Doctor's Life Simulator

Chapter 211 Endo-GIA Cutting Closer ([-] in [-])

[Ding, new task: Show your talents for the first time, complete the laparoscopic appendectomy with the chief surgeon within 60 minutes, and amaze all the leaders in the emergency department.Rewards: 1. Life simulation points. 2. Chief surgeon's aura: It can make the cooperating assistant feel at ease, and at the same time improve their operation level to a certain extent. 】

"Routine laparoscopic appendectomy usually takes 90-150 minutes. Is this too demanding?"

"It's too pretty, isn't it?"

Qin Lang really didn't want to be too high-profile, after all, it was his first laparoscopic appendectomy.

However, after thinking about it, isn't it normal that the first time is very fast?
Qin Lang: ╭(╯ε╰)╮

After communicating with the patient before the operation, the family members signed the signature, and soon the operation was arranged.

It's just that there was a lot of movement in the operating room this time. Besides Director Pang, Li Ming also became very interested in Qin Lang and chose to watch.

When he heard that Qin Lang was going to perform laparoscopic appendectomy, Zhuang Tong also took the time to rush to the operating room. He was still very concerned about Qin Lang.

In front of the operating table, Qin Lang was naturally standing in the position of the chief surgeon, Liu Peichun was in the position of the assistant holding the mirror, and the equipment nurse was on the other side.

The anesthesiologist in the emergency department had seen Qin Lang's surgery before, but this time he was still very surprised.

In fact, the small bench prepared by the gangsters in the operating room was also taken by Director Zhuang.

The anesthetist completed the routine intubation anesthesia, and then stood aside.

He also wanted to know what kind of magical power this Qin Lang had that could attract so many people to watch.

Laparoscopic appendectomy is different from ordinary appendectomy. The surgeon, the mirror assistant, and the instrument nurse stand on the left side of the patient, and the monitor is placed on the right side of the patient.

For laparoscopic appendectomy, three-hole puncture is routinely used, and a 10mm cannula around the umbilical foramen is generally selected as the main operating hole.

The 3 cm below the intersection of the umbilical level and the left midclavicular line is used as an observation hole, and the 5 mm cannula above the pubic symphysis is used as an auxiliary operation hole.

A total of three holes were operated on, and this time, Qin Lang will adjust slightly.

"Doctor Liu, follow my instructions later, we will try our best to complete the operation within an hour."

Qin Lang had to remind Liu Peichun for the task reward.

"Within an hour?"

Liu Peichun looked at Qin Lang with an exaggerated expression: "This is impossible, even Director Pang can't do it so fast."

"Prepare for three-hole puncture!"

Qin Lang didn't have time to explain, so he raced against the clock and gave the order directly. Now, under the perfect level of appendectomy, he is proficient in this series of operations.

Because the patient had an ectopic appendix, Qin Lang slightly changed the position of the lower puncture on the basis of the traditional three holes.

“..脐上缘10mm常规建立CO2气腹，置10mm套管，压力维持在9～13mm Hg”

".5mm and 10mm incisions were made at the midpoint of the connecting line between the umbilical cord and the pubic symphysis, and 5mm and 10mm trocars were inserted to place endoscopic instruments to treat the appendix"

Qin Lang directed the first assistant and the equipment nurse accurately and calmly.

"Is there something wrong with the opening position?"

Since he had not participated in the consultation before, Director Zhuang was a little puzzled.

"Director Zhuang, this patient's appendix is ​​ectopic, so the puncture position is a bit different. We have demonstrated Qin Lang's operation plan before."

Director Pang hurriedly explained.

Only then did Zhuang Tong nod his head. After all, Qin Lang was the main surgeon in this operation, but it was still recorded on Director Pang's name and supervised by him, so Zhuang Tong was still very relieved.

After Qin Lang marked the points, Liu Peichun assisted in the puncture.

Liu Peichun is still very convinced of Qin Lang, and he earnestly completes every instruction.

