[My work has been a bit chaotic recently. My daughter has just started school. The update frequency remains unchanged, but the release time will be unstable]
Uterine prolapse is caused by the weakness and relaxation of the supporting tissue around the uterus. According to the conventional idea of "solve the problem wherever it goes", shortening the elongated ligaments will fundamentally improve the degree of uterine prolapse.
The ligament reduction surgery described by Denev will be effective as long as it is successful, and the pelvic floor function reconstruction based on suspension surgery is a more advanced version.
However, because the recurrence rate of uterine prolapse is very high, as long as the vaginal opening below is still there, the returned uterus may still prolapse. Simple ligament reduction cannot completely solve all problems, and pelvic floor reconstruction is very difficult.
At this point, neither of the two conventional ideas can be realized.
Since the conventional method is not enough, in line with the principle of getting rid of the people who created the problem if it cannot be solved, Kawei gave his own suggestion: "Otherwise, you should have the uterus removed. The patient is already menopausal anyway and cannot have children. "
Hysterectomy is also a common surgical method to solve uterine prolapse in modern times. For older women who have gone through menopause, their ovarian function decreases and the uterus loses its most important reproductive function. The other function of maintaining the stability of organs is also completely lost due to its prolapse.
Therefore, for such patients, hysterectomy can fundamentally cure prolapse without changing daily life too much.
If it was Kawei, he might not consider ligament reduction or suspension at all, and would plan for a hysterectomy from the beginning.
However, even if the existence of the uterus has lost its original meaning, the patient's consent is still required before surgery. In the preoperative conversation, it is also necessary to explain to the patient the problems that may arise after resection before making a decision.
Bessim and Deneve must have never spoken, because in this day and age the doctor's choice of diagnosis and treatment has nothing to do with the patient.
The patient does not have the right to informed consent. As long as he is on the operating table, the doctor can "do whatever he wants". Of course, any disorder will be noticed by the audience and will immediately affect the reputation of the surgeon. And any highlight moment will follow the same path and be reflected in the eyes of every audience.
Hysterectomy is not difficult for Kawei, but it is much more difficult for Denev and Besim.
Now the pelvic tissue has changed its appearance after prolapse due to long-term traction, and the method of resection must be different from the original, so the difficulty of the operation will not be much worse than yesterday's pelvic adhesion. The two of them definitely couldn't perform a surgery that even Orgi, who had decades of work experience, couldn't perform.
Denev was very confident in his medical skills, but after hearing the word "hysterectomy," he still shook his head: "This operation is too difficult. I don't have the ability to do it, and I'm afraid Teacher Besim doesn't have it either."
"There are only a few doctors in Vienna who have performed hysterectomy, and the only ones who can do it are Dr. Kavi and Dr. Orgi."
Unlike his students, when Besim heard "hysterectomy", a different scene flashed in his mind: Kawei got out of the audience amidst the applause of others, walked to the operating table and took away the surgeon's seat , and then easily ended the complicated operation that had made everyone difficult.
Besim recognized Kawi's strength, but did not allow others to interfere without authorization.
So after Kawei proposed a hysterectomy, he thought the young doctor wanted to come on stage to help, and quickly refused: "Since the patient belongs to the gynecological ward of Graz Hospital, I still hope that we can complete the operation ourselves. Hysterectomy is too dangerous. , I think solving the bilateral broad ligaments and cardinal ligaments is enough to achieve the purpose of the surgery."
"In that case..." Kawei didn't think as much as he thought, and immediately gave the second suggestion, "It's okay not to remove the uterus, just close it directly after reducing the ligaments. Just use your mouth."
In just two or three minutes, Kawei changed his mind again.
If you can't solve the problem and you can't solve the people who caused the problem, then you can get rid of those who are helping. Kawei means to seal the path of prolapse and hide the uterus in the pelvic cavity forever.
The method is good. In fact, similar treatment methods have been available for a long time.
"Is it just a simple suture?"
"Can this support the uterus?"
"Everyone, I am definitely not talking about simple suturing." Kawei explained, "Next to the prolapsed cervix is the thickened vaginal wall. You only need to take out a square piece of mucosa at the upper and lower ends. After pushing the cervix into the body, , suture the two pieces of mucous membrane to each other to form a perfect shielding piece." [1]
"..."
