Chapter 218: Removal of a giant lipoma, Dr. Feng's reminder
During surgery, if gloves become contaminated, they also need to be replaced immediately to avoid infection to the patient.
This is not really a waste of money by the doctor, but is for the safety of the operation.
In ancient times, even the simplest amputation could cause infection and death. In ancient times when medicine was backward, the mortality rate of amputated hands and feet was very high.
I have to praise Chinese traditional medicine here.
The earliest general anesthesia surgery was performed by Hua Tuo in the Eastern Han Dynasty. At that time, it was possible to open the abdomen and remove the tumor. There are relevant records in both unofficial and official history, so there should be no doubt about this.
In fact, some surgical hemostasis and infection prevention methods invented by the ancient Chinese were earlier than the Eastern Han Dynasty.
Qin Shi Huang was called a tyrant, but his policies such as unifying currency and building the Great Wall made his merits outweigh his faults and have always been talked about by historians.
Little did people know that the ancient methods of stopping bleeding and preventing infection were also discovered during the reign of this tyrant.
At that time, criminals were often subjected to various severe tortures.
For example, there was the punishment of tattooing, which was to tattoo words on the face of the criminal, as well as more cruel punishments such as cutting off the nose, castration, amputation of feet, and killing.
At first, most people who were brutally executed would not live long and would quickly die from blood loss and infection. Until a jailer named Zhang Shou accidentally discovered that the wounds inflicted by the red-hot iron on the prisoners would not bleed, even though they were severe.
Later, he accepted money from the prisoner's family, and during the interrogation, three fingers of several prisoners, including that prisoner, were cut off. The prisoners bled profusely and wailed continuously.
The jailer named Zhang Shou had received money from the family and couldn't bear to see the prisoner die, so he suddenly had an idea and used a red-hot iron to burn the patient's severed finger.
The prisoner was in so much pain that he cursed Zhang Shou and wished him a miserable death.
Eventually, the prisoner fainted from the pain.
Afterwards, a total of eleven prisoners had their fingers chopped off, but only the prisoner whose fingers were burned by Zhang Shou with a branding iron was lucky enough to survive.
At this time, the prisoner also came to his senses and realized that Zhang Shou was secretly saving him.
After he was released from prison alive, his family gave Zhang Shou another sum of money to express their gratitude.
This incident also made Zhang Shou, a young jailer, see a huge "business opportunity". From then on, he began to study how to use red-hot irons to stop bleeding for prisoners and help them survive.
He received a lot of bribes from the family members.
Later, Zhang Shou made a lot of money from this business. He bought good farmland and houses in his hometown, married several beautiful wives, and had a large number of children.
In order to avoid going to the battlefield, his sons were sent to the prison system under Zhang Shou's arrangement.
At this time, Zhang Shou, using money to pave the way for himself, was actually no longer the unknown little jailer.
Instead, he gained a certain amount of power and got to know many officials.
Using his connections, he got his sons into prisons as jailers. He also told his sons the secret of using a red-hot iron to stop bleeding, so that they could also become rich.
His youngest son later carried forward this skill and developed a method of using a red-hot knife to execute prisoners, which increased the survival rate of prisoners, prevented the wound from becoming infected, festering, and causing less bleeding.
In that era of backward science, these discoveries were truly remarkable.
It is estimated that it was this discovery that laid the foundation for surgical operations in the Eastern Han Dynasty.
Zhou Can put on sterile gloves, held the scalpel and began to perform surgery on the patient.
The cold and sharp scalpel seemed to be alive in his hand, easily cutting through the surface skin of the lipoma along the skin grain.
Then use curved hemostats to separate the tumor along the tumor capsule.
All visible blood vessels were clamped and ligated.
The fifth-level hemostasis technique is very cool, and combined with the fifth-level ligation technique, he ligated the blood vessels affected by the tumor. His movements were deft, precise, and swift. When ligating, not only did he not tear the surrounding tissues, but the ligation was also firm and just right.
The surgery performed by a deputy chief-level surgeon can be summed up in four words: smooth and silky.
Up to now, of Zhou Can's four basic surgical skills, only incision has not been upgraded to level five.
At present, his incision skills are almost close to the mid-level level of a major.
There is still a long way to go before being promoted to level five.
He found that after his medical skills were promoted to level 4, if he wanted to upgrade quickly, he could not just do routine surgeries. Instead, he needed to constantly challenge those difficult surgical parts.
The first time of every operation is as valuable as a girl’s first time.
Almost every time, 100 experience points will be awarded.
If a girl can keep herself clean and save her virginity for her husband, it will be beneficial to the stability and happiness of her marriage, as well as her status after marriage.
After Zhou Can successfully separated the huge tumor carefully, he breathed a sigh of relief.
[Separation experience +1.]
[You have successfully separated a giant subcutaneous tumor from your face for the first time, and you will be awarded +100 separation experience points. ]
So cool.
101 separation experience points were successfully credited.
It is equivalent to performing more than a hundred ordinary minor separation operations.