Skillfully completed the puncture, but before Liu Peichun could appreciate his masterpiece, Qin Lang gave an order.

"Laparoscopy."

For ectopic appendix, it is difficult to find the appendix with conventional McBurney incision. However, laparoscopy is different. The field of view is wide and clear under laparoscopy, and the subsequent washing is more accurate.

This is why Qin Lang suggested laparoscopic surgery before.

Liu Peichun's level of supporting the mirror is still solid. Under the laparoscope, under Qin Lang's precise command, he quickly found the cecum under the liver.

"Intraoperative exploration found that the ileocecal area was tightly adhered to the liver, and the appendix was wrapped in a mass by the omentum."

Liu Peichun fully adapted to the role of the first assistant, and began to report the results of the investigation.

"Zoom out the camera and prepare to free the appendix."

Qin Lang gave orders unhurriedly, and Liu Peichun quickly responded. Under Qin Lang's calm and clear command, he was very at ease, and only Qin Lang's voice was in his mind.

"Free appendix found during the operation: 1cmX1cm fecal stone at the root of the appendix, highly dilated distal appendix, dark gray, smelly, a little dark gray turbid exudate around"

"Intraoperative confirmation: the patient had gangrenous appendicitis, and fecal stones at the root of the appendix."

After Liu Peichun told the results, although Director Pang and Dr. Li were already somewhat prepared, they still had some shocking aftermath.

"Sure enough, it is exactly as Qin Lang speculated. This kid is really talented in diagnosis."

Director Pang praised him without hesitation.

Li Ming didn't speak, but he was a little convinced in his heart.

To be able to put aside the interference of such classic appendicitis symptoms, peel off cocoons, and even relate to the right oophorectomy 20 years ago and the history of repeated gastric diseases in the past two years, so that the ability to reason about the disease systematically, this ability can only be called a talent.

It really has nothing to do with experience qualifications.

"Qin Lang is not only talented in diagnosis, the operating room is where he can really display his talent."

Zhuang Tong said softly at the side, he has observed Qin Lang for a long time, what a pity, he is not in his emergency department, it is a pity to follow Wei Guoqiang.

Director Pang and Dr. Li have also accepted this fact. Indeed, on the operating table, Qin Lang has shown a maturity that does not match his age, and they can even feel the aura of a senior surgeon.

That is the calm demeanor that can only be obtained after hundreds of surgeries.

"Absorb the abdominal pus, separate the forceps, and prepare the electrocoagulation hook"

"Mesoappendix 1-0 Silk Suture Ligation"

In the operating room, only Qin Lang's commanding voice was left, as well as the busy figures of Liu Peichun and the equipment nurse who were a little powerless and desperately cooperating.

"Do you feel that there is basically no time for adjustment and preparation between Qin Lang's steps?"

"It's true, it feels like I'm in a hurry."

Director Pang frowned slightly. Some surgeons in the operating room are accustomed to quick operations, but they are generally veterans who have done no less than a hundred operations, so they can form operations like muscle memory.

Could it be that Qin Lang deliberately wanted to show off because they were watching from the sidelines.

"Qin Lang, think carefully about every step, don't go too fast."

Director Pang still reminded, if you leave troubles too soon, it will not be worth the loss.

When Liu Peichun and the equipment nurse heard this, they couldn't agree more, and they waited for Qin Lang to let them rest for a while.

Especially the equipment nurses frowned, Dr. Qin was too ignorant of pity and sympathy.

"A small piece of saline gauze is ready."

However, what answered her was Qin Lang's impersonal order, taking a bottle of stamina potion before the operation, Qin Lang was actually very restrained, if it wasn't for Liu Peichun's limited level, he even wanted to speed up the steps.

"Dr. Liu, when separating the adhesions and dealing with the mesentery and the root of the appendix, sometimes intestinal damage may be caused. You can place a small piece of normal saline gauze for proper compression. In the future, you must know how to observe yourself, and prepare the normal saline gauze before performing the surgery."

Qin Lang taught it seriously, and then added: "You are still not proficient in laparoscopic appendicitis surgery, so you have to hurry up next time."

