Doctor's Life Simulator

Chapter 369 The world's first improved surgery (for subscription)

After hearing Director Zhu's words, Dr. Sun's face was serious. Many diseases in the Department of Cardiovascular Medicine are very difficult.

Qin Lang also nodded modestly.

Director Zhu was quite satisfied with the modest attitude of Qin Lang and Dr. Sun, and continued:
"The treatment of new atrial fibrillation combined with structural heart is mainly surgery, and its development has experienced left atrial isolation, atrioventricular node catheter ablation, corridor surgery, maze surgery, etc. Since Cox pioneered and developed the maze surgery, atrial fibrillation Surgical treatment has made great progress, and through continuous improvement, it has developed from maze type I to the current maze type III."

"Maze III surgery is also known as the "gold standard" for the treatment of atrial fibrillation. However, due to its large trauma, complicated operation and long operation time, there are actually not as many institutions and hospitals in China as imagined. Its safety and The effectiveness still needs to be further confirmed, and this time our department will try to perform maze III surgery."

Director Zhu originally wanted to say that it happened that Qin Lang and Dr. Sun could also take this opportunity to learn and accumulate experience.

But after thinking about the unfathomable Qin Lang, Director Zhu tentatively asked:

"Qin Lang, do you know anything about Maze III surgery?"

Qin Lang really wanted to say, isn't this a coincidence.However, in the end, he still chose to keep a low profile and give Director Zhu a chance to show off, so that he can stand aside and take action if there is a problem.

After all, he will definitely go out to exchange and study frequently in the future. The First City Hospital still needs to cultivate an elite team. Although Director Zhu is not qualified, he is rich in experience and hardworking. He is an object of training.

It takes a lot of experience and practice.

"Director Zhu, I have a little understanding of the Maze III operation. I need to learn more from you."

When Director Zhu heard that Qin Lang only understood a little, he felt relieved, and then he could boldly export it.

However, Director Zhu is still very cautious, and is still planning to invite Director Huang from the First Affiliated Hospital of Zijingang University to have a remote consultation.

"In this way, we will conduct a comprehensive examination of the patient in a while. Then, we will formulate a surgical plan. After that, I will invite Director Huang from the First Affiliated Hospital of Zijingang University to have a remote consultation. Surgery, then we will operate on the patient. If it can't be done, then transfer it to Hangzhou, and then Qin Lang, you can follow and study."

Hearing Director Zhu's arrangement, Qin Lang didn't feel much about Director Huang joining the consultation, but Dr. Sun was different. This is a very rare opportunity to learn from experts from the First Affiliated Hospital of Zijingang University.

Under the leadership of Director Zhu, he quickly conducted a comprehensive examination on the patient. Relying on the master's technique, Qin Lang initially had an idea.

[Patient: Li Xiulan, female, 63
Symptoms: rapid and extremely irregular ventricular rate, palpitations, chest tightness, dizziness, fatigue.
Diagnosis: Atrial fibrillation with valvular heart disease.

The best treatment plan: In the conventional COX maze type III operation, the traditional incision and suture has great potential safety hazards. It is recommended to adopt the world's first Cox maze IV operation. 】

[Ding, new mission, proposed improved technique.On the basis of the Cox maze III procedure, a new energy source is used instead of the traditional "cut and suture" to form a specific ablation line on the atrium, so as to achieve the purpose of eliminating atrial fibrillation and reconstructing sinus rhythm, making the operation simple and convenient. And can achieve the same effect as the Cox maze III operation.Task reward: 1.2 life simulation points. 】

Looking at this brand new mission, Qin Lang couldn't laugh or cry, it seems that this time he still has to make a move.

While Qin Lang was meditating, Director Zhu had already completed the preliminary work, and the next step was to wait. The experts from the First Affiliated Hospital of Zijingang University in Hangzhou decided the time for remote consultation.

