Doctor's Life Simulator

Chapter 370 The Department of Zijingang No. [-] Hospital Remotely Observes Qinlang Surgery

"Director Huang, Director Qian, I seem to have an idea, but I'm not very mature yet, please help me think about it together."

Hearing what Director Zhu said, everyone except Qin Lang looked at Director Zhu.

"Director Zhu, do you have any ideas for improvement?"

"Yes, in fact, the most difficult thing in the Cox maze III operation is the "cut and suture" line design. The most accident-prone during the operation is also the treatment of the tricuspid annulus, mitral valve isthmus and coronary sinus, so I was wondering if I could use Medtronic's bipolar radiofrequency forceps instead of traditional incision and stitching. In theory, radiofrequency ablation is easier to control than traditional methods, and can greatly reduce complications and operation time. "

After Director Zhu finished speaking, he was also very excited. Damn, am I creating an original and improved technique?
On the other side of the screen, after listening to Director Huang and Deputy Director Qian, they were also stunned. After thinking for a while, they looked at Director Zhu with shocking eyes:

"Director Zhu, what you said is very reasonable, and the feasibility is also very high. In this way, let's design a bipolar radiofrequency ablation line together."

Director Huang was already very familiar with the Cox Maze III technique, so he immediately took a red marker and started drawing on the whiteboard. He frowned as he continued to draw:
"There seems to be some problems. Bipolar radiofrequency forceps cannot reach the tricuspid annulus of the right atrium, and bipolar ablation of the left atrium cannot reach the mitral annulus."

"It seems so."

Several people stopped their movements again, feeling very regretful and uncomfortable, and fell into silence again.

"I know, you can use a monopolar radio frequency pen to supplement it. The monopolar radio frequency is more compact and can handle these places that the bipolar radio frequency cannot reach."

Director Zhu thought of the set of bipolar RF and monopolar RF pens in the laboratory, and blurted out.

"Not bad, not bad, Director Zhu is amazing."

Director Huang, of course, knew everything, and directly asked the subordinate doctor beside him to ask for a blue pen, and began to draw supplementary ablation lines on it.

The ablation line plan is getting more and more perfect, Director Zhu watched with relish, and was very happy in his heart. This is a rare flash of inspiration in his many years of practice, and he thought of an improved technique.

And it was years ago when an expert from the First Affiliated Hospital of Zijingang University had a long face.

It's just that Director Zhu always felt that this aura came by a coincidence. Did he really come up with it?

After thinking for a while, Director Zhu affirmed his talent and luck, which should be the so-called medical saint possessing himself at this moment.

Dr. Sun at the side saw the more and more perfect ablation line, and his eyes protruded.

"I've seen this pattern before!"

Dr. Sun said something to himself, and then he was startled. Isn't this the ghost painting on the heart model by Qin Lang before!
No, Qin Lang's pattern is smoother and simpler than Director Huang's!

Of course, Dr. Sun did not dare to utter such amazing information on such an occasion, but his heart was pounding, and he looked at Qin Lang, who was seriously watching Director Huang's plan on the screen, just like a teacher silently Acknowledgment, childish eyes of approval.

Dr. Sun suddenly understood that Qin Lang didn't want to jump out and point out that this plan was actually thought of by him one step ahead of Director Zhu. Obviously, his plan was more complete and mature.

Dr. Sun suddenly became a little moved. It's not that he doesn't want to, it's because Qin Lang doesn't care, is he so indifferent to fame and fortune.

That's right, with a genius like him, how could he care about such a little fame.

This kind of plan that Director Zhu and experts from the First Affiliated Hospital of Zijingang University came up with was nothing more than a "ghost drawing" that Qin Lang casually glanced at the video and sketched with the mentality of playing around.

Soon, under Director Huang's profound skills, the design of the ablation line was gradually perfected.

In Dr. Sun's eyes, it is also a "ghost painting talisman" that is getting closer and closer to Qin Lang.

"Director Zhu, your improved plan this time is really a big leap forward on the basis of the Cox maze III operation. After we complete this operation, we can compile a paper and publish the first Cox maze IV in the world. Operation."

Both Director Huang and Deputy Director Qian expressed their praise. Director Zhu’s improvement this time is pioneering in the field of atrial fibrillation treatment, and it is very practical and popular. It is very likely that this improved Cox maze IV The operation has been promoted in most hospitals in China, making the treatment of atrial fibrillation popular, and even becoming the "gold standard" of treatment in the near future.

