Surgery Godfather
Chapter 489 - 445: Shadows of the Past

Chapter 489: Chapter 445: Shadows of the Past

The aorta and inferior vena cava were separated up to the diaphragm opening.

In addition to separating the main trunk, countless branches had to be separated, with the branches separated to a sufficient length, otherwise during spinal correction, the powerful pull would tear the blood vessels, causing the patient’s chest to fill with blood instantaneously.

There are too many branches, each with its own branches, and almost all the main branches need to be separated like this.

This is detailed work, and there’s no way to speed it up, with Yang Ping meticulously separating the old adhesions one by one with the tip of his scalpel.

It requires patience, one cannot be impatient, discouraged, or negligent.

In addition to the heart and large blood vessels, the chest cavity also contains the thymus, lungs, trachea, and bronchi.

Now that the issue with the heart and large blood vessels has been dealt with, the thymus does not need special treatment, what’s left are the lungs and the trachea to handle.

Under the inflating machine, the lungs are expanding and contracting. The current state of the lungs is very good, and they will not be affected during the upcoming spinal correction. Some adhesions were easily dealt with by Yang Ping.

However, the trachea and bronchi are not so optimistic and need to be separated carefully like large blood vessels.

The trachea and bronchi are behind the heart and large blood vessels. Yang Ping put in two rubber strips, bypassing the aorta and superior vena cava, pulling them aside, then clamped the ends of the rubber strips with large curved forceps, giving them to the second and third assistants who were in charge of exposure.

Opening the aorta and superior vena cava revealed a window, and the hidden trachea and bronchi were exposed.

If the previous separation of the aorta and superior vena cava hadn’t been done, they wouldn’t be independently formed and wouldn’t be possible to open. The trachea and bronchi couldn’t have been exposed, and without exposure, surgery wouldn’t be possible. Exposure is a prerequisite for surgery.

Exposure of the trachea is easier than exposure of blood vessels, because of its ring-shaped fiber cartilage structure, which makes it easier to distinguish from blood vessels and surrounding adhesion tissues.

Once the trachea and bronchi are freed, the treatment of the thoracic organs is not over. Organs in the human body must have proper suspension and fixation, otherwise they will pile up due to gravity and movement.

Yang Ping had already considered this. During the treatment of adhesions, some suitable for suspension were retained, but there are very few of such adhesions.

In order to give these organs good fixation, suspensions must be rebuilt for them at key points. This seems simple, but is extremely complicated.

If there is no suspension and fixation, simply, while running, the five to eight meters long intestines will either pile up due to gravity, or twist into knots. But the fact is that this doesn’t happen, whether we’re running or even doing a few somersaults, the organs and intestines remain fixed in their original positions.

This is because our organs have a specialized structure to fix them, these fixing structures are membranes, but the fixation can’t be too rigid, it has to give the organs certain room for pulsation or peristalsis.

The main blood vessels emanating from the heart run in all directions and have a fixing function, but this is far from enough. The main structure holding the heart in place is the pericardium, so after stripping the pericardium, it should be done just okay, not completely removed, leaving the heart as smooth as an egg.

The abdominal organs are fixed to the body wall by the omentum, mesentery, and ligaments.

The intestines are wrapped and fixed by the omentum and mesentery, and the liver, gallbladder, pancreas and spleen are also fixed by many ligaments.

So, after separating the thoracic organs, the next key step is to recorrect or rebuild their fixation structure, allowing them to stay in their proper places and hold their posts.

This is beyond the understanding and operating capabilities of general surgeons. Few operations require such comprehensive consideration. Apart from rebuilding of joint ligaments in sports medicine, rarely has reconstruction of ligaments in internal organs been considered.

The majority of ligament structures have been separated by Yang Ping, but because they are contracted, they need to be extended. Very few need to be shortened because they are relaxed, and some ligaments need to be reconstructed.

Considering that the healing of the reconstructed ligaments takes time, Zheng Baosheng will be restricted in movement after the operation, he’ll be doing gentle activities on his bed for two weeks, start moving around after two weeks, and cannot engage in sports for three months.

Yang Ping began operating on these ligaments and mesenteries again, extending, shortening, or reconstructing them. The removed pericardial tissue was put to use at this time, being recycled and serving as a supplier of reconstruction materials.

Only after every ligament had been carefully handled, could the thoracic organs be considered fully treated. It seemed as if they were still squeezed together like before, but this was only a superficial phenomenon. In reality, they’ve already said goodbye to the previous adhesions.

Only due to the space limitation, they still have to squeeze together.

If the spine were suddenly to regain its normal curve, the entire thorax volume would expand, and these organs would immediately be able to be distributed in the chest cavity, placed in their correct positions, like in a normal person.

The diaphragm opening, where the chest and abdominal cavities connect, the aorta, inferior vena cava, and vagus nerve and esophagus all enter the abdominal cavity through their respective gaps.

The dome-shaped diaphragm is now also like a collapsed roof, losing its proper shape and full of wrinkles. If these wrinkles aren’t undone, once the spine is corrected and the thoracic volume is restored, they will also be pulled and torn.

Like a folded lotus leaf, the diaphragm needs to have its wrinkles opened, allowing it to gain the ability to expand, adapting to a future normal posture.

