Due to the factors of the times, the surgical instruments were crude and the field of view was not clear enough. Kawei omitted quite a few details of the operation. Even so, the entire operation lasted nearly 2 hours. Among them, the large-scale cutting actions that the public likes to see account for a very small proportion, and the most time-consuming is the meticulous blood vessel and nerve stripping.
For the four laymen, except for a small episode in the middle of the operation, the whole process was uneventful, and even the episode itself didn't create any waves. This operation seemed to be just like an ordinary amputation that occurred in the theater on weekdays, except that it lasted longer.
The evaluation they gave was stable at best and boring at worst.
Of course, the purpose of the four people coming here is not really to watch the operation. It doesn't matter whether it looks good or not. The important thing is that Justina can get off the operating table safely. The important thing is to establish a good relationship between Fa and Ao.
However, in the eyes of the other 200 surgeons, they are two completely different worlds.
Breast cancer surgery in Austria has always been limited to the removal of breast cancer. This method, which combines modern surgical tracing methods with the classic radical surgery that became popular many years later, directly created a historical precedent for breast cancer treatment in the country.
The outcome of the surgery depends not only on the method of resection, but also on whether the countess has recurred.
The former has been completed almost perfectly, while the latter is still unknown.
But since Waterman acquiesced to Kawei's choice, they were happy to try it on their own patients. After all, the recurrence rate of breast cancer was too high.
If the patient still relapses after trying it, the pectoralis major and major muscles will be lost, which will have no impact on the survival rate. The patient will die soon, which is just a small loss. But if this surgical method can significantly reduce recurrence, it will save a life, which is a profitable business for both doctors and patients.
However, the radical mastectomy performed by Kawei is much more complicated than a simple vasculectomy. It seems that only two more pieces of muscle and a pile of fat are cut away. In fact, the most troublesome part is precisely these extra operations, which are also difficult for laymen to do. The place where we find the most boring.
Franz and the other three people could feel the warm atmosphere around them, but they didn't understand the deeper meaning.
"It's actually quite understandable. If the Countess had no recurrence after surgery, then Dr. Waterman and Carvey would have pioneered a new surgical method."
Edinson has objections to Kawei, but he also has to admit the status of this operation in breast surgery: "If I remember correctly, this should be the first operation in Europe to extend the scope of breast cancer cutting to muscles. .”
"So the Countess will be fine, right?"
Ambassador Edward also had a share of credit for pulling the strings for the operation. If the operation was successful, he would also gain a good reputation when the news spread back to France.
"I can only say that this operation was a pretty good attempt. As for the countess's tumor..." Edinson did not dare to make a conclusion easily. "Mr. Ambassador, you should understand that medical treatment is full of various Uncertainty."
"Okay, I understand." Edward nodded, "When I used to go for amputation surgeries when I was young, there were still very few patients who could use ether anesthesia, and we often encountered various problems during the surgery."
"This is much more complicated than an amputation."
"I'm just giving you an example... Sigh, we're only 14 or 15 years old, but I didn't expect that surgery has developed to such an extent." Edward sighed and said with a smile, "I can't even understand how they buried their heads. What are you doing?"
"Yes, surgery is developing too fast. If the audience in the future does not have some medical foundation, they may not be able to understand the content of the surgery at all."
"I see that His Majesty the Emperor was yawning just now."
"Isn't it the same for you?"
This was perhaps the only conversation between Franz and Edward today where there was no disagreement.
Edward looked at Kawei and the two assistants who were doing the final cleaning operation, and suddenly asked: "Dr. Edinson, did you just say that this is the first of its kind in the world?"
"Although there were no reporters involved, and no surgeons from other countries were present to witness it, judging from my technical skills, this is at least the first of its kind in Europe." Edinson explained, "Because I have a deep understanding of the medical environment and medical environment in the United States. I don’t know much about breast cancer resection techniques.”
"Not in France?"
"I'm sure France doesn't."
Edward was thoughtful and suddenly asked: "How do you think the countess's breast cancer is? Is it serious?"
