Auto chess in the operating room

Chapter 104 Perfect mirror holding technique!
Hearing Qingping's solemn tone, Tian Linsheng quickly unfolded his small notebook and began to memorize it.

"In the minds of our surgeons, we must have this awareness: the information provided by patients or family members, the situation reported by subordinate doctors, and the contents of the case system are not necessarily reliable; only the surgeon's own hands are the most reliable! You have to do it yourself, and you have to do it with quality and quantity, and you don’t want to be lazy.”

"Personally touch the patient's belly, and ask the patient's condition with a few more words, sometimes you can expose small hidden dangers and solve big problems."

"Clinical work is very busy, and you may not have time to do some basic work, so you have to do it yourself. However, you must keep this principle in mind and take the initiative in your own hands. When dealing with patients with appendicitis, the chief surgeon must perform physical examinations in person. !"

Qingping took a few steps, and continued to add some of his own experience earnestly: "Before making a diagnosis, a physical examination can avoid misdiagnosis as much as possible, and avoid passive surgery when the indications for surgery are not very strong and sufficient. This is also the habit that Director Cheng forced me to develop when I was a rookie."

Listening to Qingping's words, both Tanglou and Tian Linsheng had a wonderful feeling. Cheng Jian gave Qingping this awareness, and now Qingping is educating Tanglou. From generation to generation, there is a sense of beauty and ritual passed down.

Tian Linsheng has a sense of pride, just like Cheng Jian, Qingping, and Tang Lou, they are the authentic heirs of general surgery.

"During my first surgery, thanks to the preoperative physical examination, the patient's abdominal wall muscles were relaxed after anesthesia, and the internal organs were better palpated. I discovered the ileocecal tumor that had been ignored before. It was also because of that time, I became famous in one battle, and Director Cheng also looked at me differently. Compared with the other residents, I didn’t have a big advantage originally, but from that time on, Director Cheng deliberately let me do more surgeries. Over time, the gap became smaller. Appeared.”

"Up to now, I have become an expert in acute abdomen, and one of the resident doctors in the same period has changed careers, and the other is still the chief resident."

Qingping couldn't help but sigh, for a late-stage profession like a doctor, one step forward in the early stage, and then it snowballs, and the gap is just a block away.

Tang Lou and Tian Linsheng were also thoughtful.

Especially Tian Linsheng's heart was pounding, as if he had seen himself and Wang Daquan several years later.

Qingping is also in a good mood today, and more importantly, because of Tang Lou, he wants to share his years of experience:
"In addition, the physical examination after anesthesia can also better locate the location of the lesion. If it is an open operation, it will help to choose the location of the surgical incision, and it may be possible to find nodules and tumors that were not found before."

"Why do some people perform the same operation smoothly, while others are in a hurry? The difference is that a person who performs a good operation must have combed and optimized the entire process and all the details countless times in his mind, and he is always in the In the process of constantly improving oneself. The key to the difference between good and bad surgery is: whether the surgeon is simply imitating, or using his brain."

After Qingping summed it up, he patted Tang Lou on the shoulder: "The morning class is over, and we will continue the rest of the second half class in the operating room."

Qingping left the ward in a good mood.

Leaving Tang Lou and Tian Linsheng looking at Qingping's back with admiration, it turns out that every senior attending doctor is not given for nothing.

Soon the afternoon surgery came on time, and Tang Lou and Tian Linsheng entered the operating room after getting ready for the surgery.

Qingping is the chief surgeon, Chen Wenhao is still in charge of anesthesia, Tang Lou is the first assistant, and Tian Linsheng is the second assistant.

Before the operation, blood, urine, feces routine examination, electrocardiogram, coagulation function, blood electrolytes, etc. have been performed on the patient.
While evaluating to rule out systemic medical disease, the patient's umbilicus was cleaned, unlike the McBurney incision.

After everything was in place, Chen Wenhao naturally took the lead and adopted a method different from the Maxwellian incision method, general anesthesia and intubation.

The requirements for tracheal intubation under general anesthesia are relatively high. Chen Wenhao inserted a thin steel wire gastric tube from the patient's nasal passage to the oropharynx, and then intubated it.

