed and confident, and so should the patients. This was the purpose of the conversation.

Regardless of how wealthy one is, on the operating table, there is no difference. Their bodies still conform to the principles of anatomy and physiology.

Often, ancient books would have descriptions of celebrated people bearing unusual physical features, such as exceptionally long arms, or oversized ears. From a medical perspective, these would be seen as deformities.

Like any ordinary patient, Guo Jingyao hopes that sensation and strength would return to his legs, and to be able to stand without using a wheelchair.

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He asked many questions about the details of the surgery, some of which were quite naive and even absurd, yet Yang Ping patiently explained everything. He did not want his patient to enter the operating room feeling nervous.

The operation for Guo Jingyao officially began at nine o’clock the next morning.

The surgery was scheduled in a level-100 laminar flow hybrid operating room, which facilitated a postoperative DSA angiography to confirm whether the fistula was truly closed.

The team of Chinese doctors, full of energy, led by Dr. Huang, entered the operating room.

Dr. Huang and Dr. Lin assisted Yang Ping by opening doors, fetching slippers and fetching clothes for him.

Zhang Lin was wearing all new clothes, from his hairstyle to his garments, belt and shoes. The clothes even carried a faint machine smell from the new fabric.

This operation required entrance into the spinal canal and might proceed with vascular anastomosis within the canal. To reduce the risk of infection, irrelevant personnel were prohibited from entering.

In addition to Doctors Huang and Lin, the accompanying anesthesiologist and nurse, others were not allowed in the operating room, and could only observe the procedure via video in the viewing area of the operating room.

August and Milton were among those prohibited from entering.

As the chief surgeon, Yang Ping had absolute authority to enforce some rules, all of which were aimed at only one purpose: to make the surgery goes as perfect as possible!

Guo Jingyao lied on the operating table, his body trembling slightly and his heart rate speeding up to 105 beats per minute.

“Don’t be tense!” Fatty comforted him.

His voice was trembling slightly, “I’m not nervous – I just can’t control it.”

Not nervous? His body would not lie. Fatty administered a sedative through the IV, beginning the induction before anesthesia.

Under the effects of the sedative, Guo Jingyao’s body stopped trembling and his heart rate also dropped back to the normal range: 87 beats per minute.

Successful intubation, connected to the anesthesia machine. The Zeus anesthesia machine uniquely integrated the information processing engine system with the life sign monitoring system.

The patient inhaled the anesthetic through respiration. Through the circuit system, the anesthetic was delivered to the alveoli, from the alveoli it entered the bloodstream, and the anesthetic spread to all parts of the body along with the flow of blood within the vessels, blocking the perception of the central nervous system and achieving the purpose of general anesthesia.

Guo Jingyao’s autonomous breathing was temporarily inhibited by the anesthetic, and his breathing was taken over by the anesthesia machine.

Fatty gave an “ok” gesture, much to the amusement of others. “Anesthesia successful!”

Dr. Lin remained, but Dr. Huang stepped onto the operating platform. In this surgery, not all surgeons can be foreign doctors with temporary licenses. It is necessary to have a doctor with a normal license present on the platform.

Dr. Zhou, the interventional doctor, carried out a femoral artery puncture and cannulation to one side of Guo Jingyao while in the lateral position, keeping it for postoperative DSA.

After completing the placement of the femoral artery catheter, the patient was switched from the lateral position to the prone position, lying face down on a special prone frame for spinal surgery.

The patrolling nurse, Zhou Can, used soft pads to protect each prominent bone part. The abdomen was suspended to avoid compression which would cause congestion in the spinal venous plexus. Both eyes were closed using adhesive tape to provide protection. She checked that the urinary catheter was unobstructed, and that the reproductive organs were not compressed.

Every detail had to be executed perfectly for the overall procedure to be flawless.

They disinfected their hands, laid down sterile drapes, and slowly overlaid disposable 3M sterile clothes one by one, only exposing the surgical area.

Song Zimo connected a sterile handle to the shadowless lamp, using it to adjust the height and angle of the lamp to its optimal position.

“Surgery preparation is complete. Now beginning pre-surgical safety check!”

Everyone immediately focused, stopping all activity.

“Patient for surgery is Guo Jingyao, male, sixty years old, hospital ID number—”

“Correct—”

All doctors and nurses participating in the surgery unanimously voiced their agreement. Any objections had to be raised on the spot as it was both a responsibility and a duty.

“Surgery site?”

“Thoracic vertebrae!”

“Surgical method?”

“Posterior thoracic laminectomy for formation of dural arteriovenous fistula!”

“Estimated blood loss?”

“Less than 50ml!”

“Crucial points during surgery?”

“Avoid injuring spinal cord and nerve roots. Successfully perform arteriovenous fistula formation!”

“Anesthesia focal points?”

“Ensure the patient’s vital signs are steady during surgery.”

“Does anyone have any questions about this surgery?”

“None!”

“If there are no questions, you may commence the surgery now.”

The circulating nurse closed the medical record book. The safety check was complete and the surgery could officially begin.

“Anesthesiologist, please report the patient’s vital signs.”

“Heart rate 82 beats / minute, breathing 20 times / minute, blood pressure 132/84mmHg, ear temperature 36.6 Celsius —”

“Very well! I’m going to start the surgery now, scalpel! —”

Preoperative pause check is a serious task, there is no room for carelessness. It is the last confirmation of the operation patient, the operation site, and the surgical method.

