The original technical content of the surgery is not high. For laymen, it is just a lack of experience, but the intuitive limb cutting is not difficult to understand. Therefore, wailing surgical performances can bring exciting experiences to some people, and can also bring a lot of income to doctors, reducing the treatment costs paid by "patients".
Even if anesthesia has become a routine preoperative operation, the operation time has been greatly extended, and the fast-in and fast-out operations have become more and more sophisticated, those viewers who like gore will still buy it.
After all, the surgeon was Kawei, who had performed miracles, and the surgical site was the abdominal cavity, which is rarely seen. The patient was still a murderer who had to be executed, and the king and queen were present at the scene... These conditions were all met individually. It can attract the attention of many people, and it can be considered as a stack of various stimulating buffs.
At the beginning, excluding those who didn't care about the progress of the operation at all, and the remaining ones, whether they were looking for trouble or to cheer, everyone's reaction was the same, that is, expectation.
They looked forward to a complicated abdominal surgery to open their eyes, and hoped that disembowelment would bring them sensory stimulation. They also hoped to end the murderer's life if the operation was successfully completed.
However, so far in the operation, except for simple laparotomy and pulling out the intestines with his hands, Kawei has not used any other instruments other than retractors.
No cutting, no bleeding, no suturing and easy-to-understand commentary.
Although Kawei has always emphasized that he is doing probing, is such probing really necessary? Will an exploration be required before starting any abdominal surgery in the future?
Preoperative anesthesia already makes the operation very boring. If you add another exploration, is the operation still necessary? How troublesome is this?
If the audience were drunkards, then the previous surgery performances were made with strong alcohol mixed with yam tincture. After drinking it, they would immediately get drunk and get extremely high. Although the surgery after anesthesia is less exciting, it can still be used as ordinary wine on the table. It is drinkable and can be regarded as an embellishment in life.
Even if the operation really failed, it would still be wine that had deteriorated and oxidized, and would still have a bit of a sour taste.
But the operation in front of me was too dull. There was no conflict, no climax, not even a trace of succession. The surgeons headed by Kawei stood around the operating table, constantly checking Fernand's belly, like a great god who had written a book about shopping that could not be ordered a hundred times and plopped it into the gutter.
Even if Kawei calmed down the opening scene with a blood pressure monitor, and then used Schizophrenia to attract Bo's attention, in the eyes of the audience, the opening scene was just the opening scene, and the parasite was just a one-time job.
The operation time can be prolonged or slightly dull, but the basic stimulation must be ensured. The source of stimulation is the focus of the operation, which is the flying scalpel, the splashing blood, and the severed stumps...
Without these, there will be no appreciation. Once there is a problem with the appreciation, it is useless to save it.
As early as twenty minutes ago, many people took the lead in discussing this surgical atmosphere, which was like a cool operation. As time slowly passed, the audience's emotions finally exploded after experiencing suspicion, boredom, sighs and helplessness.
Someone shouted, "Why does this boring surgery cost more than 800 crowns?", and the same thought spread among the audience like a pile of straw on fire.
Fortunately, those who could sit in the audience were all rich or noble, and their voices were quite restrained, not to the point of being noisy.
On the other hand, the surgeon's area on the other side was completely opposite. At the beginning, due to the leadership of Mosier, Ferguson, and Bottini, there were a lot of doubts, but these voices completely disappeared after the operation started.
All they have is surprise, admiration and puzzlement.
So after the audience became dissatisfied in one way or another, someone immediately stood up and said, "Can you even find this kind of major abdominal surgery boring?"
The first person to question was Yingenatz. Kawei was now half the face of the Municipal General Hospital and his own student in name only. At this time, he had to support him. What's more, from a professional perspective, this rhetorical question is absolutely correct.
Soon, several chief doctors also stepped down and expressed their attitude.
"Just the three hanging bottles hanging on the arm of the death row prisoner have already stood at the forefront of world medicine." Waterman added, "The combination of blood transfusion + infusion not only allows people to live until now, but also slowly stopped I'm vomiting blood, do you know what this means?"
