Kawei did not give up, but easily found the appendix hidden in the cecum. Regardless of whether his suspicion was correct or not, the slightly hard and thick texture was indeed very different to the soft and thin wall of the cecum.
Now there was a fork in the road before Ingnatz.
A stable and conservative approach would prevent serious mistakes. As long as the appendix was not found, and following the Western European surgeon's practice of intra-abdominal surgeries, the operation could be ended by quickly sewing on the priest's belly.
Although the process was dull and hardly exciting, at least the doctors did not make any mistakes. Outsiders only watch the surgery for excitement and are not qualified to be picky about the surgery itself.
The other path is riddled with thorns and requires a challenge to the authoritative consensus.
Of course Yingenatz prefers the first option, because his operations have always been fast and stable, and he attaches great importance to intraoperative and postoperative mortality. In his eyes, if the patient dies after the operation, the operation itself is meaningless. No matter how beautifully it is completed, it is still flawed.
That's why he was willing to believe that Kawei's disinfection could indeed bring about some changes.
But at the same time, this idea also has certain limitations.
He most likes to show off his skills with surgical techniques that have become classics. As long as the mortality rate is reduced on the basis of predecessors, it is a success. Instead of choosing to find another way, use patients to create a new surgical method, which fundamentally changes the difficulty, success rate and duration of the surgery.
Although this conservative attitude towards surgical procedures can stabilize the evaluation of the outside world, it will inevitably be criticized by some people.
Varela is one of them.
Now that the abdomen is closed, the priest's abdominal pain will not be relieved, but this has nothing to do with the operation itself. It can only mean that Schmidt has a rare disease, or the disease can be classified as a trial from God or another gift.
Of course, if he wanted to find out the cause of the disease, Schmidt could choose to send the priest's body to the autopsy room.
No matter how you look at it, this is a win-win situation, and Yingenatz will be very happy.
It's just that the likelihood of an autopsy is low, as Catholics in the church would have intervened to dissuade it. In order to save the priest's life, it is understandable that he should undergo surgery. But it is different to send him for an autopsy after his death. It is a blasphemy to the soul of the priest.
But in any case, the priest's death had nothing to do with Ingnatz's surgery.
But if he really cuts through the serosa of the cecum and finds the appendix, then forget it. If he fails to find it, his operation in public will become lost and the popularity that Kawei gathered last night will be wiped out.
Moreover, Yingnaz will definitely be charged with "accidental injury". Even the headline in the newspaper was drafted for Varela, which was called "Carelessness and ignorance destroyed the priest's appendix!"
Ingnatz was unwilling to take risks.
Kawei also knew that he was unwilling to take risks, so he immediately sounded the alarm: "Teacher, don't you forget, we deceived the priest into going to the operating table. If you go back after the operation, let him know that you were the one who made the incision." But nothing happened to his stomach, and he turned around and pushed him back to the ward to continue to endure double the pain. This..."
Appendicitis + wound is indeed twice as painful...
This small reminder immediately made Yingnaz sober up.
"Everyone, a journalist friend once criticized me for not daring to innovate and being timid in the face of innovation. Now I must give the necessary response. I don't know if Mr. Varela is here..."
He glanced back and forth in the operating theatre, not realizing that his old acquaintance was watching behind him. He could only say in disappointment: "If anyone can contact him, please pass the message on his behalf. For the sake of the priest's health, I am here today. The authority of the European abdominal surgery community must be challenged.”
After some passionate statements, the audience's response gradually became enthusiastic.
As loyal fans of Ingnatz, when faced with the courage to challenge, many people responded quite positively: "Okay! Crush those so-called authorities in Western Europe to pieces!"
"The Romance of Fairy Wood"
"Varela knows a lot about surgery and can only write some articles."
"come on!"
Amidst the applause, Yingenatz picked up the scalpel again and continued: "Judging from Kavi's judgment just now, this inflamed appendix should be surrounded by the serous layer of the cecum. I have used After judging with my fingers, this place is indeed different from the ordinary cecal intestinal wall tissue, and it is most likely the appendix."
Making a decision requires repeated thinking and a lot of courage, but when it comes to actually doing it, it only takes a few seconds.