The abstract text description prevented everyone present from reacting immediately. After thinking for a long time, many people took out pens and paper and began to use images to deepen their understanding: "Dr. Kawei, what you just said was to take a piece of mucous membrane from the top and bottom. ?”
"Yes, cut out a piece of mucous membrane, and connect the end to the yd wall." Kawei took Orji's notebook next to him, "It's like opening a piece of paper, one page on the top, one page on the bottom, and one page in the middle. Push it, then sew the two sides together to hide the middle page.”
"......I see."
“What an idea!”
"The ideas are so clear, how did you come up with all this???"
This is actually a very traditional yd closure surgery. It is mainly targeted at elderly patients with uterine prolapse who cannot undergo abdominal surgery. It can be regarded as a product of compromise. Since it is a compromise, there will be shortcomings, and the shortcomings of yd closure are obvious.
"The patient is only 53 years old. Menopause does not mean that there will be no sexual life, so the operation requires the patient's consent." Kawei said, "Besides, this is a gynecological operation. The two of them still need to practice. They will definitely not be able to do it today. . You might as well wait for the patient to recover for a period of time after surgery, and you can ask for her opinion, and at the same time you can do more exercises yourself."
The operation is not complicated, and is much easier than total hysterectomy, but more difficult than ligament reduction. It is a new challenge for both Besim and Denev.
This is a suggestion given by Kawei after consideration.
If the person standing in the audience was a general surgeon like Hills with seven or eight years of surgical experience, then Carvey would definitely not propose uterine closure and might ask him to try a total hysterectomy.
If it was Orgi who had some experience in pelvic floor surgery, then Carvey would suggest that on top of the hysterectomy, he should undergo a plication reduction repair of the loose anterior and posterior walls of the vagina.
If the surgeon changes to the more successful Ignatz or Waterman, Kawei will also go one step further. Uterine suspension + complex pelvic floor function repair will be a good challenge for them.
There is no universal surgery in the world, only the one that suits the patient is the best. This sentence also applies to doctors who are climbing the peak of surgery.
The operation was quickly concluded on Carvey's advice.
The whole thing is simple and lackluster, and Carvey can't find any sparkle. But for these two surgical novices, the operation can be said to be quite successful. At least the patient's uterus did retract into the abdominal cavity, and the prolapse was greatly improved.
He was not interested in what the patient said after he woke up, what was discussed during the operation, or the praise from people around him. He left the theater after the operation.
At two o'clock in the afternoon, Kawei just walked out of the gate of Graz Hospital. He wanted to return to the medical school quickly, and then plunged into the laboratory to find out the active ingredients of the two bottles of herbal medicine in his hand. Unexpectedly, as soon as he opened the car door, he was stopped by the young man behind him: "Dr. Kawei, I finally see you."
What came to meet him was Armor Godwin, a surgical assistant at Glaze Hospital who had previously wanted to learn anesthesia technology.
"Mr. Amor." Kawei stopped, greeted the coachman, took him to the side of the road, and asked, "Why didn't you go to the surgery just now? I thought I could see you."
"Surgery?" Amor shook his head, "I have been too busy with work recently and have no time to go to the surgery."
"Aren't you an assistant..."
Kawei also did this kind of chores, which were just repetitive and simple tasks. In fact, Amor was pretty much the same at the beginning. He could finish his own work and then gain clinical experience by watching surgeries.
But today is different from the past.
"An assistant was recently removed from the army, and Hills and Lockard also need to frequently visit the Military Affairs Office and the Military Medical Committee." Amor couldn't express his pain, "The entire surgery now only relies on me as a handyman. Not just now, Teacher Orji asked me to go shopping again."
"buy what?"
"The ureters you used yesterday were lined with copper tubes." Amor took out the sample from his pocket. "He said to prepare ten tubes first and buy more when you become more familiar with them."
"I just thought of an emergency solution." Kawei was troubled by this follow-up operation. "The impact of copper pipes on the human body has not been confirmed, and the pipe itself has no support and will deviate from its original position at any time. , it’s actually not considered safe.”
