Chapter 353： Smooth and creepy surgery

Professor Tian’s technique is very smooth.

The skin was opened and the spinous processes and lamina were exposed. The upper and lower vertebral bodies of the diseased vertebral body were all exposed sufficiently.

In order to better expose the incision, the bilateral iliac spine muscles should be cut transversely from the level of the diseased vertebrae and retracted distally and proximally.

In general, there should be at least 200ml of bleeding at this time.

Because of the process of exposing the spinous processes and lamina, a certain periosteum is treated, resulting in bleeding.

However, today's surgery is unexpectedly smooth.

The amount of bleeding is less than 50ml, and the entire field looks extra clean.

Professor Tian is very satisfied with his technique. It seems that today's hand is very smooth, and the bleeding may be less than 3000ml.

The next step is to start a lot of bleeding. Professor Tian’s hand is a lot softer and slows down very seriously. All operations are carefully identified to avoid accidental bleeding.

The rongeur begins to bite the spinous process with the tumor infiltrating and the lamina.

"嘎巴~", a piece of broken bone was bitten by a rongeur.

Because of the relationship between tumor infiltration, the bone plate is not so hard, and the sound is like a degenerate.

Although the hardness is not enough, but because of the abnormal proliferation of blood vessels, the bone plate has sufficient blood supply, so that the amount of bleeding suddenly increases.

A lot of bleeding is from now on.

A lamina was bitten by a rongeur, and Professor Tian used to cover it with a piece of dry gauze.

strange……

In an instant, Professor Tian discovered that for ten seconds, the dry gauze was soaked with blood.

Professor Tian is very high-level, although he has not reached the level of masters, but he is also a master class, and he is a professor of orthopedics near the division.

He has a deep understanding of vertebral body removal surgery.

If there is less bleeding before, it is because the level of separation is high, but it can be explained.

However, the rongeur bites the lamina, and this step is unlikely to have a particularly small amount of bleeding.

Generally speaking, from this step, surgery is performed in a pool of blood.

The kind of sucker is not clean.

Unclear vision will lead to more bleeding, and this vicious cycle will continue.

On that side, fresh frozen red blood cells have been hung up, waiting for Professor Tian’s order to be ready to enter the patient’s body.

Strange, is it a rare tumor? Blood supply is not rich?

Nor will it, Professor Tian is somewhat incomprehensible to the situation at hand.

Even if the blood supply to the tumor is not abundant, the blood supply to the vertebral body is quite abundant. No matter how long it takes for ten seconds, bleeding will soak a piece of dry gauze.

"Teacher Tian?" Dr. Zhou saw Professor Tian screaming at God. He did not know what happened and shouted.

Professor Tian wakes up from infinite speculation, condenses and continues surgery.

Continue to bite the lamina and expose the nerve roots.

The tumor invades the spinal canal. During the operation, the dura mater gradually bulges outward and there is no pulsation. The epidural fat often disappears and is displaced or deformed in the dural sac.

The vertebral plate that the rongeur bite broke, Professor Tian did not continue to cover with dry gauze, he wanted to see how much bleeding there was.

Sure enough, the amount of bleeding is very small, only a few tens of milliliters.

Is the problem of interventional surgery!

Professor Tian quickly judged the truth. However, this truth is unacceptable to him.

In the Imperial Capital, he is an expert and professor of spine surgery, often working with an interventional surgeon to complete the vertebral body removal.

But have you encountered such a small amount of bleeding?

No, not at all.

With the intervention of the interventional department, it can indeed reduce certain bleeding. It has something to do with the technique of the surgeon, but it doesn't have much to do with it.

Is it difficult to embolize a transverse artery?

Can not find an interventional surgeon, Professor Tian himself can do embolization of the transverse artery of the waist with lead clothing.

However, whether it is an interventional doctor or his own embolization of the lumbar transverse artery surgery, he can only reduce the amount of bleeding from 5000 ml to 2000, 3000 ml.

Nothing less, Professor Tian really encountered every time.

Haicheng is such a small place, is there a doctor who is stronger than the emperor?

Impossible, totally impossible.

Professor Tian thought about these things in his mind, but he did not stop at hand.

This kind of surgery is too much, and you can do it without closing your eyes. At the very least, you don't have to repeat the local anatomy when you do it for the first time.

The nerve roots were found on both sides of the dural sac with nerve strippers and protected.

Subsequently, Professor Tian began to remove the tumor tissue, the dural sac and the lateral side of the nerve root, and removed the superior and inferior articular processes and the pedicle with the tumor tissue.

In general, the role of embolizing the lumbar transverse artery before laminectomy is here.

There is no interventional embolism and threatening bleeding can occur.

What is threatening bleeding?

Some invisible blood vessels, screaming and vomiting, the whole field is red, even the bleeding blood vessels can not be found, let alone vertebral body removal.

No threatening bleeding, very good.

But... This is where there is no threatening bleeding, even bleeding is not good!

If you say that there is no bleeding, it is nonsense.

Dr. Zhou can hold the suction device without a set in his hand. It is very easy to clean the bleeding, and the surgery field is very exposed. It is good to see Professor Tian is a little panicked.

This is not a familiar vertebral body removal...

Did you do something wrong?

He stopped and recalled the entire operation without any problems!

Look at the field, the anatomical structure can be used as a map of textbooks, and there is no problem.

I really saw the ghost.

The operation was done too smoothly, and there were problems.

Professor Tian is a bit embarrassed. He has never seen such a field since he was exposed to vertebral body removal.

If in the Imperial Capital, Professor Tian has the heart to find a few colleagues, and even find his own teacher to watch the platform and see if he has made any mistakes.

But here is Haicheng.

Do it with a hard scalp.

Exposure and resection of the lumbar vertebrae, very smooth, bleeding ... or very little, lumbar vertebrae here, generally bleeding will be around 500 ml, taking 30 minutes.

This is the experience of Professor Tian.

But this horrible surgery ~ www.novelhall.com ~ bleeding volume is 30-50 ml, it took 15 minutes to complete this step.

Professor Tian began to expose the anterior and posterior aspect of the vertebral body. The vertebral body invaded by the tumor was moderately enlarged, but the boundary between the edge and the surrounding tissue was clear. Gently peeling off pushes the surrounding tissue away and peels off.

Normal, this step will still have 200-300 ml of bleeding, which takes time...

However, it is still very smooth here. The amount of bleeding is only one tenth of the usual. Looking at the suction tube in Dr. Zhou's hand, it is estimated that 20-30 ml of bleeding is good.

To dissect the vertebral body to the anterior longitudinal ligament, Professor Tian asked Dr. Zhou to use the Hohman hook to retract the surrounding tissue, and the lateral anterior approach of the vertebral body appeared in front of the eye.

Surgery... Too smooth, smooth and embarrassing, makes people fear.

Is this a vertebral body removal?

No, how can bleeding be so little? How can the operation be so smooth?

Really... I really saw the ghost!