Sun Mei quickly pulled Yang Ruixue out and said as she walked, "I'm sorry, Dr. Dave, we didn't make arrangements."
"I'm not a nurse, I'm also a trained doctor. I want to come over and observe the operation. Why can Tao Le be on stage but I can't!"
Yang Ruixue became even more excited, and Sun Mei couldn't hold her back for a while.
Her words did not impress Professor Dave, but made him even more dissatisfied.
"I remember that I had explicitly declined the request to observe the operation. There should be no other doctors at all except the team participating in the operation."
"In Chinese terms, this is a double act and dishonest. I want to have a good talk with the hospital leaders. Maybe I should form a new team myself and hire my former assistant partners instead of continuing to trust you."
When he said this, Director Shen, Director Ran, Deputy Director Jin and Mr. Guo all became anxious instantly.
After just watching half of the operation today, they all felt that they had gained something. During Dave's three years here, the entire surgical department of the first hospital will achieve comprehensive improvement, provided that he cannot leave the medical staff of the first hospital and form a separate team.
The few people who didn't want to say anything at first didn't care about offending Vice President Chang at this time.
"Xiao Yang, why are you talking back to the expert? Get out quickly, don't affect the operation!" Director Ran said.
"Today we made an exception and allowed you to enter the operating room. This is the hospital's care for young people. But instead of doing your homework, you are still making loud noises here and affecting the operation. What does it look like?" Director Shen shook his head.
"I will truthfully report what happened today to the medical office after the operation." Nurse Sun couldn't hold back her anger: "If you still don't leave, if there is any problem with the operation, the responsibility will be on you. You can bear it." Are you up?"
This sentence made Yang Ruixue sober up. Only then did she realize that this was an operation with a high intraoperative mortality rate and more postoperative complications.
What if this German expert is really unreliable and the problem ends up being his fault?
Thinking of this, Yang Ruixue pushed Sun Mei's hand away, glanced at Dave and Tao Le coldly again, then threw down her gloves, went to change clothes and left.
The head nurse shook her head and contacted the circulating nurse on her mobile phone, asking her to see the latest medical orders from the system and bring back the crystalloids and colloids to be refilled.
Seeing Yang Ruixue being kicked out, Chen Ke had a feeling of being hurt by others.
He always felt that if he made the slightest mistake, he would be the next one to be kicked out. That would be so embarrassing!
For a moment, he gathered all his energy and concentrated on observing the equipment nurse on the main stage. He strictly followed her requirements and no more mistakes were made for a while.
The first circuit nurse acted very quickly. In a short time, red blood cells and fluids were added. The patient's blood pressure rose back to 100/70, and the heart rate dropped to 90.
No one mentioned the episode again. The surgery continued as if nothing had happened.
Dave inserted the index finger of his left hand behind the uncinate process, placed his thumb in front of the pancreatic head, lifted the uncinate process and peeled it off to the right, then cut it off with a vascular forceps and tied it.
When the operation enters the middle and posterior parts, the most difficult digestive tract reconstruction is immediately performed.
Because multiple organs have been removed, the entire digestive tract of the patient's body has been completely destroyed, and the remaining organs must be pieced together to form a complete and usable internal circulation.
Specifically, it includes three stages: pancreatic stump anastomosis, biliary-intestinal anastomosis, and gastro-intestinal anastomosis, with the first stage being the most difficult.
The so-called anastomosis, simply put, is to sew two organs together.
The main postoperative complication of pancreaticoduodenal surgery is pancreatic fistula, with a mortality rate of more than 30%.
The reasons why pancreatic fistula occurs are mostly due to technical reasons, in addition to factors such as the patient's age or liver dysfunction.
Improper handling of the pancreatic stump, poor anastomosis techniques, and damage to the organs surrounding the pancreas during surgery can directly or indirectly lead to the occurrence of pancreatic fistula.
In addition, problems may also arise in the latter two anastomoses, and complications such as biliary fistula and gastric emptying disorder may occur if not careful.
Therefore, these three anastomosis places extremely high demands on surgeons.
Although Dave is a bold artist, he is now more rigorous and meticulous. For the treatment of the pancreatic stump, he chose pancreatico-jejunal anastomosis, and the chosen surgical technique was the invaginated anastomosis of both ends of the pancreatic stump-jejunum.
Although this is the most commonly used method for treating pancreatic stumps nowadays, Tao Le knew clearly that this patient’s pancreas was different from that of most people. Her main pancreatic duct was significantly posterior in the pancreatic neck.
If no special attention is paid, the main pancreatic duct will be damaged during anastomosis, leading to the occurrence of pancreatic fistula.
Dave did not disappoint her. He really has a lot of experience and can spot problems at a glance.
The solution was quite satisfactory. During the anastomosis, the pancreaticojejunostomy was moved about 1 cm to the left, bringing the main pancreatic duct closer to the center of the remaining pancreas, making the pancreaticojejunostomy more convenient.
Dave methodically moved the jejunum to the remnant pancreas and brought the two together.
He used a small circular needle and No. 3-0 silk thread and began to sew.
Of all the organs, the pancreas is the most difficult to suture. Its tissue is very fragile, and sewing it is like embroidering on tofu. It can neither be tight nor loose.
If it is tight it may cut the pancreas, if it is loose it may cause a pancreatic fistula.
Dave's needlework skills were good, Director Shen and the other two were very fascinated by it, their faces full of admiration.
Tao Le sighed in his heart. If it is not enough, the sutures are not fine and dense enough, and there is still a possibility of pancreatic fistula.
If it weren't for this situation, she simply couldn't control herself and wanted to sew him up.
But thinking about it, I knew it was impossible. In addition to Dave, there were also surgical experts like Director Shen and Deputy Director Jin present. It was impossible for him to take his turn.
The stitching is complete. Dave carefully inserted the remaining pancreas into the jejunum and completed the first step of pancreaticojejunostomy.
Three hours had passed since the operation, and beads of sweat broke out on Dave's forehead. The nurse came forward to wipe his sweat, and he continued downwards without stopping.
Biliary-intestinal anastomosis, gastrointestinal anastomosis, and finally abdominal drainage were completed.
After six hours, the operation finally entered the final step, flushing the abdominal cavity and closing it.
Tao Le thought for a moment and then asked: "Let me do the abdominal suturing."
Compared with the previous operation, the abdominal closing suturing was much simpler and did not arouse any objections from the senior assistants.
Dave had seen Tao Le's performance in teaching surgery and was amazed by her suturing skills. He immediately nodded in approval after hearing this.
Tao Le knew that suturing was only secondary. She mainly wanted to take this opportunity to use her golden finger on the patient.
