Auto chess in the operating room

Chapter 108 Tanglou Tianxiu
Ma En still had no intention of embarrassing Tang Lou, his whole mind was highly concentrated, and his brain began to spin at a high speed.

"Tang Lou, did you go in the wrong direction? Look in another direction."

Ma En hurriedly said that at this time, he felt how important Tang Lou's mirror holding skills were. According to Ma En's method, the camera went from the other end of the colon belt for a while, clear and stable, but still nothing.

"what's the situation!"

Cold sweat broke out on Ma En's forehead: "It can't be such a coincidence that I met the legendary ectopic appendix?"

Director Cheng and Doctor Qing stared at each other, Ma En was a little panicked, and blamed himself for picking such a case.

When Ma En was at a loss, Tang Lou's voice sounded:
"Dr. Ma, it may be that the colon we selected is wrong, and we need to start anew to find the real right colon."

Hearing Tang Lou's suggestion, Cheng Jian and Qing Ping just thought about it a little bit, and thought of a possibility.

Ma En doesn't understand, but it doesn't matter, Tang Lou has already started to move the camera, changing another part of the colon.

Under the camera, Ma En looked at a particularly lengthy colon, wondering where all the five sense organs were crowded together. Compared with the normal appendix, he went a long way down before he saw an abscess.

"found it!"

When Tanglou told them that they had discovered the appendix, Cheng Jian and Qingping also raised their eyebrows. Sure enough, it was the long sigmoid colon that caused the appendix to appear in the right lower abdomen.

They have encountered this situation before, and it is the first time they have encountered this situation. The appendix cannot be found along the normal colon, and ordinary novices will panic.

This is because the knowledge is not comprehensive enough, falling into a fixed mindset, or not using the brain at all, which is very fatal on the operating table.

Fortunately, Tang Lou's mind is clear enough.

Qingping smiled slightly, and said softly: "Not bad."

"Doctor Ma, the length of the sigmoid colon causes the position of the appendix to shift."

Tang Lou explained that it was only then that Ma En suddenly realized, and he felt a kind of joy in raising his posture, but it was very uncomfortable immediately, and he was the one who should popularize science!

Tang Lou didn't give Ma En too much time to buffer, and directly probed the appendix with a cold description:
". During the operation, the patient's appendix was perforated, the root of the appendix was gangrene, there were adhesions in the abdominal cavity, and the appendix was adhered to the flank, cecum, and ileum. It is recommended that the suction device be bluntly separated, and the adhesions should be cut off with an electrocoagulation hook."

Before Ma En came to his senses, Tang Lou had already arranged the operation process.

"???"

Who is the chief knife?

Ma En was complaining in his heart, but he honestly took the aspirator prepared by the equipment nurse.

Just after the blunt dissection, the electrocoagulation hook has been delivered by the equipment nurse.

".Pay attention to protecting the intestinal tube during the electrocoagulation process. Rehabilitation on the right side. Be careful with the tubular tissue."

Ma En wanted to refute, but his hands kept moving, and he even felt a little super-level.

With a clear and perfect surgical field, the camera is always one step ahead and gives the angle he wants. Ma En himself feels that this operation is a bit smoother than before.

This is the wonderful experience brought by a good mirror assistant.

Although Ma En doesn't like Tang Lou, but at this moment he has to say: It smells so good!

Marne quickly had his appendix removed, but soon found himself in trouble again.

But he was too embarrassed to speak, and his hand movements froze for five seconds.

"What are you doing, Mann?"

Qingping on the side asked some unclear questions.

Cheng Jian did not speak, but his face was also a little gloomy.

Ma En's performance is really too immature. It is a big taboo to stop still during the operation. Even if you encounter a problem and can't solve it yourself, don't you ask your superiors?
Ma En's face turned red instantly, and he was really distressed. Due to the length of the sigmoid colon, the patient's appendix was perforated and gangrene, so the diameter of the cut appendix directly exceeded 10mm.

That is to say, it cannot be pulled out from the casing of the operating hole. In the past, traditional laparotomy was performed. This situation has never been encountered before.

What can he do?
The idea was too memorized, Ma En didn't dare to look at Qingping, and instinctively glanced at Tang Lou, his eyes were full of helplessness and pity.

