Originally, Kawei was supposed to stand on the podium together as an assistant, but after the commotion just now and the mood in the audience was unstable, Kawei stopped joining in the fun.
Anyway, I need to go on stage twice in the afternoon, so there are plenty of opportunities to show off.
Compared with several previous reports, Ignatz's new surgical technique returned to the high standard expected of the Royal College of Surgeons, setting the tone for the following meetings.
However, the "new trend" itself is some brand-new surgical attempts, suggestions and an exploration of surgical possibilities, and is not universal. The triangular flap method for cleft lip repair given by Kawei is exciting enough. Judging from the oral description of the process and the final photos of the corpse repair, the effect of this new surgical method is definitely good.
But it is still an old problem, and there is a lack of examples that can be used to verify the effect of surgery.
"I have already contacted two cleft lip patients who are willing to try new surgeries. If nothing goes wrong, these two surgeries will be carried out next week."
Ignatz said: "At the same time, I will also start trying to repair cleft lips in young children. Repairing cleft lips before children grow up will appropriately reduce subsequent deformities and speech impairments."
Although there are no surgical examples, the new triangular flap surgery method is attractive enough and draws the attention of the audience from postoperative wound ulceration back to the surgery itself.
The next person who came on stage was Vice President Edinson, who brought his own surgical instruments: "Everyone should have done excision surgery for purulent tonsillitis. The tonsils are inserted into the tonsils with a circular knife sheath, and then inserted into the tonsils with a silver fork. Among them, fixing is done, and cutting is done at the end.【1】
Of course, in small clinics in the countryside, we can still see lancets used decades ago. No matter how the cutting tools are iteratively updated, the fixing method is the same, which is a silver fork. Because using other tweezers or pliers will cause varying degrees of slippage..." [2]
During this kind of cutting operation, the patient should not lie down because the congested tonsils tend to bleed heavily during surgical removal. Lying down will cause blood to choke into the trachea, causing surgical accidents.
So Edinson developed his own tonsil-grabbing tool. 【3】
The effect of the tool is definitely good, but this is not uncommon in the new trend of surgery, and it is basically regarded as a warm-up item and placed at the forefront.
Now being ranked behind Ignatz shows that Edinson has other things:
"Everyone, I have found in thousands of tonsillectomies that the partially removed tonsils will continue to grow, and the original infection symptoms are difficult to subside. This makes me have to consider whether I should do a complete tonsillectomy, including other tonsillectomies. Remove the capsule together.”
At this point, he brought up a simple hand drawing showing how to perform this new tonsillectomy.
"The 'guillotine' developed by the French from the 18th century is still usable, but it requires some minor skills in operation." [4]
Edinson made a simple gesture: "After the tonsils are encircled by the knife ring, we will not perform the resection first. Instead, we will use our fingers to squeeze the palatoglossal arch and wait until the tonsils are completely exposed before performing the resection." [5]
"What's the success rate of the operation?" Someone suddenly asked in the audience.
"Of the 30 surgeries I tried, 12 were completely resected, and the success rate was 36-37%." Edinson knew that the success rate was not high, and defended, "Surgery requires some experience and skills. I feel that I I’m almost getting the hang of it, and out of the last 10 surgeries, 5 have achieved complete resection.”
"With complete resection, there will be no recurrence?"
"Of course."
"I have also encountered cases where tonsils have re-grown. It is necessary to try this method..."
After the two deputy deans took turns, the new trend was finally back on track.
If from cleft lip and palate repair to tonsillectomy, Carvey saw the efforts of these Vienna surgeons in fine plastic surgery, then the following case of removal of a huge paracervical fibroma + postoperative repair has already formed the prototype of modern plastic surgery. .
The tumor is almost the same size as the patient's face. In order to ensure postoperative recovery, the doctor specially reserved a piece of skin as the face. The tumor is removed first, and then a skin flap is left for skin suturing.
After a long three-hour operation, she finally returned to her normal self. 【6】
"This should be the largest face and neck tumor resection + plastic surgery in history, right?"
"Indeed, this fibroid weighs 4.5kg, which should set a new record."
"How was the recovery after the surgery?"
"The fibroids have not affected the bones and muscles, and there is no problem with the bite. However, due to long-term compression, the patient's face still has some deviation. I did not think of this when making the flap during the operation, so I still have some regrets. .....”
After neck plastic surgery, I came to the ophthalmology department.
