Surgery Godfather-Chapter 311 - 0295: The Truth Comes Out
Chapter 311 -0295: The Truth Comes Out
Dr. Zhou’s operation was highly standardized and proficient. The hands of the Chinese are indeed dexterous, making Yang Ping’s earlier worries seem a bit superfluous.
Dr. Zhou, one by one, carefully and patiently selected the feeding vessels of the spinal cord.
Yang Ping acted as his guide, instructing when to stop, when to advance, and when to push the drug. Even though there was a delay from the instructions to the operation, Dr. Zhou proved to be great at understanding and cooperating smoothly.
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“Slow down, push, stop, push again, cross the fork, go to the outside, right, push another two centimeters, stop—you can push the drug now.” Every instruction of Yang Ping, Dr. Zhou was able to transform into precise movements.
“Have you studied interventional procedures, Doctor Yang?” Dr. Zhou was surprised; a surgeon also understands intervention techniques.
Yang Ping thought for a moment: “I’m very familiar with the anatomy of this area. I know the origin, course, and supply range of each blood vessel.”
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Following his navigation, Dr. Zhou surprisingly completed angiography for the first set of blood vessels quickly and safely. His familiarity with the anatomy was truly extraordinary.
The expressions on the faces of the British are always so rich. Surprise, confusion, worship, various expressions on his face were dramatically exaggerated by his facial muscles.
Milton took two steps forward to the imaging screen, puffed up his cheeks, his face flushed as if holding his breath, his eyes as wide as possible, as if doing so could obtain a higher degree of clarity.
August glanced at his old friend, unwilling to fall behind, also took two steps forward. As long as they remained outside the yellow line on the floor, they were in accordance with the hospital’s infection control requirements.
The image on the screen resembled a Chinese ink painting with dark, winding blood vessels, gradually getting thinner as they branch out. The color also varied, with just-selected vessels appearing more concentrated and others appearing lighter.
Dr. Zhou was now very accustomed to following the navigation. Not daring to speak anymore, he concentrated fully on the screen, his hand movements extremely gentle and precise while selecting the spinal cord vessels one set at a time.
Finally, the location of the arteriovenous fistula was found. The contrast agent leaked out through the fistula and entered the vein, forming a clear communication between the artery and vein.
“Dural arteriovenous fistula!” Milton exclaimed while holding his breath as if he had been waiting to shout out this sentence.
Milton’s voice was soft, fearing to disturb the operation, but he had to shout out this sentence to show that he was not inferior to August in front of him, causing August to glare at his old friend unkindly.
“What’s the global case count, August?” Milton, his eyes never leaving the screen asked.
“Don’t bother me, now is not the time for academic discussions, I also need to concentrate.” August was really annoyed.
All suspicion in Kobayashi Takeshi’s mind vanished. The doctor who was just filling the team injury was in fact a real top expert. His familiarity with the anatomy far surpassed Kobayashi’s understanding. Even the renowned trauma surgeons from Tokyo University’s Affiliated Hospital, Takahashi Fumiya and Sasaki Jiro, would have a hard time being superior to him.
Takahashi Fumiya and Sasaki Jiro, who had personally dissected over a hundred “body teachers”, those times when Tokyo University, for a certain topic, had bought several hundred “body teachers” from Eastern Europe for teaching purposes. Takahashi and Sasaki acted as the chief surgeons dissecting a total of one hundred of them.
But how could such a doctor have no international reputation to speak of? Kobayashi had never seen any of his papers, nor seen him attend an international academic conference.
Under Yang Ping’s guidance, Dr. Zhou saved considerable time. The surgery originally planned for seven or eight hours was now expected to be completed within three or four hours.
Another arteriovenous fistula was found. This patient had two arteriovenous fistulas. Yang Ping told Dr. Zhou that he could relax a bit: “There are only two arteriovenous fistulas. You can also select the rest of the groups for them to see. Take a few minutes break and then select a couple of variant arteries.”
“Okay.”
Dr. Zhou, due to his high concentration, seemed a bit tired. He thought to himself, if every surgery had Dr. Yang’s instruction, even the toughest surgeries could be smoothly completed. If Dr. Yang performed interventional surgeries, he could possibly be among the world’s top level.
After the remaining vessel groups were selected and found to be problem-free, Dr. Zhou rested briefly, then began to select the variant arteries.
Selecting these variant arteries were to prove to everyone that these vessels were the primary feeding vessels to the spinal cord, and any harm to them could cause ischemic necrosis. At the same time, the DSA images from this session would be used to create a 3D virtual reality image, which would help everyone understand the location of this vessel in the surgical approach, and how to protect it.
These few arteries are not in the standard anatomical knowledge, and they twist and turn, making the angiography much more difficult than that of some of the groups. For those groups, without Yang Ping’s guidance, Dr. Zhou could gradually complete them on his own. For these few arteries though, without guidance, Dr. Zhou would not be able to complete the surgery.
“Do not rush, slow down a little. These blood vessels have a complex course and a large curve, making them difficult to select. Any careless injury could easily cause bleeding or obstruction, just like just now. Listen to my navigation—”
Dr. Zhou did not dare to move the wire in his hand recklessly, waiting for Yang Ping to start the navigation.
