Surgery Godfather
Chapter 817 - 732: Sitting through the Surgery

Chapter 817: Chapter 732: Sitting through the Surgery

After multiple blood transfusions, Lu Jiangbei’s hemoglobin had risen to 70 grams per liter and had not fallen again, indicating that her hemodynamics had stabilized.

Next, the team began preparing for Lu Jiangbei’s surgery. The implant for fixing the headrest to the upper cervical spine had been successfully printed by a 3D printer, and the details of the surgery had been finalized.

But there was an unresolved issue—how to safely change positions during the operation.

Lu Jiangbei’s surgery required anterior-posterior fixation, and both approaches were naturally needed for completion: the anterior approach requiring a supine position and the posterior approach needing a prone position. Due to the lack of reliable fixation, switching between these two positions presented many difficulties, and with Lu Jiangbei having multiple rib and pelvic fractures, the prone position was simply not achievable.

Another preoperative discussion about this issue began.

August and Robert, who had been temporarily borrowed by the trauma ICU, had returned to the team. Lu Jiangbei had managed to wait for surgery in a stable condition, largely thanks to their contributions.

In the Comprehensive Surgery Department’s meeting room, a high-definition screen was displaying an animation simulating the positional changes during surgery.

For this surgery, changing from a supine to a prone position during the operation was very dangerous.

Some surgeons skilled in upper cervical spine procedures had encountered this fatal issue before. After completing the posterior surgery, the patient had died unexpectedly during the turning process, which instilled fear in many spinal surgeons regarding the turning process in upper cervical spine operations.

To avoid turning, some experts boldly used an anterior approach through the mouth—going in through the oral cavity, cutting the pharyngeal posterior wall, exposing the upper cervical spine, and implementing solid anterior fixation.

Unfortunately, this patient had not only a traumatic atlanto-occipital dislocation but also a comminuted atlas fracture. Fragments of bone were at constant risk of invading the vertebral canal, necessitating a combined anterior-posterior approach to thoroughly resect the atlas, then implement combined fixation.

"I also lack experience in this area. For past cases that needed combined anterior-posterior fixation, I have always relied on turning to solve the problem, but this case is indeed tricky," admitted August, shrugging his shoulders habitually, indicating he had no immediate solution.

"Is turning really that difficult?" a graduate student, bold as a novice, voiced his doubt.

This student, having participated in several discussions, was filled with questions about why everyone was so cautious and careful about turning during surgery, to the point of holding special discussions.

No one mocked him, for he was a student after all. The fact that he raised questions showed he was deeply thinking.

"This case must use a combined anterior-posterior approach. If we follow the conventional surgical method, completing the first half of the surgery in a prone position and the second half in a supine position, we could resect the fragmented atlas and achieve solid fixation. However, during the process of changing positions, we are unable to use external supports for fixation, and conventional head fixators cannot provide enough stability, which means we cannot ensure that there won’t be any accidents during turning. The estimated risk of intraoperative death related to turning is fifty percent, and we doctors are not gamblers, so we must resolve this issue before surgery," Yang Ping patiently explained to the student.

The graduate student seemed to grasp the concept, nodding, then writing down notes in his notebook

"Actually, we could use an improved scaffold for fixation and redesign the existing head fixators, extending the fixation points back to the cervical spine. This way, the fixation pins of the scaffold would be distributed across both the head and the cervical spine, securing the head using the skull and the cervical spine using the vertebral laminae. We could even look for fixation points on the scapula or the clavicle to create a solid fixation scaffold. Of course, the design of the scaffold must leave ample space for surgical operations," said Xu Zhiliang fluently.

Song Zimo nodded in agreement with the idea, but there was one obstacle he could not bypass: "Lu Jiangbei has multiple rib fractures and comminuted pelvic fractures. The anterior side of the pelvis still has an external fixation scaffold that must be retained during surgery. Think about it, even if we could use a special scaffold to fix the head and cervical spine, how could she possibly be in a prone position? Can the thorax provide support? Wouldn’t the pelvic external fixation scaffold obstruct the prone position?"

"What about a lateral position? Could using a lateral position solve the problem?" Zhang Lin proposed boldly.

Song Zimo shook his head: "The lateral position not only makes it very difficult to perform the surgery through the mouth, but even the posterior approach would be challenging. Besides, like the prone position, it’s impractical due to the rib fractures and the pelvic external fixation frame."

What a headache, I didn’t expect this surgery to get stuck on the patient’s position.

August touched his head, Robert kept silent, and the discussion had reached a dead end, with this not working and that not working either.

"Could we just perform the surgery with the patient sitting up?"

Yang Ping had been listening intently to everyone’s speeches and now began to speak.

Everyone turned with a surprised look—sitting position?

"Although surgery is a bit difficult in the sitting position, it is at least feasible. It perfectly avoids the complications brought about by rib fractures and pelvic fractures, and there’s no need to turn the patient during the operation. If we use the sitting position, we can expose the area above the shoulders out of the operating table, fixed by an external fixator."

"That’s an excellent surgical position!"

August exclaimed, having never considered sitting position in his past surgeries, even when using anterior and posterior combined fixation, always resorting to changing positions.

"The advantages of this position are obvious. There’s no need to change the patient’s position during the surgery, and due to gravity, the blood and irrigation fluid in the surgical area can be cleared more easily. Venous return and cerebrospinal fluid drainage also become easier."

Dr. Song had no reason not to support Yang Ping, experience told him that whatever Yang Ping proposed was feasible.

"It also has advantages in terms of anesthesia. I can approach the patient’s face more easily, assess whether the airway is secure, if the endotracheal tube remains in place, and better monitor cranial nerves. And in case of a cardiac arrest, compressions are more convenient. If cardiac arrest occurs in the prone position, it would be much more problematic."

Liang Fatty felt indeed this position was more favorable for anesthesia.

August sighed, "Although the idea is good, the surgical operation will become difficult, and sitting position surgery might encounter many problems, such as unusual venous air embolism, intraoperative hypotension, symptomatic pneumocephalus, acute subdural hematoma, peripheral nerve damage, laryngeal or tongue edema, and aggravated limb paralysis. That’s why many neurosurgeons hate this position."

But Yang Ping was fully confident, "Compared to the fifty percent uncontrollability during turning over, the problems with this position are controllable. For example, intraoperative hypotension, Dr. Liang should have a way to avoid it."

Liang Fatty, sitting cross-legged, said, "Intraoperative blood pressure control is my specialty, don’t worry."

"Venous air embolism, our surgical maneuvers are gentle, and we try not to damage the veins," Yang Ping proposed a solution for each issue.

Perform the surgery sitting up!

For this case, theoretically speaking, sitting position indeed seemed like the best choice.

As a master of spinal surgery, August had performed countless surgeries as the chief surgeon, but he had never used the sitting position to complete this type of anterior and posterior combined approach surgery. He was eager to see how Yang Ping would accomplish this surgery.

"So, is this issue resolved?" Yang Ping wanted to know if there were any more concerns from the group.

Dr. Song muttered to himself, as everyone was discussing how to turn the patient over, how to change positions, while Yang Ping wanted to perform the surgery with the patient sitting up. Dr. Song felt that he was always a beat behind; why couldn’t he keep up with the pace?