Chapter 1404 Perfect as a Textbook

The preoperative case analysis was completed, the field of view was switched, and the live broadcast of the operation started 10 minutes later.

"Is Boss Zheng doing the surgery?" Lei Yinghua asked.

"Um."

"What spell are you going to take?"

"..." Peng Jia was startled.

The technique... I don't know. It has been less than three hours since he got the news, and the busy side of the imperial capital has no time to pay attention to himself.

Lei Yinghua didn't say anything, just shook his head slightly.

It seems that the problem with Xinglinyuan lies in this.

This is definitely not what a medical professional website should look like.

But is surgery an emergency surgery?

Impossible, if it is really an emergency operation, the PPT will not be so beautiful that you can't pick out a single fault.

Let's look at surgery. Based on the surgeon's habits, it is very likely that surgery will be used.

Just thinking about it, Lei Yinghua saw something wrong with the picture.

Is this... a colonoscopy? ESD technology? !

It turned out to be really ESD technology!

ESD technology, also known as endoscopic mucosal dissection, refers to a minimally invasive technique that completely strips the diseased mucosa from the submucosa under the endoscope.

It was pioneered in Japan in the late 1990s and applied to clinical practice. The main purpose of this procedure is to diagnose and treat early-stage gastrointestinal tumors. It has the advantage of completely removing a certain area of ​​superficial lesions at one time.

But the technical requirements are high and difficult.

Lei Yinghua repeatedly summed up experience and finally determined that ESD technology is the best way to treat MW syndrome.

But there are also problems - there are so many polyps in the patient's colon and rectum, and some polyps are very large. During the peeling process, an accidental intestinal perforation will occur.

In the preoperative case discussion just now, the patient's film Lei Yinghua also saw.

There are at least dozens of large polyps.

Do these polyps have to be removed all at once? It should be done two or three times.

If you do the surgery yourself, you will choose this method.

There is little damage to the patient and there is not much risk. As for the slow speed, I'm afraid of something.

But if the operation is broadcast live, half of it is done, and half of it is kept.

The periscope operator looks directly into the field of view of the colonoscope screen. The colonoscope has been placed in and is being operated.

Lei Yinghua held his breath and watched carefully.

The first polyp, in the rectum 6cm from the anus. The diameter is about 1cm, and the surface is a little rough.

An experienced doctor can tell at a glance that there is a high probability that the polyp is in the precancerous stage. In other words, it has not been transformed into a malignant tumor, but if it is not removed, it will take a few months, and there will be fundamental changes.

The spray pipe sprays out the dye, which looks like a 0.5% methylene blue solution. Lei Yinghua does not like to use methylene blue, and generally uses 0.4% indigo rouge.

But this is based on personal preference, no one is right or wrong.

The methylene blue was sprayed evenly, the assistant of the surgeon was very good, and Lei Yinghua was a little envious.

It seems like a small operation, but as an operator, this is the first difficulty.

The stain is sprayed to clearly show the size of the lesion and the extent of the lesion.

Uneven spraying will make the operation more difficult.

The team of surgeons is very strong, and the assistants operate almost perfectly. Just a simple little detail at the beginning, Lei Yinghua has his own judgment.

It seems that the sprayed methylene blue has not yet completely fallen, and the surgeon starts the submucosal injection.

Without repeating several times, the surgeon injects once, and the part to be separated from the polyp is raised, so that there is enough visual field when separating the submucosa and the muscularis propria.

There are hemostatic components in the injection, which can ensure that some small capillaries are ruptured and not too much blood will be shed.

After the submucosal injection was completed, the electrocoagulation was marked, and the endoscopic incision knife began to drop at 5 mm from the edge of the lesion.

This is too fast, what's the use of the magician's hand speed? Lei Yinghua was a little disdainful.

It's just that the operation is done quickly, which is grandstanding.

Endoscopic surgery was first performed by doctors in the endoscopy room and gastroenterology department in China.

Because I am not a surgeon, the process of groping is very long.

After all, they don't have access to the anatomy of the gut, and there are some subtleties that are tricky to deal with.

And surgeons were originally...and still are used to doing surgery to solve problems.

However, under the general trend of minimally invasive surgery, surgeons gradually began to perform ESD surgery.

Lei Yinghua is one of them, and he is still the best. He has a deep understanding of ESD surgery and even has his own unique insights.

The surgeon is a young challenger, but it is useless to do the surgery fast.

Endoscopic surgery is most afraid of bleeding. Once a blood vessel ruptures and bleeds, it will take a long time to dispose of.

The damage to the patient is also enormous.

This is something that young people don't understand, Lei Yinghua watched calmly.

Sure enough, according to Director Lei's idea, after the incision, the operation speed suddenly slowed down. Not only is it slowing down, but the method is also a bit clumsy.

Lei Yinghua smiled, the practitioner was still born by hand, not as much as he did himself.

The mucosal layer of the colorectum is relatively thin, and the coagulation power cannot be particularly large, so as not to damage the muscle layer. The surgeon's choice was correct, his coagulation power was just right, and Lei Yinghua was not surprised.

If you can't grasp this detail, how dare you do live surgery? That's just kidding.

After the submucosal lift was ideal, the mucosa was incised with an endoscopic scalpel at the outer edge of the marked point.

Lei Yinghua held his breath and successfully pre-cut the surrounding mucosa is the key to the success of ESD treatment.

The endoscopic incision knife smoothly incised the mucosa around the polyp, entered the submucosa through the pre-cut incision, and then made a circular incision along the outer side of the methylene blue mark.

The technique is very skilled, not like a newcomer to the ESD surgery that has just been explored.

This kind of proficiency is completely different from the previous judgment of the practitioner... What's going on? Is it to show off some more ineffective operations?

Well, it's possible. Young people, there is always something in the heart of showing off.

But looking at the operation process, Lei Yingjie even had an illusion that the surgeon had to perform at least 1,800 ESD surgeries before he could have such a skilled hand.

Has anyone done so many ESD surgeries in China?

No, this one does not need to be recalled at all, Lei Yingjie can confirm it. Because he thought about it and couldn't do it himself.

After cutting, the separator is sent in.

Blunt separation, this is the most important node.

Many endoscopists and gastroenterologists are still not good at this point, while general surgeons are much better.

After all, there are many times of surgical incision and dissociation of the intestine, and the surgeon is very familiar with the intestine.

The separation speed of the separator is not fast, but it is not slow, layer by layer, just like cooking. The anatomical structure of each layer is very clear, avoid opening some small blood vessels, and use electrocautery and electrocoagulation to stop bleeding at any time.

After 1'22", a polyp was cut off.

This speed... Lei Yinghua nodded slightly, the surgeon dared to live broadcast the operation, and the level was still there.

For the outermost rectal polyp, the entire process of endoscopic resection is as classic as a textbook.

Although up to now, there is no textbook for ESD surgery, but in Lei Yinghua's imagination, the operation just seen is perfect. If I have to pick faults, I can only say that the speed is a little slower in the later stage, and there are some invalid operations.

Young people, in order to show off their tricks, they added those operations out of thin air. At my age, I can't.

"Director Lei, what do you think of Boss Zheng's surgery?" Peng Jia asked anxiously.