"It's also thanks to Director Huang and Director Qian who perfected the plan together. Now that the plan is in place, I will start arranging the operation immediately. After that, the two directors will need to guide the operation remotely together."

Director Zhu was also in a good mood, and immediately began to arrange the operation.

"Of course, Director Zhu, like this, I want to organize all the key doctors in our department to observe this pioneering Cox maze IV operation."

Director Huang thought about it, this is a very meaningful operation.

"Welcome, it's a great honor."

Director Zhu wished very much for being able to show his face in front of the doctors of the entire First Affiliated Hospital of Zijingang University.

"Okay, then Director Zhu, I'll go get ready and we'll go online after the surgery starts."

"Okay, see you later."

Soon both parties were offline and began to prepare for this pioneering Cox maze IV surgery.

Department of Cardiovascular Medicine, The First Affiliated Hospital of Zijingang University.

Director Huang and Deputy Director Qian began to summon the key doctors under them to participate in this operation.

On the way, I happened to meet Dean Wen Yunqi, who is a top expert in the cardiovascular field.

Director Huang certainly didn't want Dean Wen to miss this kind of moment:

"President Wen, we just had a joint consultation with Director Zhu of the First Hospital of Hecheng City. During this consultation, Director Zhu had a flash of inspiration and proposed a world-first Cox maze IV operation. We will start soon after he arranges it. For the operation, I have already arranged for key physicians in the department to participate in the observation. Do you have the interest and time?"

"The first Cox maze IV operation?"

Hearing this improved technique, Wen Yunqi was naturally very interested, and soon communicated with Director Huang, and he praised:

"Director Huang, this is a once-in-a-lifetime opportunity. You and I participated in the observation together. This operation has provided new ideas and concepts for the entire medical community to carry out maze surgery, and it may be extended to other operations. This operation Its influence may be more far-reaching than we imagined!"

Wen Yunqi's sense of scientific research is still very keen, but it's a pity that the founder is the director of the First Hospital of Hecheng City, otherwise Zijingang University can make a fuss.

While the First Affiliated Hospital of Zijingang University was preparing for the observation of all departments, the Department of Cardiovascular Medicine of the First Hospital of Hecheng City was also busy.

At the moment, Director Zhu is happily returning to the big office to arrange the operation.

Soon, he came to the desks of Qin Lang and Dr. Sun, and inadvertently saw the heart model on Qin Lang's desk, and the familiar ghost symbols on it.

Director Zhu's smile froze all of a sudden, and he woke up instantly. Images flashed in his mind, no wonder he always felt that the aura was a little strange:

"Director Qin, you..."

Qin Lang took advantage of his return to optimize the operation plan slightly. After all, Director Huang and Director Qian are the top leaders in this field. Through their consultation, Qin Lang has a new idea.

In the radiofrequency forceps operation, there is myocardial ischemia, so in order to have higher requirements, Qin Lang is going to add Konstant's protective solution (HTK solution) to make the whole operation more perfect.

After Qin Lang thought about it, when he turned around, Director Zhu looked at him with a blushing old face, and asked with some embarrassment:

"Director Qin, you thought of this optimization plan from the beginning?"

Director Zhu pointed to the heart model on Qin Lang's desktop. No wonder he was able to come up with a creative plan. It turned out that he was inspired by Qin Lang's plan.

Director Zhu wished he could find a place to drill.

"Director Zhu, I can't say that. After all, I just read the Cox Maze III procedure before, and I had some ideas, so I tried the ablation line casually, but it is not so systematic, and a complete operation has not yet been formed. The plan. I didn’t fully understand it until I heard the detailed analysis from you, Director Huang, and Director Qian.”

"So speaking of it, we can only say that our heroes see the same thing. Director Zhu, in fact, the improvement of the Cox Maze III technique is mainly driven by you."

What Qin Lang said was true. Director Zhu really only left a little impression before, and his subsequent performance relied on his accumulation.

"Huh? That seems to be the case."

How can something about scholars be called plagiarism?
After being rounded up by Qin Lang, Director Zhu immediately felt better, and became more and more appreciative and fond of Qin Lang.

Seeing Qin Lang licking Director Zhu indiscriminately, Dr. Sun's eyes widened.

Otherwise, someone is the director at a young age!
Alas, the current workplace is too difficult. There are people who are not only better looking than you, but also have better skills.

