Surgery Godfather
Chapter 724 - 645: What is the Level of the Golden Knife Award?

Chapter 724: Chapter 645: What is the Level of the Golden Knife Award?

As expected, Professor Liang’s heart was refreshed after reading the information brought by Yang Ping. His face was rosy and he seemed invigorated, no longer coughing. He ate a full five bowls of rice at noon and consumed nearly half a duck.

Those present were all familiar juniors, so his eating habits were no secret and he did not need to maintain formalities at home.

Professor Liang’s appetite, among the elderly, should be one of the highest. Yang Ping suspected that they had never fully satisfied his hunger when entertaining him in the past.

Wasn’t it mentioned that he had a viral acute upper respiratory infection? Could the virus have been killed this quickly?

Professor Hu Guolin and Song Yun were completely puzzled, but Professor Liang’s wife understood her husband’s temperament, so she was not surprised.

After lunch, Professor Liang said to his wife, "Later, please take my temperature for me. If it’s normal, I consider going back to work in the hospital."

"It’s Saturday today, why not take a break and recuperate a bit?"

Teacher Luo was still a little worried.

Professor Liang retorted stubbornly, "Five bowls of rice, half a duck, have you ever seen a patient who can eat this much?"

"Fine, you can go. Guolin, keep an eye on him," Teacher Luo reluctantly agreed, but she was still worried and instructed Professor Hu Guolin to take care of him, as he had been bedridden for three days.

"Have there been any special patients these past few days?"

He had been bedridden for a few days and just regained his strength today, naturally he was concerned about the patients in his department.

"There is a special case, a chordoma, invading the 2nd, 3rd, and 4th lumbar vertebrae. It was decided in the case discussion to operate: posterior-anterior-posterior approach, total vertebrectomy of the three vertebrae, tumor removal, implantation of 3D printed titanium alloy artificial vertebrae, and posterior pedicle screw system fixation. The surgery is massive, with high risk, probably taking more than twenty hours. We still haven’t scheduled the surgery, we are waiting for you to supervise."

Professor Liang has already handed over the position of Department Director to Professor Hu Guolin, but he still insists on making ward rounds and performing surgeries.

As soon as Professor Liang heard, he knew, "This is a world-class surgery. There are very few in the country who can perform total vertebrectomy surgery, let alone tumor resection and vertebral reconstruction. Perhaps only three or four hospitals in the country can do it. Such cases are rare. Peking Union Medical College Hospital and Huaxi Hospital have done it, albeit only for two vertebrae, taking about fifteen hours."

"Exactly, so we have to be fully prepared before we dare to start. The patient came to us because of our top-tier reputation." Professor Hu was also very meticulous and only scheduled the surgery after thorough preparation.

As soon as Yang Ping heard about the surgery, he immediately became excited. These were the kind of operations that were truly interesting.

The anatomical structure of the vertebra is extremely complex, made even more so by the invasion of the tumor. Within, there is the spinal cord, and the outside is entwined with various crisscrossing blood vessels. In front, there are the aorta and the inferior vena cava. To simultaneously cut away three full vertebrae along with a tumor and then perform reconstruction is no small feat.

This surgery is a colossal project.

"Let’s go. Let’s visit the ward." Upon hearing about this case, Professor Liang was as if injected with an adrenaline shot. He didn’t even need his usual post-meal rest.

---

Professor Liang, Professor Hu, Song Yun, and Yang Ping walked to Peking Union Medical College Hospital.

The distance from Professor Liang’s home to Peking Union Medical College Hospital was not far, and walking served as his post-meal stroll.

That earlier viral acute upper respiratory infection was a passing cloud.

When everyone arrived at the Orthopedics Department of Peking Union Medical College Hospital and saw the spirited Professor Liang, they were puzzled. Wasn’t he supposed to be sick? He did not look ill at all?

Everyone had just completed their professional training, and the doctors’ office was bustling. Everyone was busy.

Seeing Professor Liang and Director Hu, everyone greeted them respectfully.

A few doctors recognized Yang Ping and, upon recognizing him, became very excited. They ran over to chat with Yang Ping.

These doctors had all participated in the animal experiment in Guilin, and their names were even listed in Yang Ping’s published papers.

"Director Hu, bring us the medical record of the patient you mentioned, and let us discuss it in small groups," Professor Liang sat down and ordered Professor Hu Guolin.

