Edem is an old man over sixty years old and has a lot of fat on his lower abdomen. It is very troublesome to make incisions and tractions. In addition, the field tubes are also piled up here. If he wants to explore carefully, he needs to further expand the surgical field.

Kawei raised his foot and kicked the table leg on his left: "Put your head down a little further."

"good."

Damirgang, who was preparing the infusion bottle, freed his hand, held the handle on the side of the table, and continued to lower the mattress on the side of his head for a certain distance. The descending body could pull the skin, and at the same time, the organs could move toward the head with the help of gravity.

Move to free up the tight and complex structures in the lower abdomen and give more space to the bladder.

Kawei explained in detail the reasons for choosing the head-down and foot-high position, and then changed the topic and said while exploring the bladder: "I heard that someone recently reported that this movable operating table will cause damage to the arm function, and then questioned the operating table.

Changes, and even feel that the changes themselves are insignificant and will do more harm than good."

This is one of the many rumors surrounding his medicinal products.

Many people on the stage began to chat in low voices, and soon a surgeon stood up: "Dr. Kawei, this is indeed the case. The two surgeries I performed were based on the principle of lowering the head and keeping the feet high to reduce the amount of bleeding, but the surgery

Later, they all developed symptoms of decreased arm function.”

Kawei listened to his complaint and nodded slightly, seeming to agree with what he said, but what he was talking about was the bladder: "The previous cystoscopy failed to see the tumor, so I first put my hand into the back and side of the bladder to explore

The tumor is in the right location, was it Teacher Musa who spoke just now?"

"Yes, it's me." Musa sat on his seat solemnly, with a stern look on his face, "I don't dare to be a teacher. I can only be regarded as your colleague at most."

"The finished product will be available in the next few days, and there will be a brief introduction meeting at that time." Kawei said, "The cost should be 10 crowns a piece, which is not too expensive. But because it is a consumable, there is a quantity requirement when purchasing.

, please also pay attention to the instruction manual and don’t make the same mistakes on the operating table again.”

Similar to the original hysterectomy, ligation of the internal iliac artery does not affect the blood supply of the pelvic floor, but the removal of the bladder itself can greatly reduce bleeding.

"Give the candle to the nurse, and you go and do pathological sections on these lymph nodes." Kavey said, "Koch and Savarin should be here soon."

However, Kawei could clearly feel the attention of the audience on the two urinary catheters in the stands. He explained: "These are the first medical rubber catheters in Austria. Compared with the silver tubes used before, they are very soft. There are many in the stadium.

Urology surgeons should know that the physiological curvature of the male urethra is not suitable for the insertion of silver tubes, which often causes great pain.

But after the investigation just now, he has figured out the location of the tumor. Compared with product after-sales service, surgery is definitely more important: "Mr. Edem's tumor is located close to the left side, which happens to avoid cystoscopy. If we can provide

Maybe you can see it if you bend the right side 15-20°, but it’s a pity.”

"Very good, it's definitely the internal iliac artery." Kawei explained, "The external iliac artery is responsible for the lower limbs. Cutting off the blood flow will cause the lower limbs to lose their pulse. The internal iliac artery is responsible for the pelvic cavity. You need to deal with the iliac artery when performing pelvic floor surgery.

If you cannot distinguish between the two when detecting an internal artery, you can make a judgment according to the process I demonstrated."

"Yes, Dr. Kawei, it's not that we want to embarrass you. It's just that you are upset by the complaints."

"Beget."

"It seems quite a lot."

Not to mention ordinary surgeons like them, even director-level doctors such as Orgi and Massimov are in danger. Because if the evaluation is really based on the difficulty and completion of the operation, the report meeting will become a Kawei

A one-man show of man.

But in the 19th century, when neurology had hardly developed much, it was not so easy to immediately remember the cause of the injury and find out the key to the problem. Instead, they would think wildly about the details of their surgery, and maybe even classify the injury.

He piled equipment randomly on the patient's body.

Just when everyone thought the operation was about to begin to remove the bladder, Kawei returned to the common iliac vessel to deal with the retroperitoneal lymph nodes.

After two rinses with normal saline, the two conducted two carpet searches of the retroperitoneal lymph.

"Don't worry, they won't just have soft bodies."

He withdrew his right hand and asked Hermann and Damirgang to return to the operating table together, and pulled open the skin on both sides of the abdominal wall incision. Then he pushed the intestines and omentum to the upper abdomen and protected them with gauze pads to expose the pelvic cavity.

organ.

Because once distant metastasis is discovered, the surgery itself is of little significance.【1】

"Yes, it's a relatively small balloon." Mosier formed a circle with his fingers, "You only need to fill it with water to expand it."

Kawei took the scalpel and asked Berget, who was unable to go to the operating table, to stand next to Edem's head and control the light of the candlestick: "Everyone, the loss of function of the arm means that the nerves that control the arm are damaged. Think about the arm.

The function is controlled by those nerves, where are these nerves, and is there anything compressing them during the operation?"

It ranges from the bifurcation of the common iliac vessels to the opening of the femoral canal, including various lymph node connective tissues on the lateral side of the external iliac artery, around the external iliac vein, around the internal iliac vessels and around the obturator nerve.

If you still can't find the answer after the operation, I will be responsible for answering it. But for now, I still hope that you can focus on Mr. Edem's pelvic cavity and watch the operation while reading the atlas."

Kawei casually threw it away and regarded Mosier as a salesman: "Actually, when I was undergoing prostate expansion surgery, I chose to use an expandable rubber balloon to forcefully open the enlarged prostate. In the past few days, I have been with Kawei.