"The pathological examination of the lymph nodes just now has confirmed that the tumor has metastasized." After all, Edinson has just begun to contact the relationship between tumors and lymph, so he can only give a very general answer, "Since there is metastasis, it means that the tumor condition is quite serious. ”
"New surgery, serious tumor condition, if the countess can survive..."
Edward looked at Edinson, who repeated what he just said: "This will be a brand-new treatment method with epoch-making significance."
This sentence raised Austria's surgical status and gave Edward an opportunity: "Your Majesty, if possible, I hope that the medical communities of France and Austria can have more exchanges, especially in surgery."
Franz glanced at Karl and Richard and replied: "There is no problem with communication, but..."
"I understand this."
Edward knew very well what they wanted: "After returning to the embassy, I will immediately write a letter explaining the countess's condition and convey this invitation. I think His Majesty will definitely agree. As for the relationship between Prussia and Austria, , I am a soft-spoken person, and General McMahon is more capable of speaking, so in the end it still depends on the Countess’ physical recovery.”
Franz's stated goal had been accomplished by getting a clear answer from the other party.
Justina's physical recovery naturally included the effects of the second surgery and did not exceed the scope of the original plan. As for whether France can be persuaded to help at important moments, now that the basis for the call is in place, it still depends on whether Franz can provide enough benefits.
The four people and Edinson stood up one after another and quickly left the surgical theater, but there was no intention of leaving the theater.
The complexity of the operation far exceeds that of cesarean section. It is obviously impossible to learn all the operations by observing them from a distance. Various questions and discussions after the operation have become an important way for everyone to learn.
Everyone is a knowledgeable person with a lot of clinical surgical experience, and they all know what the key points are. Most of the questions raised revolve around muscle separation and resection and axillary treatment.
"Dean Waterman, what I want to ask is, does armpit dissection really require cutting off all the fat?"
Waterman shook his head, stepped forward and patted Kawei on the shoulder and said: "I'm tired, and the patient will wake up soon, so I have to stay by the bedside. Anyway, Kawei and I decided on the surgical plan together, your questions Let him answer it."
I am really tired, but more importantly I still don’t understand the details of the operation. He was the chief surgeon, and standing on the court at this time would embarrass himself, so he might as well leave early and have some leisure time.
Seeing Waterman trot and follow the cart to leave the surgical theater, Kawei took the question and replied: "Since it is a cleanup, it must be cut cleanly. This can also answer some questions about muscle separation, and it is also necessary All fat and soft tissue on the last serratus anterior muscle are removed to achieve the purpose of radical tumor cure."
"What should I do if I encounter the thoracoacromial artery when separating the pectoralis major muscle and fail to stop in time, causing the blood vessel to rupture?"
"Hemostasis and ligation." Kawei answered simply, "It will have to be severed anyway."
"How to stop bleeding and perform ligation?"
"..."
"Because arterial bleeding is very troublesome and can quickly flood the entire surgical field."
Kawei couldn't solve this problem: "Stopping bleeding and finding the hemostasis point are the most basic operations of surgery. I don't think this should be a question that can be raised in this situation."
"Dr. Kawei, I have done dissection around the shoulder before. When removing lymph nodes, we often encounter situations where lymph and blood vessels adhere to each other. Is dissection necessary at this time?"
"Definitely needed."
"Then what if the stripping is not complete."
"Then cut it off." Kawei said, "Everything needs to pave the way for tumor treatment. There will be adhesion of blood vessels and lymph nodes under the scapula. If it encounters it, it can be directly separated and sutured."
In fact, we also need to pay attention to the thoracic and dorsal nerves here. Once severed, it will definitely affect the muscle function of the upper limbs to the shoulders.
However, considering that they were all beginners, the nerves did not necessarily have to be retained, so Kawei simply mentioned: "Just now, the dean and I saved the countess's thoracic and dorsal nerves because there was no adhesion between the nerves and lymph nodes. If a patient has lymphatic and nerve adhesion here, the main method is still to remove the lymph nodes.”
"Is it really necessary to do it so thoroughly?"