Song Yun immediately went to fetch the medical record. He then opened the computer and projected the patient’s medical information onto the screen.

Seeing now that Professor Liang was about to review this case, everyone put down their work to listen attentively. The younger individuals all held notebooks. The spirit of learning at Xiehe was indeed good.

Jing Yunsong, male, 48 years old, was admitted to the hospital for waist and back pain accompanied by numbness and pain in the anterolateral part of the right thigh for seven months. Physical examination: tenderness was found at the second, third and fourth lumbar vertebrae and there was decreased sensation in part of his thigh’s lateral skin. Additional examination: an MRI scan of the lumbar spine showed occupative lesions of the second, third and fourth lumbar vertebrae, suggestive of chordoma.

The tumor of the second lumbar vertebra has grown into the spinal canal and is significantly compressing the spinal cord and nerve roots, causing damage to the cauda equina and conus medullaris; The tumor of the third lumbar vertebra has grown into the abdominal cavity, forming a huge soft tissue mass, which is adherent to the anterior aorta and inferior vena cava; The tumor of the fourth lumbar vertebra, by contrast, has invaded a much smaller area.

After Song Yun reported the case, everyone began to ponder.

Chordoma is a rare malignant tumor that occurs in the base of the skull, vertebrae, and sacrum, with an incidence rate of about 0.8 per million per year. Without effective treatment, the five-year survival rate is only about 30%, which is extremely low.

Chordomas are not sensitive to traditional radiotherapy and chemotherapy. Of the three weapons - surgery, radiotherapy, and chemotherapy - only surgery remains, so surgical treatment is the main treatment for chordoma.

The chordoma is extremely prone to recurrence after surgery. Once it recurs, it often damages the spinal cord nerves, leading the patient to suffer from urinary incontinence, paralysis of the lower extremities or even death.

Therefore, whether the tumor can be completely removed during the first surgery is the key to the treatment of chordoma.

For Jing Yunsong, out of his five lumbar vertebrae, three are affected by the tumor. Essentially, the tumor has invaded three-fifths of his entire lumbar spine. To completely remove the tumor, all three vertebrae must be removed, there is no other option.

The structure of the lumbar vertebra is very complex, with spinal nerves inside and the abdominal aorta and inferior vena cava in front, surrounded by numerous blood vessels, muscles, etc. Moreover, the shape of the vertebrae is a complex irregular one.

To completely remove the vertebrae, all normal structures around the vertebrae must be protected. Then they can be safely separated from the vertebrae for removal.

Therefore, complete en bloc vertebrectomy is also the most difficult and technically demanding surgery in the field of spine surgery.

Jing Yunsong’s tumor involves long and wide segments of the lumbar spine. The tumor grows invasively in all directions, forming a mixed state intertwined with surrounding tissues. In this state of confusion between friend and foe, the difficulty of surgery is further compounded by the need to remove the tumor and protect the already damaged spinal nerve.

After removing the vertebrae and tumor, the spine, which serves as the axial bone of the human body, will be missing three sections. It will be like a building without a load-bearing wall. Therefore, it is not enough to just remove the vertebrae, the removed vertebrae must also be reconstructed.

Traditional titanium mesh and other supports cannot substitute for the load-bearing function of the vertebrae, it’s a must to use 3D printing technology to manufacture personalized three-section vertebrae to rebuild the human "load-bearing wall".

Mr. Jing visited the top hospitals across the country. This time he came to Xiehe out of its reputation, hoping to get the best treatment.

"Surgery is the only treatment method, and everyone agrees on this point. There’s no question about the surgical method either. All three vertebrae along with the tumor will be removed, and then a 3D printed artificial vertebra will be implanted. Lastly, it will be fixed together with the normal vertebrae above and below using pedicle screws. The surgery is very difficult. We did two vertebrae last time, and it took us fifteen hours. Huaxi has also done one case," Professor Hu organized the case and repeated everyone’s discussion.

Xiehe is the ultimate destination for patients in Chinese hospitals. Once the patients come here, they no longer have the thoughts of transferring to other hospitals.

This is the final stop for medical treatment.

If the treatment is not effective here, the only option left is to go home and live well.

The doctors familiar with Yang Ping had an idea in their mind: If Yang Ping were to perform this surgery, would he be able to do it? How long would it take?

What exactly is the standard of the Golden Knife Award?

What exactly is the standard of the top surgeons in the country?

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