godfather of surgery

Chapter 1445 Aha! He got it in no time!

Chapter 1445 Aha!

The nurse wanted to chat with Yang Ping for a bit more, but the surgeon, Xia Shu, spoke up, saying while performing the operation, "Professor, it's been a long time since I've seen you. You've been so busy lately."

Yang Ping said, “You guys are so busy. You’re always in the operating room from morning till night. I start work at around 7 a.m., and you arrive at the department around 6 a.m. I finish get off work at 5 or 6 p.m., and you usually finish get off work after 10 p.m. During that time, you’re always in the operating room. Our timelines are perfectly out of sync. If we hadn’t come here to see you today, we probably wouldn’t have seen each other all year round.”

Xia Shu looked up and thought about it. It made sense. Ever since he became the deputy director of cardiac surgery, he had always focused all his energy on surgery. His wife, Cai Qiaojun, took care of all the trivial matters in his life, so he didn't have to worry about them at all.

“Yes, I hadn’t even noticed until you mentioned it. It’s true, our timelines are perfectly out of sync,” Xia Shu said.

Since they had run into Professor Yang, Xia Shu immediately thought of the question he had always wanted to ask Professor Yang.

"Professor! Do you think your theory can be applied to coronary heart disease? Essentially, coronary heart disease is atherosclerosis of blood vessels. Can this atherosclerosis be seen as an abnormality? If we activate the body's own repair mechanism, can we restore the hardened blood vessels to normal? In that case, surgery would not be necessary. Once coronary heart disease is diagnosed, we can treat it and eventually restore it to normal."

“Theoretically, it is possible, but the mechanism behind the three-dimensional spatial guidance gene theory and the stem cell theory is not yet clear. Even if it is clear, applying this theory to a specific scenario will require a lot of research,” Yang Ping told Xia Shu realistically.

After Xia Shu finished stitching the last stitch into the bridging vessel, he stopped what he was doing and gave up his position as the main surgeon, allowing his assistant to take over.

"Professor, I've decided to participate in your project as well. I specialize in coronary heart disease research, and I'd like to see if I can contribute to your theory in this area." Xia Shu had recently seen Einstein and Weber gathered at the institute, conducting research on Yang Ping's theory, and he was itching to join them. He knew there was great potential in this field. In fact, for most knowledgeable researchers, seizing opportunities and creating new trends is key to success; otherwise, they might never achieve anything in their entire lives.

Of course, scientific research should not be driven by utilitarian motives, but most researchers are driven by utilitarian motives, and only a few people are truly conducting research out of interest.

The first principle of scientific research is to be realistic and pragmatic. Therefore, Xia Shu is a very realistic person. He admits that he is ambitious and pragmatic. He came to the Sanbo Institute because he saw that Professor Yang had a bright future and that there was a promising future for him to follow.

Doesn't this prove that my choice back then was right? If I had stayed at Fuwai Hospital, I'd probably still be working at Lagou Hospital. How could I be like this now, starting my own practice in my thirties and serving as the deputy director of cardiac surgery?

“My theory is still at the hypothesis level, and there is a lot that needs further research. You can give it a try,” Yang Ping encouraged him.

Yang Ping himself knew that his hypothesis was only completing the foundational work. Just like the development of modern surgery, after the three cornerstones of anesthesia, hemostasis, and anti-infection appeared, surgery had only just begun. It would take a long time to develop further, and even now there is still a lot of room for development.

The same goes for the proto-cell theory; it has only just begun. He himself does not know how long it will take to develop or what it will become. He only knows that he has opened the curtain on a new world.

"I'll need to use your lab then, Professor!"

Xia Shu took off her gloves and surgical gown, leaving the finishing touches to her doctoral staff.

"You're welcome anytime. Our space is a bit cramped right now, so please make do. Once the super research center is completed, we'll have everything you need, so feel free to do whatever you want." The nurse brought over a stool for Yang Ping to sit and rest. It had been a long time since he had sat in the operating room like this.

Watching others perform surgery sometimes made him itch to try it himself, but he suppressed that urge. After all, he had plenty of opportunities to perform surgery in the system space, but real-world opportunities should be left to those who need them. After all, one cannot satisfy all one's impulses.

“Professor!” Xia Shu had already taken off his surgical gown. He came over and stood next to Yang Ping. “Our department admitted a very, very special patient yesterday, and I was just thinking of going to see you today to ask for your advice.”

Upon hearing the words "very, very special," Yang Ping felt a surge of excitement and immediately perked up.