After all, after doing so many appendicectomy operations in the simulated world, Qin Lang's experience is unparalleled.

Liu Peichun still felt quite rewarded for the first half of the sentence, but when he heard the second half, his whole face collapsed. Do you think everyone is a monster like you?
The first case of laparoscopic surgery, as skilled as an old attending for decades.

I am a dignified senior resident doctor in the emergency department, and I will help you with a resident doctor in the burn department who came to rotate, and he is still dismissed as slow?
Liu Peichun really felt that it was too difficult for him.

And when Liu Peichun had just completed this step, Qin Lang had already completed the separation.

"Endo-GIA Cut Closer Ready!"

Qin Lang gave another order.

"Endo-GIA Cutting Closer???"

Hearing Qin Lang's order, the bosses beside him were also surprised. Was it really said by a novice laparoscopic appendectomy?
Several big guys poked their necks forward and looked at the screen in the operation area. The Endo-GIA cutting and closing device is rarely used by novices.

When dealing with gangrene margins at the root of the appendix, simple ligation and purse-bag embedding are the most routine, and they are also the most familiar treatment methods for physicians who have undergone traditional laparotomy through McBurney's incision.

The Endo-GIA cutting and closing device is exclusive to laparoscopic resection, and it is specially invented to operate in a small operation hole.

The head of the entire closer is long and pointed, and there are two rows of small silver particles protruding above the two edges of the sharp beak, which looks like a ferocious sharp-billed crocodile.

In the shot controlled by Liu Peichun, Qin Lang controlled the silver closer's pointed mouth, piercing into the root of the patient's appendix.

Looking at the root of the patient's severely gangrene and perforated appendix, Director Pang and others also understood Qin Lang's intentions. This is the most direct and fastest way.

However, this guy is too decisive, and he is not afraid of excessive cecum resection?
"It's not enough to just cut off the root. This method is a choice made only when you are extremely helpless, because what will test the skill of the surgeon is to use absorbable threads to reinforce the cut."

Li Ming said worriedly from the side.

Sure enough, on the screen, under Qin Lang's quick operation, the closer was like a greedy silver crocodile, biting the patient's appendix root only about 0.5cm away from the cecum.

"3-0 Absorbable Suture, Needle Holder Forceps"

Without a moment's pause, Qin Lang directly ordered the equipment nurse to prepare for the next suture.

"Aren't you worried at all? The 3-0 absorbable suture has extremely high requirements for the level of suturing. If the strength is too strong, it will easily break. If the strength is weak, the sutures will loosen later, and it is easy to be infected."

Dr. Li looked at the determined Director Pang and the indifferent Director Zhuang, and asked with some puzzlement.

If it was in his medical group, how dare he entrust this kind of laparoscopic absorbable suture to a junior resident doctor.

"Doctor Li, don't worry, I don't know Qin Lang's other skills, but I dare say that there is no one better than him in the first hospital of our city for his suture level."

Zhuang Tong smiled calmly, and even looked forward to Qin Lang's stitching.

"This"

Li Ming couldn't understand the world anymore.

Soon Qin Lang completed the continuous suture of the stump under Liu Peichun's arm mirror. The needles and threads were evenly spaced, and the stitches and margins were like copying and pasting.

Clean and beautiful!

"How about it?"

Director Zhuang looked at Qin Lang's textbook-level stitching, and sighed again: "I was more surprised than you when I saw Qin Lang's stitching for the first time."

Li Ming suddenly didn't want to talk anymore.

He thought of the nights when he locked himself in the study every night after working for three to five years, practicing stitching with chicken wings and pig's trotters. He thought his stitching skills were good enough.
But how old is this Qin Lang, and his suturing skills have surpassed his decades of skill.

Next, Qin Lang still didn't stop, and directly put the appendix in the dirt bag and took it out from the puncture port.