Once the diaphragm is dealt with, it is time to open the abdomen, with a midline incision for the abdomen as well.

"Is it the liver and pancreas next?"

Professor Li was very careful, even holding his breath while speaking.

Yang Ping nodded.

Going beyond the diaphragm, entering the abdominal cavity, was no longer Professor Li’s area of expertise.

"Let’s have Dr. Song do it?" Yang Ping thought it would be more suitable to have Song Zimo assist in the next step.

In the training of the compound trauma surgery, Song Zimo had already become very familiar with the anatomy of the entire body. In terms of the heart and large blood vessels, Song Zimo was far behind Professor Li Zehui, but when it came to the anatomy of the abdominal cavity, he definitely surpassed Professor Li. It had nothing to do with fame.

Being straightforward is the greatest conscientiousness of a doctor.

"Dr. Song will assist in the next step after the treatment of the diaphragm is complete, and I will be the second assistant."

Professor Li followed the arrangements of the Chief Surgeon.

The organs found within the abdominal cavity are much more optimistic than those in the thoracic cavity, as they go through far less transformation.

---

A group of esteemed orthopedic surgeons, eager to witness the correction of scoliosis, are now engrossed in watching thoracic surgery.

The young man’s familiarity with anatomy, especially during heart and large blood vessel surgery, whether separating adhesions or carrying out suspension fixation, is nothing short of marvelous craftsmanship.

With such a firm grasp on anatomy, any surgery in his hands would seem much simpler compared to others.

Professor Qin is becoming more and more fond of this young talent.

Even if he does not poach him, he is committed to making Sanbo Hospital the 301 hospital’s medical center in the southern region.

With the support of the leadership and his own efforts, this endeavour is eighty percent likely to succeed.

---

The surgery of the abdominal cavity organs was quickly completed by Yang Ping, which mostly involved the separation of adhesions, and there was no need for fixation. The positions and lengths of the original ligaments did not need correction either.

Once the organs in the thoracic and abdominal cavities were taken care of, the main part of the surgery was completed.

A seemingly impossible surgery was systematically and successfully carried out by Yang Ping.

At this moment, Professor Li felt nothing but admiration.

If he hadn’t seen it with his own eyes, he wouldn’t have believed that anyone could complete such a procedure or possess such proficiency in human anatomy.

"You take a break, I’ll handle closing the chest and abdomen," offered Professor Li, fulfilling his duty as the First Assistant.

Yang Ping indeed needed a rest. He left the remaining work to Professor Li and Song Zimo.

They began by cleaning the surgical area, then placed drainage tubes and performed layered suturing from the inside out, to close the chest cavity and abdominal cavity. Holes were then drilled into the split sternum and steel wires were used to pull it together and secure it.

Next, it was time to correct the scoliosis while the patient was in a prone position.

All sterile sheets were removed, the patient was turned over to a prone position, and the area was disinfected and reclothed in fresh sheets.

There are strict guidelines for changing the position of the patient on the operating table.

These include tasks for several individuals, positioning, responsibilities, and hand gesture guidelines.

A head nurse from the Peking Union Medical College Hospital compiled a book called "Safe Surgery Positioning Atlas".

This is probably the only professional work in the country that systematically introduces how to position for surgery.

In Europe and America, there are specialized positioning technicians in the operating room. They specifically assist patients in adjusting their positions to facilitate the doctors’ comfort during surgery.

One should not underestimate the importance of the patient’s surgical position. A good position can make surgery much easier, while poor or incorrect positioning often increases the difficulty of surgery, sometimes making it impossible to complete, and causing complications.

This is the difference between crude and refined techniques.

If Zhang Lin and Little Five managed to publish "Hooking Techniques in Surgery", it would undoubtedly be a pioneering work that fills a gap in the domestic market and potentially even on the world stage, as they have advanced hooking techniques from rudimentary to sophisticated.

The outcome is unimaginable when you take something as simple as an apple falling from a tree and study it academically.

---

"Little Five, Zhang Lin, take the stage!"

After changing the patient’s position, Yang Ping removed his surgical gown and gloves to take a break, while Song Zimo led them to disinfect and expose the area, fixing the pedicle screws in place. Yang Ping returned to the operating table for the osteotomy procedure.

"Alright!"

Zhang Lin, trailing his urine bag, followed Song Zimo out to scrub in.

Because he walked too quickly, the urine bag swung back and forth against his thigh.

Upon seeing the urine bag hanging from Zhang Lin’s trouser leg, Professor Li immediately understood what was going on.

He recalled a time when he was a low-ranking resident, he and a senior resident drank a lot of beer and happened upon an emergency surgery. Professor Li had no choice but to sneak a urine bag onto the operating table where he had a secondary role.

The senior resident who had been drinking with him was not as clever. Standing as the First Assistant during the surgery, he could no longer hold his urine, so he had to ask his mentor for permission to urinate!

Angered, the mentor let the First Assistant go to urinate, then turned to Professor Li and said, "I’ll remember you. From now on, you will be the First Assistant."

A simple urine bag had dramatically changed Professor Li’s standing in the mentor’s eyes.

Those who can achieve great things are often the ones who can be harsh on themselves.

This young man somehow reminded him of his younger self.

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