As a veteran, Chen Wenhao naturally knows how to apply paraffin oil in advance for sufficient lubrication, so that it is smooth enough, and it is really easy to feed.

After the intubation, Chen Wenhao withdrew the laryngoscope slightly, lifted the endotracheal tube together with the tongue with a laryngoscope blade, and then clamped the front end of the gastric tube with the intubation forceps, and inserted it step by step.

After completing the anesthesia, start to move the patient to a supine position with the head slightly tilted to the left to help shift the intestine upward and to the left.

After doing all this, Chen Wenhao happily pulled out his little bench and started to watch the play.

Today is Tang Lou's first laparoscopic operation, holding a mirror. It sounds like there is no technical content, but it is not so easy to do well.

Chen Wenhao has seen too many interns being scolded by the chief surgeon.

A few days ago, Wang Daquan helped Ma En with the mirror, and he almost vomited because of Ma En. The camera was unstable and wobbled, and the lens moved closer and further away. If he was helping Qingping like this, he would have been sent back to pull it checked.

Laparoscopy is composed of a lens and a monitor. To put it simply, holding the mirror is to help the surgeon to hold the mirror to provide the surgical field.

But there is a lot of knowledge involved. First of all, the hands must be steady. The base of the lens cannot move. It must be kept horizontal. While keeping the fiber optic stationary, move the lens left, right, up and down to assist the operator.

If you can't see the operator's operation just by moving the lens left and right, you can swing the optical fiber left and right to cooperate. Generally speaking, when the person is on the left side of the lens, swing the optical fiber to the right.

When operating in the abdominal cavity, the camera cannot move too much, nor can it remain still. If it moves too much, the picture will be too wobbly, which will affect the operator.

But if it doesn’t move at all, the reflection of the operator’s instruments in the operating room and the bleeding in the abdominal cavity will affect the reflection of the optical fiber and cause unclear vision.

Therefore, holding the mirror is definitely a nightmare for rookie doctors before they really try laparoscopic surgery.

Many novices lose confidence when they are scolded at the first level.

Chen Wenhao has also seen many good helpers. Generally speaking, they are:
First: The main thing is to expose clearly, the mirror must be upright, not shaken, far and near, and the angle is appropriate

Second: It is based on the habits of the chief surgeon, which can also be understood as understanding the operation intention of the chief surgeon, so it is very important to have the chief surgeon's thinking at this time, that is to say, to be familiar with the operation process of this laparoscopy, an excellent first assistant, and even think about it In front of the surgeon, predict in advance.

This kind of help will make the surgeon so happy that he can't live without it. Once he encounters it and uses it a few times, he can't live without it.

As far as Chen Wenhao knows, Qingping is the one who does a good job in general surgery. Of course, only Director Cheng can enjoy this kind of treatment.

Seeing how he cooperated with a big guy like Qingping to hold up the mirror, Chen Wenhao really sweated for him.

Qingping, Tanglou, and equipment nurses stood on the left side of the patient, while the monitor was placed on the right side of the patient.

Different from the Maxwellian incision method, the first step of laparoscopic technique is to choose three-hole puncture. Generally speaking, three holes are made on the patient's stomach. One is put into the laparoscope, also called the observation hole, and the second is the main operation. hole, the third hole is the auxiliary operation hole.

Generally speaking, there are two ways to make holes. Qingping chose the main operation hole with a 10mm cannula around the patient's umbilical foramen. The observation hole is 4cm below the intersection of the umbilical level and the left midclavian line, and a 2mm cannula is placed 5cm to the left above the pubic symphysis. For auxiliary operation hole.

After the puncture was completed, the laparoscope was used to explore the abdominal cavity.

Tang Lou received the laparoscope, which consisted of a base and optical fiber. Tang Lou used a thirty-degree lens, so he had to control the alignment operation area in order to see things in a wider range and more clearly.

With his talent of focus, tenacity, and three-star appendectomy, Tang Lou's hands are steady, and his brain turns even faster.

Qingping watched Tang Lou take the laparoscope for the first time, deliberately did not speak, and was going to give him a few seconds to feel it and relieve his tension. Of course, he also wanted to examine his first reaction.