"And the simple blood pressure monitor he used is a pioneering work that cannot be ignored." Orji said, "Even if the operation fails now, with blood transfusion and blood pressure monitor, his name can be engraved in the history books of medicine. .”
"Even without the blood pressure monitor and blood transfusion, his cesarean section was enough to leave his name."
Seeing everyone on the sidelines praising him, Hills still insisted on his own point of view and had doubts about blood transfusions and blood pressure monitors. 【1】
Before the application effect is clear, whether blood pressure readings are really necessary to enter clinical practice requires further research. Whether blood transfusion is really as safe as Kawei said still needs to be verified by experiments and time.
But aside from these two points, because he had experienced Orji's abdominal surgery and cesarean section, and had seen Kawei's amputation, Hills had gradually understood the importance of standardizing the operating procedures in abdominal surgery.
Of course, his understanding of this aspect is still very shallow, but he still wants to be fair to Kawei: "The abdominal cavity is not an arm or a thigh. In addition to a large number of blood vessels, it is also filled with various internal organs. We are Doctor, if you use this prisoner's slaughtering skills to operate on him, it would be a blasphemy against our profession."
"Okay, don't you know whose pocket the money you spent goes into?"
After Massimov underwent his last brain surgery, he began to trust Kavey unconditionally: "Kavey will naturally give a satisfactory answer. Now that he has done so, there must be a reason for him to do so. , you are bored just because you can’t understand.”
】
With the support of colleagues, especially those who have made great achievements in surgery, the scene finally calmed down.
In fact, they know in their hearts that these are not just support among ordinary peers, but also out of the desire to learn new technologies. What really made these doctors realize the gap between themselves and Kawei was what he said after checking his abdominal cavity.
"Mr. Fernand suffered from schizosomiasis. The liver portal system was damaged and now he has portal hypertension. His spleen is infinitely expanded. Even the rectum has inflammatory nodules that have invaded the intestinal mucosa. The situation is not optimistic. .Although the patient's body is being attacked by parasites, I just checked the esophageal and gastric veins, and the varicose veins are very serious..."
Kawei gave a brief summary of Fernan's physical condition, and then said, "But I am confident that he can be cured with an operation."
This situation has completely eliminated the chance of surgery for existing surgeons. Faced with a messy abdominal cavity, not many people are willing to operate under the knife.
In fact, when faced with upper gastrointestinal bleeding, half of the top doctors present will choose to give up, and the next half will basically choose conservative medical treatment or no treatment at all.
No one would choose to disembowel him, even if the other party was a death row prisoner, they would not disembowel him. It's not that I'm worried about the failure of the operation, but because no one knows how to deal with portal hypertension after laparotomy. Even they don't know that cirrhosis is the direct cause of portal hypertension.
Kawei gave their medical knowledge a collective leap, and the side effect it brought was a lot of question marks.
They found it hard to believe that such a young surgeon had discovered the cause and surgical solution to esophageal and gastric varices less than 7 years after the French discovered them. 【2】
How can you still have confidence in such a severe situation? Before the surgery, I said I was not sure. Where did my confidence come from now?
What they don’t know is that confidence is earned through previous exploration.
An unclear diagnosis will greatly increase the difficulty of surgery, but once the diagnosis and location of the lesion are clear, the nature of the surgery changes.
Today's surgery in Kawei's hands is no longer a random incision, but a complete battle plan. The fast-forward and bloody surgical performance lost the passion under Kawei's standardized surgical procedures, but it increased the success rate.
Kawei didn't pay attention to the questions from the audience, nor did he pay attention to Edward's crazy coughing behind him. He knew that as long as he still had the trumpet in his hand, he would have the right to speak in this venue: "For the surgery, I would choose to remove the huge spleen first, and then selectively shunt the peripheral blood vessels or directly perform devascularization around the stomach. .....”
