Surgery Godfather

Chapter 268 - 0252: Details Determine Success or Failure

Chapter 268: Chapter 0252: Details Determine Success or Failure

Human anatomy is very complex; the complete extent of an abscess is far beyond what the naked eye can see. MRI can show several locations, but it is difficult to achieve a comprehensive observation during surgery with the naked eye alone.

Indeed, the use of a laparoscope, a flexible endoscope, is crucial! It is generally used in general surgery to remove gallstones. Now, Yang Ping is using it to view the actual extent of the abscess.

With the guidance of MRI imaging, the extent of the abscess is very clear. As the endoscope is inserted in various directions, thoroughly exploring the limits of the abscess before directing the suction device.

Such a device is rarely used in previous surgeries. Unsurprisingly, Xiao Su knew that this step would require it, and he also knew Yang Ping would use it. As Yang Ping habitually reached out his hand, the endoscope was timely passed into his hand, already connected with various tubes. Xiao Su had Zhou Can turn the display on as well.

Yang Ping held the endoscope in his left hand, operating the suction device with his right and thoroughly washing and suctioning from various directions, a total of approximately 3000 ml was suctioned out, of which 2000 ml was saline, leaving 1000 ml of pus.

“The laparoscope can be used in this way?” Song Zimo is interested in trying it next time.

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As he operates, Yang Ping explains: “The flexible endoscope can change the view angle, making it suitable for a complete examination. We could use a very fine flexible endoscope later. It is used for removing stones from the intrahepatic bile ducts and can explore the extent of pus inside the vertebral canal thoroughly. The rigid endoscope won’t work as it cannot enter angled areas and can easily damage the spinal cord.”

The whole vertebra of the ninth thoracic has collapsed due to the abscess, the bone fragments moved backward into the vertebral canal.

The ninth thoracic vertebra had to be removed. After dealing with the blood vessels surrounding the vertebra, Yang Ping cautioned the anesthesiologist: “Prepare for the removal of the vertebra, watch the blood pressure.”

The vertebra is a cortical bone enclosing a spongy bone, which has a rich blood supply. Therefore, during the removal of the vertebrae, there would be more bleeding than in the other steps of the surgery.

At this point in the surgery, the suction device for blood was still relatively clean as there isn’t much blood to suck. The suction device used for removing the pus had its head replaced several times, and the removed pus already measured more than two thousand milliliters.

The osteotome severed the pedicles on both sides, the intervertebral discs above and below were removed, and then the whole vertebra was taken out completely. Incredibly, this operation was so precise that Song Zimo was impressed again.

Under regular circumstances, a bird beak rongeur would be used to gnaw away the vertebral body bit by bit– an operation that inevitably results in a lot of bleeding. But now, Yang Ping pulled out the entire vertebra without any loss of blood.

The osteotomy area was sealed off with bone wax exposing the spinal canal. The exposed spinal cord was intertwined with a substance resembling bean curd and dead bones which had been causing the pressure on the spinal cord.

No wonder the patient was experiencing nerve symptoms, manifested as weakened muscle strength and sensory disturbance in the lower limbs. Without surgery, the muscle strength would continue to deteriorate and eventually reach level zero, resulting in complete paralysis of the lower limbs.

Using a curette and neurological dissector simultaneously to clean up the bean curd-like substance, some must be kept for bacterial culture and pathological examination, which is a mandatory step.

Following the spinal canal and cleaning upwards and downwards until completely free from compressing substances. Yet, Yang Ping still wasn’t reassured. After all, the spinal canal is as narrow as a tunnel, and it is incredibly challenging to discern the true extent of these pathological substances.

The laparoscope was called into use once again. Gently inserted into the spinal canal and almost scraped along the wall of the canal, moving up and down to inspect. According to the MRI guidance, there were some unpickable areas filled with abscesses. Although they didn’t cause compression, these areas could hinder recovery.

Introducing the dissector under the guidance of the endoscope, it was easy to clean these residual substances. They were suctioned and cleaned over and over until finally clean.

“Microsurgical instruments!”

Xiao Su had already prepared them in advance, knowing that Yang Ping wouldn’t skip this step and would inspect the anterior spinal artery. When Yang Ping performs a surgery, he doesn’t miss any chance to be thorough.

