My Medical Skills Give Me Experience Points
Chapter 374 - 178: Ultra-High Difficulty Clamping, Cardiac Arrest Strikes Again

Generally speaking, opting for intercostal incisions, or incisions below the neck, sternum or abdomen would be gentler than this approach.

However, when devising a surgical plan, doctors take all aspects into consideration.

If thoracotomy from the front is necessary, then it must be done.

The risks and potential complications are clearly explained to the patient's family and the patient before the surgery.

The diameter of this patient's aortic aneurysm has exceeded 5.5cm, classifying it as an extremely dangerous type. Moreover, it has heavily compressed surrounding organs, causing great physical pain for the patient.

Entering through the sternum is the most direct and quick approach.

Director Xue commanded her three assistants to perform the thoracotomy in an orderly fashion, personally handling the critical high-risk parts or directing the first assistant to do so. The surgical team she leads is exceptionally strong.

Even Doctor Long could only manage to secure the position of third assistant.

The first assistant appears to be even older than Director Xue, with a substantial amount of white hair at the temples that has spread to the top of his head. Though there are fewer wrinkles.

Medicine is a highly stressful and high-risk profession; premature ageing is almost the norm.

Many people have already developed a lot of grey hair by the time they finish clinical medical studies.

Furthermore, in assessing medical titles, age is not a consideration. As long as one's years of work meet the appraisal standards and academic, surgical volume, written examinations, and scientific achievements meet the review requirements, one can apply for assessment.

Some particularly talented and hardworking doctors can really be promoted to chief physician at the age of 42.

Others might stall in one aspect or fail to meet the requirements in multiple areas, remaining at the attending physician level as they approach sixty.

The first assistant is at least five or six years older than Director Xue Yan.

Seeing him sawing the sternum with some wavering was quite frightening.

"Remember, since the aneurysm is tightly situated behind the sternum, when sawing open the sternum, you must cleverly manipulate the sternum saw to avoid tearing the aneurysm wall and causing massive bleeding."

Director Xue guided the first assistant in sawing open the sternum while explaining the key points of the procedure to the other junior doctors.

Zhou Can had an epiphany after hearing this.

He originally thought the first assistant's age had caused unsteady hands.

Turns out it was a deliberate and conscious movement of the sternum saw.

Becoming a first assistant and earning such a high degree of trust from Director Xue truly requires considerable strength.

These invaluable experiences are lessons learned through the predecessors' bloody encounters.

Opening the thoracic cavity, the enormous aortic aneurysm is now visible.

It must be clarified that an aortic aneurysm is a vascular wall disease where, due to various reasons causing damage to the normal structure of the aortic wall, a tumor-like expansion of the vessel wall bulges outward at a particular location.

It is not a true tumor.

Their natures are entirely different.

The biggest danger of an aneurysm is rupture, leading to massive bleeding.

Also, as it continuously grows, compressing surrounding organs and tissues, it brings immense pain to the patient. If it's an intracranial aneurysm, it's even more dangerous, as it may press on any important nerve, blood vessel, or brain tissue, potentially causing major complications.

Whether benign or malignant, tumors are characterized by their rapid self-replication, destruction of the body's immune mechanisms, and invasion of normal cells and organs throughout the body.

Tumors also have the issue of compressing surrounding organs.

The largest liver tumors can even occupy a large portion of both the thoracic and abdominal cavities.

"Director Xue, this aneurysm is located on the brachiocephalic trunk, very close to the ascending aorta. Should we prepare for establishing extracorporeal circulation first?"

The anesthesiologist for this surgery is still Dr. Guan.

He maintains the integrity of an anesthesiologist, generally staying silent and not interfering with the surgery.

Only when he perceives significant risks during the surgery does he speak up as a reminder.

Ascending aortic aneurysms are not suitable for interventional surgery.

The common treatment is to excise and replace with an artificial blood vessel.

Director Xue chose to clamp the aneurysm instead of excision, perhaps considering the significant risks involved in the replacement process.

Even to this day, despite the matured technology for replacing the ascending aorta, the mortality rate remains above 10%.

If a surgeon with poor skills is the primary operator, or unexpected events occur during surgery, the mortality rate only gets higher.

After hearing Dr. Guan's reminder, Director Xue hesitated for a moment before saying "Establishing extracorporeal circulation requires preoperative heparinization, cannulation of the femoral artery and vein, which does cause certain harm to the patient. Since we're only performing a clamping procedure, the risks are relatively smaller, let's not prepare for that yet!"

She had her considerations.

This was not about cutting corners, but rather thinking from the patient's perspective.

This could save the patient surgery costs while also avoiding physical harm to them.

Dr. Guan said nothing more, and the surgery continued.

Zhou Can noticed that the aortic aneurysm was situated in a rather difficult location, at the junction near the ascending aorta and the brachiocephalic trunk.

Well, the ascending aorta and the arch of aorta are like an arch, from which three important branch arteries emerge: the brachiocephalic trunk, left cervical artery, and left subclavian artery.

These three branch arteries are quite interesting.

The left cervical artery and left subclavian artery both branch directly off this arch.

But the right cervical artery and right subclavian artery branch off from this brachiocephalic trunk.

The right cervical artery is slightly higher.

From here, one can see that the brachiocephalic trunk essentially serves as the main trunk for these two branches on the right side. Its blood supply is very significant.