During the communication, Dr. Wei found that it seems that this expanded rubber balloon can also be used to fix the urinary catheter in the bladder." [4]

"Can the rubber tube really enter the bladder smoothly? What should I do if it encounters resistance?"

The surgery is divided into two parts. The first part is the radical cure of bladder cancer. For radical cure, the bladder must be removed first.

However, they have no hostility towards Kawei, just that their skills are inferior to others. They can accept their own mediocrity and are not as entangled as Hills, and they will come to see Kawei's surgery from time to time, hoping to improve their skills.

"Other questions? How can other questions have such a high degree of overlap?"

Kawei repeatedly judged the touch that came back to his mind from his fingertips, and finally breathed a sigh of relief after confirming that everything was normal: "The tumor is single, has no adhesion to surrounding tissues, and has no surrounding metastasis."

"The cleaning started ten minutes ago."

The latter has blocked his future in the resection of hemangioma. From simple resection to blood vessel suturing, he is now required to take courses.

Kawei's technique of dissociating surrounding tissue was extremely proficient, which was not obvious during the autopsy. At that time, it was just for practice and to help several assistants become familiar with the operation.

"Next to the internal iliac artery, we can also see the ureter [3]." Kawei used vascular forceps to slowly separate it. "After we found the ureter, we slowly and bluntly dissected it down to the bladder. When we reached the bladder wall,

Cut it off and use silk thread to ligate the bladder side."

"Double chamber? Balloon???"

"Sounds like a good thing."

Everyone knew about Kawei's temper, so they all stopped talking, and his voice was the only one left in the entire theater.

"I hope there will be no metastasis." Kawei's right hand was still rummaging in Edem's stomach, and the topic returned to the adjustment operating table. "I didn't expect that the doctors would fall on the operating table, but you didn't."

Have you considered other issues?"

"Such a problem has never occurred in any surgery performed before." Moussa gave a reason that he thought was difficult to refute. "Doesn't this prove that it is caused by the new operating table? Because the only difference between operations is

It’s the operating table.”

After that, both internal iliac arteries were ligated.

The former is proficient in amputation of various parts, and the success rate has increased from the original 40% to more than 65%. He is very good at how to carefully debridement, how to choose the plane of amputation, how to ligate blood vessels, and how to embed myocutaneous flaps.

"Let's ask Dr. Mosier to introduce me here."

"knew."

In addition to clarifying the location of the tumor, he also needs to rely on exploration to confirm that there is no metastasis of surrounding organs and lymph nodes, and that there is no adhesion of the iliac blood vessels behind the bladder. He even needs to feel the liver upward to make sure that there are no metastases on the surface of the liver.

It's a tumor, so I'm relieved.

Kawei nodded: "Has anyone else encountered this kind of thing?"

In the context of increasingly sophisticated surgeries, both surgeries need to improve their respective methods of hemostasis and reduce the risk of death by reducing bleeding. Kawei's position-changing operating table can exactly achieve the purpose of reducing the amount of bleeding in the lower body, so they both use

Sluo's equipment factory customized one.

"exist."

"This is a temporary catheter for draining urine. It is produced by Mr. Laszlo's vulcanized rubber factory and is just suitable for this operation." Carvey said, "The catheter is inserted into the ureter to temporarily drain the urine that continues to flow out of the kidneys.

The size of the urine is just right, even the anti-slip fixing is omitted.”

In the absence of imaging examinations, the abdominal cavity exploration is far from over. Carvey previously extended the incision upward to 4cm above the umbilicus in order to fully explore the abdominal cavity.

Kawei looked at the "clean" retroperitoneal tissues, and changed his gloves with Mosier: "Others came to help. The instruments used just now need to be rinsed, and a brand new set has to be brought up."

"Like a balloon?"

The two of them cleaned the lymph nodes and easily sold something that had not yet left the factory.

Kawe gently incised the retroperitoneum at the bifurcation of the common iliac artery, freed one side of the internal iliac artery [2], covered it with a silk thread and lifted it up to block it. At this time, a nurse was standing by the operating table, ready to help.

With tacit cooperation, I reached out and touched his dorsalis pedis artery: "The dorsalis pedis artery is still there."

"Then how to fix it after entering the bladder?" Another doctor said, "There is a bulge in the front section of the silver tube. Although the insertion process is extremely painful, after entering the bladder, it can be stuck in place by the bulge in the front section to prevent the tube from falling off."

"Give."

Now Sergei went out with the army, and it was Musa and Paisher who appeared in the operating theater.

"I also have this problem. Patients will have paralysis and sensory impairment at the most severe stage after surgery. Some people still feel soreness and fatigue in their arms after more than a month." Paisher said, "This is undoubtedly arm dysfunction."

Resection sounds simple in theory, but is very cumbersome in practice. Separation and ligation are all basic skills. If you want to cut the bladder well and wonderfully, you need a lot of practice.

"The heart will experience some pressure now, so remember to monitor your vital signs at all times."

"good."

Kawei doesn't care about this. As long as he is younger than himself, he will call the teacher at the beginning: "Why can the teacher be sure that if the patient's arm function decreases, it must be a problem with the operating table?"

The hemostasis effect was indeed good, which at least added a touch of calmness to their hectic surgery, but complaints from patients after the operation came one after another.

Now that he is in a living person's body, he is under time pressure. He strives to do his best every step of the way, so he has no reservations. After cutting off the ureter and ligating it, Kawei looked at the diameter of the ureter and said: "Take the smallest
To be continued...