Director Zhu pursed his lips, and immediately thought of it again. Since he was inspired by Qin Lang, as the real pioneer, Qin Lang should have a deeper understanding of this surgery than himself. Moreover, Qin Lang's operation Ability, that is the best in Hecheng.

"Director Qin, I have an idea. You will be the chief surgeon of the world's first Cox maze IV operation in a while, and I will help you. How?"

Director Zhu directly suggested.

Dr. Sun who was on the side was stunned when he heard this sentence, and immediately persuaded:

"Director Zhu, although Director Qin thought of this surgical plan first, it's only theoretical knowledge. This operation is really extremely difficult. I'm afraid it's not appropriate to let Director Qin be the chief surgeon, right?"

It's no wonder that Dr. Sun is worried. After all, even if Director Zhu, who is very experienced in maze surgery, performs this operation, he still needs the guidance of experts from the First Affiliated Hospital of Zijingang University.

And Qin Lang has just seen a few of them, and being able to design an operation doesn't mean he can do it.

Director Zhu ignored Dr. Sun's opinion, just looked at Qin Lang, waiting for his answer.

"it is good."

Qin Lang agreed to Director Zhu's suggestion without any hesitation, and completed the system's tasks along the way.

"Director Zhu, Director Qin, you guys."

Dr. Sun was a little unbelievable when he saw one who dared to entrust blindly, and the other who dared to undertake recklessly.

"Okay, that's it for now."

Of course Director Zhu has his own considerations.

It was such a complicated operation that was attempted for the first time, and under the observation of experts from the entire department of the First Affiliated Hospital of Zijingang University, Qin Lang still performed calmly and confidently.

Director Zhu really admired this courage and determination: "Director Qin, then we will start preparing for the operation immediately. Dr. Sun, go to adjust the equipment and contact the experts from the First Affiliated Hospital of Zijingang University to go online on time."

"Ok."

Doctor Sun sighed, maybe this is the difference between a mortal and a genius?
Being able to participate in such an important operation, even as an assistant, his hands trembled with excitement. Seeing Qin Lang, who was about to perform the operation, was still calm, he became more envious and admired.

Ten minutes later, Qin Lang, Director Zhu and Dr. Sun entered the operating room.

The remote observation and guidance system was also turned on simultaneously, and soon, the situation in the operating room was displayed in the observation room of the Department of Cardiovascular Medicine of Zijingang Hospital.

In the observation room, apart from Dean Wen, Director Huang, and Deputy Director Qian, the other seven or eight chief physicians and deputy chief physicians of the Department of Cardiovascular Medicine were expecting the start of the operation.

Director Huang introduced to his colleagues:
"Today I invite you to observe a modified Cox maze Ⅳ operation that is very meaningful for promotion. This operation was proposed by Director Zhu of the First Hospital of Hecheng City, and the design was completed with the joint participation of Director Qian and I. It uses two The "new energy" of polar radiofrequency forceps and single-stage pen replaces the "cut and sew" of traditional maze surgery. It is very ingenious and practical, and it also provides us with a way of thinking in the field of cardiovascular disease treatment. "

"I hope that in the future, you will observe and study well."

Director Huang hadn't finished speaking when he heard a commotion in the observation room.

Director Huang frowned, then turned his head to look at the screen where everyone was discussing, and then saw the familiar Director Zhu standing in the assistant's position, and the surgeon was someone else!
Take a closer look, isn't this Qin Lang?
Everyone was stunned, and Director Qian blinked his eyes. When will Qin Lang perform the Cox Maze IV surgery again? This is not a brand-new operation that Director Zhu proposed and perfected together with Director Huang not long ago.

Didn't this kid just listen to the operation plan once?

Wen Yunqi was also a little unexpected, but he was also a little curious, how could this Qin Lang be so powerful.

In the observation room, everyone naturally knew Qin Lang, but they didn't expect that this guy returned to the city's first hospital and was able to demonstrate the operation for everyone.

After all, Qin Lang is well-known, and everyone is also sinking their hearts to observe it.

On the operating table, Qin Lang had already begun to issue the first order. Chen Wenhao began to use intravenous inhalation combined with general anesthesia, and catheters were punctured in the radial artery and right subclavian vein to monitor the arterial pressure and central venous pressure.

With no time left, Qin Lang gave instructions to the equipment nurse:

"U.S. Medtronic affinity-541 membrane oxygenator, the priming solution consists of 1 500 ml Ringer acetate solution, 500 mg methylprednisolone, and 10-20 g albumin."