"Director Qin, Dr. Sun, come here first today. If you have time, you can also study the Cox maze III operation by yourself. Afterwards, you can come up with new ideas in the consultation with Hangzhou experts. "

Director Zhu made a special note, which has two meanings. One is to remind Dr. Sun to do more homework and be prepared. When the remote consultation is held, at least he can understand the terminology spoken by the experts, so as not to be too embarrassing.

As for Qin Lang, it's really literal. After all, Qin Lang's talent is too high. He might not know what he learned when he went back and watched the video. He could really put forward great opinions in the conference room.

"Okay, Director Zhu, when we go back, we must prepare well."

Dr. Sun assured, secretly thinking in his heart that he must not hold back during the joint consultation.

However, Qin Lang also began to consider the design improvement plan. Under the master-level surgery, soon, a very mature left atrium ablation circuit appeared in Qin Lang's mind!
Qin Lang and Dr. Sun returned to the office. Dr. Sun began to search for related videos and learned about the Cox maze III procedure with great interest.

Dr. Sun studied for a while, and then looked at Qin Lang beside him. To his surprise, Qin Lang didn't open the relevant video to study, but instead drew something on the paper.

Dr. Sun touched his chin, watched his video more attentively, and thought that although he is not very talented in terms of talent, he can still work hard and surpass Qin Lang a little in this consultation. The so-called stupid bird flies first .

After studying for a while, Dr. Sun began to study the details of the Cox maze III operation, especially how to design the main means of "cut and sew".

At this time, Qin Lang looked at Dr. Sun and asked, "Doctor Sun, do you have a heart model over there? You can study it for me."

"Heart model?"

Dr. Sun became alert and realized instantly that Qin Lang was going to try to design the incision and suture on the model: "Director Qin, don't tell me that you are going to try to simulate the incision and suture design of the Cox maze III operation?"

Qin Lang was a little surprised. It seems that Dr. Sun's introduction to the Cox Maze III technique is not bad.

Qin Lang plans to improve the ablation line, and instead of using traditional incision and suture, Medtronic bipolar radio frequency forceps and monopolar pen will be used to complete the right atrium ablation line and right atrium ablation line, so it is different from the conventional Cox maze III surgery The formula is different.

After thinking about it for a while, I couldn't explain clearly to Dr. Sun who was just getting started, so I could only say perfunctorily: "That's not true, it's just a little idea, just try it casually."

After Dr. Sun heard it, it seemed that Qin Lang should be similar to himself, and he was just getting started, so he was not very confident, so he could only try it secretly, but he didn't expose Qin Lang's careful thinking: "There are some, I will Go get one."

Dr. Sun quickly brought over a model that was twice the size of a real human heart. The equipment and equipment of the First City Hospital were of very high quality. Qin Lang took it in his hand and looked at it, and found that the anatomical structure of the heart was very clear and detailed.

"Director Qin, are you trying to design a cutting and sewing plan for the left atrium and right atrium?"

Dr. Sun watched from the side very curiously. After all, Qin Lang was well-known, and he also wanted to know how far Qin Lang could do after learning the Cox Maze III technique, since they are all beginners.

Qin Lang didn't care about Dr. Sun watching, anyway, he couldn't understand his high-end operation.

I picked up two marker pens, one red and one blue, and drew on the heart model. I was very focused, and soon I was immersed in it, as if I was really operating on the operating table.

Qin Lang held two pens in his hand, and began to draw on the heart model by simulating bipolar RF forceps and a single-stage pen.

Soon there appeared on the right atrium, two circles with double red lines, a small opening with a single blue line, which looked like a sword from a distance, and finally at the very edge, a flower that looked like a flower was drawn line type.

Looking at these ghostly symbols drawn by Qin Lang, Dr. Sun was stunned. Although he is not proficient in this operation, he still has a basic judgment, and he has read it several times very carefully. These lines drawn by Qin Lang , has nothing to do with the cutting and sewing scheme.

Could it be that I overestimated Qin Lang's comprehension of the Cox Maze III technique.

"This is too amateurish. How can there be incisions and sutures designed like this."

