Doctor's Life Simulator

Chapter 226 Second Improvement!Suspension-type airless transumbilical single-hole LA (two-in-one)
In the operating room, Qin Lang, Liu Peichun, and equipment nurses are ready.

After more than 50 surgeries, the cooperation between Qin Lang and Liu Peichun has been extremely tacit, and with the bonus of the chief surgeon's aura, Liu Peichun naturally doesn't have to be afraid of cooperation problems.

The anesthetist for this operation was naturally Chen Wenhao. Because of the new surgical method, Qin Lang asked Chen Wenhao to perform spinal anesthesia.

The patient naturally emptied the bladder before the operation without indwelling a catheter.

After the anesthesia was completed, according to Qin Lang's request, Chen Wenhao put the patient in a supine position, with the head down and the feet high, and the left side was tilted about 20 degrees.After doing all this, Chen Wenhao stepped aside.

Qin Lang and Liu Peichun stood on the left side of the patient, and the monitor was placed on the right side.

Since it is a single umbilical foramen, the marking of the incision is naturally different from the McBurney incision, and it is also different from the conventional three-hole method of laparoscopy.

Qin Lang made a 1.5CM mark on the patient's umbilical foramen.

In the observation room, the faces of all the experts naturally changed. Although theoretically speaking, the range of this kind of incision is 1.5CM-2.0CM, but in order to facilitate the operation, experienced surgeons will control the incision to 2.0CM.

Those who dare to use the 1.5CM incision are either rookies or those with high skills.

"interesting."

Among the expert group, a director appreciated Qin Lang's choice.

Naturally, Qin Lang didn't think so much, and he didn't show off his skills. His only thought was to minimize the incision as much as possible, make it more minimally invasive, and more beautiful.

After all, the patient is a very young professional woman.

After the marking was completed, Qin Lang naturally took the scalpel from the equipment nurse.

Under the perfect level of incision, Qin Lang's pen-style incision is naturally extremely precise, opening the abdomen quickly one by one.

"cut protector"

After drinking a bottle of stamina potion beforehand, Qin Lang had no other distractions, completely immersed in the operation, and the airtight orders came one after another.

Having followed more than 50 sets of Qin Lang, Liu Peichun and the equipment nurse have naturally practiced instinctive reflexes.

"Kirschner wires, draw bows"

Qin Lang's next command came out, and all the experts in the observation room were once again puzzled.

Even Director Zhuang was a little at a loss.

"What the hell is this brat doing?"

Director Pang looked at everyone's reactions and explained slowly:

"Presumably all experts know that conventional single-port laparoscopic channels (R-port, Triport, Uni-X) are very expensive and can only be used once, and must be equipped with a dedicated integrated 5 mm laparoscope Equipment and special flexible single-hole laparoscopic instruments are expensive. It is unacceptable to ordinary patients."

Director Pang finished speaking halfway, unscrewed his teacup, took a big gulp, and then continued to add:
"Therefore, Qin Lang proposed a self-made abdominal wall suspension device using orthopedic traction bows and Kirschner wires."

When Director Pang was explaining, in the operating room, Qin Lang inserted the Kirschner wire through the skin subcutaneously on the extension line of the Maxwellian incision in the right lower abdomen, and the subcutaneous penetration distance was about 15 cm.

After the two ends of the Kirschner wire are fixed with the traction bow, the suspension rod and cross bar are used to lift the traction bow, and the abdominal wall of the right lower abdomen is lifted to establish an operation space.

"A powerful and unconstrained style, really a genius."

Han Hu's eyes lit up, looking at the self-made abdominal wall suspension device in the operating room.

Who would have thought that Kirschner wires could be used in this way. Kirschner wires are commonly used internal fixation materials in orthopedics. The original size of Kirschner wires is generally fixed at about 0.5 cm, and there are several different sizes with a diameter of 2-[-] mm.

It is often used to fix small fractures or avulsion fractures and other fractures with low stress. It is also often used in the fixation of temporary fracture fragments in orthopedic surgery. It is very cheap.

As for the orthopedic traction bow, it can naturally be used repeatedly.

"Director Cheng, how are you doing? Is it okay?"

Han Hu moved the stool towards the result, but the result didn't talk to him, so he moved the stool to the side.

"Laparoscopic Exploration"

Qin Lang gave the next order without stopping.

Naturally, Liu Peichun quickly inserted the laparoscope and began to investigate.

"Ultrasonic knife, grasping forceps."

Only Qin Lang's calm voice remained in the operating room.

Qin Lang grasped the forceps in his left hand and the ultrasonic knife in his right, and skillfully removed the greater omentum in the right lower abdomen, and at the same time lifted the cecum.

At the same time, Liu Peichun's camera is also along the colon, the two of them cooperated very tacitly, and soon saw the appendix.