"The patient has a lot of abdominal and pelvic fluid, and the pus needs to be sucked out before the drainage tube is placed"

Qin Lang gave the next step instructions. In order to better absorb the effusion, he first adjusted the patient's body position, with the head high and the feet low, so that the oozing pus would collect in the lower position.

In the process of changing the patient's position, Liu Peichun was at a loss for a while. How could Qin Lang perform operations beyond his knowledge.

"Block the intestine, prevent it from falling down and block the surgical field of view, and suck out the pus within the field of view."

Qin Lang's clear instructions followed closely, making Liu Peichun calm down immediately.

"Oh."

However, just after a few puffs, Liu Peichun's face turned red again.

"Gauze, gauze!"

Liu Peichun looked at Qin Lang suspiciously, not knowing why.

"Because of the body position, the epistaxis and fallopian tubes are easy to block the suction device. You can use gauze on the suction device and use the gauze as a filter."

"understood."

Liu Peichun really admired Qin Lang so much, this guy's head is so long, if he encountered such endless situations, he would have collapsed a long time ago.

[Countdown 15 minutes]

Qin Lang listened to the system's countdown. Although he was a little urgent, he still evaluated carefully, and finally decided to wash the abdominal cavity thoroughly. Although it would be faster to just wipe with gauze and suck it with a suction device, there is a risk of subsequent infection.

Hearing Qin Lang's order, Director Pang, Director Zhuang and others on the side also nodded slightly. They were really afraid that Qin Lang was greedy for speed, so they rashly chose to close their stomachs.

Thorough flushing of the abdominal cavity naturally means more time-consuming and more cumbersome, but only after the empyema is completely removed, the patient can avoid complications such as postoperative tenesmus, which do not appear to be serious, but actually indicate that the operation is lacking.

[Countdown 7 minutes 5 minutes]

After finally flushing the abdominal cavity, Qin Lang carefully checked whether there was any bleeding, and at the same time counted the completeness of the equipment.

Just as Liu Peichun was about to take over the suturing task, Qin Lang directly took over the needle holder.

"Doctor Liu, I don't have enough skills to hold up the mirror. I can't do anything about such small things as suturing."

Qin Lang smiled humbly.

[Countdown 3 minutes]

I saw Qin Lang take over the stitching job.

Liu Peichun's complexion has improved a lot. It seems that Qin Lang is still very sensible. After all, he was appointed as an assistant because he is the only one in the department who can cooperate with Qin Lang to hold the mirror.

After all, it is impossible to let a boss like Director Pang come.

Qin Lang can clearly realize that he is his senior, and it is very comfortable for him to be able to complete the stitching work of his assistant.

Seeing Qin Lang's fast stitching, Liu Peichun became more and more pleasing to the eye. To be honest, this operation really pushed his limit, and he was almost collapsed.

Liu Peichun stretched and yawned:

Qin Lang is still a good person, knowing the general situation, knowing how to advance and retreat, which can be regarded as giving him enough face.

【Countdown 1098】

[Congratulations to the host, who showed his talents and completed the first laparoscopic appendectomy within an hour.Rewards: 1.1 life simulation points. 2. Chief surgeon's aura: It can make the cooperating assistant feel at ease, and at the same time improve their operation level to a certain extent. 】

After finishing the last stitch, Qin Lang handed over the instrument to the nurse, and Qin Lang went to the bathroom in a heartless manner.

Director Pang, Dr. Li, Director Zhuang and others naturally also left the operating room, but they didn't realize it until they walked out of the operating room.

Only an hour has passed!

Only the equipment nurse and Dr. Liu were left in the operating room. The equipment nurse twisted her body and said, "Dr. Liu, I will leave this to you. Dr. Qin made me exhausted."

Liu Peichun looked at the messy operating table: "???"

It suddenly occurred to Qin Lang that he had to complete the entire operation within an hour.
"Damn, he thinks I'm slow in sewing!"

A belated humiliation sound resounded throughout the operating room.

PS: Thank you Tunji Danger for the reward of 1000 coins.Touched, happy, continue to work hard to code~
(End of this chapter)