Surgery Godfather-Chapter 275 - 0259: Hybrid Surgery

Chapter 275: Chapter 0259: Hybrid Surgery

Teng Guihua had wanted to ask a few more questions, but was stopped by Chang Juan. Chang Juan did not want this woman to disturb the doctor’s treatment.

Although she was Fang Xiaoyun’s mother, this mother had no regard for her daughter in her heart. The daughter was just a tool to be exploited for money.

If she could sell her, this mother wouldn’t blink an eye. She’d sell her daughter to get money for the down payment and renovations for her son’s house.

“The on-duty doctor in the interventional operating room is busy with a case of spontaneous intracranial hemorrhage that requires interventional embolization and needs to spring clips. I reported to the chief on duty, who is coordinating and calling the standby staff to come over.”

Song Zimo was contacting the intervention operating room. Spinal vascular angiography required a highly skilled interventionalist to go super-selective for each and every spinal artery, pushing contrast agent and distinguishing them individually.

In addition, there was an anterior spinal artery that was originally embolized where a cut was made during the operation to remove the embolization, and then anastomosed again. Once angiographed, the risk of re-embolization increased greatly.

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“What about Fang Xiaoyun’s condition?” Professor Zhang rushed to the comprehensive orthopedics office.

Yang Ping immediately reported his analysis and arrangements to Professor Zhang who sat down for a break: “I’ve also been pondering it. It looks so much like dural arteriovenous fistula. I’ve encountered a case like this before, but the symptoms didn’t manifest so quickly. That patient had lower back pain, numbness and weakness in the lower limbs, was diagnosed in another hospital as a herniated lumbar disc, and underwent surgery, but the symptoms did not alleviate after the operation, leading to complete paralysis. Later, I considered this disease. After a spinal angiography that took 6 hours, we found the fistula and performed the surgery to treat it, which made the patient regain sensation and muscle strength in lower limbs. Fang Xiaoyun’s condition is even more complex; spinal tuberculosis and dural arteriovenous fistula appearing together, causing paralysis at the same time. If true, it’s extremely rare. We need to arrange emergency DSA. If confirmed, immediate surgery is required. The patient will be placed in Intervention’s hybrid operating room.”

The hybrid operating room is a kind of compound operating room. It is generally a hundred-level laminar flow operating room that integrates DSA equipment with surgical equipment, allowing some complex surgeries to be completed in one operating room, reducing surgical risk, patient movement, and surgery time.

“We’ve already arranged it. The doctors on duty in the Intervention department are busy and short-staffed. The chief on duty is coordinating and has called in the backup team,” Yang Ping explained.

Director Han also rushed over in a hurry: “Yang, I have contacted Director Shi of Intervention. They have arranged for Director Ji to come over. Director Ji has the best skills in Intervention and has performed the most spinal vascular angiographies.”

Great, at the critical moment, Director Han could coordinate in the middle, create conditions for Yang Ping, and take the risk for him.

Although the chief on duty could also coordinate, he wouldn’t be as attentive as Director Han. When Director Han had a chat with Director Shi, they got the idea of what kind of doctor you need, so they immediately called Director Ji over, and didn’t just randomly call a doctor over to deal with it.

“Have you communicated with the patient?” Director Han asked.

Yang Ping nodded: “I just finished communicating and got the signature. The patient herself was easy to communicate with, but her mother seems to be up to no good. She evaded and dodged our questions, she is suspicious of this and suspicious of that.”

Director Han grunted in approval: “She’s an adult. As long as she agrees, it doesn’t matter about the family members for now. Xiao Zhang, bring me the patient’s case history.”

Zhang Lin immediately handed over the case history. Director Han flipped through it and signed his name in front of Yang Ping’s on the surgical consent form.

“Just follow your plan. I’ll take the responsibility if anything comes up. As doctors, there are always risks. As long as we work for the best interests of the patient and are fully prepared to control the risks, that’s enough. Later, I need to make a phone call to Old Zhao at the Medical Affairs Office for a case backup, as this is one with potential disputes with the family.”

