NovelPantry Chapter 1451 As long as he stands by, the surgery is already half successful.
Chapter 1451 As long as he stands by, the surgery is already half successful.
Chapter 1451 As long as he's standing by, the surgery is half successful.
Yang Ping arrived at the operating room at 8:00 a.m. the following morning.
Xia Shu was already inside, watching a film in front of the film reader on the wall. Hearing the noise, Xia Shu turned around.
"Professor, you've arrived very early."
"how is the situation?"
The patient has been taken to the operating room and is ready for anesthesia.
Xia Shu pointed to several markings on the film and said, "I checked it again. The calcified plaques in the right internal mammary artery are mainly concentrated in the proximal part, while the distal two centimeters are clean. The anastomosis can be set in the distal part."
Yang Ping nodded, took the films from Xia Shu, and reviewed them one by one. This was a habit he had maintained for many years: no matter how thorough the preoperative preparations were, he had to review all the imaging data himself before going into surgery. It wasn't that he didn't trust the team, but rather that there was no "almost" on the operating table, only "certain" and "uncertain."
“I’ve looked at the angiography of the great saphenous vein.” Yang Ping turned to the next image. “The great saphenous vein in the right lower limb is unobstructed throughout, with a diameter of three to four millimeters and no varicose veins. It can be used. The one in the left lower limb has a tortuous section, so we will discard it.”
"I'll have Dr. He pick it up then," Xia Shu said.
Yang Ping clipped the films back into the viewing lamp in order, his gaze falling on the last angiography film. It was the coronary tree of the heart, like a withered old tree, its branches covered with plaque and calcification, with only a few thin collateral branches barely maintaining blood supply.
"It's a miracle that this heart has lasted this long," Yang Ping said softly.
Xia Shu didn't respond. He knew that Yang Ping wasn't expressing his feelings, but rather assessing: how much reserve the heart had left, how much blood pressure drop was the limit during anesthesia induction, and whether it could withstand the need for extracorporeal circulation if absolutely necessary.
Anesthesiologist Lao Zhou pushed open the door and came in, holding a freshly printed lab report: "Professor Yang, the platelet function retest results show that the inhibition rate has dropped to 48 percent."
"Still high!" Yang Ping took the order. "But it's better than yesterday. We can reverse the high temperature during the operation with tirofiban and platelet transfusion. It should be under control."
Old Zhou nodded and turned to prepare. He was a veteran anesthesiologist at Sanbo Hospital, so there was no need for him to say much.
Yang Ping, Xia Shu, and Li Ze walked together to the scrubbing pool and began scrubbing their hands. Yang Ping felt the coolness of the iodine spreading from his fingertips to his forearm. As he scrubbed, he mentally rehearsed the surgical procedure: open chest, harvesting grafts, exploration, anastomosis... Each step was broken down into smaller movements, and each movement corresponded to possible unexpected events and corresponding strategies.
This is his unique skill: he mentally rehearses each performance at least three times beforehand: the first time for the ideal scenario, the second time for common unexpected situations, and the third time for extreme cases. Only after these three rehearsals can he be fully prepared when he goes on stage.
"Director Xia, the patient's blood pressure is fluctuating a bit," the anesthesia nurse reported.
Xia Shu put on her surgical gown and gloves and strode toward the operating table. Her assistant had already finished disinfecting and draping the surgical table.
The patient was a 67-year-old man, thin and pale, with an old scar down the center of his sternum, left from his first bypass surgery ten years ago. Xia Shu glanced down at the monitor: heart rate 82, blood pressure 105/62, blood oxygen saturation 94%.
"Is the induction complete?" he asked the anesthesiologist.
"Just finished, my blood pressure dropped by 15 millimeter mercury, and it's stable now."
Xia Shu turned to look at Yang Ping, who nodded.
“Let’s begin,” Xia Shu said.
Xia Shu was the lead surgeon, Li Zehui was his assistant, and Yang Ping sat beside him to observe and help whenever needed.
The electrocautery cut open the skin, separating layer by layer along the old scar. Subcutaneous tissue, muscle, fascia… Xia Shu's movements were slow, but every step was precise. The adhesion of the scar tissue was more severe than expected, so he patiently used scissors and the electrocautery alternately to separate it, occasionally pausing to let his assistant suction away the oozing blood.
"Sternite saw".
Xia Shu took the sternal saw and began sawing down the center of the sternum. This was one of the most dangerous moments of the entire surgery, as the porcelain aorta was located behind the sternum. If the saw went too deep, it could directly rupture the aortic wall.
He slowed down, the saw blade going deeper and deeper. Li Ze would gently push aside the mediastinal tissue with his hand to reveal a clearer view.
"Stop!" Xia Shu suddenly said.
With the saw blade less than a centimeter from the aortic wall, he put down the sternal saw and switched to a periosteal elevator, carefully separating the remaining retrosternal tissue bit by bit. This operation was much slower than sawing through it directly, but much safer.
"Alright, continue!"