Dr. Sun muttered in his heart, the more he looked at it, the more he felt that Qin Lang's design was outrageous.

"What is this for?"

I saw Qin Lang began to draw again in the left atrium, and the movement of holding the pen was very strange, as if holding an unknown instrument. Looking at the symbols on the model, Dr. Sun became more and more puzzled. A face all squeezed together:
"It looks like a pig's nose shape, hey, two more blue lines are added, what's the matter!"

Dr. Sun watched it for a while, and completely lost interest in Qin Lang's outrageous plan.

"I just said, how can self-study master such a difficult technique. It seems that this time, Qin Lang and I are not the same. When it comes to this professional brand-new technique, we are also blind, and the technique is like a mountain."

Dr. Sun still sat down in front of his computer honestly, started watching his video, and kept nodding:

"This is the orthodox Cox's maze III technique, what the hell is Qinlang! It seems that this joint consultation is my chance to perform well."

After Dr. Sun watched the operation video again, Qin Lang had also completed the ablation line design for the left atrium and right atrium, but because Qin Lang used red and blue pens instead of radiofrequency ablation, it seemed very weird It is the first improved technique, so it is very difficult to understand. In the eyes of ordinary people, it is just a series of strange red and blue symbols.

If you let the top experts in the field of Cox Maze III surgery look, you can see Qin Lang's ingenious thoughts:
Since the right atrial incision and the ablation line on the left side of the right atrial appendage cannot reach the tricuspid annulus due to bipolar ablation forceps, the ablation here is performed with a monopolar radio frequency pen for "supplementary ablation" so that the radio frequency line here reaches the tricuspid annulus place.

The ablation of the left atrial isthmus cannot reach the mitral annulus, so a monopolar radiofrequency pen is also used here for "supplementary ablation" to make the ablation line reach the mitral annulus.At the same time, turn the heart up, apply a monopolar pen on the epicardium to extend the ablation line of the mitral valve isthmus and fully ablate the coronary sinus...

Qin Lang looked at the ablation line again, put the heart model on the table with satisfaction, and looked at Dr. Sun again: "Dr. Sun, I want to go to the laboratory. If Director Zhu starts the consultation later, you can call I will."

Dr. Sun nodded, then glanced at the heart model on Qinlang's table, and shook his head:

"The brain circuit of a genius is really different from that of ordinary people. If you don't study spells here, what are you going to do in the laboratory?"

After a while, Director Zhu came to the office and walked over:

"Doctor Sun, Director Qin, follow me to the consultation room. I have already contacted the two chief physicians of the Department of Cardiovascular Medicine at the First Affiliated Hospital of Zijingang University, and the remote consultation will start in a while. Director Huang and Director Qian are also from Qin Lang's old acquaintance. Hey, where is Director Qin?"

Director Zhu walked in and saw that the seat in Qin Lang was empty.

Dr. Sun immediately stood up: "Oh, Director Qin, he said he has something to test in the laboratory, or I'll call him."

Director Zhu thought for a while: "You go to the consultation room to set up the venue and check the source of the signal. I'll go to the laboratory to find him."

Director Zhu also wanted to know what Qin Lang was doing. Before leaving, he accidentally glanced at the heart model on Qin Lang's table, saw some strange red and blue lines, and stopped to look.

It's just that after looking around, I don't quite understand it.

However, this picture left a little impression in his mind.

But he didn't care too much.

Soon, Director Zhu came to the supporting laboratory of the Department of Cardiovascular Medicine of the First Hospital of the City, and saw Qin Lang tinkering with a set of Medtronic bipolar RF forceps and monopolar pens, which were introduced by the department not long ago. equipment, and did not promote practicality.

Seeing that Qin Lang was so curious about the new equipment, Director Zhu also smiled. After all, he is still a young man in his thirties, so he really does not change his mind.

Director Zhu coughed lightly: "Director Qin, stop playing and follow me to the consultation room. The experts in Hangzhou have agreed to guide us and design the surgical plan for the patient together."