"Unsafe?"
“Maybe it will get stuck in a narrow position [2],” Kawei explained. “If no incarceration occurs, it’s okay. Once incarceration or squeezing occurs, it will also cause damage to the ureteral wall. Over time, copper will also It will be oxidized, and whether it can remain open at that time depends entirely on luck.”
"This..." Amor immediately wrote this down in his notebook, "I will talk to Dr. Orji when I get back later."
"Don't think about Orgi, think about yourself." Kawei sighed, "Think about what you do as an assistant?"
Every intern doctor or assistant who is willing to be a low-level labor force has the determination to become a real doctor, and the same is true for Amor. What he was looking for was never the pitiful salary of 30 kronor per month, nor was it for having a stable job, but for the ability to be independent on the operating table.
"I want to go to the operating table, but there are too many chores now, so there is no chance."
"I can give you a chance." Kawei said, "As long as you are interested, I will teach you, including the anesthesia we talked about in the last letter."
The failure of anesthesia is a scar in Amor's heart. Now the number of assistants has dropped sharply. Considering the number of surgical patients at Graze Hospital and the chance of anesthesia accidents, this scar will soon expand. If you want to heal scars, you must standardize the anesthesia process.
This rhetoric is tantamount to poaching. Thinking about the scene when he first entered the surgical theater, Kawei seemed familiar.
Amor has concerns about poaching. Originally, Amor was the only surgical assistant left. If he were to be poached, Orji would be left with no one available: "This is not good..."
"Sometimes they should also be given a taste of the working people at the bottom."
Amol's living standard is slightly better than that of Kawi before him, and he is not eligible for unemployment at all. Moreover, Graz Hospital had signed a contract with him, and he would have to pay a large amount of liquidated damages if he broke the contract. He didn't want to pay liquidated damages, and he had no money to pay. Kawei on the side didn't want to pay either.
Kawei doesn't value money, he lives a simple life and doesn't need much, but he would be very depressed if he had to pay an unjust amount of money for no reason: "Otherwise, the frequency of my surgeries is low anyway, so you can be an assistant temporarily." It won’t take much time.”
"Is this really okay?"
"sure."
"Teacher Hills will probably scold me to death."
Kawei didn't have time to chat with him anymore, so he took a note and put it into Amor's hand, and opened the carriage door again: "This is the time for my next surgery. If you are interested, come to me one day in advance." , I’ll let you come on stage as an assistant.”
...
Amor is just an undergraduate graduate from a local medical school. He was not favored by the professor to continue his studies, and his abilities are very average. This shortcoming is even more obvious in Graz Hospital, which is full of graduates with master's and doctoral degrees.
If nothing else happens, he will need to wait another three to five years before he can become a regular with the help of Orji. By then, he would at least be able to hold a scalpel by himself and perform simple operations such as removing epidermal tumors and suturing wounds.
Of course, in addition to this step-by-step promotion path, there is also a more efficient way, which is to become a military doctor and go to the front line.
Working in a military logistics hospital not only allows you to earn military merit, but you can also see a large number of surgical operations, which greatly improves your technical and theoretical knowledge. It's a pity that Graz Hospital is currently short of manpower and is unwilling to let go, so Amor can only stay in the hospital and continue working.
Kawei gave him a chance. Any more would be too much, and he didn't want to stalemate the relationship.
Suddenly, the driver knocked on the glass window behind him: "Dr. Kawei, the road ahead is blocked by the police. Why don't you get off the bus here? The gate of the medical school is in front of you, not far away."
"police?"
Kawei opened the car door, and the tense atmosphere immediately hit his face.
The University of Vienna is located on the busiest street. It is still lively here, but there are many policemen wearing high hats and holding guns in the crowd.
Passing carriages were stopped by them for interrogation, and pedestrians were sometimes randomly checked. There were also a number of plainclothes officers who behaved strangely mixed in among these policemen. They stood scattered on the corner of the street, with the brim of their hats lowered on their heads, smoking cigarettes and scanning everything they could see.
Kawei smelled Mick's scent after just two glances.
"What's going on?"