The sternum was completely split open, and a retractor was used to open the chest cavity. The heart was exposed, covered with a thin layer of fat, dark in color, and beating weakly. Xia Shu's gaze first fell on the aorta, a grayish-white blood vessel as hard as stone, with an uneven surface; even a light touch revealed its unsettling brittleness.
"The vitrification is even more severe than it appears on the film," Li Zehui whispered from the side.
“That’s why it’s called an ‘extraordinary’ case.” Xia Shu said without looking up.
“I will now dissect the right internal mammary artery,” Li Zehui said.
His movements were gentle and precise, like embroidery, as he peeled the internal mammary artery from the chest wall, preserving it intact along with the surrounding fat pad and accompanying veins.
Xia Shu focused intently on examining the coronary arteries. He gently touched the surface of the heart with his fingers, feeling the course and firmness of the blood vessels. The left main coronary artery was almost completely blocked, leaving only a hair-thin slit. There was a relatively normal segment of the left anterior descending artery, about eight millimeters long, barely enough for an anastomosis. Obtuse marginal branch, posterior descending artery, left ventricular posterior branch… he felt them one by one, constructing a map of the blood vessels in his mind.
"Dr. He, has the great saphenous vein been harvested?"
"It's ready, 24 centimeters long, and the quality was excellent throughout." Dr. He handed over the retrieved venous graft.
Xia Shu took it and examined it carefully. The vein walls were smooth, without any damage, and the diameter was uniform. He flushed the lumen with heparinized saline and then soaked it in papaverine solution to prevent spasms.
"The fit begins."
The first step is the anastomosis of the right internal mammary artery to the left anterior descending branch. This is the cornerstone of the entire operation: if this anastomosis fails, everything that follows will be in vain.
Xia Shu trimmed the distal end of the right internal mammary artery into a bevel and made a small incision in the vessel wall with microsurgical scissors. The target segment of the left anterior descending artery had already been temporarily blocked by Li Zehui using vascular clamps. Xia Shu made a longitudinal incision in the anterior wall of the vessel, the length of which matched the diameter of the internal mammary artery.
"70 Priscilla, double-headed needle."
Xia Shu took the needle and thread and began to sew. His movements were slow, and each stitch was carefully considered: the angle, depth, and edge of the needle insertion, the position of the needle exit, the strength of the knot... every detail was controlled within the most precise range.
This is the essence of microsurgery and the threshold of cardiac surgery. A ring of sutures is placed on a blood vessel less than two millimeters in diameter, requiring a total of twelve to fourteen stitches. Each stitch must penetrate the entire thickness of the vessel wall, but not the intima, otherwise postoperative thrombosis is likely. The stitch spacing must be uniform, the edge distance appropriate, and the tension consistent… These requirements combined constitute the greatest technical challenge of coronary artery bypass grafting surgery.
Xia Shu stitched six stitches, then stopped so Li Ze could rinse the surgical field with heparinized saline to remove any potential blood clots. She then continued stitching until the last stitch was knotted.
"Open up the blood flow!"
The vascular clamp loosened, and fresh blood from the internal mammary artery surged into the anterior descending branch. Xia Shu stared at the anastomosis, watching it slowly fill, its color changing from pale to bright red. There was no bleeding, no twisting, and the blood flowed smoothly. "Very good," he said softly, his tone devoid of pride, only a calm sense of relief.
Next was the fabrication of the great saphenous vein graft. Xia Shu divided the 24-centimeter-long vein into two segments: one 15 centimeters long and the other 9 centimeters long. The 15-centimeter segment served as the main graft, with one end anastomosed to the lateral wall of the right internal mammary artery, and the other end prepared for three distal anastomoses. The 9-centimeter segment served as a supplement to the radial artery, to be used if the posterior descending branch or the posterior branch of the left ventricle required dual blood supply.
"Has the radial artery been harvested?"
"It's taken, 20 centimeters." Dr. He handed over the second bypass graft.
Xia Shu immersed the radial artery in a papaverine solution to allow it to fully dilate. Then he began the side-to-side anastomosis of the internal mammary artery and the great saphenous vein, which was the most ingenious part of the entire operation and the core of the plan he and Professor Yang had designed.
He cut one end of the great saphenous vein into a "Y" shape, with the two branches anastomosing to the side walls of the internal mammary artery. In this way, the blood flow from the internal mammary artery can simultaneously supply the anterior descending branch and the entire great saphenous vein bridge, achieving a single source with multiple supply structures.
"The blood flow at this anastomosis needs to be sufficient," Xia Shu said as she sutured. "The blood flow in the internal mammary artery is limited. If it's narrowed here, the three subsequent anastomoses will all be ischemic."
Yang Ping carefully observed Xia Shu's every move, nodding occasionally. He knew that Xia Shu's cardiac surgery skills were already world-class.
After the side-to-side anastomosis was completed, Xia Shu used a Doppler flowmeter to measure the flow rate, which was 45 milliliters per minute, enough to supply the three distal anastomoses.