When Qin Lang heard Director Zhu's call, he got up immediately. Anyway, he had already tested it. The radio frequency forceps and single-level pen used in the laboratory were suitable for the Cox maze IV surgery he proposed.

Soon Qin Lang followed Director Zhu to the consultation room, and Dr. Sun had already adjusted the signal source. Soon, through the screen, a cross-hospital consultation officially kicked off!

Seeing the two directors on the opposite screen, Qin Lang was of course very familiar with them.

On the screen were Director Huang and Deputy Director Qian from the Department of Cardiovascular Medicine of the First Affiliated Hospital of Zijingang University.

Director Huang is very accomplished in the field of atrial fibrillation, especially in the Cox maze III procedure.

After several previous academic exchanges, Director Huang is still very kind to the City No. [-] Hospital, and the patient itself is also very clinically valuable.

Director Zhu directly communicated with Director Huang. After listening to the patient's situation and analyzing the medical records in detail, Director Huang soon had a plan.

"The most important thing about the Cox maze III operation is the "cut and suture" route design, especially for the treatment of the tricuspid annulus, mitral valve isthmus and coronary sinus."

Director Huang was very experienced and began to explain to Director Zhu, at the same time explaining the difficulties and skills involved.

At the same time, I pulled out a small whiteboard, took a marker pen and began to carefully draw the unfolding plane of the heart on it. The blood vessels, tissues, and anatomical layers on it were very clear. It's solid.

While Director Huang was talking, he described his surgical experience, while Director Zhu listened carefully. Although he had done the Cox maze III operation before, he did not understand it as deeply as Director Huang.

The reason why the Cox maze III operation is not carried out in domestic hospitals is because if the "cut and suture" is not done well, it is very easy to cause great trauma, and the whole operation is complicated due to the structure of the heart, and the points that need to be operated There are many and discontinuous, so the operation time is also very long.

Only an experienced person like Director Huang can formulate the most appropriate and suitable route.

After listening to Director Huang's explanation, Director Zhu, Dr. Sun, and Qin Lang all admired him very much. Simply speaking from the treatment of Cox Maze III, Director Huang is indeed the top expert in the province.

It's just that Director Zhu is a little embarrassed that he can understand many details of the operation, but it is still very difficult to actually operate it.

"Director Huang, your plan is indeed the limit of the Cox maze III operation, but the timing control of operation time, cardiopulmonary bypass time, aortic occlusion time, endotracheal intubation time, etc. Speed ​​is closely related, and if there is a slight error, it may lead to surgical complications."

Of course, Director Zhu knew that Director Huang's plan was performed by himself, and the success rate was very high, but it was not necessarily suitable for the chief surgeon of the city's first hospital. For example, with his operation skills, it was impossible to complete such an exquisitely designed and complicated operation.

Such a complex operation, sometimes it really needs a specific person to perform it, to be successful. To a certain extent, it requires experience and talent, and it is not a perfect operation.

That kind of technique is simpler, more popular, and the one that ordinary doctors can master through practice is the better technique.

Of course, Director Huang also understood Jule's implication, and felt that his design plan was too complicated.

Deputy Director Qian on the side also frowned, feeling a little bit like cursing in his heart, the plan is in place, your city's first hospital is not working, who can be blamed?

The scene fell into silence for a while.

"Is it possible to improve the optimization technique?"

Qin Lang on the side saw the needle, how could he miss such an opportunity, and said softly.

"optimization?"

Director Zhu looked at Qin Lang on the side. Since Qin Lang was not in the screen, Director Huang and Deputy Director Qian only heard voices on the other side of the screen. Although they were somewhat familiar, they did not recognize them. The two were also in deep thought It's just that, how can it be so easy to improve the optimization plan?
"It would be nice to be able to simplify the 'cut and sew'."

Qin Lang said to himself calmly.

The speaker has the heart, and the listener has the heart.

"How can it be so easy to improve the technique."

Director Zhu smiled wryly, but just after he finished speaking, a picture he had seen somewhere flashed in his mind, huh?
(End of this chapter)