Auto chess in the operating room

Chapter 300 Difficult operation of walking on the tip of the knife
Next, Tanglou began to puncture the second and third casings.

"5mm casing"

With talent and concentration, Tang Lou didn't realize that there was a big boss in the operating room, and continued to give orders, and the equipment nurses naturally cooperated conscientiously.

"Hey, this kid, this is what you want."

Seeing Tang Lou's operation, Professor Lin immediately reacted, and his heart became more and more admirable: "This little guy is really skilled and bold."

Second, there are generally three ways to puncture the third cannula: midline, mid-lateral, and bilateral.

Generally speaking, under normal circumstances, the most commonly used method is the midline position.

The method is to puncture into the preperitoneal space at about 1/3 and lower 1/3 of the median line between the umbilical foramen and the pubic symphysis.Relatively speaking, the operation is the simplest, but the disadvantage is that since the three cannula parts are located on the median line, the operating angle formed is not ideal, which may cause mutual interference between instruments.

However, it is easy to operate, and most doctors will use this method.

As for the mid-lateral position, it has limitations and cannot be used for bilateral hernias, so it is not suitable for this patient's situation.

As for the last one, which is also the most difficult one, this is exactly what Tanglou is trying.

The so-called bilateral position, before the cannula puncture, you need to extend your fingers first, and after entering the peritoneal space, make a complicated separation to both sides, and then under the guidance of your fingers, puncture at the level of the umbilical cord lateral to the rectus abdominis on both sides. Second, third casing.

Due to the use of finger blind manipulation, the operator's operation requirements are very high, and the strength must be just right, and non-veteran drivers dare not try it.

After all, Kato Taka did not do it easily.

Of course, the greater the risk, the greater the benefit. Using this method to maintain a certain operating angle between the instruments is not easy to interfere with each other.

"This hand, pure fingers pre-separation of the preperitoneal space, is really beautiful."

In his heart, Professor Lin compared Tang Lou's operation with his own surgery, and he couldn't find a single mistake in Tang Lou's operation. Even in some details, due to his youthful vigor, he was more durable, and he did a little more perfect than him.

"This little guy is amazing!"

A boss of Professor Lin's level has seen too many outstanding young people. In Shanghai, there are many who are faster than Tanglou. I have also seen those who are difficult to operate, but combining all these advantages, it is Very few.

At first, Professor Lin wanted to replace him as the chief surgeon, but now, he doesn't even need to guide and correct mistakes.

"This is really the easiest time to throw a knife." Professor Lin felt a little guilty, and sighed, "Damn, it just happened to be a waste of money."

"Balloon Separator"

The next step is to separate and expand the preperitoneal space. Since the patient's family is wealthy, Tang Lou adopted the most expensive balloon separator separation method.

Soon, Tang Lou was established in the space between the superficial layer of transversalis fascia and the peritoneum.

"It's so fast."

Professor Lin was a little surprised. Dr. Tang's operations were too intensive, and he didn't even breathe at all.

"Young people are different, they have great physical strength."

On the operating table, Tang Lou has already further separated the pubic bladder space (Retzius space). He hesitated to take a step forward. The preperitoneal space was established very successfully, so the pubic bladder space was naturally formed, and it was simply separated a few times. The pubic symphysis and pectin ligament are exposed.

"pretty."

Professor Lin applauded softly, this operation looks really comfortable.

Qing Ping also showed a proud look on his face, Tang Lou is really up to date, with such an excellent operation, even Professor Lin of Shanghai Magic City can't find any mistakes.

Next, Tang Lou started to explore and treat the direct hernia and femoral hernia, and completed the dissection of the hernia sac very skillfully.

Looking at the fully exposed direct hernia defect, it is very obvious that the transversalis fascia at the defect is obviously thickened.

Professor Lin also did not expect that the patient's situation was quite special, and his face finally became a little more serious. This kind of situation is called "false hernia sac".

Professor Lin is considering whether to speak out to remind that the tenement building has already started operation.

Since a large direct hernia defect would leave a cavity during the operation, Tang Lou directly pulled out the "false hernia sac" and stapled it to the lacuna ligament or pubic pectin ligament.

"clever."

Professor Lin's eyes lit up, and he took a step forward. Even he had to go through dozens of surgeries before summing up this kind of treatment.

This kind of treatment has several advantages. The first is that it can tighten the loose transverse fascia, and the second is that it can reduce the incidence of postoperative seroma.

Seeing that Tanglou was able to handle it with such ease, Professor Lin was a little doubtful whether this young doctor had gone through a huge amount of training in this kind of technique.

"Doctor Qing, there really is a remarkable talent in your hospital."

Professor Lin looked at Qingping who was at the side, and praised him.

Qing Ping and You Rong Yan, although it is normal for Tang Lou to be praised, but this is the first time that Professor Lin is of this level.

"Professor Lin, in the next operation, you still need to be on the sidelines, especially the danger triangle, death crown and pain triangle."

Of course Qingping didn't float up, he was still very strict about the operation, as long as the operation was not carried out to the last step, he dared not relax.

Regarding Qingping's attitude, Professor Lin also agrees very much. These important structures must not be damaged at all, otherwise it will lead to serious complications and even death. This is also the difficulty of TEP.

The two continued to observe the operation of the tenement building.

The so-called dangerous triangle, proposed by Spaw in 1991, also known as Doom's triangle, is located in the triangular gap surrounded by the vas deferens and spermatic vessels, and the external iliac artery and vein pass through it.

In the monitor, Tang Lou's operation is very dexterous. The angle formed by the vas deferens and the spermatic cord blood vessels is 38 degrees and 48 degrees on the right side, moving precisely.

"This control is really terrifying."

Professor Lin is also a little impressed, especially under Tang Lou's high-paced operation.

Soon, Tang Lou completed the operation of the dangerous triangle with ease.

Then came this operation, the most difficult death crown, Corona Mortis.

The patient has an anastomotic branch between the inferior epigastric artery and the obturator artery. This anastomotic branch is relatively thick and is an abnormal obturator artery branch. It is located on the outside of the pubic pectineal ligament near the iliac vein.

Among the monitors, this abnormal obturator artery branch passes in a loop from the medial side of the femoral vein and behind the pubic pectin ligament, forming a loop, that is, the origin of the crown of death.

When Tanglou separated him, Rao Shiqingping was very confident and nervous about Tanglou. Professor Lin also held his breath.

After 3 minutes, both Professor Lin and Qingping breathed a sigh of relief: "The death crown has been solved perfectly, it seems that the victory of this operation is in sight!"

Sure enough, in the following time, Tang Lou more and more quickly completed the separation of the retropubic venous plexus and the pain triangle.

Under Tang Lou's precise operation, the scope of peritoneal space separation was determined: medial to the pubic symphysis and across the midline, lateral to the iliopsoas muscle and anterior superior iliac spine, superior to the 2 cm above the syndesmosis tendon, medial and inferior to 2 cm below the pectin pubis ligament, Outer inferior to the abdominal wall of the spermatic cord.

However, within this range, a sufficiently large patch can already be placed.

"10cmX15cm patch suture."

Hearing Tanglou's choice, Professor Lin raised his brows slightly, and his heart stabilized again. This Tanglou was really walking on the edge of a knife every step of the way.

Under normal circumstances, medical glue is now used to fix the patch. Few people still insist on suturing. After all, suturing is easy to cause complications and pain, especially the position of suture is very particular!
(End of this chapter)