Surgery Godfather
Chapter 1023 - 846 How to Use a Knife in the Crannies_2

Chapter 1023: Chapter 846 How to Use a Knife in the Crannies_2

"Am I disturbing you?"

Director Zuo, seeing the images on the digital viewer, knew they had just been discussing a case and felt a bit apologetic for interrupting suddenly.

"Not at all, we were discussing a case, which can be done at any time," Yang Ping said.

Song Yun and Kong Weiquan had already served two cups of water to the directors, and the other doctors gathered around, eager to hear what the directors had to come to discuss.

Director Wen wasted no time, "I saw a child with Kawasaki Disease at the outpatient clinic, only a month old. Due to vasculitis, the opening of the left anterior descending branch of the coronary artery was already completely occluded. At present, the child is relying on collateral circulation from the remaining two coronary branches for blood supply. This condition could lead to a myocardial infarction at any time, so coronary bypass surgery is necessary to save the child’s life. Considering the infant’s young age and small size, the surgery must be performed on a beating heart. The coronary arteries of a one-month-old child are very fine, especially on a beating heart, which makes the surgery extremely difficult. There have been no such precedents before. The surgeries done in Shanghai, where they have more experience in such cases, involve the youngest patients being around 14 months old. We heard that you are very skilled at vascular anastomosis, so we came to see if there was a way," he explained.

Everyone was engaged in academic work, straightforward and direct, which made the exchange relaxed and not tiring at all.

The diameter of the coronary artery of an infant one month old is about 1 millimeter, possibly even finer, and it’s even more complicated if the child is premature.

However, with the right microscope and sutures, there are no blood vessels that Yang Ping cannot handle—it’s his signature move.

"It shouldn’t be a problem."

Yang Ping felt there was no difficulty, as it was his area of expertise.

With Yang Ping’s confirmation, Director Wen was very pleased; that meant the surgery could proceed. He had always been worried about the difficulty of anastomosing such fine coronary arteries.

"The child needs to have the surgery on a beating heart," Director Wen reminded Yang Ping.

Since the surgeries Yang Ping performed, like reattaching fingers, involved anastomosing stationary blood vessels, it was quite different from anastomosing on a beating heart.

Performing vascular anastomosis on a beating heart was more challenging, and Director Wen made sure to clarify this with Yang Ping to prevent any misunderstanding.

"No problem, just let me know when to do it. If you need help, just give me the word," Yang Ping said briskly.

"That’s great, the family is anxious, and the sooner the surgery is done, the better. Otherwise, the child could have a heart attack at any moment. We had planned to invite peers from Shanghai to join the surgery, but they also lack experience with such young patients and were not confident enough. If Professor Yang could provide technical support during the vascular anastomosis, our chances of a successful surgery would greatly increase. Thank you, Professor Yang."

Coronary bypass surgery was originally a treatment method for adults, and in recent years, it has been used to treat children with severe coronary artery disease resulting from Kawasaki Disease. However, not many hospitals in China offer this surgery. The most experienced center is the Shanghai Children’s Medical Center. They were the first to establish a pediatric myocardial disease and heart failure diagnosis and treatment center in China. This center has a dedicated Kawasaki Disease diagnosis and treatment team comprised of cardiology, cardiac surgery, anesthesia, and radiology departments. They have successfully completed over ten pediatric coronary artery bypass surgeries to date, and intervention for pediatric coronary arteries has also been conducted in a few cases.

"We’ll arrange the surgery for one of these coming days. We’ll need Professor Yang’s help then. We appreciate your time, Professor Yang."

Directors Wen and Zuo were very efficient, keeping their conversation concise, as everyone else was busy with their case discussions.

Yang Ping and the others continued to discuss the case at hand—whether to operate on a patient with a vertebral tumor or not. The risks of surgery were high, no hospitals were currently willing to accept him, and if the surgery was not performed, the patient could still move his limbs a little. However, post-surgery there was a high possibility of high-level paralysis, completely immobilizing the limbs. In such a case, if complications like lung infections occurred, the patient likely wouldn’t live much longer.

"If the tumor is removed, the spinal cord could be severed, right?" Kong Weiquan asked worriedly.

