In the history of medical development, it is never easy to make a breakthrough that is recognized by most doctors.
There are too many pioneers who, even if they hold the truth and shout about their discoveries at the top of their lungs, still cannot break the original solid medical system. Breaking the inherent cognition requires not only knowledge, courage and perseverance, but also some external things.
External forces do not play a dominant role, but they can play an auxiliary role as the icing on the cake, greatly reducing the time required for medical development.
Even though Kawei's external resources were insufficient before, he never had much say in the fight against infection. But compared to the earlier Semmelweis, at least he was not isolated by the people around him. He also had the support of the Municipal General Hospital and Ingenac around him.
A large number of surgeries and the gradually developed types of surgeries allowed him to gradually gain a foothold in Vienna.
Tracheotomy, inguinal hernia, intestinal repair, cesarean section, ventricular shunt, gallbladder cancer, cleft lip, breast hyperplasia, breast cancer, hepatosplenomectomy, intervertebral disc herniation...
These surgeries elevated Carvey to a level unbelievable for his age, and others who followed suit also saw the feasibility of the surgeries. As time went by, after it was discovered that the postoperative infection rate in the Municipal General Hospital had declined overall, anti-infection gradually became the standard for surgery at Vienna Hospital.
More than half a year has passed, and everyone in Vienna knows about disinfection and everyone is willing to do it.
With such a status, Kawei's resistance to promoting technology will naturally become smaller.
The nominal host of this conference is Waterman, but Carvey has always been in the lead. His main role is to relieve the responsibilities of diagnosis and surgery. If the time went back six months ago, Kawi might not even be qualified to enter the venue.
In fact, those who spoke up to rebut and put forward different opinions were "outsiders" who were unfamiliar with him. Those who have worked with him and are familiar with his abilities naturally have three points of trust. Even if they really have doubts, they still hope to see what new things Kawei has come up with and what changes he can bring to surgery.
Before the curved cystoscope was made from spiral steel and 48 lenses in 1936, only hard lenses could be used clinically. 【1】
The rigid scope cannot be bent, so it will not have any impact on women during the examination because their urethra is short and straight. But for men with long and curved urethras, a straight rigid scope will make the examination extremely painful. It is thicker and more unacceptable than the previous urethral dilator.
Of course, the 19th century had just ended anesthesia-free surgery, and Carvey was confident they could afford it.
But considering Edem's age and status, he still hopes to persuade this very curious old French man: "For medical advice, I still hope to use ether anesthesia, which can alleviate the pain. As long as I sleep, You’ll be fine as soon as you sleep.”
Edem sat on the operating table wearing a hospital gown and asked, "Is ether the same thing as chloroform?"
"Well, yes, they are all magical drugs that allow you to wake up and find that everything is done well." Kawei explained, "But in comparison, I prefer ether, which is less toxic and safer. "
"So you can't see the inspection process, right?"
"It's true that I can't see it anymore."
"No!" The old man shook his head slowly, "You can't see how boring the inspection process is."
"It's really uncomfortable." Kavi reminded again, "You will feel like you are being..."
"Don't say it, it's not like I haven't experienced surgery before. I'm just doing a check-up." Edem was familiar with the process, took off his pants, quickly lay on the bed, and assumed a very standard lithotomy position, "Come on. "
"All right."
Skipping the step of informed consent, Damirgaon fully sterilized the cystoscope and handed the fully lubricated mirror to Kavi.
Kawei's examination technique is not very skilled. After all, modern cystoscopy is performed by full-time urological surgeons, and many details can only be known after having done it. But he has still inserted the most basic urinary catheter, all without anesthesia, and we can learn from each other's operating techniques.
"With the palm of your left hand facing upward, use your middle finger and ring finger to hold the coronal sulcus of your penis and lift it upward to straighten the urethra." Kawei said as he did so, "Then separate the urethral opening with your thumb and index finger, hold the mirror with your right hand, and slowly enter... .”
The purpose of lifting the urethra is to eliminate the first bend of the male urethra. After entering, the cystoscope body can be lifted so that it is vertical to the horizontal abdomen.
"It's coming, it's coming, hey... it's so exciting!"