Dr. Ledo, who specializes in ophthalmology at Hartman Hospital, brought his eyeball fixation technology to everyone, using a metal fork to gently penetrate the patient's conjunctiva and sclera, so that the eyeballs no longer move randomly during strabismus correction surgery. . 【7】
The cataract removal surgery that followed was an operation from Germany.
The earliest cataract removal was extracapsular removal, without anesthesia, and the doctor and patient sat face to face. The doctor will incise the lower limbus of the patient's cornea and expand it to 120 degrees, then incise the anterior capsule and press the lower limbus of the cornea with his fingers to expel the nucleus. 【8】
The cortex is scraped off, the cornea is reset, and then the eye is wrapped. There is no suturing. 【9】
What Dr. Ledo showed to the public this time was the transscleral small incision lens removal performed by a German doctor. 【10】
When anesthesia gradually reduces the hand speed of all surgeons, the refinement of operations gradually becomes something they compare with their respective skills. Small incisions and low bleeding have begun to become indicators of the success of surgery, so small incision surgery aroused everyone's interest as soon as it was mentioned.
Because there is no phacoemulsification technology, the lens nucleus is not a chylous liquid. If you want to remove it, you need an incision that matches the size. Therefore, the size of the ordinary cataract removal incision is 6-8mm.
A small incision less than half the classic surgery?
How to get out the hard crystal core?
Magic?
"The German doctor's incision is only 3mm." Dr. Ledo took out his hand-drawn manuscript and explained, "He first incised the lens core in the eye and cut it into four parts. After the incision was completed, he made another small incision. Pull it out."
As soon as these words came out, many people immediately praised her. They did not expect to give birth after the separation.
But soon, some different voices of doubt emerged, which is the norm in the new trend: "Will intraocular incision cause unnecessary burden on the eyes? For example, corneal edema? Capsular rupture?"
"Not only the damage during the operation, but I am also skeptical about the visual recovery after the operation."
"Indeed, surgery should not pursue beauty on the scene. What is more important is whether the postoperative recovery can meet expectations. The small incision may seem exciting, and it probably won the applause of many viewers, but in the end it still depends on whether the patient is satisfied or not."
Ledo did not avoid these questions and answered them one by one: "Among the 20 cases of small-incision cataract surgery performed by this German doctor, 17 did suffer from corneal edema, 3 of them recovered on their own within 3 days, and the rest recovered. It took a little longer, about 5-7 days.”
"The probability of edema is a bit high, what about capsule rupture?"
"There are three."
"How is your vision recovery going?"
“Five patients failed to recover, and the rest improved slightly.”[11]
"There are actually 5 people? The proportion is a bit high."
"And it's just a slight improvement. It should be no different from ordinary removal."
Ledo was a little embarrassed when he said: "...After all, it is a small incision. It is a brand new attempt. These shortcomings need to be overcome slowly."
"Small incisions and large incisions require the same post-operative treatment, and they have no essential impact on the recovery of vision. I personally don't like to take such risks."
"Me too, such a high probability of corneal edema must be caused by too many cutting operations during the operation. It is better to use the classic surgical mode to avoid unnecessary trouble..."
Kawei benefited a lot from listening to these discussions, including subsequent nose reconstruction for syphilis and maxillomandibular resection + postoperative plastic surgery based on dental disease. He was amazed by the strong plastic surgery atmosphere of the surgical school.
The regular meeting in the morning wasted a lot of time because of the unharmonious "Nightingale". By the time the new wind direction ended, it was already past 12 o'clock.
Kavi originally thought that he would have to sit on the bench for another two or three hours, and was ready to enjoy the delicious food in the college with the dinner plate in the lounge. Who would have thought that Ignatz would take advantage of the lunch break to drag him to the dean's office. 【12】
Ignatz's father, Dean Waterman, was waiting for them in the room.
The old man was sitting quietly at his desk, smoking a pipe, wearing glasses, with white hair on his back, and an old surgical report in his hand.
Seeing them coming, Waterman was not polite but asked directly like an old friend: "How was the regular meeting in the morning?"
"There's a little trouble." Ignatz took Kawi and sat on the sofa. "You actually moved the British stuff into a new direction. Isn't this just to make them make trouble?"
"What does it matter..." Waterman was still looking at the surgery report in his hand, as if everything was under his control, "Anyway, there will be two brand-new surgical methods for you and Edinson. Those People will definitely calm down.”
"It's just hard on Corrigo."
"Haha, his cleft palate repair was nothing more than that. He was the last one to squeeze in to make up the numbers." Waterman said with a smile, "According to Corigo's violent and conceited character, he must have left halfway, right?"
"Um......"
