When the Doctor Uses A Hack
Chapter 1079 - 1082: The Persistence of 22°

Is a perfect-level large blood vessel anastomosis really perfect enough?

Chen Cang looked at his suturing and began to ask himself such a question!

What is perfection?

Perfection is a threshold achieved with the current means at hand.

But the current means are inherently limited.

Whether it's surgical skills or surgical plans, there is room for improvement and refinement.

This is a process that requires continuous research and advancement.

If perfection is still so sought after, what more for a master level.

Chen Cang's current aortic dissection surgery and total arch replacement are both at a master level.

To break through to perfection, there is still a long way to go.

"Number four suture."

"Irrigate with saline!"

"Hemostat clamps!"

…

The surgery continues.

Facing the repair of the intercostal arteries, Chen Cang began to calmly observe them, the third rib… the fourth rib...

Chen Cang suddenly asked Xu Ziming: "Is there a big difference in the time constraints for blood supply to the spinal cord from the intercostal arteries?"

Xu Ziming nodded: "Yes, according to the 2009 guidelines, completion within 60 minutes is possible, but later research found that actually around 45 minutes, signs of ischemic hypoxic response in spinal cord neural tissue already begin to appear. Although there is no direct manifestation, it poses some problems for later repair!"

Chen Cang looked at the complex array of intercostal arteries: "What's the optimal time?"

He Chao blurted out from the side: "Professor Wu from Ruijin Hospital can complete the repair of all intercostal arteries within 35 minutes! That is… my teacher."

Xu Ziming nodded: "Indeed, Professor Wu Nan is experienced with Marfan syndrome, has been dedicated to it for a long time, and continuously practices the repair of intercostal arteries."

After hearing this, Chen Cang nodded!

More than 20 arteries, 30 minutes!

All the time included, there's only a minute and a half per blood vessel, and this needs to encompass dealing with stitches, needle insertion… and so on!

The most important aspect of handling intercostal vessels is also to avoid damage to the intercostal nerves.

It's much more troublesome than dealing with large vessels inside the thorax.

Chen Cang can handle a grinding tool in thirty or forty seconds at the limit, but how long would it take in this case?

Chen Cang decided to find some time to practice.

…

After the surgery began, anesthesiologist Zhou He has been monitoring the patient's vital signs, because the surgery takes a long time, it's necessary to choose appropriate brain protection.

In fact, if the patient did not have Marfan syndrome and was merely an acute type I aortic dissection, they could only undergo ascending aorta replacement or hemi-arch replacement.

But with Marfan syndrome, the originally damaged ascending aorta and aortic arch have undergone fibrous layer changes, and if not controlled, problems are inevitable!

Using total arch replacement is definitely good, or using the common "elephant trunk surgery" also has significant effects!

But this actually places high demands on both the patient and the lead surgeon.

Not only does it require the lead surgeon to be skilled, but also the patient's overall condition to be good to ensure the surgery proceeds smoothly.

Athlete Tian Zhengkai has an excellent foundation, and Chen Cang is skilled enough, so at this time, total arch replacement is actually the best choice!

Ascending aorta handled!

The patient's vital signs are completely normal, ready to perform total arch replacement surgery!

Chen Cang took a deep breath and said: "Cool down!"

Hypothermia, circulatory arrest, combined with retrograde perfusion through the superior vena cava are effective strategies for brain protection!

Everyone began to get busy!

"What temperature to adjust to?" Zhou He looked at Chen Cang and asked directly.

"Adjust to 20 degrees Celsius!" Chen Cang said decisively!

Zhou He was taken aback!

Low temperature and circulatory arrest are directly related.

The lower the temperature, the longer the allowable time for stopping circulation— at 15~18 degrees Celsius, it can be maintained for 60–80 minutes!

This way, the operable time becomes much more ample.

If the temperature is higher, the time is limited, but... the patient's damage might be slightly less.

However, similarly, if you have more time, the patient might have to pay a price!

Why do they say medicine is difficult?

Because the time we fight for is actually given by the patient, and the patient's time is being devoured by the Reaper!

Every additional minute we use, the disease causes damage for one more minute, and the Reaper devours a little bit more!

It's like a tug-of-war competition, where the stake is time.

Whoever snatches the patient first, wins!

Perhaps at this moment, the feeling of competing with the Reaper for time becomes even more apparent!

And Chen Cang's choice of 20 degrees Celsius suddenly increases the demands on the doctor, because the operable time gets shorter, but at the same time, the damage to the patient is also reduced.

Zhou He glanced at Chen Cang's resolute eyes and nodded!

And Xu Ziming and He Chao also sighed in admiration: Chen Cang, this is Chen Cang indeed!

He Chao was even more filled with anticipation and excitement.

When cooled to an anal temperature of 20°C, circulatory arrest or additional retrograde perfusion through the inferior vena cava is completed simultaneously!

Chen Cang began dissecting the aortic arch!

The tense atmosphere!

The feeling of coldness in the hands!

The anxious ticking of the clock!

The beeping sounds from the monitor!

The breathing of the doctors became more and more distinct.

All signs indicated that this was a highly difficult surgery.

Dissecting the distal end of the aortic arch is a meticulous operation.

It's important to carefully identify the vagus and recurrent laryngeal nerves, to firstly dissect then use a suture to retract the nerves, especially to avoid injuring the recurrent laryngeal nerve when dissecting the lower edge of the arch.

Agile and steady, Chen Cang carefully steered clear of danger.

In less than eight minutes, he successfully completed the dissection!

Xu Ziming and He Chao exchanged glances full of surprise.

Such rapid and accurate dissection of the aortic arch saved a lot of time for the upcoming replacement surgery.

What seemed like a routine operation was full of details and invisible techniques.

Yet, for the experienced Xu Ziming, it was also an opportunity to learn and hone skills.

He Chao became somewhat excited.

Chen Cang's dissection time was in no way inferior to that of his own teacher.

Immediately afterward, Chen Cang put down the dissecting forceps and began trimming the aortic arch!

He then selected an appropriate artificial blood vessel and used 4-0 polypropylene suture to first sew the descending aortic opening.

Chen Cang spent even less time on this process; as the champion of the major vascular suturing contest in the cardiac surgery technical competition, Chen Cang felt almost no pressure dealing with these tasks.

After that, he began to sew the posterior wall containing the openings of the 3 branch vessels of the arch, where meticulous care is required to prevent bleeding from the branches and directions of the vessels.

This is the aorta, where the blood pressure is very high; any cracks or such could be a potential disaster for the patient!

Therefore, the anastomosis of the artificial blood vessel and the vessel is the key to the surgery!

It must be not only fast!

But also tight!

That's the keynote of the entire operation!

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