Surgery in the 19th century was still in the middle stage of Pangu's founding of the world. On the surface, it had been divided into urology, obstetrics and gynecology. However, many surgeons' skills were general and there were no clear divisions.
For example, Guyon, who is currently in Surgery Theater No. 2, studied under Mosier and is Albaran's senior brother. His specialization is urinary tract stenosis and prostate. After Mosier temporarily left the Palace Hospital, he became the director of the urology department here and a serious urologist.
But now, Guyon was asked to assist in this operation.
The surgeon standing opposite him was the chief surgeon, Cediyo, who was about the same age as Waterman. He was doing a blank in the history of surgery - a partial gastrectomy.
"What did you do???"
Kawi thought he had heard it wrong, and asked Albaran to repeat it again: "The patient has gastric outlet cancer, and an obvious mass can be seen in the upper abdomen. Professor Sediyo wants to cut open his stomach and remove the tumor and his All the tissue in the distal stomach is removed together.”
It sounds very reliable. Although modern partial gastrectomy for pyloric cancer is complicated, the risk has been greatly reduced. Basically, all general surgeries in tertiary hospitals can perform it.
But now it is November 10, 1866, and Bill Rotter, known as the originator of gastrointestinal surgery, is taking care of a large number of wounded soldiers at Olmitz Fortress. It will still be 14 years before the world's first gastrectomy operation is officially successful.
Of course, Kavi believed that with his help, the time to complete the operation would be greatly shortened, but the person who completed the operation should not be French even if he was not himself.
Based on the current surgical technology and equipment in Paris, the success rate of the operation is infinitely close to 0.
"This surgery is not easy."
Kawei said it very tactfully, because if you think about it, you can find many difficulties that other surgeons cannot handle, including the details of freeing the stomach and duodenum, spilled gastric acid, appropriate anastomosis methods, etc.: "The stuffer Has Professor Diyo performed this kind of surgery before?"
"It was done once, and the patient died on the operating table. But the professor has been practicing for several months for today, so it should be fine." Albaran's eyes were full of admiration, "Of course, the operation has huge risks, what? Anything can happen.”
The words are very pertinent, but as long as you are a sensible person, you should see from the face of the assistant who came to shake people that the operation is not going well.
"Where is the surgery?" General surgery is a key project in emergency surgery, and gastrointestinal surgery is the highlight. It is impossible for Kawei to not understand, "Free the duodenum? Are you resecting the tumor? Or are you ready to do it? Matched?"
The assistant's face turned pale and he shook his head repeatedly: "I, I don't understand very well. I just came to see Dr. Albaran according to Teacher Juyong's request."
"All right......"
In just two minutes, Kawei had already thought of several surgical options and possible problems in his mind, and quickly prepared various remedies. If you really need to go on stage, you won't be unable to do anything.
But surgery relies not only on technology, but also on support from other aspects.
Kawei could think of the other party's original intention of trying this kind of surgery, which was simply because general anesthesia gave them more time to operate. Although the surgical mortality rate is high, as long as the number of patients willing to undergo surgery continues to increase, success will always occur.
Unfortunately, Sedillo failed to appreciate the variety of preparations required for surgery.
There was no disinfection, no masks, no gloves, no blood transfusions, no first aid drugs and corresponding countermeasures, and even vital signs could not be monitored. This kind of third-level surgery is always accompanied by danger, and the process is full of pitfalls...
The three of them bypassed the crowd and pushed open the door of the surgical theater. What directly struck their eyes was the tense scene of surgery, surrounded by an audience similar to that of the Vienna surgical theater.
The Cathedral Hospital is actually more like a church hospital. All programs in the hospital, including treatment, are free. Of course, the surgical theater is only open to the public, and the audience must at least be medical students who come for internship.
They were all wearing gray or black formal coats, holding pens and notebooks in their hands. Although they were communicating, they were very restrained. Everyone's eyes were focused on the 20cm long incision.
The only thing that could be heard in the audience was the cry of the chief surgeon, Cediyo: "Quick, gauze! Quick, press here, the bleeding is serious here!"
"Where is the suction device? I can't see anything, suck it in quickly, suck it in quickly!"
"Lower the lights!"
Albaran did not dare to say anything. After entering the door, he changed into a surgical leather skirt with the help of his assistant. He turned away from Kavi and walked over: "Teacher, professor, I'm here."
"Where were you just now?"
"I, I went..."
