Dean Yan chatted with Mr. Peng, and Mr. Gu from the chest department caught up a few minutes later.
While Lao He was busy performing without physical objects, he listened carefully to what they said. At this time, it's all boss-level chat, and it would be too uninteresting for an anesthesiologist to come up and talk things over.
But he was curious as to why Boss Zheng took on such a big job. Normally, other doctors would be more cautious when performing surgeries on more important people. I just heard from Yi Ren that it seemed that Boss Zheng had persuaded him to do it.
From the conversation, Lao He could tell that Mr. Gu actually did not agree with the surgery. He often hesitated to speak. He should have gone to the handsome man's house for consultation the day before yesterday and participated in the diagnosis.
But Mr. Gu's opinion is not important. Lao He has nothing to worry about. He now has an almost blind admiration for Boss Zheng's level.
It is certain that Boss Zheng is of high standard. The key is stability! No matter what kind of rare surgery Boss Zheng would perform, Lao He had an "illusion", as if Boss Zheng had performed this kind of surgery countless times.
Maybe it's an "illusion", Lao He thought. He was just curious. After expert consultation, Mr. and Mrs. Peng also gave up the operation and prepared to return to their hometown to return to their roots. How much confidence did Boss Zheng have to let them stay
Soon, the sound of a flat car was heard, and the patient was brought in.
Lao He helped lift the patient to the operating table and asked softly, "Boss Zheng, do you have any special needs?"
"Lie on the left side, lean forward 30°, and move the right side into the chest." Zheng Ren said in a deep voice. While he was talking, he inserted the patient's film into the reader and read the film habitually with his arms folded, without even the slightest thought of talking to Mr. Peng.
"Okay." Lao He responded in a lowered voice.
"Anesthetize me, I'll go wash my hands right away." Zheng Ren said.
So urgent? Lao He was in a daze.
"The operation should be completed within 45 minutes from the time of anesthesia, and we strive to have as light a blow as possible. The old man is old, so he can do it as quickly as possible." Zheng Ren explained with a smile.
Lao He now knew why Mr. Gu felt that this operation was unnecessary. This was determined by the patient's physical condition.
Including 45 minutes of anesthesia, even laparoscopic surgery is too fast. Boss Zheng really dares to think about it.
Seeing Boss Zheng going to wash his hands, Lao He glanced at Su Yun. Seeing that Su Yun had installed the scaffold and other auxiliary equipment, he asked in a low voice, "Brother Yun, shall I start?"
"Start, after you insert the tube, I will start to position you." Su Yun's voice reached Lao He's ears through the three-layer mask, which was a little muffled. Lao He knew that Brother Yun might be a little nervous today. After all, even if Dean Yan expelled a group of people, there were still many boss-level tasks left to prepare for the audience.
After intubation, anesthesia, and positioning, 4'22 seconds later, Zheng Ren had finished brushing his hands, laid out sterile drape, and stood in front of the operating table.
Lao He watched Boss Zheng's movements closely and started left one-lung ventilation at the most appropriate time.
Zheng Ren placed a thoracoscope in the seventh intercostal hole in the right posterior axillary line, and the two holes in the third intercostal space in the midaxillary line and the eighth intercostal space in the scapular line were the operating holes. After punching the card and turning the camera, Lao He let out a long breath. One-lung ventilation was perfect and did not affect Boss Zheng's operation time.
However, Boss Zheng did not attack the mediastinum directly. Instead, he began to deftly dissociate the mediastinum with long-head forceps, and soon the azygos vein arch appeared in the surgical field.
A linear cutting suture device was slapped in Zheng Ren's hand. After cutting off the azygos venous arch, he began to free the mediastinum. Soon a huge diverticulum appeared on the screen.
The esophagus was freed at the level of the carina and lifted around the band. Zheng Ren was freed upward along the esophagus to expose the lower end of the diverticulum.
Only the song of good luck was floating in the operating room. Others stood behind Zheng Ren, watching the operation that was skillful to the core. No one spoke, but occasionally raised their heads to glance at the electronic clock hanging on the lintel.
At 12′22″, the diverticulum was fully exposed.
For esophageal endoscopic surgery, this is a time that makes all surgeons dumbfounded.
Normally, all that could be done in such a short period of time was to complete the anesthesia and positioning. The medical team that was a little slower might not even have laid out the surgical drapes. But Boss Zheng has already seen the esophagus.
Quick, but not enough.
Mr. Gu glanced at the time, and his black and white eyebrows wrinkled under the sterile cap.
The real operation has only begun now. Can Boss Zheng finish it
It's not that he doesn't agree with Boss Zheng's surgical plan, but he has doubts about whether the operation can be completed within an hour. Although the oldest patient he has ever operated on was a 104-year-old patient, that was only due to his physical condition.
Dr. Zheng's surgery this time seemed to be a bit wild.
Time is not a problem for Zheng Ren. After exposing the diverticulum, he used an electric knife to make a small hole at the lower end of the diverticulum to enter the diverticulum, sutured it with 2 stitches and then retracted it. The limitations of the laparoscope did not seem to affect Zheng Ren's technique. The suturing was clean and neat, and the cooperation with the assistant and instrument nurse was perfect.
After the sewing was completed, Su Yun clamped the suture with a pair of pliers and reserved it for pulling.
Make another small hole in the right side wall of the esophagus at the level of the bottom of the flat diverticulum, suture it with 2 stitches and then retract it.
Zheng Ren then used an endoscopic cutting and suturing device to enter the esophageal cavity and diverticulum cavity through the esophageal opening and diverticulum opening respectively, and cut and sutured the diverticulum and the side wall of the esophagus side by side.
The cutting and suturing device made a creaking sound. Although it was clean and neat, it still made everyone's hearts tremble.
Boss Zheng didn't even do a comparison. He just took off the cutting and suturing device and started working directly. This must be too confident.
At 23′54″ of operation time, the diverticulum was completely opened.
The incised diverticulum and interesophageal ridge form a common cavity with the compressed upper thoracic esophagus.
This method of relieving esophageal compression is rare, but looking at the anatomy, it can be clearly seen that the squeezed esophagus has begun to restore the shape of the lumen. Simply put, if the surgery is successful, the patient should be able to eat.
The biggest problem with this is fistulas.
The diverticulum and esophageal incision formed after the incision and suturing are then sutured intermittently.
Mr. Gu's brows furrowed more and more tightly. Now was the most critical part of the operation.
No matter how fast or precise the previous surgery was, once an esophageal fistula occurs after the surgery, it will be an unbearable blow for an 84-year-old man in poor condition.
The anatomical structure and blood supply of the esophagus itself remind the surgeon and doctor countless times that the probability of esophageal fistula is very high.
Is it ok to just intermittent suturing
As if this is not enough, if this is the case, even if jejunal nutrition is performed after surgery, it will be difficult to ensure the healing of the esophagus.
Boss Zheng's stitching was very detailed, and this section took a lot of time. When Mr. Gu looked at the electronic clock again, the operation had already taken 33 minutes.