Surgery Godfather-Chapter 600 - 546: Removing a Splinter is a Technical Task_2
Chapter 600: Chapter 546: Removing a Splinter is a Technical Task_2
Liang Fatty moved quickly, letting Minmin inhale some anesthesia and swiftly completed the intubation, connecting the anesthesia machine.
Zhou Can placed a retention needle on Minmin’s scalp and set up the ultrasound machine beside them early.
Hand disinfection, laying drapes, and dressing, everyone chatted as they prepped for surgery, the atmosphere was very relaxed.
Things were done from easy to difficult. The needle extractions from the limbs were relatively easier than those from the chest and abdomen.
The groin area of the thigh, where the nerves and blood vessels were concentrated, housed the femoral artery, femoral vein, and femoral nerve.
The ultrasound probe used during the surgery was sterile, as was the coupling agent. After Yang Ping applied the coupling agent on Minmin’s skin, the ultrasound probe pressed into the groin area, and the sound of blood flow was immediately heard.
Subcutaneous, fascia, muscles, blood vessels, and nerves - all kinds of images appeared on the screen. Slowly, the needle also appeared on the screen, along the direction set for extraction, Yang Ping made a small 0.5 cm cut with a scalpel.
A mosquito clamp was extended through the incision, and under the watchful eyes of the ultrasound, the clamp tip skillfully avoided the nerve blood vessels, gripping the tail of the needle tightly, then the mosquito clamp was slowly pulled out, the first needle appeared in the curved tray.
Ultrasound images were two-dimensional. It was extremely difficult to locate the three-dimensional needle based on those two-dimensional images.
Even during open surgery, things might not have gone as smoothly as they did for Yang Ping, who managed to achieve accuracy on the first try.
The needle was like a fish in water - if the fish moves in the water, the picture a person gets does not have three-dimensional vision, it’s merely a flat image. As a result, all fish seemed to swim on one plane, and the person trying to catch the fish wouldn’t be able to judge its depth, making fishing extremely difficult.
Human tissues are not water, but layers of solid tissues. These solid tissues appear as flat images on the ultrasound screen, and a needle hidden in any layer would be hard to locate.
That’s why in surgeries to extract small foreign objects, even though X-rays made it seem close at hand, they just couldn’t be found.
The surgical area was irrigated, the small incision was sutured, and then the needle from the groin area was removed.
A small incision was made, a mosquito clamp was extended into it, grabbed the tail of the needle, and then extracted it, all actions accomplished seamlessly. Each of the needles in the lower limb was effortlessly removed by Yang Ping just like this.
Next came the extraction of the four needles in the thoracic cavity. The pediatric surgical thoracoscope borrowed from the provincial women and children’s hospital came in handy. First, the ultrasound was used to locate the needles, then an opening was made in the left chest intercostal space for the scope. Yang Ping carefully incised the pericardium bit by bit under the thoracoscope, a few millimeters, with slight separation.
The needle tail was visible under the thoracoscope, right at the incision of the pericardium.
Song Zimo and Xu Zhiliang turned to look at this young professor in astonishment - they couldn’t believe his impressive ability to position so accurately.
Most people would have to probe several times, but he managed to get it right on his first try. It was as though he was the one who had initially planted the needle.
It was like a treasure hunt game - a toy was hidden in the room for you to find, and you found it directly.
Either you hid the toy, or you saw someone else hide it, otherwise, you would have had to search for it.
And it isn’t just one needle, all the needles in the limbs, and now the needle in the pericardium were likewise.
Can you not be so outstanding?
Song Zimo had a thousand question marks and exclamation points in his mind.
Using a grabber, he gripped the tail of the needle, carefully pulled it out, and placed it on the curved tray.
Indeed, the needle had rusted and the tip had penetrated at least two millimeters into the heart wall. Fortunately, the needle was removed in time, or else, with the contraction of the myocardium, the needle might have slowly penetrated deeper into the heart, and eventually, broken into the heart.
"How did this needle get in there? Through the intercostal space? How could it go this deep?" Zhang Lin asked.
Little Five answered: "The needle doesn’t remain still once it’s in, it moves with the respiratory motion of the chest cavity and the contraction of the heart, its current position isn’t the original position."
