Although staplers have been widely used in modern intestinal anastomosis, manual anastomosis with needles and threads is still a basic skill of general surgeons. If you can cleanly sew up the severed intestinal tube with a needle and thread in a short period of time, you are basically capable of treating the disease.
Kawei has been handling various surgeries in emergency surgery, and has long been familiar with the theory and operation of intestinal anastomosis.
In fact, as early as the 19th century, intestinal suturing methods had become increasingly mature [1], and many doctors who wanted to enter the field of abdominal surgery would test various self-created suturing methods on cadavers or animals.
Their suturing theory alone is actually quite good. However, it is limited by the material of the suture and the amount of practice, and there is no concept of disinfection, so the success rate of intestinal anastomosis healing is not high.
Ignatz is better at operating on limbs, and fine sutures on intestines are obviously not his strong point.
He knew very well that the neatness and continuity of the intestinal serosa needed to be ensured when suturing the intestinal tube, and he also knew that the serosa needed to be aligned during suturing. But when it comes to getting started, there will still be deviations. Whether the sutures can be aligned after being brought to the intestinal wall depends on luck.
The technique was lacking, but Ignatz's surgical intuition was still in place.
Looking at the intestinal tube that had just been easily severed by Morazo, he realized that there was indeed something wrong with his suturing technique. Even if it is sutured again now, the intestines will have difficulty healing and ulcers. At that time, it will fall into an endless cycle of "the more open the abdomen is for exploration, the easier it is to get infected, and the more infected it is, the harder it is to heal."
After a brief hesitation, Kawei finally intervened. He needed to take over the assistant's seat and end the operation as soon as possible: "Teacher, this is the catgut you introduced in the book." [2]
Now Kawei is just a "beginner", and Ignatz needs to teach him some of the most basic things: "Well, it is made of sheep intestines. It can be absorbed by the tissue when used on the abdominal intestines."
"The teacher's drawing collection emphasized that the intestinal tube must be sutured according to the Lembert suture method, and the serosa must be aligned [3]." Kawei said, and the tweezers in his hand had easily turned over the intestinal tube to reveal the serous membrane on the surface. Film layer, "Is this here?"
Ignatz nodded: "But before suturing the seromuscular layer, the internal mucosal layer needs to be sutured first."
"Yes, yes, I do remember the teacher wrote this. Use absorbable catgut for simple continuous sutures on the mucosal layer [4]. The suture should not be pulled too tight to prevent mucosal tearing. Use non-absorbable outer layer Use silk thread and perform interrupted inversion sutures, which is the method advocated by Professor Lembert."
Kawei seemed to be a die-hard fan with an extraordinary memory. He recited all these stitching points as if he had recited the entire text. Even Ignatz himself had forgotten that he had written these.
Of course, Kawei didn't know either, because they were all nonsense. Anyway, it didn't affect the timely reminder of Ignatz with these words.
Especially for continuous suturing of the mucosal layer, judging from the suture opening at the broken end, it is because the thread is tightened too tightly that the mucosal tear is caused. When doing the Lembert suture [5], he was indeed a little out of shape. There were too few stitches or insufficient distance in many places, which ultimately led to the avulsion of the serosal layer under external force.
This was caused by lack of practice. I could only blame Ignatz for being unfamiliar with abdominal surgery, and no one else could blame him.
Ignaz's reputation as the best surgeon in Austria was not in vain. Since the thread was tightened too tightly just now, let's loosen it a little this time. Since Lember's suture was wrong, let's be more careful...
He has no option to give up and seek help. All the troubles he encounters need to be faced by himself, otherwise Ignatz will be ruined.
He didn't know whether it was because Elena's deflation made him feel good, or because of something else, but this time the suturing seemed to go much smoother to outsiders. A layman would definitely not be able to tell the exact reason for the success. They just felt that Ignatz's operation suddenly became smoother.
These are just physical sensations brought about by vision, but for the experts in the audience, Ignatz's speed changes were completely reflected in the time consumption.
Current anesthesia technology is unstable, and surgical speed is still the best indicator of a surgeon. Ignatz is a surgeon who is known for his speed in operations, so it has become a habit for his colleagues to record the time during his operations.
Although the entire operation was delayed for a long time, the anastomosis of the broken ends of the small intestine was completed very quickly, and it immediately became the focus of quiet discussion among everyone at the table.
"It's 15:14 now, and it only took 12 minutes? Could it be that I saw it wrong?"
"That's right, it's more than twice as fast as before."
"It was too far away to see the quality of the stitching, but the speed certainly broke the record."
"It is outdated to talk about speed aside from quality. Personally, I still value quality more. However, based on his requirements for himself, the quality should not be too bad."