Director Han handed the case history back to Zhang Lin, and Professor Zhang gestured to also take the case history and add his own name: “Go ahead. This case is quite rare, remember to collect the data.”

“Little Five, you are responsible for collecting data. Song Zimo, Zhang Lin and I are going to the platform, Fatty will administer the anesthesia.” Yang Ping made arrangements on the spot.

“The Intervention Department just called to inform us to send the patient. They have sent two doctors and a nurse and have opened a hybrid operating room for our use.” Song Zimo informed after taking a phone call.

Su Yixuan and Zhou Can rushed to push the surgical instruments and microscope to the interventional operating room. Orthopedic surgeries required a lot of specialized instruments. For spinal surgeries, there was a complete set of spinal surgery instruments. The Intervention Department’s hybrid operating room only had some general instruments and did not have specialized orthopedic instruments.

“Let’s go and send the patient!” Director Han brooded.

Zhang Lin and Little Five quickly transferred Fang Xiaoyun to the interventional operating room using a transfer stretcher. The interventional operating room was located on the second floor of the emergency building where the Chest Pain Center was also located.

The stretcher from the Comprehensive Orthopedics Department was newly purchased with inflatable wheels and shock absorbers, which made no large noise or vibration while pushing it. Fang Xiaoyun’s mother followed behind: “Hey! Hey! Hey! What are you doing—”

“Would you stop the nonsense!” Chang Juan blocked her in fear that she would create trouble and affect the doctors’ work.

The transfer route between each building was barrier-free. The stretcher was hastily pushed to the interventional surgery room, and Director Ji, with his assistant and nurse, were already waiting in the operating room.

“Professor Zhang! Director Han!” Respectfully, Director Ji said his greetings.

“Doctor Yang!” Director Ji also courteously greeted, ignoring the others.

At this point, Yang Ping was also a celebrity in the hospital. Everyone knew about his abilities. Technical skills are highly esteemed in a hospital. If the skills are good, everyone respects them; if the skills aren’t up to par, even if there is a strong support, it’s useless. While no one may say it, people definitely look down upon such individuals.

“This patient is suspected of having a dural arteriovenous fistula? The surgery will take a long time as we have to super select each vessel, test it, and there’s also the possibility of failure. I will try my best.”

Director Ji spoke realistically, but he was very willing to try. Having not encountered such a rare case before, he was naturally excited since he had only heard of it during his advanced studies at Fuwai. Now that he had encountered it clinically, he was naturally thrilled.

Professor Zhang encouraged him: “Don’t worry. I’ve performed DSA on patients with this condition before. You can do it, and I will be here to help you.”

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That’s great. The elder generation of doctors weren’t like now. Back then, it was normal for them to explore some cross skills. Many older doctors could even take X-rays themselves.

“A week ago, this patient’s anterior spinal artery at T9 had been embolized. During surgery, a cut was made to remove the embolism and then it was anastomosed again.” Yang Ping began explaining, followed by Zhang Lin providing a detailed introduction of the patient.

Director Ji said, “You have to strictly control the amount of contrast agent used during surgery, or it may easily result in re-embolism.”

Once the patient’s condition had been handed over and the bedside talk completed, the young doctors under Director Ji began to get the patients to sign the DSA informed consent and the iodine contrast agent informed consent.

Fatty was doing the anesthesia, endotracheal intubation for general anesthesia. Fatty’s anesthesia was quick and effective. He was so efficient that people were still talking on this side when anesthesia was already done on the other side, and they could start the surgical preparation.

Director Ji greatly admired this young team, with their excellent professional qualities. This anesthesiologist, Fatty, was much better than his own anesthesiologist, who was always worrying about this and that.

“We’ll go first, carrying out the DSA of the spinal arteries. We’ll be using a femoral artery puncture and investigating one by one by one. This will probably take a good five to six hours. Why don’t you guys go and rest a bit in the meantime?”