"Forget it, let's get another suction device quickly and help suction together. There's too much bleeding."
There are a large number of blood vessels surrounding the stomach and duodenum and extra care is required during dissection. The duodenum, in particular, not only has a rich blood supply, but is also a structural intersection point for many important abdominal organs.
One side is the bile duct and portal vein, and the other side is the pancreas, which is also located far back, making it difficult to dissociate. When the surgical field itself is not clear enough, achieving no bleeding or as little bleeding as possible is the basis for completing the entire operation.
If this is not possible, then the operation is akin to murder and there is no need to do it.
Kawei shook his head slightly and walked into the auditorium alone as a medical student in the eyes of outsiders. He found a seat in the corner and wanted to see what would happen next.
However, not long after he stood still, the patient's condition took a turn for the worse. The experienced nurse on the side knew something was wrong just by checking his pulse: "Professor..."
Cediyo was fully focused at this time, staring at the huge incision in his upper abdomen: "Very good, the bleeding seems to have stopped. Let's bring some more gauze and try harder! After the view is clear, we will do another scan on the edge of the tumor. Clamp, then..."
"Professor Sedieu!"
The nurse couldn't help but call him again, and the 62-year-old surgeon finally responded: "Huh? What's wrong?"
"The patient..." the nurse sighed, then shook her head, a signature move to euphemistically express the news of the patient's death.
Cediyo guessed the result immediately, but he still refused to give up: "What happened?"
"Mr. Polis's pulse has disappeared."
Albaran dropped the suction device, put his bloody hand on the patient's carotid artery, and soon moved his fingers to the mouth and nose. The results are self-evident. The patient's heart and breathing stopped completely, and he did not survive the shock caused by massive blood loss.
As he stopped, everyone also stopped.
Sadie couldn't accept this fact for a while. His head was buzzing and he couldn't even stand up. But out of the pride of the director of surgery at the oldest hospital in Europe, he stabilized the situation with the help of other assistants:
"I have to declare the death of Mr. Polis. He did not survive the massive bleeding during the operation. This is unfortunate. The operation was a pity. Only the last few cuts were left to remove the tumor. I could not save his life." ..."
At this time, the other two suction tubes inserted into the patient's abdominal cavity were still working, and the blood in the abdominal cavity was sucked clean. Guyon did not stop holding the gauze in his hand, but carefully wiped away the remaining blood, exposing the tumor: "Albaran, go get the tissue forceps."
"good."
Sadieu was unwilling to give up and sincerely hoped that there would be another patient with a similar condition and in urgent need of surgery.
However, abdominal tumors can only be diagnosed when they grow large enough to be reached by hand. In addition, patients are still resistant to surgery. Finding a candidate for such surgery depends entirely on luck.
well......
Suddenly, some sporadic applause erupted from the audience on the stage. Along with the sentence "Professor Sedillo's innovative spirit is really refreshing," everyone's rainbow farts spurted out, becoming more and more harsh in the increasingly fierce applause.
Unlike Kawi, Cediyo seems to like this kind of praise very much. Perhaps this is the inner driving force for him to insist on the operation.
His operation was not over, and half-baked operations were not allowed in the operating theater: "Next, we have to remove the tumor for Mr. Polis...and then remove the distal part of the stomach and part of the duodenum that it invaded. resection."
This is another typical separation between human and surgery. After Kawei improved the success rate of Vienna's overall surgery, I haven't seen this kind of situation for a while, and now it seems full of emotion.
However, unlike when he first looked at Hills, he now no longer looks at this phenomenon with a purely critical eye, but has become more objective.
Most surgeons, including Cediyo, are not stupid. They all know that the patient's life and death are the most important goals, but they still choose to retain their original understanding of surgery.
That is to say, the patient's life and death belong to the patient. The doctor definitely cares about it, but he doesn't care that much. The doctor's surgery belongs to the doctor. The success of the surgery depends on whether the original surgical goal can be achieved. The patient's survival can be regarded as an accident in achieving the set goal.
This is not that they are cold-blooded, ignorant, or psychologically distorted, but a special excuse created to alleviate the guilt caused by failed surgery.
After all, in this era, the death of a patient is an accident, and the patient's survival is also an accident in a sense.
Unsurprisingly, after Mr. Polis was pronounced dead, the originally busy surgical team became much calmer. Without the weight of life, their techniques gradually became more sophisticated, and the tension on everyone's face was gone.
