Auto chess in the operating room

Chapter 160 Tension-Free Inguinal Hernia Repair
After Tang Lou cut the subcutaneous tissue, he began to ligate the branches of the superficial abdominal artery and vein and the Y external artery and vein until the aponeurosis of the external oblique muscle, exposing the superficial ring of the inguinal canal.

"Replacing the blade, retracting the thyroid hook to expose the surgical field"

Yuan Xun and Lin Dong cooperated immediately. Even though they were already familiar with the operation process, they still felt a little stressed. Tang Lou's movements were too fast.

"tissue scissors"

After Tang Lou completed the procedure of the external oblique aponeurosis, he began to search for and cut the hernia sac.

"Hemostat."

Lin Dong watched Tang Lou's operation and was amazed in his heart. He saw that he used two hemostatic forceps to clamp the upper and lower external oblique aponeurosis, and bluntly separated it under it. Inguinal ligament.

The movements are very skillful and smooth.

"Is this separating the nerves?"

Lin Dong's heart trembled, this guy Tang Lou is really a bold man with high skills.

When separating the external oblique aponeurosis, if you are not skilled, it is easy to damage the ilioinguinal nerve. Now Tanglou uses hemostatic forceps to bluntly separate the nerve from the internal oblique muscle.

Soon, Tang Lou used hemostatic forceps to pull the lower aponeurosis under the nerve, and then turned the aponeurosis eversion so that the nerve was covered and protected by the aponeurosis.

"pretty."

Even though he had done so many hernia repairs, Lin Dong still admired him. I'm afraid that's what Dr. Qing did.

"Increase abdominal pressure."

Under Tang Lou's precise control, the operation process was extremely clear, and a raised hernia was found on the anteromedial side of the spermatic cord.

"Scalpel"

Tang Lou continued to give instructions, and once again used the three-star incision to incise the cremaster muscle and the internal fascia of the spermatic cord longitudinally on the raised hernia mass.

The off-white hernia sac was clearly exposed.

"Toothed Tweezers"

Yuan Hu immediately handed the instrument to Tang Lou. Looking at the serious Tang Lou, his heart trembled slightly. Doctor Tang became serious, he was so charming.

The next step is to cut the hernia sac and check the contents inside.

"Contents of hernia sac found during operation: small intestine, omentum"

Lin Dong cooperated and reported the result, which was consistent with the preoperative judgment.

After confirmation, proceed to the next step to free the hernia sac, that is, push the contents of the hernia sac back to the peritoneal cavity.

Let these small intestines and omentum that escaped go back and forth from wherever they came from.

After the spermatic cord tissue around the hernia sac is bluntly separated in Tanglou, the next step is to ligate the hernia sac at a high position.

"Small hemostat. Line 4"

Lin Dong's eyes didn't move, he stared at Tang Lou's stitching process, even though he had seen it many times, he still couldn't get tired of it.

The suturing of the hernia sac is very particular, and purse-string suturing is used.

Sure enough, Tang Lou's sutures are still pleasing to the eye. The needle distance inside the hernia sac is controlled relatively small, while the needle distance outside the hernia sac is relatively large, so that the tightened purse will not leave a cavity.

Lin Dong naturally knows this suture method. Many doctors who have studied hernia repair know it, but they know it. If you want to really operate the stitches that are small inside and big outside, and the stitches are uniform and orderly, it is very important for the precision of the hand. The requirements for accuracy and stability are extremely high.

"Just this hand suturing technique is enough for a lifetime."

Lin Dong was a little envious in his heart, he really didn't know how Tang Lou practiced it.

Under Tang Lou's precise suturing, the sutures were ligated, and the neck of the hernia sac was closed quickly.

"Line 7"

Tang Lou's command sounded again.

Lin Dong frowned slightly, and soon understood that Tang Lou was using No. 7 thread to prevent the knot from falling off, and tied it 0.5cm above the purse suture.

"The speed is fast, but not chaotic, the heart is silky and cautious."

Lin Dong didn't know what to say, Tang Lou's surgical habits were too good, and his mind was extremely calm.

After completing this step, it is a very critical step to repair the indirect hernia.