Qingping still remembers the first time he took a laparoscope, he was excited and nervous, and his hands were shaking a little. His first laparoscopy was performed by Director Cheng for radical surgery of sigmoid colon cancer. The first time he helped him was really No idea, very dizzy, very helpless with optical fiber, no sense of direction and space.

It's like the embarrassment and panic of not being able to find the intersection for the first time when you and your girlfriend are camping in a small bamboo hut in the mountains, and the cold touch on each other's skin under the cold water vapor in the mountains.
"Doctor Qing!"

When Qingping was beaming with joy, a calm voice interrupted him.

Qing Ping frowned, Tang Lou looked at him with a pair of calm eyes in doubt, and motioned him to look at the monitor.

Without a second of pause, Tang Lou had already started to explore the abdominal cavity, the first thing was to check for trocar damage.

".confirm no trocar injury"

As the camera moves, liver, gallbladder, stomach, duodenum, colon, small intestine in sequence.
".No abnormality in any organ"

Qingping stared at the clear footage of the monitor, and couldn't help being stunned. Of course, what surprised him even more was Tang Lou's familiarity with the entire laparoscopic resection.

Why do novices always hold the mirror when they come up? Holding the mirror is not a foolish way to provide the surgical field, but to form the main surgeon's thinking, to understand and memorize the steps of the entire operation, as well as various attention points.

Soon, under Tang Lou's camera, a section of abscessed appendix appeared on the monitor.

".There was no obvious lesion in the appendix during the operation"

Tang Lou focused on the exploration of the terminal ileum, which was consistent with the preoperative preparations and went quite smoothly.

"Doctor Qing, you can start the operation"

Tang Lou took the initiative to CUE the process.

Tian Linsheng watched from the sidelines. Since it was his first time, he took it for granted: "This is the legendary holding mirror. Isn't it difficult? It seems to be similar to pulling the hook."

The eyes of Chen Wenhao and the nurse were different, especially Chen Wenhao's mouth was wide open.

This is also different from what he thought. When was it so easy to hold the mirror?

Under Tang Lou's urging, Qing Ping was also a little dumbfounded, and he was disgusted by Tang Lou, and a large teaching speech prepared before the operation was instantly useless.

Laparoscopic appendectomy is out of reach for novices, but as an attending surgeon, he has performed thousands of cases.

How can it feel?It was boring, and the only joy of teaching was disillusioned in front of Tanglou.

I can't find a reason to scold someone, get angry!
Qingping began to operate through the main operating hole, Tang Lou naturally watched Qingping's movements the whole time.

Chen Wenhao's eyes lit up all of a sudden, master, this is definitely a master!
Just from this look, he could see how powerful Tang Lou is. The average novice would only focus on the screen to watch the camera. Only veterans would understand that the real good mirror is to control the movement and process of the main knife, one step ahead of time. predict.

Sure enough, Tang Lou kept his vision in the center of the screen, and even designed the brightest light.

Unknowingly, Qingping's face was extremely relaxed, and the operation was performed more smoothly than usual.

When he was about to push away the omentum, Tang Lou's camera had been lifted a little earlier, and the field of surgery suddenly became clear.

When he separated the adhesions around the appendix, Tang Lou's camera moved closer again, zooming in on the operation.

Every time Qingping wants to make the next move, Tang Lou moves the camera ahead of time. This feeling is like when you are having a massage, when you just feel itchy, that hand pinches it up, and the force is not strong. Not small.

In short, it is comfortable, Qingping has never been so hearty.

With the seamless cooperation of Tang Lou, the separation of the appendix was completed very quickly. Qingping used non-invasive grasping forceps to clamp the edge of the mesentery at the tip of the appendix and lifted the appendix.

It also came to the treatment of the mesentery, a very critical step in laparoscopic resection.

There are four conventional treatment methods for the mesoappendix, and the corners of Qingping’s mouth raised slightly:
"Now I'm going to treat the mesentery of the appendix. How many methods do you know?"

Qingping looked at Tang Lou.

　Such a big chapter, there is no conscience^O^
　　
　
(End of this chapter)