My Medical Skills Give Me Experience Points

Chapter 1282: Chapter 505: Solution for Side Effects, Innovative Surgical Approach (Part 2)

This patient’s duodenal ulcer is almost perforated, it’s no wonder they’re groaning.

The corrosiveness of gastric acid is much more severe than imagined.

It can easily ruin the stomach, duodenum, and pylorus.

Its power is not weaker than that of regular strong acids.

"Yang Zhi, Ding Dong, when you perform this type of surgery, pay attention. You should choose to sever the vagus nerve at a position above the junction of the esophagus and stomach; otherwise, you won’t achieve the desired surgical effect."

Zhou Can explained the key surgical points to them.

He also learned some surgical techniques and key points from the notes of Deputy Director Liu of the General Surgery Department.

After determining the position, Zhou Can began to quickly mobilize the left lobe of the liver.

He directly cut open the triangular ligament, then instructed Yang Zhi to pull the patient’s left liver lobe in the upper right direction, at which point the lower part of the esophagus and esophageal cardia were fully exposed in the surgical view.

He quickly cut the serosa at the lower part of the esophagus and the esophageal cardia, separated the upper part of the hepatogastric ligament, and then directly severed it.

All movements were unusually swift; watching him perform surgery was a complete enjoyment for onlookers.

Then, he relaxed the lower part of the esophagus.

He reached out and felt on the anterior wall of the esophagus, searching for the vagus nerve.

In medical books, blood vessels are usually marked in red, and nerves are marked in yellow.

However, during actual surgery, the nerves often don’t have much color difference from the surrounding tissues. At this point, the surgeon needs extensive surgical experience to locate them by feel.

Zhou Can quickly felt a nerve at the left front of the esophagus.

It was the left vagus nerve.

He also felt around the right back of the esophagus, confirming the position of the right vagus nerve.

At this point, he was mentally prepared.

"There are two vagus nerves at this position; be sure to confirm them during surgery."

He asked the two to clean their hands, put on sterile gloves, and then feel the esophagus and surrounding tissues of the patient to find the vagus nerve.

Practical experience is very valuable.

Some lead surgeons don’t want extra complications or to waste time with students during surgery, so they merely point and explain the anatomical sites while operating, never letting their subordinate doctors get hands-on experience.

Imagine, can students trained this way really be skillful?

Many surgical residents who have worked for several years are still like novices during surgical anatomy. It’s not necessarily because they didn’t study hard, but rather because their teachers didn’t teach them effectively.

The opportunity for practice was too little.

"I think I’ve felt it; it feels quite distinct, like a fiber band."

Yang Zhi was the first to feel the vagus nerve.

After feeling a suspicious area, he immediately sought confirmation from Zhou Can.

"Ding Dong, you should feel it too."

Zhou Can said to Pu Dingdong.

In terms of talent, Pu Dingdong is not inferior, and he is more practical and meticulous than Yang Zhi.

Zhou Can was quite satisfied with the two assistant doctors under him.

They both performed well usually.

After feeling for a while, Pu Baodong identified both the left and right vagus nerves. He also carefully relied on his eyes to distinguish them.

"Alright, now watch me sever the vagus nerve."

Zhou Can carefully separated the vagus nerve from the esophagus.

Then he instructed Yang Zhi to lift the nerve using a nerve hook.

He continued separating this nerve with scissors.

He used scissors, not a scalpel.

After separating five to six centimeters in length, the gastric vagus nerve trunk could be excised.

The excised length cannot be too short; generally, two to three centimeters need to be removed. The excision of the other vagus nerve trunk is done using a similar technique.

At this point, the excision of the gastric vagus nerve trunk was completed.

"Xiao Zhou, after severing the gastric vagus nerve trunk, food tends to stagnate in the stomach. Do you have a good approach to address this?"

Dr. Xu had been silently observing from the side, not easily interrupting.

Now that the surgery was nearing completion, he raised the issue of resolving postoperative side effects.

"Performing pyloroplasty should be able to address the issue of gastric content retention."

Zhou Can had already mastered the solution.

"It seems you’ve studied General Surgery quite carefully, hurry up and proceed!"

Dr. Xu was very satisfied with his answer.

Not delaying any further, Zhou Can performed a pyloroplasty on the patient.