Standing on both sides of the open abdominal cavity were two hot surgeons, and their cooperation was much better than during the first inguinal hernia repair. Kavi used his fingers to tighten the wall of the cecum. Yingenatz's forceps caught a serous membrane, picked up the tip of the knife, and bluntly separated the cecum. He soon saw the red appendix embedded in it.
"It's the appendix. Everyone, I dare to say that this is the appendix of the priest!"
Ingnatz was glad that he listened to Kawei's advice and quickly separated the remaining serous membrane, slowly exposing the root of the appendix to everyone.
"This is undoubtedly a major discovery for the surgical community."
“The Austrian surgical community finally has something of its own?!”
"The King invested so much money in establishing the Institute of Surgery and spent so many years studying it. What's the result?"
"As a result, except for the plastic surgery department inherited by the current dean, there is no one that can perform abdominal surgery!"
"Professor Ingnatz still dares to do things, and Mr. Varela's comments are still too arbitrary. Wasn't it him who performed the first anesthesia operation? Instead, it was the former dean of the College of Surgery, and his father did it at that time Stop it." [1]
A short period of success can bury most of the mistakes. At least in the eyes of these viewers, Yingenatz is still an Austrian surgical legend.
He also made similar remarks to his father, believing that anesthesia was dispensable, which would not only prevent him from observing the patient's condition during surgery, but would also lead to the possibility of killing the patient. However, due to some public opinion and academic pressure, he still performed the first anesthesia operation in Austria.
No one can escape the law of true fragrance, not even top surgeons.
In comparison, missing last night's cesarean section actually contributed to Kawei's rise. After all, it was just a small thing.
However, not long after the argument similar to "Ignatz is still great" appeared, the operation process poured a basin of cold water on everyone's head: "Father's appendix is too long..."
Ingnatz made a separation along the incision upwards, hoping to pull out the appendix hidden in the cecum.
Unfortunately, the appendix and cecum are closely attached, and the serosal layer is tightly pressing against the appendix. They are like a symbiotic relationship, hugging each other and extending upward along the direction of the incision.
If it happened in modern times, I'm afraid the surgeon would extend the incision again without hesitation. After all, the most troublesome appendix has been found, and it is impossible to close the abdomen without success. 【2】
But in the 19th century, the longer the operation took, the more resistance it encountered.
Their own reputation, the next day's newspaper, the reaction of the audience on stage, and the unprepared surgical process will all bring endless pressure to the surgeons. In that era when giving up was not considered a medical malpractice, closing the abdomen was definitely not a good thing, but at least it allowed people to put down their burdens and take a breather.
After all, if you want to continue the operation, you don't need to continue on the original basis. Instead, you need to expand the incision and continue to free the cecum and even up to the ascending colon.
The wax table chandelier and portable oil lamp in the operating theater illuminated the operating area brightly, but inside the incision, the priest's right upper abdomen was in darkness. Without stable anesthesia, first aid measures, and Kawei’s God’s perspective, if the incision continues to be enlarged, the risk will increase exponentially.
"Teacher, the current incision is 12cm, which is already the limit. I'm afraid there are not many abdominal surgeries with such a large incision in Austria." Hermann suddenly mentioned, "If the incision is extended further, it will be 17cm."
"17cm..."
Even Kawei, who has undergone thousands of operations, also knows the dangers of surgery, but he needs to consider it more comprehensively.
Although ether anesthesia sounds simple, and you can fall asleep just by smelling it, in fact, controlling the amount of anesthesia is a very complicated technical task. Once the dose exceeds the threshold, ether will inhibit the respiratory center, interrupt the patient's self-help breathing, and eventually suffocate to death on the operating table.
Therefore, the operation time in the 19th century was very short, and many patients could not withstand the second anesthesia.
During the preoperative preparation period, Kawei knew that the priest had a severe reaction to ether, and several adverse reactions such as retching, choking, and salivation occurred immediately after use. The possibility of another anesthesia failure was very high. In this case, continuing the operation was indeed quite risky, and he was ready to give up at any time.
Because Kawei didn't have the confidence to convince Yingenatz again, it would be a very unwise choice to fall out with his "teacher" in front of so many fans.