“Push forward, continue, continue, push forward about 0.5 centimeters, which is 5 millimeters!” Yang Ping expressed it in two units to prevent Dr. Zhou from mishearing.
“Stop! Now cross the branch.Rotate the wire, stop! Push forward 5 millimeters, stop! The curve is too large, do not advance more than 5 millimeters each time. Stop after each step, think clearly before proceeding.”
“Alright, continue forward, stop, push the contrast agent!”
The tree-branch-like ink painting spread out, indeed, this was a main blood-supplying vessel of the spinal cord.
Dr. Zhou’s palms were completely drenched in sweat. Despite the gloves, they felt somewhat sticky. Looking at the image on the screen, he could hardly believe that he had successfully navigated this complex vascular path.
Doctor Lin and Dr. Huang stared at the screen without uttering a word.
The surgery proceeded slowly as the blood vessels twisted and coiled. Dr. Zhou’s hand remained steady, each minor movement cautious and measured, needing his utmost concentration.
A split second of inattention could lead to the guide wire piercing the blood vessel, triggering bleeding or damage the interior of the vessel, leading to an embolism. The repercussions of each mistake were extreme.
At this moment, Dr. Zhou felt like he was driving a car on a windy mountain road at night, the edge of the roadway a sheer abyss.
Each advancement felt like following a specific navigation, turning the steering wheel slightly left, then right.
A little further now, stop. Having successfully navigated a few branches, one successful exercise of super-selection completed, he injected contrast agent and moved onto the next vessel.
The second and third blood vessels were successfully imaged without any issues. The vivid curved line of contrast agent on the screen traced the path of the blood vessel.
With the successful super selection of the three variant arteries, Dr. Zhou gently let out the breath he had been holding. It felt like he had just put down an invaluable fragile antique.
The feeling was akin to the break of dawn, the car reaching the peak of the mountain. Looking down, the mountain road snakes along the cliff edge, a bottomless abyss below. The seemingly impossible climb had been accomplished, the fear only sinking in after all was said and done.
Dr. Zhou shivered involuntarily, perhaps a sign of stress relief.
Finally, it was done. They could all breathe a sigh of relief and start speaking again.
The truth was revealed!
The diagnosis made by the Chinese doctors based on the CT and MRI was correct. The patient indeed had a dural arteriovenous fistula, and there were three variant arteries supplying the spinal cord.
“Can we use virtual reality for a 3D reconstruction? A 3D image would offer a much more intuitive perspective,” suggested August.
“Our central hospital has the facility for it. We can transmit the data there,” Doctor Lin agreed with him.
“Yes, using virtual reality to reconstruct the spinal cord and vessels would be more direct. I can see everything clearly,” Milton finally grasped the situation.
Unfortunately, Milton was a step behind August, who had already understood the situation before the DSA procedure. This could leave him feeling insecure in front of August for a long time.
The DSA procedure took close to four hours, which was relatively swift given the circumstances and without any wastage of time in between.
Dr. Zhou was no longer just another person in other people’s eyes, but a “man from Earth.”
With such a complex case seeming so effortless in his hands, his confidence during the analysis, his familiarity with the procedure during the DSA, made it seem like everything was straightforward.
Milton reflected on Yang Ping’s words: “Actually, this case is quite simple. It’s not complicated. Since it’s rare, it can be overwhelming at times.”
Doctor Yang was calm, collected, and at ease, while everyone else seemed confused, lost, and at wits’ end, unable to comprehend even after he had explained the case fully. Only August managed to understand it beside him, leaving Milton feeling humiliated.
Dr. Zhou removed the catheter and applied pressure to the puncture site with sterile gauze to stop the bleeding. At the same time, Dr. Lin was coordinating with doctors to collect images for transmission to Singapore to create virtual reality 3D images.
Meanwhile, Yang Ping went to the changing room to remove his lead apron. Both August and Milton followed, trying to help Yang Ping take off his apron.
“Can you explain more precisely how to accurately diagnose such vascular disorders using CT and MRI scans?” asked Milton, yanking at one side of the lead apron.
“And how do you perform hand-drawn reconstructions of medical images?” chimed in August, tugging at the other side of the lead apron.
They each pulled back, removed the lead apron, and hung it on the rack.
“Explaining these doubts isn’t as easy as you think,” replied Yang Ping with a nonchalant expression.
If he didn’t have intricate knowledge of the anatomy, explained seemed temporarily impossible. Wait until he has gathered his experiences and turned them into universally applicable knowledge then it would be easier to understand.
Just like the reconstruction of multiple knee ligaments, it could be generalized when a standard procedure for it was established.
“Doctor Yang, I finally get it. This case is like a series of nested diagnostic traps. When you overcome one trap, you immediately encounter another, forming an inescapable chain of traps. This classic case should be used as a teaching example at Cambridge University’s school of medicine,” Milton observed, a bit late in his understanding.
“According to you, it should be Charité Medical School!” argued August without hesitation.