In addition to this, after severing the vagus nerve, he also performed a diaphragmatic hernia repair surgery on both sides of the patient’s diaphragm to prevent the formation of a diaphragmatic hernia.

During diaphragm suturing, since the legs of the diaphragm need to be brought together and then sutured, the difficulty is quite high.

This requires a high degree of precision in suturing and ligation.

During this, he also earned a considerable amount of suture and ligation experience points.

Each ligation earned him a hefty amount of ligation experience point rewards. He worked particularly hard to accumulate more ligation experience points.

By the end of the surgery, his ligation experience points had increased to over 94,000, getting very close to 100,000.

Under normal circumstances, he would need to perform about six thousand more ligations to successfully advance.

However, if he could encounter surgical tasks involving sutures similar to the peritoneum or dura mater, or surgeries with extremely high ligation requirements, his advancement time would be greatly shortened.

In the end, it still requires performing more major surgeries; only difficult surgeries offer the opportunity to earn substantial experience point rewards.

"Ding Dong, you close the patient’s abdominal cavity!"

Yang Zhi was now highly proficient in closing the abdominal cavity.

His surgical skills were not bad originally, and having followed Zhou Can around for so long, he had countless opportunities for practice, with his surgical ability improving rapidly.

Pu Dingdong’s surgical ability was relatively lacking.

Zhou Can cultivated all of his subordinate doctors equally.

There’s no preference or neglect.

Seeing the surgery entering the final stage, Dr. Xu felt reassured and left.

"Dr. Zhou, should we wait for Dr. Pu to finish suturing the abdominal cavity, or move to do another surgery?"

"You and Qiao Yu prepare another operating room; I’ll oversee this here first."

"Alright!"

Ma Xiaolan and Qiao Yu went to prepare another operating room.

Usually in the afternoon, Zhou Can is the busiest in the emergency operating room.

Dr. Xu always works at a steady pace; only surgeons with strong skills have the privilege of operating in this hundred-level operating room. Those with slightly lesser skills end up doing surgeries in the old operating room.

Therefore, once it’s afternoon, there is usually an empty table available in the hundred-level operating room.

Zhou Can watched as Pu Dingdong performed abdominal cavity suturing on the patient. There wasn’t much to worry about.

Pu Dingdong’s suture skill is quite good, and he works especially carefully.

The abdominal anatomy of this patient was completed by Zhou Can; the cut was neat, making the suturing relatively easier.

Both the inner and outer layers are relatively easy to suture.

As he watched, his thoughts gradually drifted to the patient who came all the way from Shanghai to seek treatment.

That patient’s aortic dissection tear was too long.

Besides replacing the aorta, it’s hard to think of other good solutions.

However, performing the vagus nerve excision surgery just now gave him some inspiration.

When cutting the vagus nerve, it needs to be severed from the top end to achieve the desired therapeutic effect.

To address the problem of gastric content retention, a pyloroplasty was performed.

It was equivalent to addressing the issue by operating on the base of the stomach.

So, is it possible to apply this method to the patient with an aortic dissection by finding a solution from the distal end of the aorta?

There is a significant difference in how blood vessels and nerves work.

Nerves primarily conduct bioelectrical signals.

These electrical signals are extremely complex.

If the circuit is wired incorrectly, it could directly cause a short circuit or other unpredictable problems.

Each nerve conducts different electrical signals.

They form a series of complex neural instructions.

But blood vessels are different; the blood within is not much different.

The blood from head to foot is interchangeable.

The blood in the human body is continuously circulating.

As long as you don’t mix up arterial and venous blood, there should be no problem.

He seemed to have grasped a thread of opportunity.

Finding a solution from the distal end of the aorta, with arterial blood being universally applicable throughout the body.

Perhaps a bypass is an excellent, albeit somewhat radical, surgical idea.

The bypass method is sometimes used in treating heart disease too.

This isn’t exactly a new idea.

But the idea of creating a bypass from the distal end of the aorta to send blood back to the upper end still carries some innovation.

The diseased segment of the aorta is very long, involving at least four arterial branches. These branches provide blood to vital organs or other critical body parts.

Cutting them off is infeasible, but finding a way to reconnect blood from the distal end of the artery with these branch vessels to form a new circulatory path might be a completely new surgical approach.