godfather of surgery

Chapter 1454 This shouldn't be happening.

Chapter 1454 This shouldn't be happening.

In the morning, Yang Ping did not go directly to the operating room, but went to the neurosurgery ward first.

The patient with the cavernous hemangioma in the medulla oblongata was surnamed Gong, 47 years old, a middle school Chinese teacher who had taught for 25 years and had taught 11 graduating classes of senior high school students. Yang Ping had already memorized this information last night, but he still wanted to see the patient in person and hear his voice before the surgery.

The lights in the ward were already on. Teacher Gong was leaning against the bed, and his wife was sitting on the edge of the bed.

Yang Ping nodded and walked to the bedside. Teacher Gong looked better than in the photos he had taken two weeks ago; his face wasn't as pale, and his eyes were much brighter. He was wearing a blue and white striped hospital gown, and his head had been shaved, revealing a smooth scalp with a few faint spots on the top—marks left by sun exposure.

"Teacher Gong, how are you feeling?" Yang Ping asked.

"It's alright." Teacher Gong's voice was soft but steady. "I'm still a little dizzy and unsteady on my feet, but it's much better than when I first arrived."

"Eating? Are you choking?"

"I don't choke, I can eat without any problems, and I can drink water without any problems either." Teacher Gong paused for a moment, "It's just that sometimes I feel a tightness in my throat, like something is stuck there."

Yang Ping felt a tightness in his chest and his throat tighten. This could be a sign of medullary dysfunction or edema around the lesion compressing the vagus nerve. In either case, it meant that surgery could not wait any longer.

"The surgery is today," Yang Ping said. "I need to tell you a few things, so listen carefully."

Teacher Gong nodded, and his wife held his hand tightly.

"First, you will be awake for a period of time during the surgery. You will hear us talking and may feel your head being opened, but it won't hurt. Don't be nervous, just do as the anesthesiologist tells you. Take deep breaths, move your toes, say a few words, and cooperate with us to do these tests."

"Secondly, some situations may occur during the surgery, such as you suddenly being unable to move your hand or foot, or your speech suddenly becoming unclear. If this happens, don't panic. It may be because we are approaching an important nerve. We will stop the operation immediately and continue after you have recovered."

"Third, and most importantly," Yang Ping looked into Teacher Gong's eyes, "no matter what happens, don't move. If you move, our operation will deviate, potentially causing irreversible damage. So, no matter how uncomfortable it is, you must endure it and remain calm."

Teacher Gong was silent for a moment, then nodded.

"Professor Yang, I have another question."

"You said."

"If... I mean if... something goes wrong during the surgery, will you save my life or my function?"

Yang Ping looked at the forty-seven-year-old man. He had taught for twenty-five years, including eleven graduating classes of senior high school students, and had even persuaded a student who wanted to jump off a building to come back from the brink. The fact that he asked this question showed that he had seriously considered the worst-case scenario, that he was mentally prepared, and that he was a truly rational person.

Yang Ping said, "If we encounter this situation, theoretically we would save your life first, but based on my technical skills, we can actually save both."

"Okay, thank you," Teacher Gong said with relief.

Yang Ping walked out of the ward and stood in the corridor for a few seconds. A nurse pushed a treatment cart past, the wheels making a soft gurgling sound on the tiled floor. He took a deep breath and walked towards the operating room.

The medical profession truly possesses an inherent divine quality; sometimes, in addition to technical skills, one must also have a conscience.

At eight o'clock, everyone was in the operating room.

Xu Zhiliang stood in front of the operating table, discussing the final details with the anesthesiologist. His assistant, a young doctor in his thirties, was helping to position the patient, securing the head to the head frame to ensure it wouldn't shift in the prone position. Nurses were counting the instruments, calling out each item one by one, their voices crisp and efficient.

Yang Ping walked to the hand scrub basin and began scrubbing his hands. Xu Zhiliang followed and stood beside him. The two scrubbed their hands side by side without saying a word; only the sound of running water and the scrubbing of the brushes against their skin could be heard.

After washing their hands, putting on surgical gowns and gloves, Yang Ping walked to the operating table and stood in the first assistant's position, while Xu Zhiliang stood in the surgeon's position.

The surgery began in silence.

Xu Zhiliang picked up the scalpel and made a midline longitudinal incision at the back of the patient's neck. He cut through the skin, subcutaneous tissue, and fascia layer by layer. His movements were slow, each incision precisely measured. This was his style: unhurried, calm, and as steady as a rock.

Yang Ping watched from the side, secretly approving.

