Professor Tian's technique is very smooth.
The skin was incised to expose the spinous process and lamina, and the two vertebral bodies above and below the diseased vertebral body were fully exposed.
In order to better expose the incision, the sacrospinal muscles on both sides should be cut transversely from the level of the diseased vertebra and retracted distally and proximally respectively.
Generally speaking, there should be at least 200ml of bleeding at this time.
Because in the process of exposing the spinous process and lamina, a certain amount of periosteum needs to be dealt with, which may lead to bleeding.
But today's surgery went surprisingly smoothly.
The blood loss is less than 50ml, and the entire surgical field looks extremely clean.
Professor Tian is very satisfied with his technique. It seems that his hand is very smooth today and the surgical bleeding may be less than 3000ml.
The next steps were about to start bleeding profusely. Professor Tian's hand became much gentler and he slowed down very seriously. All operations are carefully identified to avoid accidental bleeding.
The rongeur began to bite off the spinous process and lamina that were infiltrated by the tumor.
"Gaba~" with a sound, a piece of broken bone was bitten off by the rongeur.
Because of tumor infiltration, the bone plate is not that hard and the sound is like broken leather.
Although the hardness is not enough, due to the abnormal proliferation of blood vessels in the tumor, the bone plate has sufficient blood supply, causing the amount of bleeding to increase suddenly.
Heavy bleeding starts from now on.
A piece of lamina was bitten off by a rongeur, and Professor Tian habitually covered it with a piece of dry gauze.
strangeness…
In an instant, Professor Tian discovered that it took a full ten seconds for the dry gauze to be soaked with blood.
Professor Tian has a very high level. Although he is not at the level of a master, he is still an orthopedic professor at the level of a senior master, almost a master.
He has a deep understanding of vertebral body removal surgery.
If there was less bleeding before, it could be explained by my high level of separation.
However, if the rongeur bites the lamina, this step is unlikely to result in very little bleeding.
Generally speaking, starting from this step, the operation will be performed in a pool of blood.
The kind that can't even be sucked clean by a suction device.
And unclear vision will lead to more bleeding, and the vicious cycle continues.
Over there, fresh frozen red blood cells have been hung up, waiting for Professor Tian's order, ready to be transfused into the patient's body at any time.
Strange, could it be some kind of rare tumor? Not rich blood supply
No, Professor Tian couldn't understand the situation in front of him.
Even if the blood supply of the tumor is not abundant, the blood supply of the vertebral body is quite abundant. It will never take ten seconds for bleeding to soak a piece of dry gauze.
"Teacher Tian?" Dr. Zhou saw that Professor Tian was stunned and didn't know what was going on, so he called out softly.
Professor Tian woke up from the endless speculation, concentrated, and continued the operation.
Continue to bite off the lamina and expose the nerve roots.
The tumor invades the spinal canal. During the operation, it can be seen that the dura mater gradually bulges outward without pulsation. The epidural fat often disappears and the dural sac is displaced or deformed due to pressure.
Professor Tian did not continue to cover the lamina broken by the rongeur with dry gauze. He wanted to see how much bleeding there was.
Sure enough, the amount of bleeding was very small, only a few dozen milliliters.
It’s a question of interventional surgery!
Professor Tian quickly determined the truth of the matter. However, he couldn't accept this truth.
In the Imperial Capital, as an expert and professor of spine surgery, I often cooperate with interventional surgeons to complete vertebral body removal surgeries.
But have you ever encountered such a small amount of bleeding
No, not even once.
With the cooperation of the interventional department, bleeding can indeed be reduced to a certain extent. It has something to do with the artist's technique, but it doesn't have much to do with it.
What's so difficult about embolizing just one transverse lumbar artery
Unable to find an interventionalist, Professor Tian could perform the transverse lumbar artery embolization operation even while wearing a lead gown.
However, whether the interventional doctor or himself performed the transverse lumbar artery embolization surgery, they could only reduce the bleeding volume from 5000 ml to 2000 or 3000 ml.
No matter how little, Professor Tian has never encountered it.
In a small place like Haicheng, there are doctors who are stronger than those in the imperial capital
Impossible, absolutely impossible.
Professor Tian was thinking about these things in his mind without stopping.
There are too many surgeries of this kind, and it can be done with your eyes closed. At least you don’t have to recall the local anatomy like you did the first time.
Use nerve dissectors to find the nerve roots on both sides of the thecal sac and protect them.
Afterwards, Professor Tian began to peel off the tumor tissue, the dural sac and the outside of the nerve roots, and removed the upper and lower facet joints and pedicles one by one along with the tumor tissue.
Generally speaking, this is the role of transverse lumbar artery embolization before laminectomy.
Without interventional embolization, threatening bleeding would occur at this time.
What is threatening bleeding
Some invisible tiny blood vessels were bleeding out, and the entire surgical field was bright red. Even the bleeding blood vessels could not be found, let alone performing vertebral body removal.
There is no threatening bleeding, which is good.
But... there is no threatening bleeding in this, not even bleeding!
It would be nonsense to insist that there was no bleeding at all.
But Dr. Zhou held the suction device without a sheath in his hand and easily sucked out the blood. The surgical field was well exposed, so much so that Professor Tian panicked.
This is not the vertebral body removal surgery that I am familiar with...
Did you do something wrong
He stopped and recalled the entire operation process. There was no problem!
Looking at the surgical field, the anatomical structure is so clear that it can be used as a textbook map, and there are no problems.
What a hell.
The operation went so smoothly, but there were problems.
Professor Tian felt a little uneasy. Ever since he came into contact with vertebral body removal, he had never seen such a surgical field.
If he were in the imperial capital, Professor Tian would deliberately ask a few colleagues or even his own teachers to come and observe to see if he had made any mistakes.
But this is Haicheng.
Just go ahead and do it.
The exposure and removal of the lumbar transverse process went smoothly, and the bleeding... was still very small. The general bleeding at the lumbar transverse process is about 500 ml, and it took 30 minutes.
This is Professor Tian’s experience.
But in this damn surgery, the blood loss was only 30-50 ml, and it took 15 minutes to complete this step.
Professor Tian then began to expose the anterolateral surface of the vertebral body bones. The vertebral body invaded by the tumor was moderately enlarged, but its edge was clearly demarcated from the surrounding tissue. Gently peeling can push the surrounding tissue aside and perform the dissection.
Normally, this step will still cause 200-300 ml of bleeding, which is time-consuming...
But it was still going smoothly here, and the amount of bleeding was only one-tenth of the usual amount. Looking at the suction tube in Dr. Zhou's hand, it was estimated that 20-30 ml of bleeding would be good.
After dissecting the diseased vertebral body to the anterior longitudinal ligament, Professor Tian asked Dr. Zhou to use a Hohman retractor to retract the surrounding tissue, and the lateral-anterior approach to the vertebral body appeared in front of his eyes.
The surgery... went so smoothly that it made people feel trance-like and frightened.
Is this a vertebral body removal surgery
No, why is there so little bleeding? How could the operation go so smoothly
It's really... I've seen a ghost!