At this stage of the operation, the audience was clearly divided into three parts.
Among them, the smallest proportion are those director-level doctors.
With my solid anatomy skills and the telescope in my hand, I basically understood the entire procedure of the surgery. Although the details are still a mess, and many operations cannot be seen clearly, at least the general direction is grasped.
The rest of the doctors who have medical foundations make up the second part.
They have good knowledge of anatomy, but they don’t know much about the abdominal cavity, an area that is not very involved, so a lot of the content is confused.
They had already skipped the details of the operation. Remarks such as "Pay attention here!", "You need xxx here", "Don't xxx here" and so on were completely beyond their understanding. These young doctors just hope that if they can master the purpose and operation summary of each surgical procedure, even if they complete the task, they will at least be worthy of the thousands of kronor they spent.
Unfortunately, it is not easy to do this.
Many people can only figure out a general framework while listening, watching and discussing. In addition, live discussion is a double-edged sword in the same situation as a live broadcast. As a result, many people can actually understand very little. limited.
For them, apart from learning some basic suturing techniques, it is still too early for them to watch Kawei’s surgery involving surgical ideas and specific treatment methods.
Apart from these two categories, the largest proportion of the rest are capitalists and aristocrats who have no medical foundation. He had no idea how the surgery had reached this point, no idea when the surgery would end, and no idea how to deal with the vascular shunt next.
The only thing they knew was that Fernan's spleen was gone, and Fernan was still alive and well.
These people also included Edward, who was sitting in the VIP seats.
Even if he didn't understand anatomy or surgery, he could still see some clues from the on-site reaction and the calmness of the surgical team. Difficulty aside, at least so far, the surgery is still within control.
This feeling that reality and the expected direction in his mind were slowly derailing and gradually going their separate ways made Edward couldn't help but ask the medical consultant next to him: "What do you think of the surgery?"
"The operation itself is exciting enough. In addition, the blood transfusion and blood pressure monitor used are very creative. The recovery of spleen blood is also a pioneering work, and the effect is very good..."
Although he expressed his true feelings, the words he used were all polite, because the consultant's attention was entirely on the surgery, and he was afraid of missing the subsequent vascular anastomosis surgery.
But Edward couldn't care about this: "So, when did the operation fail?"
"...fail? Why fail?"
The consultant didn't understand what he meant for a while. Only when he came back to his senses did he realize the original significance of the operation: "Judging from the blood pressure and heart rate reported by the nurse just now, this patient is living well. Most of the operation has passed. Judging from the previous surgical techniques and procedures, there shouldn’t be any major problems.”
"Will there be no problems? Isn't this operation difficult? Isn't the success rate infinitely close to 0?"
Edward had had this premonition before, but he always felt that at Kawhi's age, there was no way he could handle this kind of surgery. In fact, even standing on such a stage at this age requires extraordinary courage, let alone surgery.
Now after listening to his consultant's words, Edward became more and more worried about what to do after the operation was successful.
After all, Kawei didn't express it this way when he talked to him about surgery before. He compared the success of the surgery to a young man who didn't know anything and suddenly cooked a table of luxurious French cuisine. Now it seems that the so-called young man who "knows nothing" is actually a figure similar to Alphonse.
Edward was a little unhappy: "He is a death row prisoner, this is the execution ground!"
"It's a pity that people are not dead yet. Death is the execution ground. If you are not dead, you can only count the surgery." The consultant knew that he was a little anxious, so he could only comfort him, "But the subsequent vascular anastomosis is very difficult. If it is not done well, It’s probably very difficult for people to survive.”
"Are you serious?"
"Really...probably..."
...
The success rate of surgery in their eyes has long since changed due to the modification of the surgical plan.
Previously, this success rate was given because it was determined that there was a liver tumor and the difficulty of liver tumor surgery was considered. Now there is no need to move the liver, and splenectomy and venous diversion are not too difficult for Kawei.
Before the spleen was removed, the success rate of the operation was over 70%. Now after the splenectomy, Fernan's vital signs remain stable, and the success rate is over 80%.