"Intraoperative findings: suppurative acute appendicitis, root perforation and gangrene, severe adhesions"

Seeing the situation in the abdominal cavity, all the experts breathed a sigh of relief. Qin Lang only made such a small incision. Now that he encounters such a complicated situation, the biggest difficulty of single-port LA is at this moment. Due to the limitation of single port, for The operator's subtle operation requirements are very high.

"Ultrasonic Hemostasis Knife"

"Is that what he wants?"

Mentioning Qin Lang's instruction, all the experts were taken aback for a moment, and then immediately reacted.

"This Qin Lang is too crazy!"

Obviously, Qin Lang is preparing to operate with both hands at the same time, using an ultrasonic hemostatic knife to treat the mesentery.

Ultrasonic hemostatic scalpel has very high requirements for the operator, and the strength and angle must be controlled well, and it is not allowed to touch the tissues around the appendix.

Otherwise, it will lead to electrical burns of the intestinal tube around the tissue. Dr. Huang once encountered his own resident doctor, who did not operate properly, resulting in excessive wounds and pain in the right lower abdomen after surgery.

When the experts were nervous, Zhuang Tong and Director Pang were the gods. After all, this was Qin Lang's basic operation.

Sure enough, in the next second, there was a sound of exclamation in the observation room!

"Pay attention to Qin Lang's hand controlling the claw."

On one side of the screen is the surgical field in the patient's abdominal cavity, and the other camera angle is Qin Lang's hand.

I saw his hand micromanipulate seven or eight times in a few seconds, constantly controlling the direction and angle of the grasping forceps.

At the same time, in the operative field, it can be seen that the grasping forceps are not always in one position of the appendix, but are constantly being fine-tuned.

At the same time, Qin Lang's other hand, controlling the ultrasonic hemostasis knife, also entered through the single umbilicus.

This kind of picture is just like Zhou Botong's left and right hands interplay technique, or drawing a square with the left hand and drawing a circle with the right.

Synchronously performing fine micro-manipulation with both hands requires a very high degree of concentration and finger strength, and the flexibility of the wrist is very high.

"Slow coagulation mode,,,"

While operating with both hands, Qin Lang issued further instructions at the same time, and the equipment nurses were no longer surprised, and immediately completed the debugging.

"Frozen. The camera zooms out, the panorama camera zooms in, close-up"

Qin Lang controls the pliers and the ultrasonic hemostasis knife with both hands, and at the same time directs Liu Peichun's cavity trajectory, just like a senior director directing the cameraman.

The picture is not only clear, but also beautiful!

After exactly 3 seconds, the coagulation of the mesenteric blood vessels has been completed.

In the observation room, there was a complete silence until the Qin corridor was completely closed.

"This treatment of mesoappendix is ​​far better than that of an ordinary chief physician."

Although Dr. Huang was somewhat prejudiced before, after watching Qin Lang's operation, he had to say that it was really pleasing to the eye.

Director Han Hu took a sip of tea and didn't speak, but he was looking forward to the next operation.

Director Pang glanced around, raised the corner of his mouth slightly, and thought: This is just where we are, and the performance has just begun.

In the operating room, Qin Lang naturally still had no distractions.

The next step was the treatment of the stump of the appendix. Qin Lang observed that the gangrene at the root of the appendix was only 4mm away from the cecum.

"Absorbable thread, needle holder."

Qin Lang naturally chose the most suitable simple ligation + "8" cecum seromuscular layer suture.

Seeing Qin Lang use absorbable thread with ease, in such a small operating space, the experts are naturally a little unbelievable.

Especially the knotting of Qin Lang is really beautiful, the distance and size between the knots are uniform and beautiful.

"Such a solid basic skill, it seems that you have practiced a lot on weekdays. Shu Ya, you have to take a good look, there is still a lot to learn."

Han Hu said to Ma Shuya beside him.

"Ah."

Ma Shuya was convinced. In the department before, her basic skills were second only to Senior Brother Lu Min, but she was still a bit unsatisfactory in front of a pervert like Qin Lang.

Of course, apart from the basic skills, Ma Shuya admired Qin Lang's grasp of the entire operation process and rhythm in this operation.

It's too mature.

"Irrigate the abdominal cavity and place a drainage tube."

Qin Lang continued to issue instructions, and this operation soon entered the final stage.

What everyone didn't expect was that after Qin Lang finished the operation of the main knife, he didn't even let go of the final suture.

"This?"

Han Hu watched Qin Lang doing the simplest stitching with great enjoyment, and his heart was slightly touched.

"No wonder, his basic skills are so solid. Even if he has become the chief surgeon, he still does the simplest sutures himself. This attitude is worth learning."

Ma Shuya also admired Qin Lang silently in her heart.

Only Director Pang and the others felt a little helpless, and they didn't know why Qin Lang had such a special habit of suturing.