"Coronary artery disease, preparing for bypass surgery. This patient's coronary arteries are a combination of porcelain aorta and diffuse small vessel disease..." Xia Shu said concisely, trying to get to the point as soon as he spoke. The professor is very busy now, and he doesn't have time to beat around the bush with ordinary cases.

"Porcelain aorta + diffuse small vessel disease?"

This is indeed an "extraordinary" case. The so-called porcelain aorta is characterized by extensive calcification of the aortic wall, resembling an eggshell. Normal bypass surgery requires drilling holes in the aorta for proximal anastomosis, but with porcelain aorta, clamping it can cause plaque detachment leading to stroke or aortic rupture. This forces doctors to abandon standard techniques and switch to non-contact techniques, such as using the internal mammary artery for in situ bypass or using a vein for a "Y-shaped bypass" to completely avoid the aorta.

Diffuse small vessel disease: The target vessel diameter is <1mm, or there is long-segment diffuse stenosis, and a suitable anastomosis site cannot be found. Even with a microscope magnified 25 times, and sutures thinner than a hair, anastomotic obstruction or long-term failure may still occur.

When these two factors are combined, it becomes a truly daunting combination for coronary artery bypass grafting. Surgeons must employ non-contact techniques to avoid the aorta while using extremely limited graft material. The graft may only have one vein left, requiring multiple anastomoses to connect a cluster of fragile, tiny blood vessels. This is akin to sewing the thinnest gauze with the finest thread on a rocking boat, and only being able to sew it once.

"How is your overall condition?" Yang Ping asked.

Any surgery requires familiarity with both local and systemic conditions. Sometimes, the overall systemic condition is the key factor in deciding whether to perform the surgery and how to perform it.

"It's also very, very special!" Xia Shu seems to be not very good at humanities, as his choice of words is at the level of "Holy crap".

Now that there are four superimposed cases, it seems to be a truly special case. Yang Ping sat up straight.

Xia Shu stood next to him. The nurse brought over a stool, but Xia Shu waved her hand and said, "I'm fine standing. It's more comfortable standing."

"The left main coronary artery is 90% narrow and the right coronary artery is also occluded, with blood supply coming from only one blunt marginal branch."

A slight drop in blood pressure during anesthesia induction can lead to cardiac arrest, necessitating extremely rapid and precise left main coronary anastomosis performed without cardiopulmonary bypass and while the heart is still beating. "Severe COPD!"

If one cannot tolerate one-lung ventilation and the risks of traditional cardiopulmonary bypass are extremely high, the only option may be minimally invasive or off-pump surgery.

"Extremely poor blood clotting function!"

The risk of postoperative bleeding and infection is extremely high. These patients require almost no heparinization after bypass surgery, and the anastomosis is very easy to become blocked.

This is already three "very" times, and Yang Ping was about to express his opinion.

"We still need another surgery," Xia Shu immediately added.

Yang Ping mentally calculated that there were six "very" cases in total. This case would be a direct rejection for bypass surgery anywhere else, yet Xia Shu dared to accept it.

"Professor, I have powerful connections, so... so I accepted it without much thought. You said the research institute is my home, my eternal support. I've already told the patient and their family that we..." Xia Shu rattled off a string of questions.

"Alright! Enough with the nonsense. If you have anything else to say, just say it all at once. Don't ramble on like a sheep spitting out dung." Yang Ping said impatiently. Xia Shu was usually quite honest, but ever since he got married, he's become so glib and his eloquence has improved quite a bit.

Elderly patients with "porcelain aorta + diffuse poor distal vascular conditions + reoperation" are often referred to in the literature as "desperate coronary artery bypass grafting," and many centers simply choose not to perform the procedure.

"The recognized hallmark of the pinnacle of technology is the complete revascularization of the entire artery without contact with the aorta, without cardiopulmonary bypass, especially when the bypass grafts are made only by the bilateral internal mammary arteries and radial arteries, and all proximal anastomoses are made in a 'T' or 'Y' shape within the thoracic cavity. This is an extreme test of the surgeon's psychology, skills, and teamwork."

"Your case covers the whole spectrum, are you trying to become number one in the world?"

Yang Ping finally hit the nail on the head: this case was clearly not an ordinary case; it was definitely a Mount Everest case.

"Look, many departments in our hospital have achieved first place globally and first place in Asia. Our department also needs to produce something, right... But the most important thing is not these things. Academic reputation and honors are secondary; they are external things. The most important thing is that we must have a heart that is wholeheartedly dedicated to serving patients, relieving their pain, and not backing down when faced with difficulties, not..." Xia Shu's tone was excited, and she spoke these words more fluently than if she were reciting a book.