"It ended at 12 o'clock, which is a little later than the previously scheduled time." Waterman took off his glasses and asked, "What do you think of Dr. List's point of view?"
"Surprisingly, I have never connected wound ulcers with microorganisms." Ignatz shook his head. "The idea is very novel, but I haven't seen the French chemist's experimental report. I think it's better to wait for a new experiment. The conclusion is good.”
"If you haven't seen it before, take it and have a look."
Waterman handed the report in his hand just now to Ignatz's hand, and then looked at Kawei beside him: "You should also take a look at it together. After reading it..."
"I've seen it, there's no need to read it."
"Seen?"
The father and son looked at him together: "Do you still care about the chemist's experimental report?"
"I was a little bored at the time, so I just flipped through it."
Kawei knew that he would be asked sooner or later, so he took this opportunity to test the dean of the surgical college's attitude towards infection: "I think the views of Mr. Lister and Mr. Pasteur have some truth, and they are consistent with my father's insistence on preoperative surgery." Preparation works in different ways.
After being inspired by Mr. Pasteur, I realized that microorganisms may be everywhere, and only our skin can prevent them from invading the body. This also proves from the side why the wound will fester whenever the skin is opened. It also proves why puerperal fever occurs after childbirth, because childbirth temporarily opens the channel between the body and the outside world. "
"What does that have to do with your insistence on washing your hands before?"
Waterman was a little surprised when he saw Kawei, and explained: "Don't be surprised, my son often shares some things about the hospital with me, and sometimes I also go to the theater to watch surgeries."
"I think this is related to the concentration of microorganisms. The concentration of microorganisms in the air is thin, and the concentration on the hands is much higher." Kawei has evidence in his hand. "Semmelweis, an obstetrician who used to be a doctor at the Municipal General Hospital, once said We have suggested washing hands, which can effectively reduce the chance of puerperal fever and surgical wound ulceration.”
"I have read the reports of those operations, and I am very clear about the current condition of the patient in your hands..." Waterman said, "Don't worry about my attitude, because I believe what you said about the preoperative preparations. It really played a decisive role.”
"Thanks......"
"Don't be too hasty to thank me. Besides, there's no point in thanking me."
Waterman picked up the pipe again and stuffed it into his mouth: "What you have to convince is not me, but the old die-hards. You also saw during the regular meeting just now how difficult it is to get them to change their status quo. Washing hands and cleaning wounds means To admit that they are not clean and that the surgical incisions they made is not clean is a desecration of their sacred profession."
Kawei nodded: "Indeed, Dr. Semmelweis was driven away under such circumstances."
Waterman was not interested in Semmelweis. He only cared about the surgery he was in charge of: "I especially want to know now. In the afternoon meeting, you will use some of your own surgical experience to revisit Dr. List's surgery." Opinion?"
Kawei felt that there were some problems with the arrangement of the meeting content from the beginning, but now it seems that everything was purposeful. The old man not only wants to expand the abdominal surgery department, but also looks at the bad chance of postoperative infection. After all, the average surgical mortality rate of 40%+ is really outrageous.
The doctor can say that it was caused by the environment, but he, the dignified dean of the college, cannot.
Waterman wants to directly solve the two major troubles in the development of surgery. His ambition is not small, and of course the resistance is not small, so he hopes to throw Kawei, who has no interest entanglements, out to explore the way.
Kawei was somewhat mentally prepared, but he was still indescribably awkward before going on stage. This old fox was much more difficult to deal with than his son. He couldn't help but glance at Ignatz sitting next to him, and said half-jokingly: "I thought it was just a report on two surgeries."
"After the report is over, you can continue to talk about some new ideas." Waterman smiled nonchalantly and said, "I would like to insert your preoperative theory into the new wind direction in the morning, but if it is right next to Liszt If the doctor's opinions are expressed together, I'm afraid those people will go berserk on the spot, and your surgery report in the afternoon will be ruined..." [13]
The three of them looked at each other and were silent for a long time. Finally, it was Kawei who spoke his mind first.
In fact, after learning about Semmelweis, his idea has always been simple, just wait.
"My father always told me that actual actions and objective facts are the best evidence. There is no need to convince others, because verbal persuasion is meaningless. So I firmly believe that as long as the postoperative mortality rate of my patients is much lower than that of other Surgeons, over time they will follow my lead.”
"How can I see it?"
"Because this is a business, and no patient will play with his or her life. Without patients, there will be no income from theater tickets. They will not live for the so-called 'holy', 'clean' and money."
－－－－－－Digression－－－－－
This chapter is too difficult...