Edem raised his head to see the whole process clearly, but found that he didn't have enough field of vision lying on his back and missed the opening scene. Just when he was about to shout for help, Herman brought a pillow and raised the back of his head.
"Thank you...ah yo!!!"
A burst of electric pain suddenly came from his lower body. His whole body couldn't help but tremble, and his body reflexively wanted to lean back: "This is really powerful, so powerful."
Kawei stopped his hand. At this time, the mirror port has passed through the bulb of the urethra [2], and then down to the sphincter: "How about it? If you feel uncomfortable, you can also use ether now. I have the best in the world here." anesthesiologist."
"No need!" Edem grabbed the sheets with both hands and specifically called Herman to his side. "Young man, hold my shoulders from behind. That's right, that's it... Okay, Dr. Kawei , I’m ready, come on!”
】
"You have to relax."
Edem's face was full of questions: "Relax? How to relax?"
"Muscles relax."
"How can you relax your muscles when it hurts so much?"
Seeing that he was slightly nervous, Kawei patted his stomach gently with his hand: "Although you should hold your hands tightly and your head, neck and shoulders freely, your stomach should be relaxed. Otherwise, the sphincter will spasm, and the camera will become very uncomfortable." trouble."
Edem tried Kawi's request, trying to get used to the feeling, and asked: "How much trouble?"
"It's like stabbing a wooden board with a bayonet."
Seeing that he still didn't understand, Kawei glanced at Heman behind him. The latter also understood it clearly. He made a fist with his left hand and used the index finger of his right hand to poke the joint between the index finger and thumb. At the same time, he said: "That's probably what it looks like."
"...I'll try my best to cooperate."
Kawei nodded, raised his penis further with his left hand, and continued to push the mirror mouth down and forward with his right hand. The external sphincter is forced to open under this downward pressure action, and the entire cystoscope reaches the urethra and prostate smoothly.
This process has caused Edem a lot of pain, his face turned red, and his hands clenched the sheets tightly. If Herman hadn't been pushing him from behind, he might have moved his body backwards and messed up the entire examination.
Now that he has passed the prostate, Kawei no longer has the caution in his hands. Based on the principle that long-term pain is worse than short-term pain, the scope body is further depressed to minimize the curve of the posterior urethra, and then the scope mouth is pushed into the bladder.
With a slightly embarrassed shout, the scene ended. 【3】
"Okay." Kawei let go and handed over the task of holding the mirror to Damirgang, "Mr. Edem, how do you feel now?"
"It's not bad." Edem's forehead was covered with fine sweat. He watched the thick cystoscope enter his body. He always had a strange feeling. "Dr. Kawei, I need to make sure of one thing. I am Not the first patient to be examined?”
"It may not be the first one, but it must be the first one whose inspection is successful."
"That's good! That's good!!!" Edem looked up at the ceiling with satisfaction, "This is really a wonderful experience, haha~~~ I must write it in my diary!" [ 4]
"I'm glad I can bring you a good memory." Kavi smiled and removed the cushion, letting him sleep smoothly before announcing to everyone, "Now Dr. Damirgaon will lower the height of the cystoscope, and Dr. Berget will go to the hospital." Put fuel at the light source and ignite it.”
With the help of the flame, the dark mirror tube suddenly shone with the luster that metal should have, and at the end of the mirror, Kawei finally saw the scene inside the bladder: "When examining a living person, I was talking to the corpse just now. Differently, we cannot rush to find the location of the lesion, but must prepare the bladder first."
Anyone who has seen Kawei’s surgery knows the meaning of this sentence:
[When a new knowledge point appears, please grab a pen and paper and write it down. If you miss it, it will be lost. ]
While asking Beget to prepare the rubber hose and syringe, Kawei asked: "I wonder if any of you have done an anatomy of the bladder?"
"Of course."
"Bladder anatomy is the basis of lithotripsy. Based on everyone's surgical experience, it is impossible that we don't know it."
"Um, I'm sorry." Kawei suddenly explained, "Maybe I spoke too vaguely. I was referring to the anatomy of the internal structure of the bladder, not the location of surrounding organs and blood vessels."
"Internal anatomy?"
