Surgery Godfather-Chapter 480 - 437: Super Brain

Yang Ping is right, this case is unique, no one has performed a similar surgery; including the anatomy, it is also one of a kind.

The anatomical relationship in the chest and abdomen was in utter chaos. If one didn’t know the detailed medical history, they might think that multiple surgeries have been performed in the chest and abdominal cavities.

The heart and large blood vessels are a problem, as are the liver, gallbladder, and pancreas.

The patient’s heart and large blood vessels are compressed in a narrow, malformed space. They can’t hold up much longer and will eventually die of heart failure. Living to the age of eighteen is already remarkable.

This malformation wasn’t caused in a short period of time but evolved gradually over a long time. The malformation of the heart and large blood vessels significantly affected the function of the heart. Coupled with the pressure caused by spinal malformation and displacement caused by adhesions, the situation has worsened. The massive accumulation of ascites now is a result of this.

Not only did this cause ascites, incorrect body positions could also lead to shock.

Obstruction of the inferior vena cava’s return flow causes a decrease in the volume of blood returning to the heart. The pressure in the right atrium decreases, the cardiac output correspondingly decreases, leading to a drop in blood pressure. In severe cases, a series of manifestations of shock occur. In a supine position, the symptoms are even worse. Clinically, this kind of syndrome is referred to as inferior vena cava syndrome or positional shock.

In clinical practice, pregnant women tend to develop this special condition, such as in cases of multiple pregnancies, polyhydramnios, and other conditions where the uterus abnormally enlarges. The enlarging uterus compresses the inferior vena cava, leading to return flow obstruction and triggering the symptoms mentioned above.

Now, there are neither fetuses nor tumors compressing in this patient. The constriction of the inferior vena cava is due to adhesion. The wall has become bent and flattened. The malformation of the spine and thoracic cage also cause compression, leading to a syndrome similar to the one described.

If a fetus or tumor compresses the venous cavity, patients are prone to shock when in the supine position.

Zheng Baosheng’s situation is unique. Several body positions can lead to shock for him. Due to the body’s self-protection instinct, he has identified these positions and consciously avoids them.

However, this makes sleeping at night risky. A sudden drop in blood pressure could lead to shock at any time, posing a life-threatening risk.

Once a shock-inducing position is assumed, if it lasts more than five minutes, symptoms of shock follow—they include dizziness, chest tightness, nausea, vomiting, frequent yawning, cold sweats all over the body, increased pulse rate, decreased blood pressure, and a rapid drop in systolic pressure below 80mmHg.

If the decrease in blood pressure isn’t swift, like in sleep apnea syndrome, he could wake up from sleep, adjust his position, and obtain relief.

However, if blood pressure drops rapidly, and he loses consciousness quickly, he could die in his sleep.

Ever since he developed these symptoms, his parents have been taking turns to watch over him at night, ensuring he doesn’t go into a shock-inducing position.

Surviving to this day, Zheng Baosheng has already weathered numerous threats to his life.

"Aside from ascites and heart failure, his liver has also enlarged. Without surgery, there isn’t much hope of survival. Yet, the odds of a successful surgery are almost nil."

Seeing Yang Ping’s perseverance, Professor Li now feels it’s worthwhile to take risks.

Risking a surgery and not trying it both means certain death, so why not take a proactive approach?

"What can I do?"

Originally, Professor Li thought that Yang Ping would ask him to be the chief surgeon, but since Yang Ping said he would do it himself, Professor Li didn’t say anything more.

"If convenient, let’s carry out this surgery together. Would Professor Li be interested?"

Yang Ping felt that the experience of an exceptional cardiac surgeon could be instructive to him.

Even with the system on his side, Yang Ping does not isolate himself. Keeping open-minded in academia, he could go further and higher.

All of Yang Ping’s medical knowledge comes from reading in the system space and practicing on a large number of experimental bodies. Still, he needed the experiential knowledge of others.

As the old professors often say, learn from teachers, books, practice, and peers.

In this case, whether out of interest or responsibility, Professor Li was willing to participate in the surgery. He also wants to see where Yang Ping’s audacity to perform this kind of surgery comes from.

Afterwards, Yang Ping and Professor Li started discussing the details of the surgery. Because of its immense complexity, every detail must be handled well.

Initially, the people around could participate in the discussion.

As the conversation went on, the others, including Professor Wu Yucheng, couldn’t join in, because the discussion was getting more advanced, and their knowledge base simply could not keep up.

"The space here is too narrow and irregularly so. The curves of the channel are too large, making it difficult to implant an artificial blood vessel. Otherwise, we could use interventional methods to implant the artificial blood vessel in advance to improve the venous return, which would also facilitate the separation of the vena cava during surgery. Even if a rupture occurs upon separation, there will be no excessive bleeding."

"There are difficulties, but we can try."

"We must preserve these mesenteries. After successful adhesion separation, if these mesenteries aren’t present for support, the heart and major blood vessels would have a significant degree of mobility inside the chest cavity, which is extremely dangerous."