The muscles were separated layer by layer, exposing the foramen magnum and the posterior arch of the atlas. Xu Zhiliang took the drill and began the posterior fossa craniotomy. The sound of the drill echoed in the operating room, mingling with the sounds of the monitors.

The bone flap was carefully removed, exposing the dura mater, which was white, smooth, and pulsating slightly. Xu Zhiliang used micro-scissors to cut open the dura mater, and cerebrospinal fluid seeped out and was sucked away by a suction device.

"The intracranial pressure is not high," Xu Zhiliang said.

Yang Ping nodded. Low intracranial pressure was a good sign, indicating that the two weeks of conservative treatment had achieved the expected results.

The microscope was pushed over, and Xu Zhiliang sat down, pressing his eye against the eyepiece. His assistant sat down on the other side, while Yang Ping stood beside him, observing the surgical field through the secondary microscope.

The cerebellar hemispheres were gently separated, exposing the floor of the fourth ventricle. It was a thin, paper-like structure beneath which lay the dorsal side of the medulla oblongata. Through this thin wall, the underlying lesion could be seen: a dark red, mulberry-like vascular malformation.

“The location is excellent.” Xu Zhiliang’s voice was low, as if he were talking to himself.

Yang Ping understood what he meant. The lesion was located shallower than expected, only two millimeters from the floor of the fourth ventricle, almost immediately visible upon opening the brain. This meant that no additional brain tissue resection was needed, minimizing damage to normal structures.

"Start cutting," Xu Zhiliang said.

Microsurgical scissors are inserted into the surgical field, and the lesion is dissected little by little along its edge. Cavernous hemangiomas do not have a true capsule, but their boundaries are relatively clear, surrounded by a band of glial proliferation. Experienced surgeons can completely dissect the lesion along this band of proliferation.

Xu Zhiliang's assistant carefully processed the tiny blood-supplying arteries using bipolar electrocoagulation. Each vessel had to be clearly observed before electrocoagulation; indiscriminate burning was not an option. Blind burning could damage perforating vessels, causing ischemia in normal brain tissue.

As the assistant, Yang Ping was mainly responsible for exposing the surgical field and applying suction. He gently pulled on the brain tissue with a suction device to create better operating space for Xu Zhiliang. This task sounds simple, but it requires extreme skill. The suction force must be just right; too light and the exposure will be insufficient, too heavy and it may damage the brain tissue.

The surgery went smoothly, and the lesion was gradually separated from the surface of the medulla oblongata.

"Wake him up," Xu Zhiliang said to the anesthesiologist.

Anesthesiologist Zhou adjusted the depth of anesthesia. A few minutes later, the patient began to breathe spontaneously, and the laryngeal mask airway was switched from controlled ventilation to assisted ventilation. Teacher Gong's eyelids twitched, and then she slowly opened her eyes.

"Teacher Gong, can you hear me?" Old Zhou leaned down and asked in his ear.

Teacher Gong blinked and answered, "Okay."

"Now we need you to cooperate with some movements. Let's start by moving your left hand."

Teacher Gong's left hand twitched slightly.

"Okay, very good. Now move your right hand."

His right hand moved too.

"Now move your left toes."

No response.

The air in the operating room seemed to freeze for a moment.

"Teacher Gong, move your left toes." Old Zhou said again, raising his voice by half an octave.

There was still no response. Xu Zhiliang's hand froze in mid-air.

"Don't panic." Yang Ping's voice was calm, like a bucket of cold water poured over everyone's heads. "It's probably caused by positional pressure. Lift the blanket off your left foot and check if it's being pressed down."

The nurse lifted the blanket, revealing Ms. Gong's left foot from under the sterile sheet. The blanket below her ankle was indeed partially tucked in, restricting the movement of her toes.

"Teacher Gong, try again, move your left big toe," said Lao Zhou.

This time, Teacher Gong could clearly feel her left toes move.

Everyone breathed a sigh of relief. Yang Ping had a fine layer of sweat on his forehead, but he didn't raise his hand to wipe it away.

“Continue,” he said.

The surgery continued, and two-thirds of the lesion had been separated, leaving only the deepest part attached to the dorsal side of the medulla oblongata. This was the most dangerous and technically demanding part of the entire operation. It was adjacent to the hypoglossal and vagus nerve nuclei, and the slightest mistake could have disastrous consequences.

Xu Zhiliang switched to a finer pair of micro-scissors and began to separate the last layer of adhesion.

“Teacher Gong, open your mouth now,” Old Zhou said.

Teacher Gong opened her mouth.

"Stick your tongue out."

