Chapter 183 Learning from the experience of highly complex surgeries, and receiving praise from Director Hu
After entering the operating room, he found the patient already lying on the operating table.
Unlike the imagined supine position, the patient took a 90-degree lying position on the left side.
This supine position is determined based on the surgical field of view, location, and content of the surgery. It is not a one-size-fits-all supine position. Zhou Can even saw a manic patient undergoing general surgery, who was pressed on the operating table by several doctors and forced to wear a breathing mask for anesthesia.
Later, after the operation, the patient was sent back to the ward and had his hands and feet tied to the bed with gauze.
Prevent him from going crazy and hurting people.
The doctor will ask the patient to choose different lying positions according to the needs of the operation.
In the operating room, in addition to Zhou Can and Dr. Wu, there were three nurses and an anesthesiologist.
The anesthesiologist is administering anesthesia to the patient.
This preparation is usually done in advance. The nurse will go into the operating room in advance to sort out the items and check whether all the garbage has been disposed of. Then, she will prepare the instruments and drugs needed for the operation.
"He was given anesthesia and a double-lumen intubation, right?"
Zhou Can had not learned any professional anesthesia techniques, but he had seen them so many times that he could basically guess the anesthesia methods for various surgeries.
Then surgical residents need to do one month of residency in the anesthesiology department.
By then, I will definitely learn some advanced anesthesia knowledge and specific operation methods.
"right!"
The anesthesiologist was a male doctor in his fifties with a zombie-like face and he never smiled when he spoke.
"Can I help you?"
What Zhou Can valued was the two-point insertion experience of the cannula.
As the number of departments he is involved in regular training increases, his knowledge is also increasing, and he has a clearer understanding of the future direction of medicine.
Minimally invasive, endoscopic surgery is moving from a new trend to mainstream.
If you plan ahead, you will succeed; if you don't, you will fail.
In addition to practicing traditional surgery, Zhou Can will also spare no effort to improve his advanced medical skills whenever he has the opportunity.
“Go ahead!”
The anesthesiologist was really frugal with words. Plus, he never had a smile on his face, which made it hard for people to get close to him.
Doctor Guan is much more easy-going than this man.
Zhou Can was not polite and helped with intubation, upper respiratory mask, etc.
The anesthesiologist was slightly surprised to see that he treated the bronchial intubation as if it were a game, and couldn't help but look at Zhou Can twice more.
Without saying anything, the two of them silently completed all the preparations for the patient before anesthesia.
Zhou Can stepped aside.
Not long after, Director Xue and Deputy Director Lu rushed to the operating room with the surgical team.
"Not bad, the patient has been anesthetized!"
Director Xue has a cheerful personality and praised me with a smile.
Then she asked the scrub nurse to help her put on sterile gloves, check the marked incision sites on the patient's body and the patient's vital signs, and after verification, the operation began.
"Who does the routine disinfection?"
"I!"
The nurse on duty answered.
"Remember to expand the range a little bit next time. I think you must be a frugal girl."
It was originally a critical remark, but when it came from Director Xue's mouth, people were very happy to accept it.
The atmosphere is also very relaxed.
The nurse smiled embarrassedly.
"It is best to lay a towel before incision, and then make a right posterolateral incision."
Director Xue patiently taught her doctors while performing surgery on patients.
Her movements were as steady as ever.
Zhou Can found that the vast majority of cardiothoracic surgeons, as long as they were of a higher rank, inherited Director Hu Kan's "steady" surgical style.
In addition to being steady, Director Xue also has the dexterity that is unique to female doctors.
"When you cut, remember not to rush, but to cut layer by layer. Cut the skin layer first, then the subcutaneous tissue layer, and then the muscle layer. At this time, you can see the ribs. Just cut the fifth posterior rib."
After saying that, she signaled Deputy Director Lu to cut the ribs.
"Then enter the chest cavity through the fourth intercostal space for exploration."
No thoracotomy surgery is simple.
Zhou Can stood under the operating table, watching and learning carefully.
Having mastered the basic skills only provides a good foundation for surgery. If you want to independently complete such a major surgery, you still have a lot to learn.