Let’s explore the anterior spinal artery then. Yang Ping carefully revealed it, cautiously clasping it with the microforceps to feel the tension of the blood vessel wall.

No, it didn’t feel right. The sensation underneath the forceps was too hard, not the feeling of typical vasculature, it must be an obstruction.

“What? Is it obstructed?” Song Zimo registered Yang Ping’s actions with his microforceps.

“It’s obstructed!” Yang Ping confirmed with certainty.

The obstruction was almost two centimeters long, exactly the part under compression previously. If the obstruction was not removed, the spinal cord would degenerate due to ischemic necrosis, the post-operative paraplegia would not recover and would continue to worsen. All the hard work until then would be in vain.

“What should we do?” Song Zimo anxiously asked.

Fortunately Yang Ping had done the exploration; otherwise, if the patient’s sensation and muscle strength in the lower limbs didn’t recover or even worsened postoperatively, it would be too late for an exploration then.

“The embolism shouldn’t have been there for long, it’s still possible to reopen the blood vessel now,” Yang Ping judged from the hardness of the blood vessel under the forceps.

A surgery, with perfect results, is assembled from countless perfect details.

“Cut off the blood vessel, remove the thrombus, and then perform vascular anastomosis?” Song Zimo guessed.

Yang Ping nodded, “Prepare the microsurgical instruments for vascular anastomosis!”

A careful investigation changes the fate of this patient, or else, she could likely spend the rest of her life in a wheelchair.

In spine tuberculosis surgery, the step to investigate the anterior spinal artery does not exist, because most spine surgeons lack microsurgical mindset and experience.

Yang Ping decisively cut the anterior spinal artery, gently drove out the blood clot, which was like a tiny earthworm, laying on saline gauze in Xiao Su’s palm.

“Take a photo!”

Yang Ping instructed. Zhou Can was momentarily free under the table and helped to take a picture. Taking pictures was to document the surgery fully, accumulating original data for future research.

Following the procedure of microsurgical anastomosis of small blood vessels, heparin saline was used to wash the blood vessel, trim the external membrane of the blood vessel, suture the blood vessel without any damage, check if the blood vessel is leaking blood, and if the pulsation is good.

After observing for a full two minutes, Yang Ping finally felt at ease, “Alright, let’s proceed with interspinous bone grafting.”

Song Zimo began to harvest the iliac bone. Harvesting iliac bone requires skill, as it is necessary to achieve satisfactory volume without affecting the donor area’s appearance and function.

“I’m getting married before the Spring Festival, you guys must come and have fun, I’ve sent an invite to Director Han, I’ve asked the head nurse to send out the other invites, I’ll deliver yours personally later,” Little Five said all of a sudden.

“So soon?” Fatty was surprised. He was the fastest among the group.

“If I don’t host the banquet soon, I’ll have to host it while holding a baby,” Zhang Lin said lightly.

“What? You’re going to be a dad, you’re more than just a step ahead,” Fatty hadn’t expected this at all. He didn’t even have a girlfriend and this guy was about to become a dad.

“My future in-laws are insisting, I can’t disobey them,” Little Five said helplessly.

“After getting married, are you going to quit being a doctor and become a landlord?” Zhang Lin teased him.

Little Five’s in-laws are locals of G City. They made a fortune selling electrical appliances between the Mainland and Hong Kong in the eighties. Then they invested in real estate and made even further profits. It’s said that they own several buildings in the CBD of G City.

The couple only has this one daughter, and they’re very cautious about her marriage. They were very pleased with Little Five when they met him; a handsome young man with a good education, a doctor, an all-round good catch.

Now that Xiao Qing is pregnant, the couple is overjoyed about becoming grandparents, urging the two to get married as soon as possible. They told them not to worry and that they would organize everything.

“Little Five, do you have a younger sister? An older sister will do too!” Fatty felt he was lagging far behind.

“You should have said so earlier!” Little Five said while suturing.

Fatty got excited: “So, you do have a sister?”

“If you had said it earlier, I could have persuaded them to have another child, but I guess it’s too late now,” Little Five laughed.

Amid their banter, the sutures by Little Five and Zhang Lin remained stationary, keeping the surgical field well exposed.

Song Zimo extracted a perfectly square iliac bone, it looked excellent.

Yang Ping used a retractor to separate the vertebral bodies and inserted the iliac bone graft, a perfect fit.