Famous Among Top Surgeons in the 90s-Chapter 1935: Precision Monitoring
Mo Guai said orthopedics is a gathering place for strong men and women; all this work requires full strength.
Normally, seeing Senior Chang’s suave appearance and Doctor Liu’s gentle demeanor, who would think that in orthopedic surgery, they break bones with a snap, like Popeye after eating spinach?
Regarding cardiac surgery, if it weren’t for the development of thoracoscopic techniques, traditional surgery would also require breaking bones. Because of this, Xie Wanying looked at the rib shears, a bit eager to try her hand. The first time on stage, the teacher would never give her this opportunity; she could only observe how the seniors use the tools to convey strength quickly to achieve the goal, then research it herself to ensure that next time she has the chance, she doesn’t make a mistake.
After cleaning the tissues connected around the diseased thoracic vertebra, the next step is to remove the entire diseased thoracic vertebra from the body, which is a critical first step in the entire surgery. To outsiders, it might seem that once the connections around the thoracic vertebra are removed, the piece should naturally come out, no need for anything else.
This is a mistaken notion for those not clear about human anatomy.
In the middle of the thoracic vertebra is the vertebral foramen, which connects into a spinal canal, through which runs the central nervous system: the spinal cord, that controls the trunk and limbs.
The importance of the spinal cord to the human body is self-evident. It can be said that without the spinal cord, the brain’s signals to the body would have zero execution effect; the signals cannot be transmitted.
To separate the vertebra from the spinal cord without injuring the spinal cord, the only way is to cut the vertebra in two from above the spinal cord. The vertebral foramen and the spinal cord are closely connected, especially since this is a diseased vertebra with a tumor connecting the vertebra and the spinal cord, making it extremely easy to accidentally injure the spinal cord. How to ensure cutting the bone doesn’t injure the central nervous system? The eyes cannot see clearly, relying only on monitoring like a fire alarm. At the slightest sign of injury, the alarm goes off, and the doctor stops operating to avoid the alert zone. In spinal surgery, such fire alarm-like monitoring is called neurophysiological monitoring. The common types are three: SEP to monitor ascending sensory nerve conduction, commonly known as somatosensory evoked potentials; MEP to monitor descending motor nerve conduction, known as motor evoked potentials; EMG to monitor the nerves that control muscle activity, known as electromyography.
Each of the three monitoring items has its strengths and weaknesses. If conditions allow, using all of them can maximize their strengths and complement one another, giving the doctor more comprehensive data to fully implement intraoperative monitoring, ensuring surgical accuracy to avoid accidental injury.
With all monitoring in place, as the Chief Surgeon is busy cutting, there isn’t time to look at the monitoring screen first-hand, so the assistant must be responsible for timely reminders. On-site, Doctor Liu quickly gave the students a briefing on how to observe the data to help as soon as possible.
"Simply put, these monitors are similar to other monitoring projects; a rough judgment can be made by looking at the waveforms. A significant fluctuation or distortion of the waveform certainly indicates there is an abnormal situation," said Doctor Liu.
The human invention of waveforms serves this purpose, as the undulating curves allow the eye to intuitively and quickly judge abnormal changes in data without needing the eye to carefully discern each change in numbers. 𝘧𝘳𝘦ℯ𝓌𝘦𝒷𝘯𝑜𝑣𝘦𝓁.𝒸𝘰𝓂
The only downside is that waveform graphs generally represent one kind of data change; if a complex situation arises, other data must be combined for comprehensive judgment, making mental estimation essential. Thus, the doctor staring at the instrument’s brain is constantly working, not as relaxed as others might think. This is most frequently expressed in the complaints of anesthesiologists.
