Surgery Godfather

Chapter 2216: Chapter 1447: Professor Yang’s Words (2)

Xia Shu paused for a moment, indeed he had considered this question before but hadn’t found a good solution. He blinked, as if reevaluating the distance in his mind, then his expression became more grave.

"There’s another issue." Yang Ping continued, "Your great saphenous vein Y-shaped bridge is anastomosed to the right internal mammary artery. Is the flow at this anastomosis adequate? The right internal mammary artery itself has limited flow, and you are splitting it to supply the posterior descending branch and the postero-lateral branch of the left ventricle, which may lead to inadequate blood flow. It might not be a problem in the early postoperative period, but long-term competition for blood flow could lead to bridge occlusion. In other words, you should consider the long-term effect of this surgery."

Xia Shu’s face turned sombre, although most of his face was covered by a mask, the anxiety in his eyes was unmistakable. The two problems mentioned by the professor were increasingly critical.

"What do you think should be done?" Xia Shu humbly asked for advice, realizing he lacked assurance, felt his plan was missing something, hence the need to consult Professor Yang earnestly.

Yang Ping did not answer immediately, but took the pen from Xia Shu, turned over his paper, and drew a new diagram on the back. He drew quickly, but each stroke was confident, the lines smooth and clear.

"My suggestion is to abandon the radial artery in situ bridge plan." Yang Ping said while drawing, "You use the right internal mammary artery to anastomose to the anterior descending branch, which is the gold standard, don’t move it. Then use the great saphenous vein to make a long bridge, one end anastomosed to the right internal mammary artery, the other end to make three distal anastomoses to the obtuse marginal branch, the posterior descending branch, and the postero-lateral branch of the left ventricle. As for the radial artery, you should take it out and make a free bridge, with one end anastomosing to the great saphenous vein and the other end to the main trunk of the right coronary artery, if the right coronary main trunk is not usable, then anastomose it to the posterior descending branch to create dual blood supply."

Xia Shu stared at the newly drawn schematic, the expression above his mask gradually relaxing, his eyes almost glowing.

"There are several advantages to this." Yang Ping continued, "First, you only have one proximal anastomosis, that’s the one between the great saphenous vein and the right internal mammary artery, the others are distal, which is relatively easier to operate. Secondly, the great saphenous vein has large flow, enough to supply the three distal anastomoses. Thirdly, the radial artery as a free bridge is not limited by length and can be anastomosed anywhere, with great flexibility. Fourthly, the posterior descending branch having dual blood supply, even if one bridge vessel has an issue, the other can compensate, ensuring high safety and redundancy. This kind of surgery is different from usual surgeries, we need to have redundancy awareness."

"Brilliant!" Xia Shu couldn’t help but pat his thigh, the sound echoing in the operating room. Several young doctors and nurses doing finishing work looked over, and Xia Shu smiled bashfully.

Yang Ping put down the pen: "Of course, this plan has its difficulties. Your great saphenous vein needs to be long enough, at least over twenty centimeters. Pre-surgery, you need to do venous angiography to assess the quality of the great saphenous vein. If the vein is varicose or hardened, then this plan is not feasible."

"Understood!" Xia Shu carefully folded the paper with the plan, mimicking Director He’s earlier solemn action as if receiving an imperial edict.

Looking at Xia Shu’s serious demeanor, Yang Ping suddenly felt a warmth in his heart.

They are truly growing.

"Professor, there’s one more thing." Xia Shu took down the films from the viewing lamp one by one, speaking while doing so, lowering his voice slightly, "This patient’s coagulation function is extremely poor, both PT and APTT are significantly prolonged, and platelet function is also not good. We’ve done a thromboelastogram showing a deficiency in coagulation factors and platelet function, caused by medication."

"The patient has long been on dual antiplatelet therapy at an out-of-town hospital, later used anticoagulants due to gastrointestinal bleeding, several medications compounded, causing chaos in coagulation function. We have ceased all anticoagulants and antiplatelet medications upon admission, reexamined coagulation function with some improvement, but still not ideal."

"It’s been five days off medication now."

"However, five days is insufficient, cessation of dual antiplatelet therapy should take five to seven days, warfarin cessation takes three to five days, and with various drugs compounding, metabolism in the body could take longer. We think to wait another two days, then recheck coagulation function and thromboelastogram. Once the data returns to a range acceptable for surgery, arrange the procedure."

"But the patient’s angina symptoms are severe, occurring daily." There was clear urgency in Xia Shu’s voice.

Yang Ping understood Xia Shu’s dilemma, doctors making decisions often face two difficult choices. Waiting risks issues with the patient; not waiting bears the same risk. Just like standing at the edge of a cliff, moving forward is an abyss, stepping back is also an abyss, the only option is choosing the relatively less deep abyss to leap into.

"Let’s do this." Yang Ping considered a compromise plan, slowed his speech, and articulated it clearly, "Today and tomorrow prepare for the surgery, including prepping blood, prepping platelets, prepping coagulation factors. Recheck coagulation function the morning after tomorrow, if the data meets standards, the surgery can proceed in the afternoon; if not, wait another day, while intensifying medication treatment for angina to control symptoms as much as possible."

"Great!"

Xia Shu was very satisfied with this plan, he nodded heavily.

In fact, he also considered doing this, but having Professor Yang’s affirmation gave him much reassurance.

Yang Ping glanced at the surgery timer on the wall, unknowingly had been in the operating room for more than an hour. He stood up, stretching his somewhat stiff neck.

"Professor, are you leaving now?" Xia Shu also stood up, a bit reluctant.

"Not leaving, I’m going to check Neurosurgery." Yang Ping said, "Xu Zhiliang has five brainstem tumor cases today, I’ll take a look and go."

Xia Shu chuckled: "Professor, are you going to visit every department?"

Yang Ping pushed open the operating room door and walked into the corridor.

The corridor was quiet, as he walked forward along it, passing several operating rooms, each door with the red "Surgery in Progress" indicator lit. Through the small observation windows, he could see the busy silhouettes inside.

One operating room was performing laparoscopic cholecystectomy, the chief surgeon was a young doctor, skilled with agile movements, evidently well-trained. Yang Ping glanced twice, recognizing a new PhD in the General Surgery Department, having only joined last year and now independently performing laparoscopic surgeries.

Another was doing knee joint replacement, the sound of bone sawing leaked through the door gap, making one’s teeth feel sore.

Yang Ping looked at each room in turn, suddenly overcome with an indescribable feeling.

He arrived at the entrance of the Neurosurgery Operating Room and peered inside through the observation window.

Xu Zhiliang was seated at the microscope, fully focused on surgery. His movements were slow, each cut careful, like disarming a bomb. The assistant beside him, a young Neurosurgery doctor, cautiously used a suction device to remove blood from the surgical field.

Brainstem tumor surgery is the crown of Neurosurgery.

The brainstem is the life center, controlling breathing, heartbeat, blood pressure, consciousness... any issue here can be fatal with even the slightest error. Thus surgeons performing brainstem surgery must have a big heart, able to withstand unimaginable pressure.

Xu Zhiliang indeed has such a big heart.

Now, Xu Zhiliang is a leading figure in brainstem tumor surgery within the country. Performing one to two hundred brainstem tumor surgeries annually, keeping mortality rate below one percent, placing his results among the global elite.

Yang Ping stood outside the small observation window watching for a full five minutes.

He still didn’t enter to disturb, as brainstem surgery demands absolute concentration where any distraction could lead to catastrophic consequences. So, he quietly stood watching through the small pane of glass, witnessing his student demonstrate his skills on the operating table.

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