Since the operation of pulling out the sleeve was the finishing touch, the cavity environment could not be found, and Tang Lou didn't realize it either.

Seeing Ma En's expression on the verge of crying, Tang Lou confirmed in a low voice, "Can't pull it out?"

"Well, stuck!"

Ma En nodded heavily, looking like a black face with constipation for a month.

"The mesentery is hypertrophic, and the mesentery can be trimmed and pulled out of the casing many times."

"!!!"

My god, Marne also realized it, it's so simple!
The operation is naturally extremely simple, but this is the first time he encounters such a situation, and there are two big bosses staring at him, so Ma En's thinking is naturally rigid.

Under the reminder of Tang Lou, Ma En quickly trimmed, and the lens also thoughtfully gave a close range, sufficient brightness and vision.

At this time, Ma En's tears were about to burst into tears. Fuck Wang Daquan, the hand-damaged and brain-dead Wang Daquan, Tang Lou is such a caring little cotton-padded jacket called the chief knife.

Like an adult stool that has been held back for a week, it has gone down a thousand miles, relieved, and radiant!
Ma En understood Qingping too well.

It's him, he also wants a mirror-supporting assistant like Tang Lou, it's so easy to use.

"The appendix is ​​thicker than the sleeve and can be taken out of the specimen bag in advance, which can effectively prevent incision contamination"

Tang Lou continued to add.

"okay."

Ma En himself didn't realize that the whole operation process was completely in Tang Lou's rhythm.

Qing Ping at the side said gently to Cheng Jian: "How is it?"

Cheng Jian didn't speak, but his eyes lit up. He was also a little tempted by Qing Ping's previous proposal. Maybe he could give it a try?

Tang Lou is indeed very familiar with the laparoscopic surgery process, and he has a certain degree of advance and retreat in dealing with emergencies. He even felt a kind of aura that only experienced surgeons have in him. The eight-character summary is:

Command with a degree, sway freely.

Since the appendix of the patient here is not only perforated, but also gangrene, the treatment near the edge of the gangrene is very particular.

The distance from the gangrene edge to the cecum is different, the degree of gangrene is different, and the methods used are also different.

Although Ma En had tried the Maxwellian incision method, it was the first time he encountered it in laparoscopic surgery. He had an idea, but he was not sure.

"Tang Lou, what do you think?"

This time, Ma En sincerely asked for advice again.

Tang Lou controlled the camera, scanned the base of the appendix again, and thought for a few seconds:
"Dr. Ma, you can see that the gangrene edge at the root of the appendix is ​​5mm away from the cecum. I suggest simple ligation + figure 8 cecal seromuscular layer suture."

"Why not simply ligate?"

Cheng Jian on the side was also interested and asked a question directly?
Ma En looked at Director Cheng unexpectedly. In fact, he was also a little puzzled, because he was thinking of simple ligation.

"Simple ligation is suitable for those whose distance from the edge of the appendix to the cecum is more than 5mm. Because the distance is too short, it is easy to crack in the later stage of simple ligation."

Cheng Jian nodded, and continued to ask: "What if the current edge distance is within 3mm?"

Ma En was trembling on the side. Fortunately, Director Cheng didn't ask himself, otherwise he would have been scolded again.

Tang Lou's tone remained unchanged: "If it is within 3mm, then simple ligation + pouch embedding is required. Only in this way can we best prevent fecal stone infection in the later stage."

"Then what if the root is severely gangrene and perforated, and even the purse embedding can't handle it?"

Hearing Director Cheng's life-threatening three-time questioning, Ma En didn't dare to take a breath. He was flustered and envious at the same time. The panic was of course his own, and the envy was Tang Lou. He talked eloquently in front of such a difficult triple-hit .

If only he was Marne.

What a show!
Sure enough, Tang Lou gave the last correct answer: "Then it can only be treated with the Endo-GIA cutting and closing device."

After getting a satisfactory answer, Cheng Jian finally calmed down.

With the assistance of Tang Lou's national service, Ma En perfectly completed this case of laparoscopic appendicectomy, which was beyond his ability.

Before leaving the operating room, Cheng Jian said to Qingping:
"I changed my mind and agreed with Tang Lou to start performing laparoscopic surgery."

(End of this chapter)