Surgery Godfather
Chapter 1030 - 850 - Flower Knife

Chapter 1030: 850 Chapter Flower Knife

Indeed, it was a bit awkward. If both senior directors handed over the task of closing the chest to their junior doctors, they wouldn’t be doing anything themselves, which would be unacceptable.

If a paper was to be written about this case, Director Wen would definitely be the first author. If he didn’t do anything in the operating room, it would certainly be criticized.

Therefore, Director Wen and Director Zhang honestly completed the final step of closing the chest together.

The scene was somewhat comical. Several doctors stood around watching the two big shots suture the chest, while under the scrutinizing gaze of everyone, they pretended to be calm, but inside they were extremely uncomfortable.

"Place the drainage tube?"

"Yes, place it!"

Normally, inserting drainage tubes, determining the length of the tubes, and trimming the side holes were tasks for junior doctors. Now suddenly having to do it themselves, there was a slight unfamiliarity.

Doctor Chu stood by without making a sound, just quietly watching the two big shots operate.

In the orthopedics operating room, Song Yun had already fully exposed the lateral aspects of cervical vertebrae 4, 5, and 6. The automatic retractors were also in place, and the gauze had been properly placed where needed.

After dealing with the cardiac surgery issues, Yang Ping scrubbed back in. The timing was very well-managed and did not affect the progress of his own surgery at all. Seeing Yang Ping return so quickly, Song Yun said, "What? They managed on their own? You’re not needed, Professor?"

"Oh, I just helped them build two bridges. Let’s start our surgery quickly," replied Yang Ping as he positioned himself, and the preparations for this side of the surgery began.

The bypass was completed? That couldn’t be so quick. This wasn’t some simple skin laceration on a finger or a torn tendon that could be dealt with in a few minutes. This was a coronary bypass. Song Yun wanted to ask more about the specifics, but Yang Ping had already started operating, so Song Yun had to keep up with the pace.

"Just two bridges, it didn’t take much time. I guess they’re almost finished with their surgery over there," said Yang Ping as he glanced at the surgical field.

Song Yun was already performing subperiosteal dissection on the vertebrae plates on both sides, but further lateral dissection was not possible because of the presence of articular processes, transverse processes, and nerve roots entering and exiting through the intervertebral foramen.

If the vertebral plate is considered a plain, then these structures are mountainous areas. Subperiosteal dissection can be easily performed on the flat vertebral plate, but it is impossible within the intricate protuberances and crannies.

This time, they were using a conventional high-frequency electric knife. Before using the knife, Yang Ping checked that all connections were secure, as the use of an electric knife is very particular and has certain safety protocols.

The electric knife cable was fixed at sterile points on the sterile drape without using instrument wraps, which many doctors prefer to use.

Due to coupling phenomena, the working cable or electric knife can transfer energy to adjacent cables or metal instruments. If the electric knife cord is wrapped around a fluorescent light tube and the knife is activated, it could light up a lamp that requires 220V. Therefore, if the electric knife cable is wound around vascular clamps or other instruments to fix it, it could cause the clamps to heat up and lead to danger.

"Anesthesiologist, what’s the concentration of oxygen for the patient?"

"30%!"

It seems the anesthesiologist was also cautious, well-aware that using the electric knife carries the risk of burning the patient if the oxygen concentration is higher than 40%.

After everything was confirmed, the surgery began.

The tip of the electric knife started extending from the vertebrae plate outward, beginning to perform subperiosteal dissection on the complex transverse processes, superior and inferior articular processes, and vertebral arch roots. This was the real subperiosteal stripping, with the knife always close to the bone, lifting the periosteum cleanly and keeping all other tissues outside it.

Subperiosteal stripping with the electric knife was thorough and bloodless, which made the surgery look very smooth.

Soon, the dorsal aspect of the vertebrae plates and articular processes from cervical 4 to cervical 6 were fully exposed, and the attached muscles were covered with gauze and then retracted to either side. Zhang Lin and Little Five excelled in the use of retractors; their skill was irreplaceable. Whether it was someone else or automatic retractors, neither could replicate Teacher Zhang and Teacher Wu’s meticulousness with the retractors.

The next step was fenestration. The vertebrae plates of three vertebrae needed windows because only through these windows could the tumor, spinal cord, and nerve roots within the vertebral canal be exposed from the dorsal side, and tumor excision around the nerve roots could be performed, as well as cleaning of the intervertebral foramen.

In surgical operations, exposure is a profound art. Doctors who don’t understand exposure might work hard for half a day without seeing where the surgical targets are, or even if they can see the targets, they would still feel very constrained in their operations.

This is why the same surgery is easy for some and fraught with difficulties for others. Exposure can be a critical factor.

Unbeknownst to them, more and more observers accumulated in the operating room, all coming from the cardiac surgery side. When they awoke from their confusion, they realized the extraordinary level of skill displayed by Yang Ping in just those few minutes.

The orthopedics operating room was different; it was equipped with screens capable of live broadcasting, intended for teaching. This allowed the doctors below to see the details of the surgery at any time without crowding around the operating table, which would increase the risk of contamination, and where they could not see anything anyway.

With the LCD screen connected to cameras on the surgical lights, every detail of the surgery was transmitted to the screen.

On the screen at the moment, a faint wisp of smoke drifted past and was captured and carried away by the suction device.

The smoke produced by the electric knife had a good name — aerosol, fumes, or thermal plume. This layer of smoke not only disrupted visibility but also posed health risks to the doctors, so it needed to be cleared immediately. This was typically done with a suction device, but a more advanced method involved a specialized smoke evacuator.