Next, as long as the anastomosis between the splenic vein and the inferior vena cava is completed, Kawei can turn to the rectum. There was an inflammatory stimulus caused by egg deposition, and the next surgical plan needed to be determined in a short time. That is, based on the location of the inflammation, the choice is whether to preserve the anus, abandon the anus, or not operate at all.
"Give me the vascular suture," Kawi said to Berget. "It's in a small bottle in the drawer of the box."
This is a silk thread that has been compositely braided and soaked in chromium solution to strengthen its toughness. It is three times thinner than the original catgut and has higher toughness. Although in Kawei's eyes, it is still a poor product of the 19th century industry, it is still much better than other silk threads.
At the same time, it is also the key to subsequent blood vessel suturing.
Suture threads alone are not enough. There is another key to vascular suturing, which is the carrier on the thread, a smaller diameter vascular anastomosis needle and a slender needle holder.
The inferior vena cava is deeper into the abdominal cavity than where the spleen and pancreas were just now, and is surrounded by mesentery, omentum and a large number of intestinal tubes. Not only is the field of view difficult to expose, it is also very laborious to operate.
Human hands have too many joints and their size and length are not suitable for exploring such areas. This is not obvious in the superficial layer of the abdominal cavity. Once the surgical area reaches the deep layer, instruments can only be used to increase the length and reduce the volume.
Needle holders solve this problem.
Considering the gripping strength and simple operation technique of the needle holder, as well as the increasingly popular endoscopic surgery, almost all modern surgeries use needle holders.
“Because the inferior vena cava is too deep to handle with my hands, I chose a pair of short-head forceps instead of holding the suture needle with both hands for suturing.”
Kawei has long been accustomed to this surgical method, and holding the needle directly with his hands will affect the operation. But in the eyes of outsiders, the method of using pliers to fix the suture needle was too advanced. What is even more advanced is Kawei's vascular anastomosis method, because it is necessary to consider the healing condition of the inner side of the blood vessels after suturing, and the fibrous capsule of the blood vessels needs to be peeled off before suturing. 1】
This practice of actively creating damage during surgery for better healing is actually very common.
"Vascular anastomosis itself is not too difficult, especially when these operating instruments are available." Kawei explained, "The important thing is how to keep the blood vessels open after the anastomosis. What needs to be done to keep the blood vessels open is to prevent blood from flowing in Coagulation here is nothing more than preventing blood vessel narrowing.”
At this point, he used tweezers to lift up the blood vessel coating, cut it with small scissors, and removed this coating: "When suturing blood vessels, this coating is easily brought into the blood vessel wall. Once it enters the blood vessel wall, although it is not suitable for anastomosis, The mouth itself has no effect, but it will hinder the blood flow..."
This is a theory that should not have appeared in this era. In order to let them understand it better, he could only add the explanation of carriage congestion.
Many people immediately understand that once a carriage is jammed, the driver will never be happy. Sometimes they would curse each other, and sometimes they would fight with each other. Once they got into a fight, the whole road would be unreachable.
The same goes for blood vessels.
"After the stripping is complete, the remaining venous lumen that needs to be anastomotic needs to be cleaned." Kawei took the syringe from Berget's hand and dripped the normal saline inside into the lumen. "These clots If it follows the vascular anastomosis and then enters the lumen, it is very likely that thrombus will form as soon as the suturing is done, which will make the entire operation useless.”
After saying that, he looked at the nurse.
"Heart rate 96, blood pressure 122/68."
Kavi nodded.
"After cleaning, first use silk thread to select inversion suturing. The suturing technique is to fix the upper and lower points first, and then in the middle. This will help to provide support. It is also convenient for reference for the alignment of the incision." Kawei spoke. The back wall has been anastomosed with a lot of effort. "After the back wall is finished, we sew the front wall of the anastomosis, either continuously or intermittently."
Suturing blood vessels is a technical job.
Not to mention that the audience couldn't understand, even the three assistants standing beside the operating table were confused.