In particular, the surgical techniques and precautions are worth studying carefully.
Even if both lung lobes are removed, the surgical methods may be completely different.
This requires the practitioner to be knowledgeable and apply what he has learned flexibly in order to be able to adapt.
"There are three main goals for the exploration: to ensure that there is no adhesion between the chest wall and the lung, no pleural effusion, and the specific location of the tumor on the lung lobe."
Each of the above three points is very important.
In the middle and late stages of lung cancer, the lungs and chest wall are prone to adhesion. If you want to have surgery at this time, you must carefully separate them.
In fact, patients who have reached this stage no longer need surgery.
Most of them have already metastasized.
Doctors with conscience will generally tell patients that their cancer cells have spread throughout the body, or have spread widely to multiple organs and tissues in the chest. They don’t need to spend a lot of money on treatment, and can eat and drink whatever they want, and take their time. If they take medication, it will mainly be used to relieve pain, and to improve the quality of life of patients in the late stage of cancer as much as possible.
After examination, it was found that this patient was very lucky.
There was no adhesion between the lung and the chest wall, no pleural effusion, and the tumor was in the posterior segment of the right upper lobe of the lung, with a diameter of about 4 cm.
Not particularly big.
No tumors were found in the surrounding organs and tissues.
This is already an ideal situation.
During the operation, because the surface pleura was shrunk and the tumor was close to the hilum of the lung and very close to the upper lobe trachea, it was impossible to perform a local resection.
In addition, the upper mediastinal lymph nodes were enlarged and involved the innominate vein, and obvious pericardial effusion was seen.
It is basically consistent with the inspection results.
Director Xue performed a right upper lobectomy on the patient to ensure that the cancer cells were completely removed to prevent recurrence.
Looking at the removed lung lobe and the tumor on it makes one's scalp tingle.
Even though doctors deal with blood and pus every day, they still naturally feel fear when they see a cancerous tumor.
This is also a manifestation of respect for life.
Ordinary people will only feel fear and realize that their lives are threatened when a knife is placed on their necks.
Doctors know much more medical knowledge than ordinary people and are well aware that human life is very fragile.
Even today, cancer is still synonymous with death.
The main reason is that there are no obvious symptoms in the early stages of cancer, and most Chinese people are very frugal and don't like to do physical examinations. If cancer is found, it is basically in the middle or late stages .
Developed countries do much better in this regard.
Their cancer mortality rate is low, not because their medical skills are many times more advanced than those of China, but because of early detection and early treatment.
In the early stages of cancer, as long as it is removed and supplemented with radiotherapy and chemotherapy, satisfactory cure results can basically be achieved.
It's like a forest fire; when it first starts, it's easy to put out.
Once the fire grows bigger and spreads into long lines of fire, it will be difficult to put out.
Zhou Can memorized all of Director Xue's techniques for removing lung lobes.
"Lymph nodes are the body's loyal guards. When there is inflammation or cancer cell attack, they will swell. The upper mediastinal lymph nodes are so swollen that they must be cleared out. This clearance needs to be thorough. Before the clearance, the pericardial effusion can be treated first."
Her movements were not fast, but she moved forward steadily and methodically.
It's like a war.
There are certain strategies for which part of the enemies to destroy first, which part to deal with next, and how to finish off the process in the end.
I saw her open the pericardium, remove part of the pericardial wall, and then skillfully drain the yellow transparent effusion. Then she cut the mediastinal pleura in a circular manner.
The lymph nodes in areas 10 and 11 are exposed.
After being cleared, the right superior lobe vein was dissected out.
Incision has many application scenarios, and what she performs now is basically incision.
Next, she double ligated the proximal end of the superior lobe vein and cut it.
Then the pulmonary fissure was opened and the right pulmonary artery trunk and three branches to the upper lobe were dissected out. The procedure was repeated and the proximal end was double ligated and then cut off.
The purpose of doing all this is to dissect the right upper lobe bronchus.
After dissecting out the right upper lobe bronchus, the stump closure device was used directly to close the bronchial stump.
This operation is really complicated.