Entering the vertebral canal, the electric knife was swapped for a scalpel, and the forceps in hand were exchanged for bipolar electrocoagulation.

The dissection within the vertebral canal proceeded close to the nerve roots. The heat from the electric knife could easily cause thermal damage to nerve roots, but the scalpel would not.

The scalpel in Yang Ping’s hands took on various postures, allowing the tip to excise the tumor around the nerve root from any angle.

However, the tumor had completely enveloped the nerve root, and as everyone pondered how to liberate the nerve root from the tumor’s compression, a section of the nerve root had already been exposed in the surgical field.

Under the malicious compression and torment of the tumor, the nerve root had lost its original luster and elasticity. What was once plump and smooth no longer existed, replaced by flattening and indentation.

Song Yun, as the assistant, was dazzled by the deft movements of the scalpel in Yang Ping’s hand. If it weren’t for today’s tumor excision surgery in the crannies, Song Yun would have never known that such an ordinary scalpel could be handled in this manner, how flexibly this instrument could be used.

"Professor, does this way of handling the scalpel have a name? Why have I never seen it in any textbooks?" Song Yun couldn’t help asking.

Indeed, if it weren’t for this special kind of surgery, Yang Ping wouldn’t be forced to use this self-taught technique that was beyond the textbooks.

When he initially mastered this technique, Yang Ping had not thought about naming it, so he casually named it: "Flower knife! Allowing the scalpel tip to be at the best angle at any time, especially suitable for complex anatomical areas."

"Flower knife," Song Yun thought, one still hadn’t mastered One-Stroke Flow, and now a new skill, Flower Knife, had emerged—it was a case of lifelong learning.

Song Yun remembered this name; he didn’t have time to observe how the surgical knife changed hands in Yang Ping’s hand as he had to concentrate fully on being a good assistant.

"Performing subperiosteal dissection is easy on the long bones of limbs, but it’s hard on the complex vertebrae. The vertebrae plate is relatively flat, making it easy to perform subperiosteal dissection. However, the complex anatomical parts such as the intervertebral foramen are almost impossible to do, but subperiosteal dissection is the safest, so when performing orthopedic surgery, you must master subperiosteal dissection on all terrains," Yang Ping commented.

The scalpel continued along the nerve root, reaching the intervertebral foramen. The tip adhered to the bone, constantly lifting the complete periosteum. The so-called subperiosteal dissection effectively meant to scrape off the muscle and tendon from the bone seamlessly; achieving removal of muscle and tendon en masse without leaving any residue on the bone—that’s the qualification for proper subperiosteal dissection, which means completely separating them from between the periosteum and the bone tissue.

The blade tip was actually circling inside the oval hole of the intervertebral foramen, inching its way in, and then continuing the dissection on the exit side.

"Professor Yang is busy right now."

"I’m just taking a look."

The cardiac surgery had ended, and during the interval before the next surgery, Director Wen, with Director Zhang in tow, came to see Yang Ping—a few minutes to complete a coronary bypass, and the same person turned out to be an orthopedic doctor.

There were quite a few people in the Operating Room, and the two big names couldn’t find appropriate places, so they could only observe the operation on the screen from a distance.

The young doctors all concentrated on the surgery, with none noticing anyone coming in.

Several intervertebral foramina were dissected in this manner, followed by the tumor excision outside the dura mater. Aside from the intraspinal tumor, Yang Ping planned to clear the tumor in the vertebral canal completely to achieve thorough decompression.

There was no clear boundary between the tumor and the dura mater, but Yang Ping still found a latent invisible dividing line.

The tumors inside the spinal cord remained untouched, while the tumors outside the dural sac, especially those responsible for pain in the nerve roots, had been completely peeled off, even the intervertebral foramen had been cleaned, making the entry and exit of the nerve roots appear very relaxed.

In theory, the nerve roots had been liberated from the pressure of the tumor, and the pain should be relieved, but the actual results were unknown, as there’s much uncertainty in medicine.

If Yang Ping was willing, he could have cleanly excised the spinal cord’s tumor, but doing so would be pointless and recklessly increase the potential for a high-risk paralysis. The purpose of surgery is to resolve issues; when that cannot be achieved, no matter how beautiful the surgery is, it is meaningless.

Surgery is a means, never an end!

"You go ahead with the surgery; I’ll watch here."

"Shall I call you over when it’s time to eat?"

Director Zhang, captivated by the surgery, decided to stay and watch the surgery, as Director Wen had to return to his own Operating Room.

How could the surgical knife on the screen be so agile, able to dissect from different angles, as if the surgeon’s hand holding the knife could move 360 degrees, just like a robotic arm?

Director Zhang couldn’t help his curiosity and approached the Operating Table to see for himself how the knife was being manipulated so flexibly without understanding how it was grasped.

What kind of gripping technique was this, and why had he never seen it before?

As an experienced doctor, Director Zhang was proficient in all kinds of gripping positions—the pencil grip, violin bow hold, palmar grasp, and reverse pick—but he had never seen this kind of hold. It was reversible, adaptive, worked in all directions; this young man was indeed unconventional, even in his way of holding the knife.

Director Zhang was attentive, watching how Yang Ping’s hands moved, then he took a pen from the shelf and held it in a similar manner to test it out; indeed, it was just as he observed—flexible when needed, stable when necessary.

The anesthesiologist watched Director Zhang, who felt a bit embarrassed and chuckled.

The anesthesiologist pointed to the pen in his hand, "That’s my pen; I need to record some things. Could I have it back, please?"

PS: I’m a bit busy today, so I’m posting less, please excuse me!