The preoperative case analysis ends, the field of view is switched, and the live broadcast of the surgery begins 10 minutes later.
"Boss Zheng did the surgery?" Lei Yinghua asked.
"Um."
"What method are you going to use?"
"..." Peng Jia was startled.
The technique... I don't know. It had been less than three hours since I got the news, and the people in the imperial capital were so busy that they had no time to talk to me.
Lei Yinghua didn't say anything, just shook his head slightly.
It seems that this is the problem with Xinglinyuan. The surgeon doesn't know what kind of surgery to use.
This is definitely not what a medical professional website should look like.
But is the surgery an emergency surgery
It's impossible. If it was really an emergency surgery, the PPT wouldn't be so beautiful that I wouldn't be able to find any faults.
Let's look at surgery. Based on the surgeon's habits, it is very likely that surgery will be used.
Just as he was thinking about it, Lei Yinghua saw something was wrong in the picture.
This is... a colonoscopy? ESD technology? !
It’s really ESD technology!
ESD technology, also called endoscopic submucosal dissection, refers to a minimally invasive technique that completely peels off the diseased mucosa from the submucosa under an endoscope.
It was first pioneered and applied clinically in Japan in the late 1990s. The main purpose of this surgery is to diagnose and treat early-stage gastrointestinal tumors. It has the advantage of completely resecting a certain area of superficial lesions at one time.
But the technical requirements are high and difficult.
Lei Yinghua repeatedly summarized his experience and finally determined that using ESD technology to treat MW syndrome was the best way.
But there is also a problem - there are so many polyps in the patient's colorectum, and some polyps are quite large. During the removal process, intestinal perforation may occur if one is not careful.
In the preoperative case discussion just now, Lei Yinghua also saw the patient's film.
There are at least dozens of large polyps.
Do all these polyps need to be removed at once? It should be done in two or three times.
If I were to do the surgery myself, I would choose this method.
The patient's injuries are small and there is not much risk. As for slowing down, that's not what I'm afraid of.
But if the surgery is broadcast live, half of it is done and half is left, no matter what you think, it is not good.
The visual field surgeon looks directly into the field of view of the colonoscope screen. The colonoscope has been lowered in and is being operated.
Lei Yinghua held his breath and watched carefully.
The first polyp was located 6cm away from the anus in the rectum. The diameter is about 1cm, and the surface is a little rough.
An experienced doctor can tell at a glance that there is a high probability that the polyp is in the precancerous stage. In other words, it has not transformed into a malignant tumor, but if it is not removed, fundamental changes will occur in a few months.
The spray pipe sprayed out the dye, which looked like a 0.5% methylene blue solution. Lei Yinghua doesn't like to use methylene blue, and usually uses 0.4% indigo carmine.
But this is decided based on personal preference, no one is right or wrong.
The methylene blue was sprayed evenly, and the surgeon's assistant was particularly good. Lei Yinghua was a little envious.
It seems like just a small operation, but as an artist, this is the first difficulty.
The dye is sprayed to clearly show the size and extent of the lesion.
Uneven spraying will make the operation more difficult.
The team of surgeons is very strong, and the assistants’ operations are almost perfect. Just from a simple little detail at the beginning, Lei Yinghua made his own judgment.
The sprayed methylene blue seemed to have not completely fallen before the surgeon started submucosal injection.
Without repeating it several times, the surgeon injects a single injection to raise the area where the polyps are to be separated, so that there is sufficient field of view when separating the submucosa and muscularis propria.
The injection contains hemostatic ingredients, which can ensure that some small capillaries rupture and prevent excessive bleeding.
After the submucosal injection is completed, electrocoagulation is marked, and the endoscopic incision knife begins to cut 5 mm from the edge of the lesion.
This is too fast. What's the use of a magician just using his hand speed? Lei Yinghua was a little disdainful.
Just trying to do the surgery quickly is a form of sensationalism.
Endoscopic surgery was first performed by doctors in endoscopic laboratories and gastroenterology departments in China.
Since I am not a surgeon, the process of exploration was very long.
After all, they have no access to the anatomy of the intestine, and there are some subtleties that are difficult to deal with.
Surgeons, at first... and even now, were still used to operating to solve problems.
However, under the general trend of minimally invasive surgery, some surgeons are gradually beginning to perform ESD surgeries.
Lei Yinghua is one of them, and he is still the best. He has a deep understanding of ESD surgery and even has his own unique insights.
The surgeon is a young challenger, but there is no use in doing the surgery quickly.
Endoscopic surgery is most afraid of bleeding. Once a blood vessel ruptures and bleeds, it takes a long time to deal with it.
The patient's injuries were also extremely severe.
This is something young people don't understand. Lei Yinghua watched calmly.
Sure enough, according to Director Lei's idea, after the incision, the operation speed suddenly slowed down. Not only is it slow, but the method is also a bit clumsy.
Lei Yinghua smiled, he was still a skilled practitioner and he didn't do as much as he did.
The mucosal layer of the colorectum is relatively thin, so the electrocoagulation power cannot be particularly high to avoid damaging the muscle layer. The surgeon's choice was correct. His electrocoagulation power was just right, so Lei Yinghua had no surprises.
If you can't grasp these details, how dare you live broadcast the surgery? That's a joke.
After the submucosal lifting is ideal, use an endoscopic incision knife to incise the mucosa at the outer edge of the marked point.
Lei Yinghua held his breath and smoothly pre-incised the surrounding mucosa, which is the key to successful ESD treatment.
The endoscopic incision knife smoothly incises the mucosa around the polyp, enters the submucosal layer through the pre-incision, and then makes a circular incision along the outside of the methylene blue mark.
His technique was very skillful and he didn't look like a newbie just exploring ESD surgery.
This sense of proficiency is completely different from my previous judgment of the artist... What's going on? Is it because there are some more invalid operations just to show off your skills
Well, it's possible. Young people always have something to show off.
But looking at the operation process, Lei Yingjie even had an illusion. The surgeon had to perform at least 1,800 ESD surgeries before he could have such a skilled feel.
Has anyone in China performed so many ESD surgeries
No, there is no need to recall this, Lei Yingjie can confirm it. Because after thinking about it, he couldn't do it himself.
After cutting, the separator was sent in.
Blunt separation, this is the most important node.
Many laparoscopists and gastroenterologists are always not good at this, but general surgeons are much better.
After all, there are many surgical operations to cut and free the intestines, and surgeons are very familiar with the intestines.
The separation speed of the separator is not fast, but it is not slow either. Layer by layer, it is like a cook undressing a cow. The anatomical structure of each layer is very clear, and some small blood vessels are avoided. Electric cauterization and electrocoagulation are used to stop bleeding at any time.
1′22″ later, a polyp was removed.
This speed... Lei Yinghua nodded slightly. The surgeon dared to live broadcast the operation, and his level was still high.
The entire process of endoscopic removal of the outermost rectal polyp was as classic as a textbook.
Although there is no textbook on ESD surgery so far, in Lei Yinghua's imagination, the operation he just saw was perfect. If I have to find fault, I can only say that the speed in the later stage is a little slower, and there are some invalid operations.
Young people, in order to show off their skills, they add those operations out of thin air. At my age, I can't do it.
"Director Lei, what do you think of Boss Zheng's surgery?" Peng Jia asked anxiously.