Intraoperative exploration showed no abnormal changes in the stomach and small intestine. The liver is normal in size, has a smooth surface, and is not covered with nodules like those seen in patients with cirrhosis.
However, the gallbladder was obviously congested and edematous, and was as big as the fist of most adult men.
The swollen gallbladder is like an inflated balloon. Looking at the posture, if you are not careful, the gallbladder will explode into the sky with a "bang".
Wow, how many stones must be in this gallbladder
It's not necessarily stones, it could be parasites.
Why do I have the feeling that if I touch it, my gallbladder will rupture, and a large amount of bile will flow into the abdominal cavity, and the operation will be contaminated? It's over. I can't watch it. If I continue to watch it, I'll probably have nightmares, the kind of nightmare where I can't finish the surgery after a night of surgery.
The unknown doctor who said he wouldn't see me was actually very honest. There was no one left in the live broadcast room. People kept coming in late to watch the operation performed by Daniel, who had become a legend in Xinglin Garden.
Zheng Ren made a small incision 0.5cm away from the liver with the tip of a knife, and then started his signature blunt dissection.
The people watching the live broadcast were all professional doctors, and even those who had never performed more than a hundred surgeries were embarrassed to post comments in the live broadcast room.
But no one can achieve Zheng Ren's blunt separation.
After repeatedly watching the "performance" of 49+1 appendectomies performed by Zheng Ren, some people began to try a wider range of blunt dissections, but the outcome was frustrating, and there was almost no medical accident of tearing the intestines.
During this time, a post appeared in Xinglin Garden, specifically gathering the comments of all those who tried surgery after watching the live broadcast for everyone to discuss.
Some people thought it was because of their poor skills, but when they looked at the post, they all looked the same.
It seems to be a problem of cognition. I don’t know how many practical operations Daniel did to develop this skill.
When Zheng Ren used hemostatic forceps and fingers to perform blunt separation intermittently, the live broadcast room became quiet.
Many people's fingers trembled slightly following Zheng Ren's movements during the live broadcast.
But... that kind of state where the cook knows how to do things with ease, and you can tell at first glance that you can only watch, but never learn.
The gallbladder is congested and edematous to the size of most adult men's fists, and its surface tension is extremely high. Not to mention blunt separation, everyone present has to be careful when performing a simple open cholecystectomy. If you are distracted, your gallbladder may rupture.
However, the surgeon in the live broadcast did not think at all. The curved forceps inserted under the serosa layer of the gallbladder surface that was incised by the blade, and quickly separated it.
This speed... is simply seeking death.
But no one would say this.
Why? Because everyone who said it before was slapped in the face, and there were screenshots of the perpetrators as proof, and they were placed in the discussion thread for future generations to use.
A few seconds or more than ten seconds later, the blunt dissection had reached the neck of the gallbladder. The surgeon began to dissociate the gallbladder triangle, which was wrapped in a mess of connective tissue caused by inflammation.
The technique is skillful and the movements are not fast, but every step seems to be done without thinking, which makes many doctors present feel frightened.
This is such a tightrope to walk. Generally speaking, professors from tertiary A hospitals... Why tertiary A hospitals? Why professor? Because hospitals below the tertiary level do not dare to perform such surgeries, the risk of medical accidents is extremely high.
Even if it is a tertiary-level hospital, ordinary small attendings and inpatients will not touch it.
You have to at least lead a group of professors to have enough confidence to perform such a difficult surgery.
Whatever you do, you will definitely do it carefully. You will definitely not be like this big guy in the live broadcast room, who directly uses pliers to separate bluntly without thinking.
In fact, the artist's movements are not very fast, but very accurate. The anatomical structure of the gallbladder triangle is like a painting, gradually appearing in front of everyone.
This guy must have dissected several anatomy teachers, no! A few are definitely not enough, at least a dozen or twenty are needed.
In China, the number of gross anatomy teachers is so small that some medical universities only have one gross anatomy teacher for each class.
A group of eight people or, in legend, a group of four people dissecting anatomy with a gross teacher is a treatment that only a few medical universities have.
For example, in a major northern border town, the school is still a medical school, but the corpses of countless Kwantung Army soldiers from decades ago are preserved for dissection. The doctor who came from that medical school never knew what a general teacher was.
This kind of honorific is never used by the Kwantung Army, even if it has been soaked in formalin liquid for decades.
Because the number of teachers in general is scarce, many doctors above the clinical attending level do not hesitate to work part-time as forensic doctors.
Of course, this is a special treatment only for doctors who want to make progress in third- and fourth-tier cities where there are no full-time forensic doctors.
Live broadcast surgeries must have been performed by a large number of gross anatomy teachers. This was gradually revealed in the gallbladder triangle area. When the gallbladder triangle was completely exposed, the doctors unanimously came up with this idea.
The cystic duct and cystic artery were clearly exposed, and ligation and cutting were started, followed by retrograde resection of the gallbladder.
Removing the gallbladder just announces that the curtain has been lifted on this operation.
Laparoscopic surgery was very good, but I didn’t expect open cholecystectomy to be able to achieve this level of success.
In the Xinglin Garden, a doctor expressed his feelings blankly.
An expert will know if it is there as soon as he reaches out his hand. No need to look at anything else, just a cholecystectomy, everyone already believes that the surgeon will complete the operation beautifully.
As for how much you can learn from it, it depends on each person's talent.
Are you stupid? You can't even perform open surgery. Where can you go for laparoscopic surgery
Not necessarily. Nowadays, many junior doctors at the attending physician level start their practice from laparoscopic surgery. Those two just now, you have unintentionally exposed your age.
The gallbladder was removed, and I felt that there were at least three to five stones over three centimeters in the gallbladder.
The anatomy done by Zheng Ren was so clear. After the gallbladder was removed, the common bile duct and common hepatic duct were clearly exposed in the surgical field, and you could tell which one was which at a glance.
But he still avoided any accidents and reached out for a 5ml syringe, punctured and extracted the bile, and confirmed that it was the common bile duct.
Making a traction thread to stretch the common bile duct, Zheng Ren stretched out his hand and the condom-wearing suction device was gently tapped onto his hand.
The moment the common bile duct was cut open, the suction device was inserted inside.
There was no gap at all, and the large amount of bile accumulated in the common bile duct was sucked away by the suction device before it could be ejected by the huge pressure.
This detail attracted the attention of doctors in Xinglin Garden.
In general surgery, some degree of protection near the common bile duct is required, because bile will inevitably flow out.
However, the surgeon in the live broadcast room did not use any protection at all. The incision made in the cystic duct was about the same size as a sheathed suction device, and no bile could flow out at all.
Everything is just right, it looks extremely simple and easy. Only those who have actually done this kind of surgery will know the difficulties involved.
Suddenly I felt a little sad. I had an incision and drainage operation for acute obstructive suppurative cholangitis a few years ago. During the operation, bile flowed out, which caused postoperative infection. It was bacterial at first, and then became fungal. It took a month to recover.
I agree, the surgeon's operation is really stable. The incision of that knife is as big as the suction device. Is this kind of hand feeling and eyesight developed through training
That's talent, don't dream about it.