"The sheath of the heart must be completely stripped off, as it already shows signs of narrowing."

"We can use a temporary bridging technique on the blood vessels before surgery, allowing the blood to circulate in a different route, avoiding the area of surgery."

"No, it’s best to have blood filling in. It’s more conducive to separating."

"Yes, if necessary, the heart can be taken out, which could make handling the pericardium and structures within the mediastinum easier. Then, we can rebuild a suitable bed for the heart."

"Some of these adhesions can be useful; they can’t be completely removed."

"What about the liver, gallbladder, and pancreas? Do you need me to get someone to assist?"

"No need, I can handle them."

"There is also a significant risk factor. This patient has RH negative blood type; the preparation of blood for transfusion will face many restrictions. Can enough blood products be prepared?"

"We will get in touch with the blood bank in advance to prepare sufficient blood products. We will also use a series of autotransfusion techniques to assist."

"If necessary, we can use the low-temperature technology to reduce the oxygen consumption of tissue cells. This might extend the duration of the application for blood vessel blocking techniques."

"Blood vessel blocking techniques are for temporary use only, so there is no need to use them during surgery. During the operation, blood circulation is beneficial for separation."

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The two discussed for a full two hours. Others just sat aside foolishly, listening to them converse. fɾēewebnσveℓ.com

From clinical to basic medical science, then back to clinical again, they covered anatomy, physiology, biochemistry, histology and embryology, pathology, pathophysiology, and so on. They also cited the latest articles from various journals and brought together the achievements of cardiovascular experts worldwide.

After the discussion, Professor Li began to reassess this young doctor. Dr. Yang Ping seemed to have a vast amount of knowledge within his mind. What he had mastered had far exceeded the depth and breadth that a surgeon should know. At times, it required much effort for Professor Li just to keep up.

He now somewhat believed that this young man dared to venture to conduct this kind of surgery because he had a solid theoretical knowledge foundation.

Professor Li decided to stay and complete the surgery with Yang Ping.

Yang Ping asked Little Five to book rooms for Professor Li and Professor Wu at Tri-Bo Hotel. Professor Qin said, "No need to bother, I’ll book for them. We can stay in the rooms next to mine; they are all vacant."

Since Professor Qin was also staying at Tri-Bo Hotel, it would be convenient for them to chat.

Yang Ping asked Song Zimo to gather all the doctors in the teaching room. He needed to give a simple report on this case so everyone could grasp some knowledge beforehand for the benefit of the patient’s treatment plan execution.

All of them were in the department, except for Zhang Lin.

Song Zimo said with a smile, "Zhang Lin is in the training room explaining the basic operations of arthroscopy to a few young doctors. A few young doctors from Xiehe Hospital also came to listen."

His ability to discuss arthroscopic operations indicates rapid progress.

"He and Little Five practice for one or two hours a day. They’re making quick progress. He was just asked by the Obstetrics and Gynecology department to help out. He showed off some endoscopic operations in the Emergency Department’s operation room." Song Zimo offered this progress report on the two students as well, as Yang Ping usually left Zhang Lin Xiaowu under the tutelage of Song Zimo.

Yang Ping was puzzled, "He was asked by the Obstetrics and Gynecology Department to help?"

"A patient was admitted to the Emergency Department with acute abdominal pain. No issues were found in the procedure for acute abdominal diseases, but upon surface ultrasound scan of the uterus, ovaries, and fallopian tubes, two active, strip-shaped organisms were found. An X-ray further revealed two images resembling spinal bones in the uterus. The patient finally admitted that two live eels had accidentally entered her body. The Emergency Department immediately requested a consultation with Obstetrics and Gynecology. They decided to use a hysteroscope to remove these foreign bodies in the emergency operating room. Given the fact that these organisms are still alive and slippery, it’s not easy to remove them. They’re aware of our excellent arthroscopy techniques, so they requested our help, although we felt it a bit of an overkill. Zhang Lin happened to be available, so he went to their aid. He didn’t embarrass us, using the grasping forceps once and solving the problem within two minutes. He’s quite proud of himself now." Song Zimo clarified the entire incident.

This was no strange matter; when Yang Ping was in the Emergency Department, he often encountered such foreign body removals. There were cases from the rectum, the urinary tract, etc., and the foreign bodies varied greatly.

Zhang Lin, who was with Yang Ping every day and trained strictly by Song Zimo, naturally progressed faster than others in both theory and practice, with broader exposer.

"Be strict with Zhang Lin and Little Five. Basic knowledge, basic theory, basic skills – they have to master each point completely," Yang Ping told Song Zimo.

"What about Little Five? How’s he doing?"

"Little Five’s practical ability is very strong, especially his skills in endoscopy. He is making rapid progress, especially mastering the fundaments like eye-hand separation, and the ’triangle’ technique."

Song Zimo then made a call to Zhang Lin and informed him about the meeting in the teaching room.

Shortly after, he arrived, followed by a few young doctors. He was still discussing the key points of endoscope operation. Apparently, he was explaining well – the doctors were listening attentively with respectful looks on their faces.