Auto chess in the operating room

Chapter 153 Mirizzi Syndrome

After Tang Lou, Professor Huang and Lai Meiyun communicated before the operation, the operation officially started half an hour later.

Anesthesiologist Qian Zhe performed general anesthesia on Lai Meiyun with endotracheal intubation, and took a supine position with legs apart.

Tang Lou took a pen and made an incision mark 2 cm below Lai Meiyun's delicate and small umbilicus. In order to cooperate with the operation, the umbilicus was obviously carefully cleaned once.

I don't know if it was too hard, but it was a little rosy.

Looking at Lai Meiyun's white and flat abdomen, it would be a bit violent to leave an ugly scar.

"veress needle puncture"

As an assistant, Lin Dong performed the puncture.

"Carbon dioxide, pressure maintained at 12 mm Hg"

Due to the single-channel method, there is also a precise control of the air pressure.

Listening to Tang Lou's step-by-step operation procedure of the controller.

Professor Huang and Director Cheng who were guiding at the side nodded slightly.

"Scalpel"

After Tang Lou took the scalpel, he directly chose the pen-holding method. Using the open method, he incised the peritoneum through the linea alba to prepare for the passage.

The whole movement is smooth and fast.

Looking at the incision technique in Tang Lou's tiny operating space, Professor Huang praised Director Cheng: "Xiao Tang's basic skills are very good."

Incision is an essential skill for every surgeon. It is easy to say, but difficult to say. It is quite skillful to be able to do it so accurately and smoothly.

Especially such a young man.

"X-CONE Single Channel System Preparation"

Soon the equipment nurse brought over the X-CONE single-channel inlet system that had been prepared.

Although he had heard Tang Qichen's introduction many times before and seen the video of the operation, it was the first time Cheng Jian had seen the operation on site.

X-CONE single channel inlet system is composed of 2 pieces of metal and rubber sleeve.

Its incision only needs to be about 2cm, so after the operation is completed, it can be minimally invasive, which is very suitable for idols like Lai Meiyun who rely on their bodies and faces for food.

The establishment of the entire single-channel portal system is very simple. After the two metal sheaths are hooked to the abdominal wall and merged, the rubber sleeve is put on to complete the establishment of the single-channel surgical portal system.

The rubber sleeve is composed of four 4mm operation holes and one 5mm operation hole, of which the 1mm operation hole can be converted into a 12mm operation hole by inserting a matching converter, and is equipped with a venting part to reduce smoke interference.

The rubber sheath has a relatively large range of motion, combined with the pre-bent grasping forceps and the endoscope with a length of 50 mm and a diameter of 5.5 mm, it can effectively reduce the mutual interference of instruments and improve the success rate of the operation.

At the same time, the X-CONE single-hole inlet system can be reused many times after disinfection without additional medical expenses.

"The X-CONE single-channel entry system is very convenient and practical, and it has really improved the success rate of the operation."

Professor Huang has personally operated dozens of machines, and has a deep understanding. He sincerely hopes that it can be popularized, which is one of the reasons why he is willing to participate in this surgery.

Cheng Jian nodded slightly. The innovation of surgery is closely related to the progress of medical equipment, and of course the most important thing is the operator.

Advanced technology and a talented healer, combined, can often burst out infinite energy.

In front of the operating table, after completing the establishment of the single channel, Tang Lou slightly adjusted the patient's position, with the head high and the feet low.

The next step is to start the first step of dissecting the gallbladder triangle.

I saw that Tang Lou used the curved forceps to pull the bottom of the gallbladder toward the head side very delicately. The next step is to identify the Rouviere groove.

The Rouviere groove is the only visible landmark on the surface of the right liver and was first proposed by the French anatomist Rouviere in 1924.

During the development of hepatobiliary surgery, with the in-depth understanding of the anatomy of Rouviere's groove, it was realized that cutting the cystic duct above the plane of Rouviere's groove can effectively avoid extrahepatic biliary tract injury.

Therefore, when dissecting the gallbladder triangle, the Rouviere groove will be identified first, and the safe triangle area will be determined based on this.

On the screen, under the fine dissection of Tang Lou, the confluence point was clearly revealed, and the safety triangle was quickly found along the Rouviere ditch.

"Xiao Tang, you have a very deep understanding of the anatomy of Rouviere's sulcus."

Professor Huang praised again.

"It's really quite skilled."

Cheng Jian replied indifferently, but he was very happy in his heart. It is rare to see a practitioner who can be admired by Professor Huang. He has a face.

Tang Lou was already working quietly and focused on the operation there. After confirming the safety triangle, he opened the retroperitoneum directly downwards, and then separated the gallbladder fossa upwards and backwards.

"The movement is well controlled, and the mentality is also very stable, and I didn't get too greedy to free other structures."

Professor Huang continued to comment that the more you look at Tanglou, the more you like it. Many physicians have reached this point, and they will superficially synchronize and dissociate other structures. It seems very neat, but it is easy to accidentally damage the portal structure.

"Splitting Pliers"

With talent and concentration, Tang Lou was completely immersed in the operation. After dissecting the posterior triangle and anterior triangle of the gallbladder, he began to dissect the cystic artery and cystic duct with separating forceps without stopping.

"ultrasonic knife"

Another order, issued calmly.

The equipment nurse immediately handed over the equipment.

"It is quite decisive to cut off the cystic artery directly with an ultrasonic scalpel."

Professor Huang looked at Tang Lou's steps on the screen, and was very happy. He didn't expect that the operation in Hecheng No. [-] Hospital would not be successful this time, but instead, he had a bigger surprise.

The next step was to peel off the gallbladder, and on the screen, Tang Lou controlled the curved forceps to pull the bottom of the gallbladder in the upper left direction.

The gallbladder was stripped from the right side of the gallbladder bed. It was obviously a single-channel operation hole, which gave Tang Lou a sense of relaxation for laparotomy.

Especially the operation that has been going on for so long, instead of being tired, it is getting more and more energetic.

"Xiao Tang's concentration and energy are very good, really suitable for the operating room."

Professor Huang has taken too many interns and residents, and even some trainees from municipal hospitals who used to be chief physicians, what a vicious vision.

"Tang Lou is a well-known physical monster in our academy."

Cheng Jian said quietly from the side, after all, he also suffered from it.

On the screen, Tang Lou continued to control the curved forceps to clamp the round ligament of the liver and pull it headward, peeling off the left side of the gallbladder bed.

After the left and right sides join forces, continue to peel off toward the hilum of the liver.

At this point, more than half of the work has been completed. The next step is to reconfirm the relationship between the cystic duct and the common bile duct. As long as there is no problem, the proximal end of the cystic duct can be clamped directly.After the ultrasonic scalpel is cut off, the gallbladder can be removed.

Cheng Jian already breathed a sigh of relief.Professor Huang was a little bit unsatisfied.

However, Tang Lou's hand on the screen suddenly stopped.

"what's the situation?"

Cheng Jian was a little unexpected.

Professor Huang also looked at the screen, only to see that the camera stopped at the cystic duct and the neck of the gallbladder.

"The cystic duct is too long with the common hepatic duct"

"Stenosis of the hepatic duct caused by stones lodged in the neck of the gallbladder."

Professor Huang's eyesight is astonishing, he saw the clue at once, and Cheng Jian at the side also reacted, and the two of them almost blurted out at the same time:

"Oops, it's Mirizzi syndrome."

(End of this chapter)