Earning high experience points from the system is a skill-based job, and Zhou Can never tires of the huge rewards he gets from completing each challenge.
The lipoma has been separated and the blood vessels have been ligated. The next step is to cut it off.
It is difficult to remove this huge lipoma, but he is confident that he can do it well.
"Strange, where does this lingering feeling of danger come from?"
Zhou Can couldn't help but wonder.
I thought the danger must be hidden in the process of separating the tumor from the surrounding tissues, because this is the most difficult.
Even though Zhou Can used the quick knife technique to control the fourth-level separation technique, he still encountered many difficulties.
Fortunately, we got through it smoothly.
Now that the separation of the lipoma has been completed, the sense of danger has not disappeared, but has become much more severe.
Which part of the surgery does this sense of crisis come from?
Is it dangerous to remove this lipoma?
The difficulty of resection is not as high as separation, so there should be no danger.
Zhou Can even wondered if the more he knew, the more timid he became.
Many older doctors are very cautious when performing surgery or administering medicine to patients, and they seem extremely timid.
Now, Zhou Can seemed to have developed the same "cowardice" as those old doctors.
"Mr. Liu, do you think there are any major potential risks in removing this tumor?"
Zhou Can had no choice but to ask Mr. Liu for help.
"Given your anatomical skills, you are fully capable of safely removing this lipoma. Don't think too much. We surgeons must be bold and careful. Where is the confident and challenging Zhou Can? Show your courage. I, the senior doctor in charge, am not afraid, so what are you afraid of?"
Mr. Liu gave him the greatest encouragement.
The two of them have performed 700 to 800 surgeries of all sizes, and Elder Liu is very clear about Zhou Can's surgical ability. It is also because of his high trust in Zhou Can that he insisted on letting Zhou Can perform the surgery even when Zhou Can raised questions and showed timidity.
The purpose is to train Zhou Can.
Help him improve his surgical skills.
Many difficult surgeries are unlikely to have been experienced by a resident physician like Zhou Can, who has only worked for a short period of time. Even a chief physician who has worked for decades may have never experienced them.
You can only try to challenge it.
There are too many hurdles to overcome in life.
"Then I'll start cutting!"
Zhou Can calmed himself down and then began to remove the huge tumor from the patient.
Swish, swish, swish!
The monopolar electrosurgical knife easily removed the lipoma at the root.
In order to prevent recurrence, some adjacent normal tissue was deliberately removed.
All tumors, whether benign or malignant, are prone to recurrence if not completely removed. This is something that many novice surgeons are most likely to overlook.
Even some attending physicians who have been engaged in surgical work for more than ten years may fail to perform clean and thorough tumor removal due to various reasons.
Compared with ordinary scalpels, electric knives have many advantages.
It has fast cutting speed, good hemostasis effect, simple operation and can effectively reduce complications.
When removing or incising the subcutaneous tissue, various organs and tissues in the abdominal cavity and chest cavity, doctors often choose to use an electric knife.
However, some older doctors insist on using ordinary scalpels.
Because they think that ordinary scalpels are easier to control and master. It is said that the most powerful hospital in the capital, which has top surgical experts, never uses electric knives when operating on patients.
He has successfully completed many extremely difficult operations that required extreme precision.
I have to say, this is a miracle.
Zhou Can's current knife skills and anatomy skills were only at an average level. He could not understand why the top surgical expert insisted on using an ordinary scalpel.
One thing is certain, even the current Tuya Hospital, and even many top hospitals in other provinces, are still unable to achieve a true no-surgery restricted area within the brain.
The brainstem is still considered a surgical contraindication by the vast majority of surgeons.
Even though robot surgery has been highly praised abroad, I have never heard of anyone daring to perform brainstem surgery.
But the top surgical expert in the capital dared to do it, and the key is that he succeeded in more than one case.
Therefore, the debate about which is stronger, ordinary scalpels or various high-tech scalpels such as electric scalpels, LEEP knives, and low-temperature plasma ablation knives, has never stopped.
It is an indisputable fact that ordinary scalpels have not been eliminated so far and are still widely used in surgery.
Zhou Can neither rejects traditional "cold weapons" nor enthusiastically supports surgical knives such as electric knives invented in later generations.
Anyway, use whichever is more convenient.
For example, the great saphenous vein rotary cutter is also a high-tech product. Using it can avoid making multiple incisions and cause less trauma to the patient.
Another example is the ultrasonic emulsification suction knife, which not only reduces the amount of bleeding during surgery and postoperative complications, but also speeds up postoperative recovery. It also has the functions of ultrasonic emulsification, suction, flushing, ultrasonic cutting hemostasis, and ultrasonic debridement.
It is simply incomparable to ordinary scalpels .
It is safe and accurate to separate blood vessels and bile ducts. It is one of the essential surgical tools for hepatobiliary surgery.
Especially for doctors who are not good at separation techniques, it is simply a lifesaver.
The separation technique, which was originally only at the lower level of residents, can be immediately improved to the excellent level of residents after using it.
The medical progress brought about by science and technology cannot be ignored.