Director Ji, his assistant, and the nurse all put on their lead coats. Every person started looking for their own lead coat to put on. Professor Zhang also needed a lead coat. The lead coat was not breathable and very heavy, weighing several tens of kilograms. Wearing it for several hours on an eighty-year-old person can be quite uncomfortable.

“We are now using the supine position to do the DSA, when we find the fistula, we then switch to the prone position for you to perform surgery, is that okay?”

Director Ji came back after scrubbing his hands, disinfected the operating area, and put on his gown and gloves.

“You have worked hard, Director Ji!”

“It’s fine, we are all doctors. This kind of thing happens all the time. Today is my wife’s birthday, I promised her I would have dinner with her, but just as we sat down, I got a phone call. There’s no way around it, after all, we are doctors.”

Could they replace him?

Well, not really. With this type of case, you need a skilled doctor to have a high success rate.

Director Ji is in his forties, his hair is grizzled, and he is lean. He is one of the leading directors of his department.

The Interventional department is divided into several areas: the Neurointervention group, the Cardiovascular Intervention group, and the Tumor Intervention group. Old Ji belongs to the Cardiovascular Intervention group, which is an important part of the Chest Pain Center.

Old Ji came from the cardiovascular department. After getting married and having a child, he began to deal with interventions. Generally, those who work in interventions are frequently exposed to X-rays. Those without a spouse or child are unwilling to pursue this field, and hospitals typically do not select unmarried hopefulls.

With skillful movements, Old Ji punctured the femoral artery and inserted the guide wire and catheter. The first spinal intervertebral artery was successfully catheterized.

You can only investigate one by one. If you use too much contrast medium, it doesn’t work. If you use too little, it also doesn’t work. The dosage must be accurately controlled and the catheterization technique must be gentle and precise.

“Push the contrast agent, Omnipaque!”

Omnipaque is a non-ionic iodine contrast agent. It is a safe intrathecal contrast agent. For the angiography of spinal arteries, you must select contrast agents that can enter the spinal canal.

“Fine, that’s enough. You want less, right? Old Zhang?” Old Ji asked Professor Zhang.

“Yes, if there’s too much it could cause embolism.” Professor Zhang was knowledgeable and experienced in all aspects.

“Yes! When I was being trained at Fuwai, a fellow trainee said that their hospital had a case of spinal artery angiography, which led to spinal artery embolism and caused spinal cord supply obstruction. The spinal cord was ischemically necrosed and the person was paralyzed. They have had a lawsuit going for many years, so it’s better to use less for high-risk factors.”

But if you use too little it won’t fulfill its function as a contrast agent. So mastering the right quantity requires a lot of experience.

“No, let’s move on to the next one!”

There are twenty-four intercostal arteries alone. This was only the beginning, one artery would not be conclusive within ten minutes or so.

“Professor Zhang, why don’t you go rest for a bit? I can handle it here.”

Director Han was worried he couldn’t handle this, all-nighter, and on top of that such a heavy lead coat.

Professor Zhang waved his hand: “It’s okay, I have experience with this type of case, and I have also done this kind of DSA, I can provide them with some suggestions. You guys go ahead and take a break outside, these young guys will need to be ready for surgery later.”

Professor Zhang’s tone was stern, like a command. He was doing this to protect the young people. After all, they hadn’t gotten married or had children yet, he wanted to limit their X-ray exposure as much as possible.

“It’s okay, I’ll stay inside, I want to see the angiography situation.” Yang Ping had also put on a lead coat, everyone was wearing a lead coat.

Professor Zhang lost his temper: “Why aren’t you listening? When I say go, you go. Why are so many people crowding around watching?”

Director Han immediately ordered Yang Ping: “Only the professor and I need to stay here, everyone else out! Did you hear that?”

Even wearing a lead coat couldn’t entirely protect them during five-six hours of X-ray exposure. They also had surgery later on, and orthopedics doctors are often dealing with X-rays. Unnecessary exposure should be avoided as much as possible.

Alright then, Yang Ping led everyone out to the changing room to rest.

They could lean against something and nap for a while. If Director Ji found the fistula, he would call everyone back in.