This should be the first time he clarified the basic surgical plan to the audience.
Splenectomy is easy to understand. In today's abdominal surgery, removing a damaged or swollen spleen is a relatively common surgical procedure, and the difficulty is not too high. But what’s the shunt after that? What is the art of disconnection?
Can surgeries that have been performed on limbs and organs also be performed on blood vessels?
Since the concept of aneurysm appeared in the 18th century [3], the most direct and only way to deal with blood vessels clinically is to ligate it.
Broken blood vessel? ligation.
Broken blood vessel? ligation.
Need to cut away some tissue or disconnect blood vessels? Or do a ligation.
Even if Kawei had undergone simple blood vessel repair or compression to stop the bleeding, ligation was still the absolute mainstream.
They also thought about anastomosis of blood vessels, but this fantasy was soon defeated by the simple surgical suture needles. In fact, even if modern vascular surgery is given to them, due to the lack of anatomy and clinical understanding of the blood vessel wall, even if the blood vessels are really anastomosed, there will always be lumen stenosis caused by inward proliferation of the suture.
Kakawi still put the sutured blood vessel to his mouth and said confidently: "Don't get excited. If you have any questions, we can wait until the operation is over. I will try my best to answer your questions, whether the operation is successful or not."
After saying this, he began to ask Berget to prepare the instruments while continuing to talk about the next surgical plan:
"After dealing with the spleen and blood vessels, we will choose a solution for the rectal mass based on the patient's blood pressure, heart rate, and the extent of the nodule. Before that, we still need to focus on the spleen. This is not an ordinary spleen. , it is not easy to deal with..."
Before working on the spleen, Kawei also needed to do a simple portal pressure measurement to show the effect of the surgical solution on portal hypertension.
Damirgaon and Bergert turned down the skin at the lambdoid incision and then laid the omentum flat over the incision. Kawei chose a thicker omental vein as the measurement point, and Hermann filled the long J-shaped glass tube (composed of a glass tube, a rubber tube and a needle) brought by Bergert with physiological saline, and the needle Puncture the vein from bottom to top. 【4】
The level of saline in the tube gradually decreases as the needle enters the blood vessel until it stops at 31cm.
"The normal portal pressure is around 13-24cm water column, and 31 is already very high." Kawei removed the pressure glass tube, and then asked Herman to suture the veins with a needle and thread. "After the splenectomy, we can Then look at the pressure within the blood vessels. If the pressure returns to the normal range by then, the shunt surgery can be eliminated."
As he spoke, he found the spleen-gastric ligament with forceps: "Next, according to the basic procedure of splenectomy, we need to ligate the splenic artery. Give me the scissors..."
The scissors accurately found the non-vascular area on the spleen and stomach ligament in Kawei's hand, gently cut a small hole, and then used vascular forceps to clamp the blood vessel to separate the ligament. 【5】
"This is the spleen-gastric ligament, and next to it is the splenocolic ligament. The reason for cutting is to better separate the spleen..."
Kavi used pliers to clamp the blood vessels on both sides, and then used a knife to cut the ligament in the middle. Then Herman and Damirgang worked one at a time while suturing the broken ends.
Kawei continued to explore around the spleen and found that there was schistosomiasis infestation. Although it would not cause severe inflammation in the abdominal cavity, there would still be many adhesions. If these adhesions are ignored and forced dissection is performed, massive bleeding will definitely occur. This is not the style of modern surgery.
However, while he was looking around for spleen adhesions, Herman made a move that almost killed Fernand.
"What do you want to do?" Kawei blocked Herman's arm with his hand and asked.
Hermann was a little confused: "I want to turn up the fundus and greater curvature of the stomach to increase your surgical field."
"We don't have this step in the corpse exercise, so don't move around." Kawei removed his hand, used his own to gently lift his stomach, and said, "You all come and see what's underneath."
[General surgery practitioners should be very familiar with this, a must-teach for gastrointestinal surgery]
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