"I even cut off the muscle to prevent recurrence," Kawei said. "To be honest, the lack of reshaping of the incision after this kind of surgery really hurts the mentality of female patients."
"So Dr. Carvey and Dean Waterman will perform radical mastectomy for breast cancer again in the future, right?"
"If there is a chance."
After solving several key problems in stripping blood vessels and nerves, everyone focused on the skin flap at the beginning.
In the original resection, the upper and lower skin flaps were randomly collected, with random thickness, leaving a lot of tissue. What's more, the plane after suturing was not even enough.
Now Kawei has proposed the skin flap production method for the first time. Just like an old director who has performed hundreds of breast cancer surgeries, he said: "The skin flap must be made as thin as possible, especially when it is separated into the axillary area for axillary lymph node dissection. It is particularly important. Otherwise, the axillary skin flap is too thick and not elastic enough, and effusion and necrosis may easily occur after surgery."
After two hours of hard work, the final result was necrosis, which no one wanted to see.
However, flap production requires considerable skill, and Kawei himself is also in the process of groping for experience. He has very little to teach them: "Okay, are there any other questions?"
"I would like to ask, the dye used by Dr. Kawei before the operation seems to have been used at the end. I wonder what the purpose is?"
"This stain can destroy bacteria." Carvey said, "I will not only use it on the surgical incision, but also continue to drip diluent into the countess's blood vessels after the operation to reduce her chance of postoperative infection."
“Blue dye can fight incision ulcers???”
"Yes, my experimental results have proven this."
"It's incredible."
"Is there any specific data to support it? If not, it would be too random."
Kawei knew that someone would say this, which was understandable, and he indeed only had a small number of bacterial culture results in hand, lacking a large amount of experimental data. In fact, there were only a minority of people present who believed in the theory of microbial pathogenicity. It was obviously unrealistic for them to believe that dyes could prevent ulcers.
"As I said before, the surgical results are the standard for testing methods." Kawei said, "I will choose to use methylene blue as an anti-infective drug to continuously inject into the patient's body for subsequent surgeries. Everyone will wait and see."
"..."
"Oh, by the way, if anyone is interested in this magical dye, you can go to the Karachi Pharmaceutical Factory to buy it. It costs 15 kroner per bottle. You can choose to take it orally or intravenously. The specific dosage will be informed when purchasing. Ours."
After the question and answer, this stage has come to an end.
Kawei informed all the surgical steps and answered all the questions that could be answered. Whether they can turn these written descriptions and viewing experience into a workable operation depends on their ability.
"If there is no problem, I will withdraw first." Kawei packed up his surgical instruments and prepared to leave.
Suddenly someone asked: "Dr. Carvey, if possible, would you be willing to move to St. Mary's Hospital, where there is a breast cancer patient in urgent need of surgical treatment."
Throwing knife? ? ?
Kawei looked up and followed the voice: "Can't Dr. Massimov do it?"
"The tumor is too big. Ordinary mastectomy may not be able to cure it. Teacher Massimov is not sure." Before Kavey could speak, the young surgeon continued, "Doctor Kavey doesn't have to worry about the cost of the operation. The hospital will also properly resolve equipment and drug issues."
"Okay, let's discuss it together after it's over and see if I have time."
"Thanks."
"By the way, Dr. Carvey, we have one last question."
"what is the problem?"
"I heard that the countess needs a second reconstruction. The surgical incision is so huge, and so much breast and muscle tissue has been lost. How to reconstruct it? Or maybe Dr. Carvey and Dean Waterman already have an idea?"
Kawei sighed: "There is only a first draft now. Whether it is feasible or not will have to be further confirmed by autopsy."
After all, surgeons in the 19th century were more willing to go the route of epidermal plastic surgery, so the audience on the stage was very interested in the secondary reconstruction: "Can you reveal some details?"
"Actually, it's just a rough idea. We hope to choose myocutaneous flaps on the back and abdomen for combined transplantation." Kawei explained while patting his belly and lower back. "I'm afraid it will take some time for the specific plan, but Earl If Madam wants another operation, she will have to wait for about three months, which is plenty of time."