“Isn’t the bladder just a cystic organ?”
"Yeah, what does this have to do with cystoscopy?"
Kawei tried to ask: "Are the cystic organs still full after the urine is emptied?"
"Of course not."
"I asked Mr. Edem to empty the urine before the examination. What should be the state inside the bladder now?" Kawei glanced at everyone, "Should it be in a contracted state? It is a cystic structure, like a A balled-up paper bag, rather than a structural steamer, because air can't exist without urine."
"I see......"
Before others knew what Kawei wanted to say, Jacob and Mosier successively guessed the reason for doing so.
"Empty the urine before the endoscopy to prevent colored urine from interfering with vision." Jacob said, "What you need to do now is to inject enough water into the bladder to remove the shrinkage. The bladder is full."
Ginger is still spicy. Kawei briefly talked about the theoretical basis, and Jacob had already thought of clinical practice.
"Teacher Jacob is really amazing. In just a few seconds, he told me the details of the operation that I had been thinking about for three days." Kawei took the rubber tube given by Begut and slowly moved it along the lens body. Put it into the bladder and connect the syringe, "But I still want to ask one more question."
"what is the problem?"
"Why does it have to be stretched open?"
"Because the interior of the shrunken bladder is full of deep and shallow folds, the area that is truly visible in the field of view is very limited. Only by opening the bladder can the complete inner wall of the bladder be seen. That's why you emphasize the internal structure of the bladder and Ask your assistant to hold the rubber hose.”
Jacob looked at him and asked, "That should be the reason, right?"
"Wonderful!"
Kawei injected cold water into the rubber tube to stop the bleeding and flush the bladder at the same time. Only by thoroughly cleaning the inside of the bladder can the surrounding structures be seen clearly: "Teacher Jacob's urology skills are really profound. I was offended by the question just now. "
"No offense." Jacob drew several sketches on the paper with a pen, and quickly wrote down various notes on the side, "Your cystoscopy is more powerful than my casual lip service just now. Much more.”
This is absolutely true. The only person who feels ordinary is probably the modern Kawi.
Endoscopy has not made much progress since the hands of Bosini in the early 19th century, and the development of medicine and surgery has not reached the point where endoscopy is required. This makes endoscopy very useless, and the only ones that can be used are the anorectum, yd, ear and nose that are short distance apart.
If it can be used on the bladder of adult men in a non-invasive manner, it will greatly reduce the cost of examination. Not only is the examination process simple, doctors are more willing to use it, and patients are more likely to accept it, which invisibly promotes the development of endoscopy.
Of course, all this seems to be going smoothly, but it all needs to be based on the results of the inspection.
If the check fails, Jacob's push alone is still limited. But if the examination is successful, coupled with the subsequent surgery, Vienna's already top-ranked urology department will be pushed to a new level.
"How is it?" Jacob was very concerned.
Kawei moved the mirror slightly and said calmly: "I didn't see the tumor. It may be that the distance between the mirror is too long, or the tumor may be closer to the entrance of the bladder. However, I can clearly see the tumor entering the bladder." The urine is clean without blood, but the bladder that I originally cleaned has bloodshot eyes."
Everyone left their seats and leaned towards the operating table.
They are all surgeons who can perform surgeries by themselves. They believe what they see is what they see. No one will admit the test results without judging by their own eyes. It was also their first opportunity to look inside a living person's bladder.
"It's so far away, I can't see clearly."
"Let me try...there is indeed no blood in the urine that goes into the bladder."
"I just looked at it, and the opening of the ureter is very clean."
Jacob also tried once and asked: "Does this also mean that the location of the lesion is inside the bladder?"
"Yes." Kawei looked at Mosier, who had been questioning him before, "Teacher Mosier, I have thoroughly cleaned my bladder just now, and there was no serious damage when the cystoscope entered the urethra."
"I understand." Mosier nodded, "I also think the location of the lesion is inside the bladder."
"Where's Teacher Massimov?"
"I can still see a little bit clearly, it's exactly what you said."
"Dean?"
"No need to ask, of course I support you."
Kawei breathed a sigh of relief, walked up to Edem, and said, "Mr. Edem, I think we need to discuss the time of the operation."