The tongue is sticking out, centered, without any deviation. The hypoglossal nerve is functioning perfectly.

"Now swallow your saliva."

Teacher Gong made a swallowing motion, and her Adam's apple moved up and down slightly. Vagus nerve function is normal.

"Cough."

A light cough, clean and forceful.

Yang Ping secretly admired Xu Zhiliang's skill, which had reached a level of perfection. He had operated in the most dangerous area without causing any impact on his nerve function.

"The lesion has been completely removed." There was finally a hint of relief in Xu Zhiliang's voice.

He used micro-forceps to remove the dark red vascular malformation from the surgical field and placed it in a surgical basin. A nurse handed him a piece of gelatin sponge and gently pressed it onto the wound to stop the bleeding.

"Check the wound again," Yang Ping said.

Xu Zhiliang nodded and used bipolar electrocautery to treat the small spots that were still bleeding one by one. He cleaned each one thoroughly, leaving no potential problems.

"Teacher Gong, let's do it one more time," Old Zhou said. "Move your left toes."

My toes moved.

"Move your right hand."

The right hand moved.

"Smile."

Teacher Gong's lips twitched slightly, forcing a smile. Of course, no one could see this smile.

"The bleeding has stopped satisfactorily; we can close the skull now," Yang Ping said.

Xu Zhiliang began closing the skull, meticulously suturing the dura mater, repositioning and fixing the bone flap, and then suturing back the muscles, fascia, subcutaneous tissue, and skin layer by layer.

Throughout the entire process, Mr. Gong remained conscious, occasionally performing actions according to Mr. Zhou's instructions. Only after the last stitch was completed did Mr. Zhou re-intensify the anesthesia, allowing him to fall into a deep sleep.

"The surgery is over." After saying these two words, Xu Zhiliang slumped back in his chair as if deflated.

Yang Ping glanced at the timer on the wall: three hours and forty minutes. It went more smoothly and faster than he had expected.

More than an hour later, Ms. Gong was wheeled out of the operating room and sent to the ICU.

Ms. Wang stood at the door of the operating room, her eyes fixed on it. When the door opened, she saw her husband lying on the gurney, his face pale but his breathing steady, his chest rising and falling rhythmically. Tears welled up in her eyes instantly.

"The surgery went smoothly." Xu Zhiliang walked up to her, his voice slower than usual. "The lesion was completely removed, and the nerve function was not damaged. She will be observed in the ICU for a few days, and then transferred back to a regular ward after her condition stabilizes."

"Thank you, Director Xu, thank you, Professor Yang..." Ms. Wang grasped Xu Zhiliang's hand, tears streaming down her face.

After leaving the operating room and changing out of his scrubs in the changing room, Yang Ping checked his phone. There were three missed calls, all from Tang Shun. He also had several WeChat messages, one of which was from Mainstein: "Professor, there's a major discovery in the functional verification experiment of the unknown factor! Come and see!"

He returned Tang Shun's call: "What's up?"

"Professor, there's been a problem with Weber's experiment." Tang Shun's voice was somewhat anxious. "The results from the conditioned medium group can't be reproduced no matter what we do. Weber has done it three times, and all three times it didn't meet the standard. Now he's extremely worried, saying that the impressive data from last week might be a false positive."

Yang Ping frowned.

“I’m going over there now. Tell Weber not to rush and to prepare the raw data. I’ll see what’s going on.”

After hanging up the phone, Yang Ping quickly walked out of the operating center and headed towards the research institute.

Inside the research institute, Weber sat in front of a computer in the lab, his brow furrowed, arms crossed, like a statue. Tang Shun stood beside him, holding a lab notebook, flipping through something.

"The professor has arrived," Tang Shun said.

Weber turned his head and looked at Yang Ping, a hint of frustration in his eyes.

"Where's the data?" Yang Ping walked over and asked directly.

Weber pulled up the data on the computer. Yang Ping bent down and looked at it line by line. These were the results of three independent replicate experiments. In the first experiment, the conditioned medium group performed very well, consistent with last week's data. In the second experiment, the effect was halved. In the third experiment, almost no effect was observed.

"Were the three batches of conditioned medium prepared in the same batch?" Yang Ping asked.

“Yes,” Weber said.

"What about the cell condition? Are the cells used in each experiment from the same passage?"

“Yes.” Weber nodded.

Yang Ping straightened up, walked to the cell culture room, opened the incubator, took out the batch of stem cells used in Weber's experiment, and observed them under a microscope.

Cells don't have anything special about them, right?

Is there a problem with some part of the experiment, or is this how it is supposed to be?