A surgical patient needs to undergo triple checks before surgery in the operating room. Once when collecting the patient from the ward, again before anesthesia in the operating room, and finally just before the chief surgeon begins the surgery.

This persistent verification reduces the errors of operating on the wrong patient, the wrong part, or using the wrong surgical method to a minimum.

On the screen in the observation area, during the preoperative check, August, Milton, Kobayashi Takeshi also stood up straight, respectful, as if they were there in person.

This sense of formality constantly reminds surgeons to maintain reverence for the surgery and life itself.

The yellow line on the floor next to the operating table marks the boundaries which observers must not cross.

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If crossed, it could contaminate the surgery, and once contaminated, there is a risk of infection. Infection spells disastrous consequences for any surgery, especially orthopedics, which could be downright catastrophic.

In the barbaric era of surgery, there were no disinfectants, no anesthesia, and no hemostasis and blood transfusion. In such a surgery era with no basics, even a simple amputation surgery had a mortality rate of fifty percent, people died of pain, bleeding, or infection.

Back then, surviving after surgery was considered luck, whether one could survive was equivalent to flipping a coin.

After mastering the three major techniques of disinfection, hemostasis and blood transfusion, and anesthesia, the field of surgery officially entered the modern era.

It’s hard to imagine that in those times, to stop the bleeding after an amputation, some doctors would plunge the bloody stump into boiling water or hot oil. Patients often fainted due to the excruciating pain.

The only observer on the scene, Doctor Lin Mingyuan, consciously stood behind the yellow line.

The noise from the air treatment machine and the air conditioning system, the “breathing” sound of the anesthesia machine became the background noise of the operating room, which everyone was used to.

Yang Ping, dressed in surgical gowns, wearing a sterile cap and face mask, with his eyes protected by goggles, Song Zimo stood opposite him, Zhang Lin Xiaowu at their sides.

The scalpel in his hand felt like a pet that had been nurtured for many years, possessing its own consciousness.

A ten-centimeter longitudinal incision was made, the skin was cut with a single stroke, then the deep fascia was sliced open with an electric knife. The bright red bleeding spots were eradicated by the use of double electric coagulation in the initial stage.

Subperiosteal dissection was performed along the side of the spinous process, which could reduce bleeding.

The muscles beside the vertebra were stripped down from the spinous process and the lamina, along the bone surface.

Snow-white gauze was held in Song Zimo’s hand, ready to be used for hemostasis, but it wasn’t needed.

The less blood lost during surgery, the less interference with the patient’s physiological function, and the better reflection of the skill level of the surgeon.

The spotlight above had several cameras that filmed the surgical field from different angles, transmitting images to the screens.

There was not a single superfluous movement, and every step was extremely concise.

In less than three minutes, the surgeon revealed the lamina in a bloodless state. An automatic hook was inserted, and the surgical space was revealed.

The surgery seemed extremely easy, with every move being extremely precise. This kind of surgery had entered a different realm.

“Can you do that? After entering the lamina, doesn’t even need to use gauze?” August asked.

Milton shook his head, “I can’t do it, neither can you.”

“Does he have magic that can temporarily stop the patient’s blood flow?” August always had some bizarre ideas.

“Remember, you are a doctor.” Milton reminded.

“Doctors evolved from wizards.”

“Why don’t you say barbers then?”

“The earliest doctors in Europe were barbers, the red, white, and blue signs used to be the signs of the barber shops.”

“He started to open a window on the lamina, doesn’t he need to utilize some anatomical markers or imaging tools for positioning?”

“Uncovering-style window opening, this is my forte.”

Uncovering-style window opening requires excellent surgical skills, opening a window on the lamina, the outer and inner surfaces of the lamina are of different sizes. Like a manhole cover, the outer mouth is large, the inner mouth is small, after the surgery, the cover can be replaced, just fitting and not sinking.

In this way, the back of the vertebra is protected, there is no bony defect, the stability of the spine is even better.

The cover was lifted, revealing the dura mater.

In the middle of the spine is a hollow bony canal, which harbors the spinal cord. The spinal cord, like the brain, is the center of the human body’s nerves. But while the brain is the upper center, the spinal cord is the lower center.

The spinal cord is as delicate as tender tofu, and its outside is wrapped in several membranes, among which the outermost layer is the dura mater. This surgery is to operate outside the dura mater.

“He found the fistula, right under the window.” Milton said, looking at the screen.

“Just by this precise positioning, he is at least 5 years ahead of us.” August exclaimed.

“No, there’s only us here, just us, we can be bolder, why not ten years.” Milton was serious.

“Oh God, the blood vessel is indeed stubbornly in front of the arteriovenous fistula, it can’t be pulled apart, those damn things.”

“Only a tiny gap can be revealed, the surgery has to be completed in this gap, which is very difficult.”

Under the microscope, two small rubber strippers gently pulled the blood vessels open a bit, revealing a gap to operate in.

The surgical target lied still under the window, it deceived through rounds after rounds of case analysis, eventually falling into the hands of Yang Ping.

“If only there was a robotic surgical system for microsurgery, using a delicate mechanical arm terminal instrument, providing a three hundred and sixty-degree range of motion, it would be able to handle this kind of surgery.”

“Can Doctor Yang’s wrists and fingers move in three hundred and sixty degrees?”