It seems that they are still more accustomed to dissecting dead bodies than treating living people.
...
Kawei had never seen such an exaggerated internal tumor in a long time. Even from such a distance, he could still see that the patient's pylorus was swollen into an apple. There are ulcers and adhesions around it, and there must be metastasis in the abdominal cavity. From a modern perspective, it is not suitable for surgery.
If we put this aside and just talk about the surgical method, Kawei still prefers Bi-i surgery.
The origin of the name "Bi" is Billroch's billroch. The procedure has undergone various improvements and fine-tuning since its creation more than 140 years ago, and is still active on the operating table of general surgery.
The Bi-i method directly anastomoses the remnant stomach and duodenum, which is simple to operate. After the anastomosis, the gastrointestinal tract is close to the normal anatomical and physiological state, so complications are relatively rare. 【1】
There are many advantages, but the disadvantages are also obvious.
Because the tumor has adhesions and the duodenum itself is dragged down by the surrounding complex structures, it will definitely be difficult to dissociate. In addition, due to the larger scope of the tumor, if the scope of gastrectomy is increased, the tension will increase during gastroduodenal anastomosis.
If the tumor really affects the anastomosis after resection, Kawei will still change to the more flexible Bi-II method.
Also designed by Bill Rotter, the duodenum, which has a complicated anatomical structure and cannot be flexibly anastomosed, is directly discarded, and the simple jejunum at the rear is used instead. There is no limit to the scope of gastric corpus resection in the Bi-II type, and it is more widely used clinically. 【2】
However, because the operation is complicated and the original normal anatomy and physiological structure changes, complications will be more likely.
Judging from Cediyo's statement, what he wanted to do was also the Bi-i type, but he did not completely complete the necessary dissection work before performing tumor resection, which resulted in massive bleeding.
In Kawei's view, finding the location of the bleeding and identifying the mistakes in his surgery are the key. But Cediyo didn't seem to have this intention: "My judgment on the level of gastrectomy was not wrong, and the position of the duodenal stump was also correct. Make incisions up and down..."
The surrounding audience watched in amazement and cheered, even calling Sediyo the first person in the world to perform abdominal surgery.
It is estimated that only Kawei felt uncomfortable in the audience.
He didn't care about those false names, and it wasn't the name given to Cediyo that made him feel uncomfortable. He knew very well that the theoretical knowledge in his mind and the techniques in his hands were inherited through the efforts of these sages.
The only thing that made Kavi uncomfortable was the surgery itself. Cedieu's surgery was too rough.
Speaking of this step of tumor resection, the correct approach is to use large closing forceps to close the proximal and distal ends of the stomach first, then use sutures to perform full-thickness interrupted sutures, and finally use a scalpel to cut. Suturing first and then cutting can effectively prevent the gastric acid secreted by the mucosa from leaking out, and can also prevent bleeding when the gastric wall is incised.
However, Sedieu lacked experience and could not have known these details.
"Dr. Juyong, you are responsible for doing the pathology of the tumor."
"good."
"Albaran, come here and help me, I will do the next stump anastomosis."
"yes."
In Sedillo's view, cutting the tumor was the most difficult step, and the suturing now was just the finishing work, so he quickly got over Boris's death. His technique returned to its usual lightness and gentleness, and at the same time he also remembered Albaran's main task today:
"I remember you are going to the train station in the afternoon, right?"
"Yes." Albaran raised his head and glanced at the auditorium. When he saw that he could not find Kavi, he said, "At the request of the Ministry of Foreign Affairs, I went to the train station to pick up a guest on behalf of the hospital."
】
"I know, it's the surgeon hired by the domineering Edward in Vienna..." Serdieu chuckled twice, "If it's Waterman or Yingenatz, maybe I I just went, but I didn’t expect..."
Albaran held the duodenum in his hand and didn't know what to say: "He has arrived at the hospital."
"Oh, come on. If possible, I really hope he can see this operation." Cediyo was very confident in his skills. "Although Mr. Polis's death was an accident, not everyone can Do a good job of gastrointestinal anastomosis.”
Albaran is just a young doctor who has just graduated. He is not even considered a doctor here and can only be an intern or assistant.
Facing the chief director of surgery, he did not dare to say a word, let alone resist at all, because no one knew what changes his resistance would bring to his future.
Just as the whole audience was talking about it, a French sentence with a slight German accent suddenly floated out from the corner: "Professor Sedillo, I am watching from the audience."