This type of case was more trouble than it was worth, as few doctors were willing to stir up this hornet’s nest. The likelihood of postoperative high-level paralysis was extremely high, and since the patient’s condition could worsen with surgery, it essentially meant there was no cure—to put it plainly, it was untreatable!

"Yes, look here at cervical level 4, it has already traversed the spinal cord. If we remove the tumor, there is a high risk of causing tetraplegia, and since hemangioblastomas tend to recur, even if we remove it now, it could likely come back later. But as doctors, all we can do is our best, right? We can’t guarantee a complete cure, but we can try to find a way through surgery to alleviate his pain, at least to relieve it," Yang Ping pondered how best to proceed with the patient’s surgery.

Song Yun said embarrassingly, "It’s all because I’ve caused you trouble. During the outpatient service, I saw how much the patient was suffering, and other hospitals refused him, so I thought we should take him in. Even if we don’t operate, we could at least provide symptomatic treatment to ease some of his pain."

Yang Ping consoled him, "How can you say it’s trouble? Aren’t we always facing trouble? If Xiehe doesn’t take him in, where else is this patient supposed to go? Nowhere else to turn, right? Let me think about it."

"Have doctors suggested radiotherapy?" Song Yun added information.

Yang Ping shook his head, "Absolutely not. Radiotherapy is the last thing we want because the part of the spinal cord that receives radiotherapy will swell. Once that happens, it will exacerbate his illness, causing even more severe neurological symptoms. If the swelling can go down on its own, that’s good. Over time, the spinal cord function may be restored to its pre-radiotherapy state. But if the swelling doesn’t subside, it could cause permanent high-level paralysis. So we have to be extremely cautious with spinal cord radiotherapy."

"I’m wondering if we could remove the tumor surrounding the nerve root, which could reduce the patient’s pain since it’s the tumor’s irritation of the nerve root that’s causing it," Yang Ping reflected.

"The aim of surgery isn’t necessarily to cure but could be to alleviate symptoms, extend life, improve the quality of life, and so on."

Song Yun understood Yang Ping’s point, "Shall we do a more detailed and precise localization of the source of the pain again?"

"Yes, that’s very significant for the surgery."

"But—look, these several nerve roots are all involved by the tumor. How do we remove it? They’re all in difficult-to-reach corners."

"So what? This is Xiehe, the last resort for patients. Whether it seems possible or not, you have to make it possible. There’s no turning back," Song Yun said firmly.

"Should the internal fixation from the previous surgery be removed?"

"No, keep it! Removing it would destabilize the cervical spine, and we’d have to fix it again. Let’s not do the same work twice. Look at the C5 vertebral body; there are signs of a pathological compression fracture."

"If we don’t remove the internal fixation, it will obstruct the surgery. The exit point of the nerve roots is already a tricky spot, and with the internal fixation, it’s impossible to make an incision," Kong Weiquan had always been worried about this, getting a headache just looking at the tumors at those locations.

As everyone was discussing the case, a fragrant breeze swept in, and a gorgeous figure appeared at the door of the doctor’s office — Qiu Ruo, the beauty of the operating room, dressed particularly beautifully today, clearly having made a great effort.

"Our operating room beauty is treating us to a meal today."

Yang Ping, deep in thought about the surgical approach, didn’t pay much attention to Qiu Ruo at the door, just responded with an acknowledgment.

"Let’s have our meal first, then. After eating, we can discuss it further. This patient definitely needs surgery. Without it, the pain caused by the nerve roots will be unbearable, and he’ll likely be writhing in pain in bed."

The nurse from the operating room, Qiu Ruo, looked forward to Yang Ping’s visits to Xiehe every month with great anticipation. She had truly fallen for Yang Ping, hopelessly in love since the first time they met.

She shared this with her best friend Xiao Su and, before Xiao Su could even speak, she told Xiao Su that no matter what, she was going to bravely pursue Yang Ping. He was her Prince Charming, fulfilling all her fantasies about a partner. If Xiao Su dared to stand in her way, she would cut ties with her,

Xiao Su could only respond: You’re going to be socially dead.

Qiu Ruo retorted: Just wait and see, I will win him over.

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