"Continue, obtuse-edge branch."
The target vessel segment of the blunt marginal branch was of acceptable quality, approximately 1.2 mm in diameter and 1 cm in length. Xia Shu trimmed a branch of the great saphenous vein and anastomosed it, the movement still slow and precise. After blood flow was restored, Doppler ultrasound showed a flow rate of 18 ml per minute, indicating good patency.
"The later descending branch."
The condition of the posterior descending artery was worse than expected: the distal end was almost completely occluded, with only the proximal segment barely usable. Xia Shu anastomosed the second branch of the great saphenous vein here, and then had Dr. He anastomose one end of the radial artery to the posterior descending artery as well, creating a dual blood supply.
"Posterior branch of the left ventricle".
At the final anastomosis, the blood vessel in the posterior branch of the left ventricle was less than one millimeter in diameter, forcing Xia Shu to use a higher-powered magnifying glass. Fine beads of sweat began to appear on his forehead, which the nurse gently wiped away.
"70 Prilin, single-headed needle."
The moment the needle pierced the blood vessel wall, Xia Shu felt that familiar resistance—not the normal elasticity of tissue, but the brittleness of calcified plaque. He adjusted the angle of insertion, avoiding the plaque, and passed through the relatively normal blood vessel wall.
One needle, two needles, three needles… each needle prick felt like walking a tightrope; the slightest misstep could tear a blood vessel. Xia Shu held her breath, completely focused, as if the entire world had shrunk to the tiny, millimeter-square field of vision beneath the needle tip.
The final stitch is tied to open the blood flow, and fresh blood from the radial artery rushes into the posterior branch of the left ventricle, merging with the blood flow from the great saphenous vein to form a dual blood supply.
Doppler!
Li Ze placed the probe on the screen, and a clear blood flow waveform was displayed: "Unobstructed, flow rate 12 ml per minute."
Xia Shu straightened up and let out a long breath. He glanced at the timer on the wall: three hours and fifteen minutes. It took longer than he had expected, but it was still within an acceptable range.
"Stop the bleeding completely before closing the chest," he said.
This is another crucial step. The patient has poor blood clotting function, and any small bleeding point could develop into a major problem after surgery. Xia Shu and Li Zehui would examine the surgical field inch by inch, performing electrocoagulation, suturing, compression... leaving no potential bleeding point unchecked.
"Platelet transfusion, cryoprecipitate, begin," Xia Shu said to anesthesiologist Lao Zhou.
"We're already losing."
"Did you use it for Luo Feiban?"
"Used, injection complete."
Xia Shu nodded and began closing the chest. He secured the sternum with wire and sutured the muscles, fascia, subcutaneous tissue, and skin layer by layer. He performed each step meticulously, knowing that the success of the surgery depended not only on the procedures performed on the operating table but also on every detail afterward.
"Surgery is complete!"
The monitor showed: heart rate 78, blood pressure 112/68, blood oxygen saturation 96%. Urine output was normal, and drainage volume was low.
The surgery was finally over, and Yang Ping smiled with satisfaction.
Xia Shu knew that without Yang Ping's presence, he wouldn't have been so confident and relaxed during the surgery. Although Yang Ping hadn't performed the surgery, just having him there made Xia Shu feel that the operation was half successful.
"Professor, thank you for your hard work."
“You’re the ones who are working hard,” Yang Ping said as he took off his surgical gown and gloves. “Postoperative management is crucial. Platelet function hasn’t fully recovered yet, so anticoagulation needs to be delayed. You should take turns personally supervising the first day.”
"understand!"
Yang Ping walked out of the operating room, changed out of his scrubs in the changing room, and put on a white coat. He checked the time; it was 1:30 PM. He still had things to do at the research institute that afternoon, but he decided to have lunch first and call Tang Shun to check on things.
The cafeteria wasn't crowded. Yang Ping got a light meal and found a corner to sit down. He'd only taken a couple of bites when his phone rang.
It's Xu Zhiliang.
"Professor Yang, where are you?"
"The cafeteria staff just finished surgery, what happened?"
"There's a patient...brainstem...I'll send you a WeChat message." Xu Zhiliang probably suffered internal injuries from holding it in over there.
Soon, Yang Ping received a WeChat message from Xu Zhiliang: "There is a patient with a cavernous hemangioma in the brainstem who is in a coma. The family wants to transfer him here. I have assessed the situation and it is feasible, but the location is very deep, on the dorsal side of the medulla oblongata, which carries a very high risk. I would like to ask you to come and take a look at the scans together."
Yang Ping put down his chopsticks. "Send the video to my email address. I'll be there at 2:30 this afternoon."
"Okay, thank you, Professor."
After hanging up the phone, Yang Ping finished his meal in a few bites and headed towards the research institute.
The research institute was as busy as ever. People were discussing experimental data in the corridor. When Yang Ping passed by the cell laboratory, he saw Mainstein and two students observing something under a microscope with focused expressions.
He didn't disturb them and went straight to his office.