“What does Cai Qiaojun feed you every day? You’re completely different from when you first arrived, when you were so dull,” said a circulating nurse who was busy moving around nearby.

Another nurse chimed in, "Cai Qiaojun is quite something. When Xia Shugang first arrived, he was the target of a lot of attention. But she acted so quickly. By the time everyone realized what was happening, they had already announced their marriage."

While others were discussing academic matters, these senior nurses preferred to chat about their personal lives, chattering away incessantly. When He Xiangjun, the director of the Department of Thoracic Surgery, heard that Professor Yang was in the operating center, he immediately took some time to come over and chat for a bit. He had just come in when he heard the nurses chattering away.

Director He said, “Are you not convinced? You have to accept it whether you like it or not. This is efficiency. Unlike some people who are hesitant and indecisive, even when there are obviously good talents, they wait for others to come and pursue them. Times have changed, and our mindset needs to change. Look at how many new PhDs have come to the Sanbo Research Institute, and quite a few of them are single. Why haven’t you made any moves? Maybe one of them will become an academician in the future, and you will become the wives of academicians. It’s like buying stocks. You see others buy potential stocks and make a fortune, and you’re envious and drool. But if you were asked to buy stocks now, you wouldn’t understand any of the potential stocks even if you bought just one.”

“We know there are a lot of potential partners at the research institute, but there’s nothing we can do. We can’t just go to the institute, grab someone, and say we’re dating. Why don’t you talk to the head nurse and ask her to arrange a social event with the institute?” a young and pretty nurse said, feeling aggrieved.

Another nurse was about to join in the argument when Director He became serious: "Alright, Professor Yang and Dr. Xia are discussing surgery. Don't you have any manners? Always interrupting with trivial matters. After get off work, change into a pretty dress, spray on some perfume, and groom yourself nicely. Then stroll around the institute entrance. When you see a doctor come out, go up to him, pretend to bump into him, and then yell 'Ouch! I twisted my ankle!' Make up the rest of the story yourself. There's a ready-made template here, but you can't copy it. If you're worried about copyright infringement, just bump into him while buying a cup of milk tea, apologize, add each other on WeChat, and offer to do his laundry. Those young doctors at the institute are all walking with their heads down, thinking, and they're completely under your thumb. What can you do if you don't know how to handle them? You couldn't even get Wen Ruzheng from the pathology department, but he was snatched away by a policewoman from the Provincial Public Security Bureau! You are a disgrace to Sanbo Hospital..."

Yang Ping listened to Director He's stern reprimand of the nurse and laughed. He recalled how Xia Shu had helped push Cai Qiaojun's wheelchair for over a month after she sprained her ankle. They ended up becoming like family, which was truly a classic story.

"Director He, Director He... I didn't expect you to be such an expert. Could you please give me some detailed guidance?" a nurse exclaimed in sudden realization.

"Drainage tube, drainage tube! Drainage tube!!!"

Dr. He, who was finishing up, called out three times, and the scrub nurse Cai came back to her senses: "Oh, oh, oh..." She had just been listening attentively to Director He's instructions.

The surgery went very smoothly, and the chest closure was completed quickly. The scrub nurse said to Dr. He, "Dr. He, I heard from Director He that before you came to the cardiac surgery department, you specifically studied a topic about pulmonary nodules, how to determine the benign or malignant nature of pulmonary nodules from imaging images?"

“Yes, back when cardiac surgery wasn’t a separate field, I did study this topic and looked at a lot of CT images of lung nodules.” Dr. He immediately became interested when talking about his area of ​​expertise, and the unpleasantness he had just felt because of the nurse’s slow response vanished.

"Wow, you're amazing! I've finally found the right person. My dad's chest CT scan during his physical exam revealed lung nodules, and he's very worried..." The nurse's voice was gentle yet anxious, her eyes filled with a longing for help.

Dr. He immediately said, "Don't rush. Find some time and bring all the CT scans so I can take a look."

"Okay, thank you. I'll schedule a time with you after the surgery," the nurse said gratefully.

"Director He, we'd like to talk to you later. Could you please give us some more detailed instructions on the methods you just mentioned?" the pretty nurse said to Director He.

Director He Xiangjun was taken aback. Damn, some people are slow to understand, while others understand immediately. People's fate is often in their own hands.