"I don't agree. The suturing just now is not satisfactory. Let's take a look at the postoperative period. The slowest is one month, and the fastest is only two or three days."
"So, you guys have been discussing it for so long and still haven't gotten to the point. Why did he suddenly speed up?"
After being simply surprised and a little jealous, they began to look for the real reason why Ignatz could speed up.
We are all doctors working on the operating table, and we are well aware of the difficulty of intestinal suturing. What the surgeon has to do is to use a needle and thread to penetrate the intestinal wall tissue, and then tie the thread with a knot. Every link is closely related to practice.
In this case, it is impossible to double the speed in a short period of time. An improvement of 1-2 minutes is already an extraordinary performance.
Since the surgeons at the front and back are both Ignatz, and the instruments used have not changed, the only factor that can cause drastic changes in speed is the assistant who just came on stage.
"So, Ignatz's pauses have indeed become less frequent."
"The sutures of interrupted sutures are one span and one knot. The assistant needs to expose the needle entry and exit positions when he is suturing, fix the silk thread during the knotting process [6], and cut it immediately after knotting. Thread. If the thread runs out, he needs to hand over a new needle and thread. At the same time, he must always maintain the direction and distance of the candlelight..."
"No need to analyze, it's just that young man who cut down his time."
"Who is that guy?"
"Ignaz just said that he is a graduate of Vienna University Medical School."
"Graduates? Why have I never seen them before?"
"I haven't seen it either..."
Kawei really saved Ignatz a lot of trouble and time, making the connection of each of his movements extremely smooth.
To be able to do this requires not only decades of surgical experience, but also a pair of eyes that are good at observation. When he was standing in the preparation area just now, Kawei was not in a daze, but was carefully observing Ignatz's surgical behavior and habits.
Each surgeon has his own fixed knotting technique and surgical speed, as well as requirements for the angle and intensity of light.
By silently recording their original surgical rhythm, you will be able to appear where they want you to appear when they need it most, and with the candlelight that best suits their eyes, deliver what they want most.
In fact, Kawei has done a very outrageous job in some aspects. Whether it is finding anatomical levels or inserting needles, he has done a better job than Hills. This gap was so obvious that even Elena and her niece on the side saw some clues, and even their voices became much softer due to the influence of the audience.
"Auntie, is Dr. Ignaz's surgery speed so fast?"
"How do I know this?"
"Auntie's words do make sense."
"What words?"
"The success of the operation has a lot to do with the assistant." The girl said with a smile, "Just now, the stitches kept stopping and it looked very awkward. Now I have an assistant and I feel much more comfortable. Dr. Ignatz is like It’s like a different person.”
Elena said no more.
Her mood was very complicated. The person on the operating table was her biological brother, so she naturally hoped that his operation would be successful. But compared to incarcerated hernia, which has a recurrence rate of 90% and an average mortality rate of 50%, Elena hopes that her son Berget, who is hiding in the corner, can come to the stage and stand out.
Morasso thought the same way before, but it was a pity that the apprentice took all the limelight away.
His movements were steady and his techniques were experienced, and there was no strangeness in his eyes that looked at Ignatz, but rather a battlefield veteran who had seen through every move of the opponent. It gave Elena the feeling that Morazo looked like when he was teaching Berget the swordsmanship.
However, compared to the one-sided confrontational practice at that time, Kawhi is now more like feeding.
In the eyes of outsiders, her acquiescence was the greatest compliment to the master and apprentice on the operating table, but more than half of this compliment was given to Kawei. The woman's intuition told her that this young man was not simple.
...
It is said that the eyes of the beholder are clear to the authorities, and this is absolutely true.
While others were praising the assistant, Ignatz, the surgeon, was concentrating on the suturing and did not realize the importance of Kavi. After all, after climbing over the mountain of intestinal anastomosis, he still had to face another mountain, the suturing of the hernia gap.
"Everyone, I have completed Count Morasso's small intestinal anastomosis. The apposition is smooth and the sutures are firm. I am sure this is the smoothest and most confident suturing time I have ever had in my life."
Ignatz reported on his results as usual, and the staged success once again stimulated his enthusiasm: "Next, I will use the suturing method used by Dr. Cooper at the time, first narrowing the internal ring of the hernia, and then closing it. The abdominal fascia layer is sutured to the inguinal ligament.”
The suturing itself is not difficult, but the postoperative recurrence rate forces all surgeons to choose to lie flat, and Ignatz is no exception: "Although Dr. Cooper's treatment method cannot reduce the recurrence rate, I at least cut out The necrotic intestine saved Count Morasso’s life.”
Kawei handed over the needle and thread again: "Teacher, this is the medium-sized silk thread you want..."