The two good friends were standing at the operating table with nothing to do.
This patient was a baby and the operating room was so crowded that there was hardly any space, so both brothers stood far from the operating table, simply starting to chat.
Large and blunt foreign bodies, such as shrapnel, rarely move.
However, these sharp, thin needles can easily move and some may even enter the blood vessels, threatening the patient’s life.
Based on the locating by the surface ultrasound, Yang Ping used the thoracoscope to locate the three other needles; one tucked in the mediastinum, one lodged between the two lobes of the right lung, and the last one stuck to the wall of the aorta.
Everyone breathed a sigh of relief once all three needles in the thoracic cavity were retrieved, especially the needle hanging on the wall of the aorta.
"Damnit, just how evil must you be to do such a thing to a little child?" Zhang Lin swore.
Xu Zhiliang looked up, turning his head to look at Zhang Lin.
Zhang Lin thought Old Xu was going to scold him again, so he immediately plastered on a grin.
"What sort of a monster does this?!" Xu Zhiliang cursed and then immediately resumed the surgery.
The operation continued, and they then began to remove the needles from the abdomen.
At that moment, Director Zhao came in: "How is it going, Professor Yang?"
"My goodness, are those really needles inside? It makes my scalp prickle."
Looking at the dish on the instrument table, which already contained twenty or thirty needles, Director Zhao felt quite uneasy.
"There are still four in the abdominal cavity that haven’t been taken out, we’re preparing to do so."
Song Zimo was stitching up several small incisions on the chest while Yang Ping used the surface ultrasound to locate the six needles in the abdomen. As expected, the positions of the two needles were completely different.
Whenever these big shots address him as Professor Yang, he would always ask them to simply call him Xiao Yang, or Doctor Yang.
But it seemed like it didn’t do much good; even Dean Xia called him Professor Yang.
So Yang Ping simply stopped fighting it, since it was just a matter of addressing him.
Nevertheless, he found that being addressed as Professor Yang was rather pleasant.
"Needle extraction is a technical task, don’t rush it, take it slowly," Zhao advised generously.
Dr. Jin from trauma orthopedics had arrived at Director Zhao’s back at some point, he agreed: "Indeed."
The sound was close to Director Zhao’s ear, startling Zhao. He looked back in surprise and found Dr. Jin standing behind him.
"There was a case where a needle had been shot into the patient’s right upper arm by a high-pressure pneumatic gun used by a factory worker. The patient didn’t have any obvious symptoms, but it had to be removed. After four to five hours of repeatedly looking for the needle under C-arm fluoroscopy and unsuccessfully locating it, despite having seen it in the image beforehand, it was frustrating. Later, I palpated it by hand, feeling layer by layer of tissue for over an hour. Still not finding it, I had no choice but to give up the surgery. The patient later on paid a follow-up visit to me after discharge. He said he was not uncomfortable at the time, but later when his right arm was in the wrong position, the tiger’s mouth area of his right hand would feel numb and painful, like a needle prick."
"Could it be that the needle ran from the upper arm to the hand’s tiger’s mouth? That’s so bizarre!" Zhang Lin said excitedly.
Dr. Jin continued: "I thought so too, it couldn’t be that strange, could it? So I went to ask Director Han for advice. Director Han said, ’take another X-ray. If the needle is still located in the right upper arm, there’s a good chance it’s inside the radial nerve.’
"So I did it according to what Director Han suggested, the needle was still in the original place, it hadn’t moved. After I did the initial diagnosis of the patient’s right radial nerve surface projection, sure enough, the moment I pressed on it, the patient reported an abnormal sensation in the area governed by the right radial nerve, especially in the tiger’s mouth area. He said it felt numb and painful, like a needle prick."
"I immediately suggested that the patient undergo surgery again. Luckily, the patient agreed. This time, I made an incision in the radial nerve sheath according to the location shown in the X-ray. My goodness, there lay the tiny needle, vertically."
Old Jin shared this clinical case with great excitement.
At this point, Yang Ping had already inserted the laparoscope, inflated the abdomen and begun searching for the six needles in the abdominal cavity.