Zhou Can used an electric knife to completely remove the lipoma safely without any accidents.
[Incision experience +1.]
[You successfully removed a huge subcutaneous tumor on your face for the first time, and you are rewarded with +100 incision experience points. ]
It was such a pleasure to perform this difficult and major surgery.
Another 101 incision experience points were earned.
The experience points gained from this medical skill are not easy to earn.
Zhou Can was extremely happy to earn so much money at one time.
At the same time, he also felt that his anatomical skills seemed to have improved significantly.
A quick inspection revealed that the incision had been successfully promoted to the intermediate level of attending physician.
This level is roughly equivalent to that of a senior attending surgeon.
"Wow, this is the first time I've seen such a big lipoma!"
When Wu Ziyu saw that Zhou Can had successfully cut off the lipoma, she immediately took it out with tissue forceps and placed it in a basin.
Lipomas are often multi-lobed and irregular in shape.
This lipoma was irregular in shape but not lobate.
Zhou Can did not feel much joy, because the sense of crisis was more urgent.
From the moment he had the lipoma removed, he felt inexplicably uneasy.
A careful examination of the wound showed that the base of the tumor was removed very cleanly without any residue, and there was no major bleeding or damage to important nerves.
This operation was considered to be done very well.
After checking several times and finding no hidden dangers, Zhou Can looked up at Old Liu.
"Master Liu, do you think we can sew it up now?"
"Sew it up! Great job!"
Mr. Liu doesn't praise others easily.
If he says it’s good, then it’s really good.
Zhou Can did not hesitate any longer and immediately sutured the patient's wound and performed some skin flap repair.
Because it involves suturing wounds on the head and face, a very high level of suturing is required, and it is necessary to avoid ugly and hideous facial scars after the operation.
It was definitely a blessing for the patient to have Zhou Can suture his wound personally.
Chief surgeons would not take care of things like skin suturing. At most, they would leave it to their attending doctors.
I'm afraid no other attending physician's suturing skills are as good as Zhou Can's.
The exception is special attending physicians like Dr. Xu who were promoted from chief physician.
After the patient was stitched up, his vital signs were stable and no accidents occurred.
Zhou Can's heart was temporarily at ease.
It's really strange. Upgrading the anesthesia technique to level three is a good thing, but why does it give me an inexplicable sense of danger?
This caused Zhou Can to be nervous for several hours in vain.
"Xiao Zhou, the operation went very well! Why do you look a little off today? You seem to be worried."
Old Liu noticed some subtle changes in Zhou Can's expression.
I couldn't help but ask the reason.
"I can't explain it either. I had an inexplicable sense of danger when I was operating on this patient just now."
Zhou Can expressed his doubts.
"Hey, I've had this experience too. When doing any major surgery, everyone's nerves are on edge. It's normal to feel nervous and worried about what might happen. Now that the surgery is over and everything went smoothly, there's no need for you to worry about it anymore! Relax and get on with the next surgery! There are many more surgeries waiting for you!"
Old Liu doesn't want to see anything happen to General Zhou Can.
Do ideological work on Zhou Can on the spot .
Comfort him.
"Okay! Maybe I'm just worrying too much!"
Zhou Can calmed himself down and prepared for the next operation.
Anesthesiologist Dr. Feng had already packed up his things. Before leaving, he said to Zhou Can, "If your intuition is correct, the sense of crisis may come from the patient's postoperative complications. The patient's postoperative recovery needs to be closely monitored."
After saying this, Doctor Feng left.
Postoperative complications?
Zhou Can was shocked, but at the same time he had a flash of enlightenment.
No wonder I am always uneasy. It turns out that the risks of surgery not only come from the surgical process, but may also appear after the operation.
I overlooked this point.
"Tell the doctor in charge to pay close attention to this surgical patient."
Zhou Can said to the nurse.
"Yeah, okay!"
The nurse on duty agreed and took the patient to the recovery room to wake him up from anesthesia.
Zhou Can's hidden status in the department is quite high. Not only the attending physicians and resident doctors, but also the chief physicians and deputy chief physicians are very polite to Zhou Can.
Unless the patient has been kicked in the head by a donkey, the attending physician will take this matter seriously.
What Zhou Can explained was no different from what Elder Liu explained in person.
After sending this patient away, the next surgical patient was brought in by the intern.
The intern follows up on the operation by inserting a catheter, preparing the skin, making various preparations for the patient before the operation, and performing routine checks on blood pressure, heart rate, body temperature, etc.
After everything is ready, we receive notification from the operating room and send the patient there on time.
Sometimes, the surgeon only performs the surgery and does not necessarily check the patient's information. The intern who follows up the surgery has the obligation to ensure that the right patient is sent for surgery. If the surgeon performs the wrong surgery on the patient, the intern is doomed.
The surgeon in charge will also be in trouble.
Having surgical privileges suspended is the lightest punishment.
Although the probability of this happening is low, it is still possible.
From these aspects, the responsibilities of interns who have little presence are actually quite important.