"The Italian Sorin Electa type blood salvage machine is used for blood washing and recycling. The perfusion flow rate during the operation is 2.2-2.4 L/(m2 min), and the hematocrit (HCT) is not lower than 0.21."

Qin Lang further optimized the operation plans of Director Huang and Deputy Director Qian, so when he issued these two unfamiliar orders.

In the observation room, Director Huang and Deputy Director Qian were stunned for a moment. This was somewhat different from their design.

Huh?
It's just that in the operating room, Qin Lang's quick operations did not mean to explain to the experts on the other side of the screen.

He directly took the scalpel and began to open the chest in the middle.

"Heparin. First aid, ready to establish extracorporeal circulation"

Seeing Qin Lang's incision technique, he was amazed.

"blocking the superior and inferior vena cava"

"Scalpel"

The continuous operation of the Qin corridor, the oblique incision of the right atrium is made perpendicular to the right atrioventricular groove, the upper end of the incision is 1.5 cm away from the atrioventricular groove, and the lower end cuts the ridge of the border.

Seeing Qin Lang's operation, Director Huang frowned in the observation room, almost applauding Qin Lang's precise operation.

"As expected of Director Qin, everyone should pay attention to his operation, especially the position of the hand incision. Afterwards, everyone should also pay attention to cutting the ridge at the lower end, and pay attention to avoiding the sinoatrial node area, so as not to cause damage to the conduction system."

After listening to Director Huang's words, all the doctors began to study humbly.

The doctor himself is a skilled person, whether he can do it or not, it is clear when he makes a move, Qin Lang's incision technique, in the observation room, these attending physicians and deputy chief physicians think that none of them can surpass him.

"When did the No. [-] hospital in this city become so powerful. Director Zhu came to our department for further study before. I didn't expect that he would be able to create such a powerful Cox maze IV operation in just a short time. Director Qin is also excellent as always. A brand new operation, They can do everything with such proficiency.”

When the entire observation room was engrossed by Qin Lang's hard-core operations, Qin Lang began to improve and optimize the operation's core operation.

"Medtronic Bipolar RF Forceps. Single Stage Pen."

Qin Lang picked up the bipolar radio frequency forceps with both hands very steadily. Radio frequency is a high-frequency vibration with a frequency of 15 times per second.

The principle is that the human body is a complex structure composed of many organic and inorganic substances. The body fluid contains a large number of dielectrics, such as ions, water, colloidal particles, etc. The human body mainly relies on the movement of ions to conduct current.

Under the action of high-frequency alternating current, the ion concentration change direction changes back and forth with the current direction as positive and negative half cycles.Under high-frequency oscillation, the ions between the two electrodes move rapidly along the direction of the electric force line, gradually changing from a moving state to a vibrating state.

Due to the different sizes, masses, charges and moving speeds of various ions, the ions rub against each other and collide with other particles to generate biological heat.

Therefore, the friction between them and other molecules and ions in the cells will heat up the lesion, causing the water inside and outside the cells to evaporate, dry, pyknosis and fall off, resulting in aseptic necrosis, so as to achieve the purpose of ablation.

"So everyone must not underestimate this step. It is a test of the surgeon's grasp of the ablation time and to ensure that the atrial wall is completely prevented from being damaged. Moreover, since a large amount of heat is generated during ablation, temperature control is even more important."

Director Huang, as the main designer of this operation, of course has a very deep understanding of these operations, and the more he is like this, the more he admires Qin Lang. This kid knows how to listen to it.

"It's really amazing."

Director Huang couldn't help sighing.

The attending physicians in the observation room also nodded, not knowing what to do!
"The next step is to cool down, block the aorta, and start perfusing cold blood cardioplegia."

When Director Huang was confidently and forward-lookingly introducing the next operation, the voice of Qin Lang in the operating room also sounded:

"Cool down. Block the ascending aorta and perfuse with HTK solution."

Hearing Qin Lang's instruction, there was an uproar during the observation, especially Director Huang thought his ears had heard it wrong.

Wen Yunqi in the middle opened his eyes slightly, and looked at the young doctor on the screen. Director Huang had reported this improvement plan to him, and he also recognized it very much.

But now in the operating room, there is a major deviation from the plan set in advance by Director Huang and others.

What exactly is going on?

(End of this chapter)