Facing Zheng Ren's relaxed smile, everyone's nervousness was somewhat relieved.
At the beginning of the operation, after opening the chest, Zheng Ren cut the mediastinal pleura around the roots of the lungs and bluntly separated the lungs to expose the hilar blood vessels.
Lin Yuan and Gu Xiaoran then retracted the upper and lower lobes of the lungs to the rear, exposing the front edge of the lung hilum. First, divide the superficial superior pulmonary vein, ligate and cut off the upper lobe vein and middle lobe vein respectively.
Dr. Charles stood silently watching the operation, his pupils gradually narrowing.
The standard pneumonectomy procedure is a textbook-level operation. Fifteen minutes after the operation was started, the arteries and veins of the right lung were exposed and ligation began.
The doctor could tell that Zheng Ren did not pursue speed, but performed the operation step by step. It's just that the operation was performed extremely smoothly. Not only the surgeon and the first assistant, but also the second and third assistants knew the surgical process very well, and their tacit understanding was astonishing.
What do practitioners hope for most
The most important thing is that the surgical field is clean. Not only will bleeding block the view, but it is also critical to use a retractor to pull other tissues apart and expose the surgical field.
When Zheng Ren bluntly dissected the right lung to expose the hilar blood vessels, second assistant Lin Yuan and third assistant Gu Xiaoran pulled apart all the tissue that needed to be pulled apart in advance, fully exposing the surgical field.
During the surgical practice, Dr. Charles did not notice the role of the assistant. At that time, he focused all his attention on the 3D printed lung tissue donor; on Zheng Ren’s microsurgery skills.
Today, when facing real patients and looking at this operation from the beginning, Dr. Charles thought that the performance of the two young men was perfect.
Surgery is not done by one person, and today the second and third assistants perfectly explained this.
"Liver function, alanine aminotransferase..."
"Blood gas analysis..."
At 15 minutes, Lao He began to report the test results. Liver and kidney function, blood gas analysis, and several major indicators are reported clearly.
"Next time." Zheng Ren replied simply. Others sounded confused, but Lao He nodded to indicate that he understood.
The assistant beside Dr. Charles translated for him behind him, and the doctor began to think about these numerical problems.
Now looking at the liver function, the total bilirubin is 89 μmol/L, which is 4 times higher than the upper limit of normal value. However, according to the medical records, this young patient's total bilirubin was high before surgery, which was considered to be related to several liver interventional embolization surgeries.
The kidney function is good, the blood gas analysis is also ideal, and the ECMO is running smoothly. Dr. Charles smiled. Dr. Zheng was really cautious. He even limited the dosage of low-molecular-weight heparin before the operation and continued to observe during the operation.
Although doctors are said to be cautious, Dr. Zheng was a little too cautious today.
After getting the first test report, Zheng Ren ligated and severed the first branch of the pulmonary artery, the anterior apical artery.
Immediately, the right pulmonary artery trunk was completely exposed and blocked with a thick silk suture.
"Zheng, you are too cautious." Dr. Charles finally couldn't bear it anymore and began to communicate with Zheng Ren.
You have to wait here, generally 10 minutes. However, the patient has already been put on ECMO. Even if the blood pressure drops due to the resection, there will not be a big problem, as long as he pays attention to the fluid replenishment for a long time.
"Doctor, because the patient's liver function is not good, I have to be careful." Zheng Ren explained to Dr. Charles why he carefully monitored his blood pressure with the assistance of ECMO.
In the operating room, Zheng Ren's voice was mixed with the singing of good luck. Others standing on the stage, including Su Yun, did not move, but seemed to be waiting for something.
"Didi beep~~~" The monitor alarm sounded, and the arterial pressure displayed on it continued to decrease.
Dr. Charles does not think it is necessary. As long as the fluid is replenished for a long time, can the operation be stopped because the blood pressure drops after blocking the right pulmonary artery
It's simply impossible, so Zheng's waiting is meaningless.
But then Su Yun made a gesture without hesitation, and Gu Xiaoran, who was standing next to him, pulled the sterile drape upward, retaining the sterile area and exposing the left groin.
What is this going to do? Dr. Charles was stunned.
The ICU doctor who had been prepared for a long time came immediately from the operating room and pushed over a set of strange-looking machines. The Shay man handed him a puncture kit, and after brushing and disinfecting his hands, he began to perform the operation.
The machine... is pieced together, looking like it has been patched with countless patches, a bit shabby and worn. The sound of the monitor alarm ringing in the ears made people feel irritated. It seemed that the good luck songs were no longer so pleasant, and they also became irritable.
Dr. Charles did not comment on the machine. He squinted his eyes to carefully watch the ICU doctor's operation.
The femoral vein was punctured and cannulated to establish a circulation path, and the ICU doctor began to open the machine and connect the tubes.
Adsorb bilirubin, plasma exchange! Dr. Charles soon discovered the usefulness of this machine. Blood pressure drops, need liver dialysis? Is this operation a bit excessive
It is true that hypotensive states can cause damage to kidney and liver functions, but kidney damage is generally considered to be more serious. Intraoperative dialysis... seems not necessary.
Could it be that Dr. Zheng practiced surgery for a long time and finally lost himself? Dr. Charles wondered. But out of respect for the magician, he did not express his doubts about Zheng Ren.
After establishing the liver dialysis channel, Zheng Ren immediately opened the blocker and continued the operation. Despite the alarm sound of the invasive arterial blood pressure monitoring, he began the methodical operation again.
Lin Yuan retracted the lower lobe forward, and Zheng Ren and Su Yun began to ligate and cut the inferior pulmonary ligament.
Then the mediastinal pleura was pushed open, the inferior pulmonary vein was freed, ligated with sutures, sutured and then cut.
Gu Xiaoran retracted the upper lobe of the lung downward, freed the right main bronchus below the azygous arch, cut it 0.5 to 0.8 cm away from the tracheal carina, and sutured it.
No one spoke, and the silent surgical process was accompanied by the piercing sirens. Even the tacit surgical cooperation seemed less clear and eye-catching, and became irritable.
Is this possible? Dr. Charles looked more at the monitor and looked at the changes in blood pressure, feeling a little worried. He was worried that the patient's lowered blood pressure could lead directly to cardiac arrest, which could lead to failure of the surgery.
Although the blood pressure is still within the tolerable range, there is no way to justify not replenishing fluids.
"Give heparin 82U/kg, prostaglandin E1 860U/kg, Perferdex solution antegrade perfusion, perfusion pressure 52cm H2O, perfusion temperature 4℃." Zheng Ren said solemnly.
"Zheng, do you need rehydration?"
After enduring it for a few minutes, Dr. Charles finally couldn't hold it any longer and began to whisper suggestions when Zheng Ren was about to give perfusion fluid before the lung transplant.