Zhou Can even felt that his brain was not enough.
Director Xue is so young, yet he was able to stand out from the crowd and be awarded a senior professional title. His surgical skills are even stronger than Zhou Can expected.
Of course, her academic ability is probably even better.
This is an excellent female doctor.
"After removing it, we can clean the lymph nodes and mediastinal pleura in zones 1, 2, 3, 4, 7, and 8. Finally, we can remove the affected bloodless vein. The spread, cunningness, and concealment of cancer cells are far beyond imagination. If the surgery is not done meticulously and some cancer cells are missed, it is easy for the cancer to recur after the surgery."
She warned everyone.
"Once the disease relapses, it means the end of a life. If patients choose to trust us, then we must also be highly responsible and treat them with the same care and consideration as if they were our own business."
Basically, the doctors in Tuya who are promoted to the title of deputy director have excellent medical ethics.
At least among all the chief physicians Zhou Can had met, none of them took patients' lives as a joke.
"Finally, we open the inferior pulmonary ligament and remove the lymph nodes in zone 9. At this point, the operation is complete. After a careful inspection, if there are no missed fish, we can end the operation."
The entire operation was completed successfully and Deputy Director Lu took over the remaining work.
She sat beside him and rested with a satisfied look on her face.
"Director Lu, can you let me do the suture?"
Zhou Can has been watching for so long that he is already itching to try it.
It is impossible for him to carry out the high-risk cleaning and excision, but he is fully capable of the finishing suturing work.
And have the confidence to do it well.
"Your suturing skills are no worse than mine. I'll leave it to you."
Deputy Director Lu had seen Zhou Can's suturing skills, which were so high that they beat all the attending physicians.
"Thank you for your trust!"
Zhou Can happily began to suture the patient.
Deputy Director Lu was also happy to take a break and gave some guidance from time to time.
After several hours, this level 4 operation was finally completed.
It started at around nine in the morning and it is now four twenty-seven in the afternoon.
During this period, no one ate or drank water.
They all persisted in their posts.
Being a doctor or a nurse is a very hard job.
"Okay, everyone, go eat and rest for a while. We will come back in about half an hour to continue the next operation."
Director Xue has two major operations today.
Whether it is this cancer patient or another patient undergoing tracheal fistula closure surgery, there is no time to delay.
Surgery must be performed as soon as possible.
No matter how hard or tired she is, she has to grit her teeth and persevere.
Therefore, it is very important to train a few successors.
With a capable assistant, the surgeon can be much more relaxed. With the cooperation of everyone, they can maintain their energy and strength.
The operation just now was basically performed by Director Xue. She should be the one who works the hardest among all the people.
Maybe he also wants to accumulate more surgical experience while he is still young, in preparation for future promotion to second-level director or first-level director.
It must be explained here that the third-level, second-level, and first-level directors are job levels set by top hospitals like Tuya, not professional titles. There are only four professional titles for doctors: resident physician, attending physician, associate chief physician, and chief physician.
Directors, on the contrary, attach more importance to job level.
Because it is evaluated internally, theoretically, its value should be higher.
Why is the status of the attending physician far lower than that of the deputy chief physician?
It’s not that their levels are so different, but that as long as the attending physician passes the exam and has enough years of work experience, he or she will be automatically promoted.
The assessment of associate senior professional titles is much more difficult.
As for the higher level of professional title evaluation, it is many times more difficult than the associate professional title. And the current trend seems to be getting more and more difficult.
This is due to the serious internal problems and the rapid development of China's medical technology.
China has already caught up with internationally developed countries in many areas, and has even surpassed them. It is expected that it will become increasingly difficult to obtain senior professional titles in the future.
Director Xue was promoted to senior professor at such a young age, which is inseparable from his own efforts.
The operation just now was enough to fully demonstrate her surgical ability.
Everyone changed their clothes and walked out of the operating room one after another.
Several doctors were walking towards us. The one leading them was steady and had an extremely powerful aura.
It was none other than Director Hu Kan.
Following behind him were Director Le and others.
