Surgery Godfather

Chapter 2211: Chapter 1445: Enlightened in an Instant (Part 2)

Diffuse microvascular disease: Target vessel diameter is less than 1mm, or a long segment is diffusely narrowed, making it difficult to find a suitable anastomosis site. Even using a microscope with 25x magnification, with sutures thinner than a hair, there might still be an issue with anastomosis failure or long-term failure.

When these two factors combine, it is practically a devil’s combination for coronary bypass surgery. Doctors need to use no-touch techniques to avoid the aorta and must work with extremely limited graft vessel materials. The graft vessel may only be a single vein, requiring multiple anastomoses to connect a bunch of fragile tiny blood vessels. It’s like sewing the thinnest gauze on a rocking boat with the finest thread and only having one chance to get it right.

"How is the overall condition?" Yang Ping asked.

In any surgery, you must be familiar with both local and overall conditions. Sometimes, the overall condition is the key factor in deciding whether or not an operation can proceed and how it will be performed.

"It’s extremely, extremely special!" Xia Shu seems not too proficient in the arts, with vocabulary of the "holy crap" level.

Now with four ’extremely’s piled up, it really is a special case. Yang Ping sat up straight.

Xia Shu stood next to him, the nurse brought over a stool, Xia Shu waved his hand: "I’ll stand, standing is comfortable."

"Left main stenosis is 90%, and the right coronary is also occluded, relying only on a single obtuse marginal branch for blood supply."

During anesthesia induction, even a slight drop in blood pressure might lead to cardiac arrest. It needs to be completed extremely quickly and accurately in non-extracorporeal circulation, with the heart beating, for left main anastomosis.

"Severe COPD!"

Unable to tolerate single-lung ventilation, the traditional extracorporeal circulation is extremely risky; perhaps only extremely minimally invasive or beating-heart surgery can be selected.

"Extremely poor coagulation!"

Postoperative bleeding and infection risk are extremely high; such patients require almost heparin-free operations after bypass, which makes the anastomosis highly prone to blockage.

That’s already three ’extremely’s. Yang Ping was just about to express his opinion.

"And it’s a repeat surgery," Xia Shu immediately added.

Yang Ping mentally calculated, a total of six ’extremely’s; this case would be directly rejected for bypass surgery anywhere, yet Xia Shu dares to take it.

"Professor, it’s because I have strong support, so... so I didn’t think much and accepted it. You said the institute is my maiden home, my forever backing. I’ve already told the patient and family, we..." Xia Shu rattled on.

"Enough! Don’t waste words, what else is extremely, say it all in one go, don’t be as disjointed as a sheep passing stool," Yang Ping said impatiently. Xia Shu usually quite simplistic, but since marrying, has become slick and smooth-talking, his eloquence has improved greatly.

"Old patients with ’ceramic aorta + poor diffuse distal vascular conditions + repeat surgery’, these cases are often referred to in the literature as ’hopeless coronary bypass’, many centers directly choose not to do it."

"The acknowledged hallmark of technical peak is: completing full arterialization, no aortic contact, and complete revascularization under beating-heart, non-extracorporeal circulation, especially when all proximal anastomoses are done inside the chest using ’T’ or ’Y’ combinations with only bilateral internal mammary arteries and radial arteries." This is an extreme test of the operator’s psychology, skills, and team collaboration.

"Your case ticks all the boxes. Are you trying to be the world’s first?"

Yang Ping’s final remark hit the nail on the head; this case is obviously not a normal case, it’s definitely a Mount Everest case.

"Our hospital many departments have received global firsts, Asia firsts, our department also needs to present something, right... But the most important thing isn’t these; academic fame and honor are secondary, external matters, the most important is that we must have a heart fully devoted to serving patients, to alleviate patient’s pain, shouldn’t retreat when facing difficulties, shouldn’t..." Xia Shu spoke excitedly, his speech more familiar than reciting textbooks.