They only felt that Kawei's sutures were repeatedly intersecting the two ends of the pink mass, connecting the two unrelated structures. Because the anastomosis is small, the operation is performed as if it were performed at one point.
If it were someone else's surgery, they would have started asking questions long ago.
But Kawei's surgery did not allow questions, not only to interrupt the train of thought, but more importantly, they didn't know how to ask to make themselves appear less stupid.
"Is there anything you don't understand?"
"Well..." Damirgang was more experienced than the other two in terms of suturing, "Why is the needle inserted from the lumen outward every time? Instead of from the outside in?"
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"In order to prevent the residual tissue around the blood vessels from being replaced inside." Kawei explained, "Although the blood vessels have been almost freed, there is still a lot of fat and soft tissue on the surface. If there is any outside-in, you only need to bring in a little bit. It causes a chain reaction.”
"It turns out it's to prevent blood clots..."
Kawei quickly completed the anastomosis between the splenic vein and the inferior vena cava, and immediately entered the post-operative cleaning and examination phase.
The first thing is the location and shape of the splenic vein. In order to maintain the smoothness of the splenic vein, this side branch should try to share the pressure of the entire high-pressure portal system. At least the splenic vein cannot be twisted, nor can it be compressed by other organs, let alone bend.
"Loosen the hemostat."
After Kawei's examination, the first thing to do is the blood circulation.
Essentially, the quality of the suture needle is still not enough to perfectly complete a venous anastomosis. The needle hole at the anastomosis itself is a damage, and it will definitely bleed: "There is a bleeding point here, give me gauze..."
After two consecutive compressions, the bleeding point at the anastomosis was stabilized.
"Here, bring up the pressure gauge just now."
"good."
“Splenectomy and venous shunting are excellent surgeries for the treatment of portal hypertension,” Kawei explained. “The effect is immediate.”
I saw that the people in charge of the experiment just now were replaced by Berget and Damirgang. The long glass tube was still pierced into the mesenteric blood vessel: "It has dropped to 23cm."
This is the most intuitive manifestation of the effect of the operation, and it also allows Kawei to finally announce: "Now let me tell you that the patient's splenectomy + splenic portal vein shunt has basically ended. The patient's vital signs are very good, and the operation was successful...
...Half the battle is over, there is another troublesome part. "
...
The splenectomy + shunt operation took Kawei a full hour and a half. Counting the previous half-hour of exploration, Fernand had already been given ether twice. If another rectal surgery is performed, this number will have to be doubled again.
Rectal surgery does not mean +1 for surgery, but also +1 for surgical incision.
There is no problem with the chevron-shaped incision in the upper abdomen to reach into the abdominal cavity for exploration, but it cannot solve the delicate surgery of the lower abdomen. Kawei needed to suture the upper lambdoid incision first, and then make a midline incision in the lower abdomen. The overall trauma was very large.
The long-term use of ether itself is dangerous. Although the vital signs are stable now, when the surgical incision is further expanded, no one can say when the numbers will change drastically.
Amor was sitting in the preparation area outside the surgical area. Because Fernand was surrounded by four assistants and nurses, he could only solve the problem of anesthesia records by repeatedly entering the hospital.
The records include vital signs during anesthesia, supply and replenishment of infusion drugs, blood transfusion volume, and urine output checks. At the same time, it is also necessary to record the intensity of various reflexes during anesthesia, and grasp the timing of adding ether to ensure smooth operation in the mid-term.
Judging from individual reactions, Fernan's physical condition is pretty good, at least he won't have too many side effects like others. Coupled with the proper use of the dose, the irritation to the body caused by an over-medication in the middle is also minimized.
So when Kawei asked about the anesthesia situation, Amor relied on the experience accumulated in these days and replied: "I can still persist."
"Okay, Damirgang will suture the lambdoid incision, and we will continue to process the rectum." Kawi and Damirgang changed positions and came to the lower abdomen. "Disinfect it again, and then make the incision after I check it again. This time We need to speed up.”
The second half of the operation officially begins.
