Listening to Qingping's solemn tone, Tian Linsheng quickly opened his small book and started to memorize it.

"In the minds of our surgeons, we must have this awareness: the information provided by patients or family members, the situations reported by lower-level doctors, and the content that appears in the case system are not necessarily reliable; only the surgeon's own hands are the most reliable!

You have to do it yourself, and you have to do it with quality and quantity, and you have to do it yourself and not be lazy."

"To touch the patient's belly in person and ask a few questions about the patient's condition can sometimes reveal small hidden dangers and solve big problems."

"Clinical work is very busy. We may not have time to do some basic work, and we must do it by others. However, we must keep this principle in mind and take the initiative in our own hands. When treating patients with appendicitis, the surgeon must personally examine the patient.

!”

Qingping took a few steps and continued to add some of his personal experience in a serious tone: "Before making a diagnosis, conducting a physical examination in person can avoid misdiagnosis as much as possible and avoid passive surgery when the indications for surgery are not very strong or sufficient.

This is also a habit that Director Cheng forced me to develop when I was a rookie."

Listening to Qingping's words, both Tanglou and Tian Linsheng had a wonderful feeling. Cheng Jian gave Qingping this consciousness, and now Qingping is educating Tanglou. From generation to generation, there is a sense of beauty and ritual passed down.

Tian Linsheng has a sense of pride, just like Cheng Jian, Qing Ping, and Tang Lou, they are the authentic descendants of general surgery.

"During my first surgery, thanks to the preoperative physical examination, the patient's abdominal wall muscles were relaxed after anesthesia, and the internal organs were better palpated. I discovered the ileocecal tumor that had been ignored before. It was also because of that time,

I became famous in one battle, and Director Cheng also took a special look at me. Compared with the other residents, I didn’t have a big advantage originally, but from that time on, Director Cheng deliberately let me do more surgeries. Over time, the gap became smaller.

Appeared."

"Now I have become an expert in acute abdomen, while one of the residents at the same time has changed careers, and the other is still the chief resident."

Qing Ping lamented that for a late career like a doctor, if you can take one more step in the early stage, then it will snowball, and the gap will be just a small gap.

Tanglou and Tian Linsheng were also thoughtful.

Especially Tian Linsheng's heart was beating loudly, as if he had seen himself and Wang Daquan several years later.

Qingping is also in a good mood today, and more importantly, because of Tanglou, he wants to share his many years of experience:

"In addition, the physical examination after anesthesia can also better locate the location of the lesion. If it is an open surgery, it will help select the location of the surgical incision, and may also be able to discover nodules and tumors that have not been discovered before..."

"Why do some people perform the same operation smoothly, while others are in a hurry? The difference is that people who do a good operation must have sorted out and optimized the entire process and all the details countless times in their minds, and they are always in a state of confusion.

In the process of constantly improving oneself, the key to distinguishing the pros and cons of a surgery is whether the surgeon is simply imitating or using his or her brain."

After Qingping summarized, he patted Tanglou on the shoulder: "The morning class is over, and we will continue the rest of the second half of the class in the operating room."

Qingping left the ward in a good mood.

Tanglou and Tian Linsheng were left looking at Qingping's back with admiration. Sure enough, every senior doctor was not given in vain.

...

...

Soon the afternoon operation arrived on time. Tanglou and Tian Linsheng entered the operating room after getting ready for the operation.

Qing Ping is the surgeon, Chen Wenhao is still in charge of anesthesia, Tanglou is the first assistant, and Tian Linsheng is the second assistant.

Before the operation, the patient had been tested for blood, urine and stool tests, electrocardiogram, coagulation function, blood electrolytes, etc.

At the same time, systemic medical diseases were excluded during the evaluation. Different from the Maxwell incision method, the patient's umbilicus was cleaned.

After everything was ready, Chen Wenhao naturally took the lead and adopted a method different from the Maxwell incision method, which was tracheal intubation under general anesthesia.

The requirements for tracheal intubation under general anesthesia are relatively high. Chen Wenhao inserted a thin wire gastric tube from the patient's nasal passage to the oropharynx, and then intubated it.

As a veteran, Chen Wenhao naturally knows how to apply paraffin oil in advance to fully lubricate it, so that it is smooth enough and can be fed in easily.

After intubation, Chen Wenhao withdrew the laryngoscope slightly, lifted the endotracheal tube together with the tongue body with the laryngoscope, then clamped the front end of the gastric tube with the intubation forceps and inserted it step by step.

After completing the anesthesia, start to move the patient to a supine position, with the head slightly tilted to the left, which will help the intestines shift upward and to the left.

After doing all this, Chen Wenhao happily took out his little bench and started watching the show.

Today is the first laparoscopic surgery in Tanglou. Holding the mirror may sound like a low-tech operation, but it is not that easy to do it well.

Chen Wenhao has seen too many interns being scolded by the head surgeon.

A few days ago, Wang Daquan was holding the mirror on Ma En and almost made him vomit. The camera was unstable and was shaking. The camera was moving closer and further away. If he had been holding the mirror like this for Qing Ping, he would have been sent back to the hospital long ago.

Ticked.

Laparoscopy consists of a lens and a monitor. To put it simply, the laparoscope helps the surgeon to hold the mirror to provide the surgical field.

But there is a lot of knowledge involved. First of all, the hands must be steady. The base of the lens cannot move. It must be kept horizontal. While keeping the fiber optic stationary, move the lens left, right, up and down to assist the surgeon.

