Chapter 353 A Smooth and Creepy Surgery

Professor Tian's technique is very smooth.

The skin was incised to expose the spinous process and lamina, and the two upper and lower vertebral bodies of the diseased vertebral body were fully exposed.

In order to expose the incision better, the sacrospinalis muscles on both sides should be cut transversely from the level of the diseased vertebra, and retracted distally and proximally respectively.

Generally speaking, there should be at least 200ml of bleeding at this time.

Because in the process of exposing the spinous process and lamina, a certain amount of periosteum must be dealt with, resulting in bleeding.

But today's operation was unexpectedly smooth.

The blood loss was less than 50ml, and the entire operative field looked exceptionally clean.

Professor Tian is very satisfied with his technique. It seems that today's hand style is very smooth, and the surgical bleeding may be less than 3000ml.

The next step is about to start bleeding profusely. Professor Tian's hands are much gentler, and he slows down seriously. All manipulations are carefully identified to avoid accidental bleeding.

The rongeur began to bite off the spinous processes and lamina with tumor infiltration.

With a sound of "Gaba~", a broken bone was bitten off by the rongeur.

Because of the tumor infiltration, the bone plate is not so hard, and the sound is like broken leather.

Although the hardness is not enough, the bone plate has sufficient blood supply due to the abnormally proliferated blood vessels of the tumor, resulting in a sudden increase in the amount of bleeding.

The massive bleeding starts from now on.

A lamina was bitten off by a rongeur, and Professor Tian habitually covered it with a piece of dry gauze.

strangeness……

In an instant, Professor Tian realized that ten seconds had passed before the dry gauze was soaked in blood.

Professor Tian's level is very high. Although he has not reached the level of a master, he is still a professor of orthopedics at the level of a senior master, close to the level of a master.

He has a deep understanding of vertebral body removal surgery.

If there was less bleeding before, it was because of the high level of self-separation, which can be explained.

However, the rongeur bites off the lamina, and it is impossible to have a particularly small amount of blood loss in this step.

Generally speaking, starting from this step, the operation will be performed in a pool of blood.

The kind that suckers can't suck clean.

If the vision is not clear, it will lead to more bleeding, and this vicious circle will continue.

On the other side, fresh frozen red blood cells have been hung up, waiting for Professor Tian's order, ready to be transfused into the patient's body at any time.

Strange, is it some rare tumor? Blood supply is not rich?

No, Professor Tian is a little incomprehensible to the situation in front of him.

Even if the blood supply of the tumor is not rich, the blood supply of the vertebral body is quite rich. No matter what, it would never take ten seconds for the bleeding to soak a piece of dry gauze.

"Teacher Tian?" Seeing that Professor Tian was in a daze and didn't know what happened, Dr. Zhou called out softly.

Professor Tian woke up from the infinite speculation, concentrated and continued the operation.

Continue to bite off the lamina to expose the nerve root.

The tumor invades the spinal canal. During the operation, the dura mater gradually bulges outward without pulsation. The epidural fat often disappears, and the dural sac is displaced or deformed under pressure.

The lamina bitten off by the rongeur, Professor Tian did not continue to cover it with dry gauze, he wanted to see how much bleeding there was.

Sure enough, the amount of bleeding was very small, only tens of milliliters.

It's a matter of interventional surgery!

Professor Tian quickly judged the truth of the matter. However, he couldn't accept this truth.

In Imperial Capital, as an expert and professor of spinal surgery, I often cooperate with interventional surgeons to complete vertebral body removal.

But have you ever encountered such a small amount of bleeding?

No, not once.

With the cooperation of the interventional department, it can indeed reduce a certain amount of bleeding. It has something to do with the technique of the surgeon, but it doesn't have much to do with it.

Just embolize a transverse lumbar artery, what's the difficulty?

No interventional doctor could be found, and Professor Tian himself was able to perform the embolization of the transverse lumbar artery in a lead suit.

However, no matter whether it is the interventional doctor or he performs the embolization of the transverse lumbar artery, he can only reduce the blood loss from 5000 ml to 2000 or 3000 ml.

No matter how little, Professor Tian really has never encountered it.

In such a small place as Haicheng, is there a better doctor than the imperial capital?

Impossible, absolutely impossible.

Professor Tian was thinking about these things in his mind, but he didn't stop at hand.

This kind of surgery has been done too much, not to mention that you can do it with your eyes closed, at least you don't have to recall the local anatomy repeatedly like when you did it for the first time.

Use a nerve dissector to find the nerve roots on both sides of the dural sac and protect them.

Subsequently, Professor Tian began to peel off the tumor tissue, the outer side of the dural sac and nerve root, and removed the upper and lower articular processes and pedicles together with the tumor tissue found one by one.

Generally speaking, before laminectomy, the effect of embolizing the transverse lumbar artery is here.

There is no interventional embolization, and threatening bleeding occurs at this time.

What is Threat Bleeding?

Some, some invisible tiny blood vessels were bleeding, and the entire surgical field was completely red, and even the bleeding blood vessels could not be found, let alone the vertebral body removal.

No threatening bleeding, which is fine.

But...there is no threatening bleeding, not even bleeding, okay!

It would be nonsense to insist that there was no bleeding at all.

But Dr. Zhou held the suction device without a condom in his hand, and he sucked up the bleeding easily. The operative field was well exposed, so Professor Tian panicked a little.

This is not the vertebral body removal surgery I am familiar with...

Did you do something wrong?

He stopped and recalled the whole operation process, there was no problem!

Looking at the surgical field again, the clear anatomical structure can be used as a textbook map, and there is no problem.

What the hell.

The operation went so smoothly that there were problems.

Professor Tian was a little apprehensive. Ever since he came into contact with vertebral body excision, he had never seen such a surgical field.

If it was in the imperial capital, Professor Tian would have the heart to find a few colleagues, and even his own teacher to watch the stage to see if he made any mistakes.

But this is Haicheng.

Bite the bullet and do it.

The exposure and resection of the transverse process of the lumbar spine went smoothly, and there was still very little bleeding. For the transverse process of the lumbar spine, the bleeding is generally about 500 ml, and it took 30 minutes.

This is Professor Tian's experience.

But in this damn operation, the blood loss was only 30-50 ml, and it took 15 minutes to complete this step.

Afterwards, Professor Tian began to expose the anterior and lateral surfaces of the vertebral body. The vertebral body invaded by the tumor was moderately enlarged, but the boundary between the vertebral body and the surrounding tissue was clearly defined. Gently peeling can push the surrounding tissue away for peeling.

Normally, there will still be 200-300 ml of blood loss in this step, which is time-consuming...

But here is still very smooth, the amount of bleeding is only one-tenth of the usual, looking at the aspirator tube in Dr. Zhou's hand, it is estimated that 20-30 ml of bleeding is not bad.

After dissecting the lesioned vertebral body to the anterior longitudinal ligament, Professor Tian asked Dr. Zhou to retract the surrounding tissue with a Hohman retractor, and the lateral anterior approach of the vertebral body appeared in front of his eyes.

The operation... was so smooth, it made people feel dazed and fearful.

Is this vertebral body removal?

No, why is there so little bleeding? How did the operation go so smoothly?

Really... What a hell!