Compared with the traditional suturing through tissue overlap, the tension-free repair uses a patch made of artificial biomaterials to strengthen the posterior wall of the inguinal canal without increasing the tension of the surrounding tissue, and there will be no unbearable pain after surgery , There will be no pulling sensation and local uplift.

"Long tweezers. Round needle absorbs thread"

Lin Dong assisted Tang Lou to fix the patch on the pubic aponeurosis. Since Tang Lou's previous exposure and separation were very clear, the position was quickly placed.

Tang Lou started suturing again, suturing the lower edge and the smooth surface of the inguinal ligament continuously. At this point, most of the basic operation table has been completed.

In hernia repair, since there are many layers of incision, there are many places that need to be sutured, and different tissue structures, aponeurosis, etc. must use different suture methods.

Therefore, a large number of sutures consume a lot of energy and time of the operator, which is one of the reasons why it takes a long time for ordinary operators to perform this operation.

"Large round needle No. 4 silk thread."

After entering the continuous and uninterrupted fancy stitching, both Lin Dong and Yuan Xun were surprised to find that Tang Lou's speed was getting faster and faster, and it had been faster for more than an hour. Instead of being exhausted, his mental state was getting higher and higher. .

"Sure enough, the more you fight, the braver you become."

Yuan Xing's eyes lit up, and every nurse who had been with Tang Lou in the operating room would describe Dr. Tang in this way.

Other doctors, in the middle of the operation, were getting worse and worse, but Tang Lou became more excited as he went to the later stage, and the strength and frequency of movements became faster and faster.

Yuan Aldo handed over the equipment immediately.

And Tang Lou completed a textbook-style interrupted suture of the external oblique aponeurosis.

"Short round needle with toothless tweezers. No. 1 silk thread."

Only 10 minutes later, Tang Lou completed the intermittent suture of the subcutaneous tissue.

"Bighorn Needle No. 4 Silk Thread."

After Tang Lou issued the order, Yuan Alde was already ready. After Tang Lou's intermittent sutures were completed, he immediately disinfected the skin with ethanol gauze, covered the incision with gauze, and applied it to fix it.

And at the same time in No. 6 operating room.

Wu Ye was also in the middle of the operation, and without distraction, he inserted surgical instruments into the abdominal cavity through the small hole in the abdomen.

"Patch."

Wu Ye yelled, and the nurse quickly handed it over.

Wu Ye was a little excited. This operation was smoother than before, and his operation was much smoother. He had the feeling of breaking through the bottleneck that he hadn't seen for a long time.

"It may be that the pressure turned into motivation. This operation has refreshed the time of all my previous operations."

When Wu Ye thought of going to Tang Lou's operating room later, the corners of his mouth curled up as he watched him guide with his hands behind his back while he was halfway through the operation.

Wu Ye held back his smile and settled down again, continuing to skillfully place the patch into the preperitoneal space.

"Nail Gun"

Due to the laparoscopic surgery, the mesh is fixed by firing metal nails with a nail gun.

Soon Wu Ye completed the fixation of the patch, which means that most of the operation has been completed.

Wu Ye straightened his waist, and vaguely heard the creaking sound of the lumbar spine. After all, he had been undergoing surgery for so long, so he was a bit of an occupational disease.

However, this is also his accumulated proof that doctors need to pile up surgeries.A rookie, why should he step on his head.

Taking a breath slightly, Wu Ye hurriedly threw himself into the operation, although even if he rested a little longer, he would definitely come faster than Tang Lou, but one minute earlier, he could see Tang Lou still suffering from the operation. .

Wu Ye's spirit lifted again.

"Doctor Wu, this operation is going so fast. It's improved again."

Wu Ye's assistant licked a very timely sentence.

Wu Ye laughed: "Today's operation is quite special, I can only complete the next operation by myself, and wait for the next operation, I will reward you with aponeurotic suture."

"Thank you, Dr. Wu."

The intern quickly thanked him and continued to hold the mirror.

In laparoscopic surgery, there were not many sutured places, but Wu Ye completed this operation in 10 minutes.

Looking at the time, it was less than 100 minutes, which had already broken his personal record.

After leaving the follow-up care to the assistant, Wu Ye rushed to the operating room in the tenement building excitedly.

He wants to see what step Tang Lou has completed, is he fixing the patch?Or suture the aponeurosis?Or are you still looking for the hernia sac?

(End of this chapter)