Sure enough, after finishing the suture, Qin Lang changed his face and walked out of the operating room without looking back.

【恭喜宿主完成任务：一周内完成40例ERAT手术，5台悬吊式无气腹腹腔镜阑尾切除术。获得任务奖励：1.1点人生模拟点，2.天赋超级术野：能够看到10倍清晰的术野。】

During the preparations for Qin Lang's surgery, Zhuang Tong went back to his office, and quickly returned to the observation room with a few cups of freshly brewed coffee.

"Director Cheng, I really don't want to have a cup. It is mellow and rich. After drinking, it will be warm and energetic."

"I'm used to drinking herbal tea."

The results refused indifferently, picked up the teacup in front of him, took a sip, and chewed a few pieces of tea leaves in his mouth.

Han Hu and Ma Shuya thankfully took the coffee from Zhuang Tong.

Director Han took a sip lightly: "Not bad, really good. Director Zhuang, this trip to the City First Hospital is really worthwhile."

Zhuang Tong laughed.

"Qin Lang's surgical ability is really powerful. I also admit that he has certain attainments in suspension-type gasless laparoscopic surgery, but being good is good. It doesn't mean that there is no doubt about the current amount of surgery."

Seeing Zhuang Tong and Han Hu's victorious posture, they finally couldn't hold back and said something coldly.

"No rush, we have time."

Zhuang Tong took a sip of strong coffee and leaned half on the back of the chair: "Director Cheng, be patient."

Seeing that Zhuang Tong and the others were drinking warm coffee, he picked up the teacup again, and found that the bottom of the cup was already reached. He was embarrassed to ask Director Pang to pour water, put down the teacup, and sat down in a stuffy manner, frowning.

10 minute later.

In the operating room, it was ready, and a new patient appeared in the eyes of everyone.

What the experts did not expect was that the patient selected by Qin Lang this time was a little boy less than ten years old.

"Director Zhuang, this Qin Lang really knows how to select patients."

Dr. Huang, who is extremely experienced, said with some admiration and some concern:
"As we all know, children's acute appendicitis is more serious than that of adults, and children's omentum is underdeveloped, the inflammatory response is not easy to localize, perforation is easy to occur, and it may even cause systemic poisoning, and the prognosis is serious."

"Therefore, the surgeon needs to have a deeper understanding of the operation, and the operator has higher requirements for the operation."

"Moreover, appendicitis in children and appendicitis in adults, in addition to the operation process, is more difficult in the preoperative diagnosis. Due to the younger children, it is difficult to accurately describe the history of abdominal pain, and because they are afraid of examination, they are not cooperative enough. It can easily affect the judgment of clinicians."

"Yes, I agree with Dr. Huang's point of view, or we can change to an adult. The diagnosis of children is not so accurate."

"I suggest not to go up the difficulty level just for this observation, it's better to be cautious, it's better to choose an adult."

As a result, he finally found an opportunity to make up for it. In fact, even he dared not say that he could diagnose appendicitis in children 100% correctly, and there were more uncertainties.

As for Qin Lang, he admits to his surgical talent, but the diagnosis is not only based on talent, but more on experience and experience.

"Director Cheng, don't worry, we have made enough preparations before the operation. If ERAT is really not possible, we will change it to the conventional Stryke 30-degree laparoscopy and three-port method."

Director Pang explained.

"Since Director Pang is so confident, let's start."

Chenggong snorted coldly and stopped talking.

In the operating room, in order to ensure the success rate of the operation, Qin Lang naturally used a single case simulation before the operation to confirm the patient's condition:

[Patient: Cao Xiaodou, male, 7 years old

Symptoms: due to persistent right lower quadrant pain, accompanied by nausea, vomiting, clear mind, poor spirits, acute facial appearance, no yellow staining of skin and mucous membranes all over the body, pathological murmur of superficial lymph nodes, flat and soft abdomen, tenderness and rebound tenderness in the right lower quadrant Positive, limited muscle tension, no obvious abnormal mass, negative Murphy's sign,
Drum sound to percussion, negative shifting dullness, physiological curvature of the spine, free movement of limbs, physiological reflex exists, but pathological reflex is not elicited.

Routine blood test: white blood cell count 12.3 × 109/L, neutrophil 0.81; B ultrasound shows "right lower quadrant appendix enlargement".

Diagnosis: acute appendicitis, pinworm appendicitis
The main cause of appendicitis: caused by parasitic obstruction, the scientific name of pinworms is worms, and the ectopic parasitism of pinworms forms worms and eggs in the appendix, causing pinworm appendicitis.

Treatment plan: Use ERAT to suck out the pus. Due to the obvious inflammation, a plastic stent needs to be placed, and the stone extraction basket is used to completely remove the worms and eggs. 】

(End of this chapter)