Surgery Godfather

Chapter 2214: Chapter 1446: The Great Talent Snatching War (Part 3)

Each of these operations taken separately is a high-difficulty surgery in the Thoracic Surgery Department, let alone both combined.

What’s more problematic is that there is adhesion between the tumor and the superior vena cava. Although there are no clear signs of invasion, the position is too close, so close that during separation, it may cause damage to the vein wall at any time. If the superior vena cava ruptures, the bleeding will be very torrential, and stopping the bleeding will be extremely difficult.

Yang Ping flipped through a few pages and focused on the image in the mediastinal window.

"How are the lymph nodes?" he asked.

Director He was prepared, took out a folded piece of paper from his pocket, unfolded it, and handed it to Yang Ping: "Preoperative staging was done with EBUS, with one positive in the 2R area and another in the 4R area, no clear signs of metastasis in other groups of lymph nodes. PET-CT shows the SUV values of these two lymph nodes are low, one is 4.2, the other is 3.8, so it should be N2 stage, but not N3."

Yang Ping nodded. N2 stage implies ipsilateral mediastinal lymph node metastasis, although not early, it’s not completely without surgery opportunity. The key is whether these two positive lymph nodes can be cleaned completely.

"What about the opposite side?" Yang Ping asked again.

"Random multi-point puncture of opposite lymph nodes was done, all negative."

"That’s good." Yang Ping put down the paper, "This case can be done, but there are several key points you need to pay attention to."

Director He immediately took out a notebook, knowing that every word uttered by Professor Yang might be invaluable experience, so he had to record it word for word.

"First, the method of carinal reconstruction." Yang Ping pointed to the image of the carina position on the screen, "With such a large resection area, simple end-to-end anastomosis definitely won’t work, the tension would be too great. I suggest you do left main bronchus-trachea end-to-side anastomosis, and then anastomose the right main bronchus to the side wall of the left main bronchus, forming a ’side-end-side’ structure. This way, there is no tension at the anastomosis, and the blood supply is good."

Director He quickly recorded, nodding while typing.

"Second, pulmonary artery replacement." Yang Ping continued, "What material do you plan to use?"

"I originally planned to use Gore-Tex artificial blood vessel." Director He said.

"Gore-Tex can be used, but I suggest you apply a layer of biological glue on the blood vessel wall before anastomosis." Yang Ping said, "This surgery will definitely require postoperative anticoagulation, although the pulmonary artery pressure is lower than the aorta, the risk of bleeding at the anastomosis is still high. Biological glue can help seal the anastomosis, reducing postoperative bleeding."

Director He nodded repeatedly, he truly had not thought of this detail.

"Third, and most importantly." Yang Ping turned around, looking into Director He’s eyes, "In this case, the biggest intraoperative risk is not bleeding, nor anastomotic leakage, but airway management."

"What do you mean?" Director He was taken aback.

"Think about it, after carinal resection and reconstruction, the anastomosis of the trachea and main bronchi is right there, and your surgical approach is median sternotomy plus right anterior thoracotomy incision, postoperative patient’s cough reflex will be greatly affected. Once sputum cannot be discharged, and accumulates near the anastomosis, mild cases may cause atelectasis or pneumonia, severe cases may lead to anastomosis dehiscence." Yang Ping paused, "So, for this case, postoperative fiber optic bronchoscope suction must be frequent, at least twice a day, without interruption for the first three days."

Director He meticulously recorded these words.

Yang Ping pointed to another image on the screen, saying: "Another detail, although the superior vena cava doesn’t have a clear invasion, you must be cautious during separation. I suggest you place a blocking band on both the proximal and distal ends of the superior vena cava. In case it ruptures intraoperatively, immediately block it, control the bleeding, and then repair it. Don’t wait until it breaks open before scrambling."

"Understood!" Director He recorded this sentence as well.

Yang Ping checked the time, unknowingly he had been speaking for nearly ten minutes. He handed the mouse back to Director He, leaned against the back of the chair: "That’s it, go back and think it over. This surgery can be done, but it cannot be rushed, preoperative preparation must be sufficient, intraoperative operation must be meticulous, postoperative management must be in place, all three phases are indispensable."

Director He, as if finding a treasure, put his phone back in his pocket, continuously expressing his thanks: "Thank you, Professor Yang, thank you, Professor Yang! When I return, I’ll redo the plan according to what you said, and invite you to review it once the plan is ready."

"Go ahead." Yang Ping waved his hand.

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