If you cannot see the operator's operation by just moving the camera left and right, you can swing the optical fiber left or right to match. Generally speaking, if the person is on the left side of the lens, swing the optical fiber to the right.

When operating in the abdominal cavity, the camera cannot move too much, nor can it remain still. If it moves too much, the picture will be too wobbly, which will affect the surgeon.

But if you don't move at all, the reflection of the surgeon's instruments in the operating room and the bleeding in the abdominal cavity will affect the reflection of the optical fiber and cause unclear vision.

Therefore, holding the mirror is definitely a nightmare for novice doctors before actually trying laparoscopic surgery.

Many novices lose their confidence due to being scolded at the first level.

Chen Wenhao has also seen many good mirror helpers. Generally speaking, they are:

First: The main thing is to expose clearly. The mirror should be straight and not shaken. The distance and angle should be appropriate.

Second: It is based on the surgeon's habits, which can also be understood as understanding the surgeon's operating intention. Therefore, it is very important to have the surgeon's thinking at this time. In other words, if you are familiar with the laparoscopic operation process, an excellent first assistant will even want to do it.

In front of the surgeon, predict in advance.

This kind of help will make the surgeon so happy that he can't live without it. Once he encounters it and uses it a few times, he can't live without it.

As far as Chen Wenhao knows, Qingping is the one who does well in general surgery. Of course, only Director Cheng can enjoy this kind of treatment.

Seeing Chen Wenhao holding the mirror in cooperation with a big boss like Qing Ping, Chen Wenhao was really worried about him.

Qingping, Tanglou, the instrument nurse stands on the left side of the patient, and the monitor is placed on the right side of the patient.

Different from the Maxwell incision method, the first step of laparoscopic technology is to choose three-hole puncture. In layman's terms, three holes are made in the patient's abdomen, one is inserted into the laparoscope, also called the observation hole, and the second is the main operation

hole, the third hole is the auxiliary operation hole.

Generally speaking, there are two ways to make holes. Qingping chose the main operating hole with a 10mm casing around the patient's umbilicus, an observation hole 4cm below the intersection of the umbilical line and the left midclavicle line, and a 5mm casing 2cm to the left above the pubic symphysis.

It is an auxiliary operation hole.

After the puncture is completed, laparoscopy is performed to explore the abdominal cavity.

Tanglou received the laparoscope. The laparoscope is composed of a base and optical fiber. Tanglou uses a thirty-degree lens, so he needs to control the alignment operation area to see things in a wider range and more clearly.

With talent, focus, toughness and a three-star appendectomy, Tang Lou has a steady hand and a very fast mind.

Qingping watched Tanglou take the laparoscope for the first time, and deliberately did not speak, preparing to give him a few seconds to feel it and relieve his tension. Of course, he also wanted to test his first reaction.

Qingping still remembers the first time he took a laparoscope. He was excited and nervous at the same time, and his hands were shaking a little. His first one was a radical resection of sigmoid colon cancer performed by Director Cheng, and the first time he held a laparoscope was

I can't figure it out, I'm very dizzy, I'm helpless with fiber optics, and I have no sense of direction or space.

It's like the embarrassment and panic when you and your girlfriend are camping in a small bamboo hut in the mountains and can't find the intersection for the first time, and the cold touch on each other's skin under the cold water vapor in the mountain forest...

"Doctor Qing!"

While Qing Ping's eyebrows were dancing with joy, a calm voice interrupted him.

Qingping frowned, and in confusion, Tang Lou looked at him with a pair of calm eyes and motioned for him to look at the monitor.

Without a second's pause, Tanglou had already begun to explore the abdominal cavity, first of all to detect whether there was any trocar injury.

"... Confirm that there is no trocar damage..."

As the camera moves, the liver, gallbladder, stomach, duodenum, colon, small intestine...

"...There are no abnormalities in any organ..."

Qingping looked at the clear lens of the monitor and couldn't help but be stunned. Of course, what surprised him even more was Tanglou's familiarity with the entire laparoscopic resection.

Why do novices hold the mirror when they come in? Holding the mirror is not just to provide surgical field, but to form the thinking of the surgeon, to understand and remember the steps of the entire operation, as well as various precautions.

Soon, under the tenement building's lens, a segment of the abscessed appendix appeared on the monitor.

"...No obvious lesions were found in the appendix during the operation..."

Tanglou also focused on exploring the terminal ileum, which was consistent with the preoperative preparation and went quite smoothly.

"...Doctor Qing, you can start the operation..."

Tanglou took the initiative to CUE the process.

Tian Linsheng watched from the sidelines. Since it was his first time, he took it for granted: "This is the legendary holding a mirror. Isn't it difficult? It seems to be similar to pulling a hook."

The eyes of Chen Wenhao and the nurse were different, especially Chen Wenhao's mouth opened wide.

This is different from what he thought. When did it become so easy to hold the mirror?

Under Tanglou's urging, Qingping was also a little bit dumbfounded. He was also disliked by Tanglou. A long paragraph of teaching rhetoric prepared before the operation was instantly useless.

Laparoscopic appendectomy is out of reach for novices, but as a specialist, he has performed thousands of cases.

What can it feel like? It's boring, and the only joy of teaching is disillusioned in front of the tenement building.

I can't find a reason to scold someone, I'm so angry!

Qingping began to operate through the main operating hole, and Tanglou naturally watched Qingping's movements throughout the process.
To be continued...