"What has Cai Qiaojun been feeding you every day? You’re completely different now from the dull person you were when you came," said a patrolling nurse bustling about.

Another nurse chimed in: "Cai Qiaojun is indeed incredible, Xia Shu was eyed by many when he first came, who would have thought she would act so quickly, and by the time everyone realized, they already announced their marriage."

While others discussed academia, these seasoned nurses liked to talk about domestic trivialities, chatting endlessly. Director He Xiangjun from the General Thoracic Surgery heard that Professor Yang was in the surgery center and took a moment to come chat, hearing the nurses chattering as he entered.

Director He said: "Are you not convinced? Whether you’re convinced or not, you must be; this is efficiency. Unlike some who hesitate, even with good prospects, wait for others to pursue. Times have changed, so must concepts. Look, how many new PhDs have come to the Sanbo Research Institute, quite a few are single, how come there’s no action from you all? Maybe one could be an academician in the future, and you would be an academician’s wife. It’s like buying stocks, seeing others buy potential stocks and make money; you envy them. But now to buy stocks, amidst many potential stocks, you can’t tell any.

"We also know many potential stocks are at the institute, but what can we do; we can’t climb up to them and certainly can’t run to the institute to grab someone to date, can we? Why don’t you talk to the head nurse about organizing a meet-up with the institute?" A young and beautiful nurse said aggrievedly.

Another nurse was about to join the argument when Director He became serious: "Alright, Professor Yang and Dr. Xia are discussing surgery, and you chime in with trivialities, wait for getting off-duty, change into a pretty dress, spray some perfume, tidy yourselves up nicely, then take a stroll to the institute entrance. Spot a PhD coming out, approach and pretend to stumble and twist your ankle! The story thereafter - invent yourselves. The ready template is here, yet you won’t copy homework. If afraid of infringement, spill a cup of milk tea on him, then apologize and exchange WhatsApp to help with laundry. Those young doctors at the institute walk deep in thought with heads down; can’t you manipulate them? It’s their fault for not being manipulated; what can you do? When pathology’s Wen Ruzheng was there, you couldn’t even win him and he was taken by a provincial policewoman. You are a disgrace to Sanbo Hospital..."

Yang Ping listening on the side, hearing Director He admonishing nurses with such detail, also smiled, recalling how back then Cai Qiaojun twisted her ankle, and Xia Shu insisted on pushing her wheelchair for over a month, and pushing, they became family, truly a classic.

"Director He, Director He... I never thought you’d be such a master, can you guide us a bit?" A nurse finally realized.

"Drainage tube, drainage tube! Drainage tube!!"

Dr. He shouted three times while finishing up, directing Instrumental Nurse Cai to come back to her senses: "Oh oh oh..." She was just listening intently to Director He’s instruction.

The surgery was very smooth, quickly completing chest closure. Instrumental Nurse said to Dr. He: "Dr. He, I heard from Director He, before you came to Cardiac Surgery Department, you specifically researched a topic regarding lung nodules, on how to determine the benignity or malignancy of lung nodules from image pictures?"

"Yes, before Cardiac Surgery Department divided, I did research this topic, studying many CT images of lung nodules." Speaking about his area of expertise, Dr. He immediately showed interest, and the displeasure due to the nurse’s delayed cooperation earlier disappeared completely.

"Wow, you’re amazing, I’m glad to have found the right person; my dad’s chest CT during a check-up revealed a lung nodule, he’s very worried..." The nurse’s voice was gentle and anxious; her eyes filled with a yearning for help.

Dr. He immediately said: "Don’t worry, find a time, bring all CT scans over to let me help take a look."

"Okay, thank you so much; I’ll set a time with you after the surgery." The nurse said gratefully.

"Director He, later we’ll come to discuss what you were speaking about, can we get some more detailed guidance?" The beautiful nurse approached Director He and spoke.

Director He Xiangjun was momentarily dumbfounded; darn it, some people take forever to figure it out, while others get it right away. People, many times their fate truly is in their own hands.

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