However, Yingnaz withstood the pressure and made a timely decision: "Continue to extend the incision upward and give me the scalpel!"
This was a rather bold decision, which surprised Kawei: "Teacher, further up is the liver area."
"I know."
Ingnatz's scalpel did not hesitate, and carefully cut open the skin and muscles upwards, again exposing a large section of intestine: "The operation is quite difficult. We have reached the ascending colon, and we still haven't seen the tail of the appendix here. . The entire appendix drilled out of the serosa layer of the cecum here and completely entered the retroperitoneum of the liver area..."
Anyone can hear his helplessness.
The abdominal cavity is a restricted area for surgery, and the liver area is a restricted area within a restricted area.
Even in off-limits areas, a significant number of surgeons still take risks performing appendectomies and inguinal hernia repairs. But no one dares to perform liver and gallbladder surgeries, no one has even touched them, and there is not even a decent report.
For the priest, God's sanctuary is far away in heaven.
For abdominal surgery, God's sanctuary is in this palm-sized liver area.
The entire ileocecal part has been completely freed, and the surgical area has entered the peritoneum from the outside of the peritoneum at the beginning, and now it has jumped out of the outside of the peritoneum. Ingnatz's separation is still continuing, and more than 50 minutes have passed since the beginning of the entire operation, not far from the usual recovery time from ether anesthesia.
"Come on, teacher."
Kawei was like a prophet, helping Yingenatz speed up with his hands, and also giving him hope: "I have a hunch that the appendix crowd is just ahead."
"Um......"
Ingnatz's hand speed did not slow down, but his voice became lower and lower, much like the way he used to do Morazo's groin.
He was prepared for the surgery to fail.
But the only thing in the world is persistence. Persistence will always give rewards to those who persist, it’s just a matter of time.
Suddenly, moving forward along the middle of the appendix, Yingenatz saw a purple-red irregular ball, but in Kawei's eyes, it looked more like an upside-down gourd. 【3】
Everyone's first reaction is the gallbladder, because in the liver area of the right upper abdomen, the only organ with this color and shape is the gallbladder. But the appendix held in Kawei's hand always reminded everyone that this was not the gallbladder, but the appendix.
Because you only need to push it gently, you can see the liver not far away and the normal gallbladder under the liver.
"Amazing discovery!"
"This appendix is the best in the world in terms of location, length and shape of the end!"
Ingnatz regained his anger slightly, and his voice was dull. Everyone could feel the pressure on his shoulders, and at the same time hear his excitement: "Kavi, quickly calculate how long it is? I guess It has to be 30cm!”
Kawei made a rough comparison with his fingers: "About 27cm, very long!"
"Father, it turns out that the Satan you are talking about is not our scalpel, nor the medicines prescribed to you by Fatolad, but this appendix! Give me the crow's beak forceps!"
Ingnatz took the forceps handed over by Herman, cut off the tissue and blood flow at the base of the appendix up and down, and then sutured half of it with Kawei: "Everyone, the key point of appendix surgery is to find the appendix. Now that we find the appendix, it's just a matter of time. It’s much easier to handle. All you need to do is suture the blood vessels and cut out the appendix, and then..."
"Teacher, the priest seems to be awake!" Kawei held the intestines and needle and thread in his hand, bent down, and pressed one of the priest's thighs with his elbow.
"Yes, I saw it." Yingnaz nodded and pressed his flailing arm with his elbow. "Herman, go ahead and apply the second anesthesia. The operation is almost over. Reduce the dosage by half."
"good!"
"You also need to always pay attention to the priest's heart rate and breathing."
"good!"
After the lessons learned from the last groin surgery, Yingenatz realized that long-term surgery will definitely become the mainstream in the future, so during the period after the surgery, he has been training on cooperating with secondary anesthesia during the operation.
The chief surgeon and the first assistant cannot be separated. At this time, the second assistant and the nurse need to complete the second anesthesia together.
Herman practiced the most diligently, and the anesthesia process had already been engraved into his muscle memory.
The training made him very experienced in this crisis. While doing a good job as a device nurse, he and the nurses around him also kept an eye on the priest's movements. As soon as the priest regained consciousness, the ether mask that had been prepared for a long time was pressed on his face.