"Director Hu, Director Le, are you going to perform that extremely difficult major surgery?" Xueyan seemed to know what surgery they were going to perform.
"Yes! This is a rare learning opportunity. You just finished your surgery. Why don't you join us?"
Director Le rushed to answer because he knew that Director Hu was not a talkative person.
"I can't help it. I have a major surgery today. It will probably be evening by the time I'm done."
Director Xue was helpless.
Every chief physician has a heavy workload. They have to schedule two major operations a day and are basically too busy to have time to eat.
Generally speaking, at her level, one would have both teaching and scientific research tasks.
That will be even busier.
"It seems that you are very busy today. Don't worry, I will make a teaching video at that time. I will include Director Hu's surgical explanations. You can take some time to watch the teaching video and it will also have a certain learning effect."
Director Le comforted her.
Female doctors, especially beautiful and elegant female doctors, are still very popular in the department even if they are in their forties.
Director Le obviously wanted to show his courtesy to her.
This kind of display of goodwill is a man's instinct and does not necessarily require an extramarital affair or something like that.
"Thank you! Bye!"
She smiled and waved.
"Dr. Zhou in your group is very special!" Director Le did not intend to end the conversation immediately.
"What's wrong with him? Is he young and reckless, and did he offend you or other doctors with his words?"
Director Xue is quite protective of the doctors under her.
Even though Zhou Can had only been working in her group for a few days, she still had a strong desire to protect him.
"No, no. He reminded me in the morning that the patient in bed 54 who was undergoing coronary bypass surgery might have taken analgesics with anticoagulant effects. Later, when I talked to the patient before the operation, I found out that the patient had indeed taken aspirin five days ago. Although a coagulation screen was done before the operation, no obvious abnormalities were found."
Director Le obviously wanted to praise Zhou Can in front of Director Hu and Director Xue.
I feel grateful for Zhou Can's kind reminder.
Otherwise, I wouldn't choose to talk about this on this occasion.
"If he hadn't been careful, neither I, the attending physician, nor the attending physician would have noticed this. This is also a safety hazard. As you know, when we perform minor surgeries and invasive examinations, we won't do coagulation function tests unless the patient's medical history indicates obvious coagulation disorders. Because screening for coagulation function before minor surgeries does more harm than good."
The coagulation function test mainly includes platelet count and prothrombin.
"With Dr. Zhou's reminder, and after asking the patient, I found out that he had taken aspirin very quickly, which posed a potential risk of major bleeding during surgery. So I made preparations to prevent major bleeding, including fresh platelets, which are rarely prepared, just in case."
When Director Le talked about this, there was a hint of relief on his face.
"During the operation, the patient's bleeding volume was significantly higher than normal. The fresh platelets and anticoagulants that were prepared came in handy, which ensured the smooth completion of the entire operation. Dr. Zhou is really great."
When he said this, Director Le smiled at Zhou Can with gratitude.
Performing surgery is like fighting a war. Being prepared and being unprepared are two completely different concepts. The outcomes may also be completely different.
When Director Xue heard that Zhou Can had done a good thing, she couldn't help but smile with relief.
"Is the patient in bed 54 under Zhou Can's care?"
Director Hu Kan, who had been silent, asked.
"It's not his responsibility. He is a patient in our group. He was able to find the problem and had the courage to tell me about it. He is very attentive, responsible and has excellent character."
Director Le knew what Director Hu Kan meant by asking this question.
"Well, you did a great job indeed! Such an outstanding young man deserves great training. When I perform some important operations in the future, I can bring him with me." Director Hu Kan gave a huge compliment.
Being able to perform surgery under Director Hu Kan is definitely something many doctors dream of.
There will be more to learn.
Especially some advanced surgical techniques and methods.
"Thank you Director Hu! Director Le!"
Zhou Can was secretly delighted as he had more and more opportunities in cardiothoracic surgery.
The experience gained from these major surgeries will bring unimaginable benefits to his future independent surgeries.
Rapid growth in surgical skills requires not only talent and diligence, but also opportunity.
Watching top experts perform surgery every day is definitely different from watching ordinary directors or attending physicians perform surgery.
