Surgery Godfather
Chapter 823 - 737: Still Microscopic Surgery?

Chapter 823: Chapter 737: Still Microscopic Surgery?

Doctor Wen spat out a string of nos, and Song Zimo couldn’t get a word in.

Even Xu Zhiliang seemed extremely impatient, he turned around and gestured for Robert to aim the phone at him.

"You, you, his mother’s, just, one word, success, rate, high, not high?"

Hearing this Xu-style speech, Zhang Lin’s neck broke into a sweat. He was part of Xu Zhiliang’s group, a subordinate doctor to Xu Zhiliang, and had to deal with this mode of communication almost every day. Whenever he encountered such a stutter, not only did Zhang Lin not dare to contradict him, but he also had to listen respectfully and earnestly from start to finish, not missing a word.

Wen Ruzheng’s voice came from the phone, "Very, very, very high, almost the same as a, a, a regular frozen tissue section."

His mother’s, actually daring to mimic him, Xu Zhiliang was so annoyed he itched.

"Tell him, if there’s any mishap, this time he won’t be allowed to wear even underpants when he streaks," Yang Ping said to the phone.

The stuttering voice of Wen Ruzheng inside ceased immediately, and after a while, he said softly, "Is Professor Yang there?"

"Here!" Yang Ping responded himself.

"Hurry up and send the specimen down, rest assured, the technique is mature, I, Wen Ruzheng, a man of integrity, won’t—" Doctor Wen spoke with a serious tone.

Robert cut off the call promptly, and everyone in the operating room wanted to laugh, but out of respect for Xu Zhiliang, they all held back.

"Li Guodong, personally take the specimen to the Pathology department, don’t come back immediately, wait for the results before returning," Yang Ping instructed Li Guodong to be in charge of the specimen.

The piece of bone was placed into a sterile specimen bag, and Li Guodong, wearing gloves, carefully labeled the bag and held it in his hand. He left the operating room and headed to the Pathology department.

After the bone piece had been sent off, August suddenly noticed something. Yang Ping’s bone-nibbling forceps went in and out effortlessly, but he was actually removing the bone around the cyst, ultimately extracting the cyst and the surrounding bone intact.

How did he do that?

How is it possible to completely resect a cyst with just a pair of bone-nibbling forceps without the aid of any intraoperative imaging, such as a C-arm X-ray or CT-scan monitoring?

If this were a malignant tumor, then this surgical technique would undoubtedly be a true no-tumor technique, a perfect achievement in complete resection.

August walked around the operating table’s yellow no-cross line several times and then lingered near the instrument table. He was eager to see what was special about those long-handled, pointed bone-nibbling forceps. He even suspected they might have some sort of smart detection equipment on them.

Although he was at a distance, August could still clearly see the bone-nibbling forceps. They were just an ordinary pair of long-handled, pointed bone-nibbling forceps, not showing anything special apart from being particularly suited for microscopic procedures.

How did Professor Yang manage to completely resect the bone cyst without damaging the cyst wall or letting its fluid leak out?

Despite the surgery appearing calm and undisturbed, August racked his brains wondering why, but couldn’t figure it out no matter what.

Most of the anterior transoral surgery had been completed. The remaining steps involved filling bone into the artificial atlas within the internal fixation device, which comprised a front arch, back arch, and two side pieces, trying to mimic the mechanical structure of a normal atlas.

The internal fixation device spanned the atlas, using the occipital condyles and the axis as to rely on fixed head and neck. This fixation was temporary, and ultimately the hope was that the filled bone would heal together with the skull base and the axis, effectively performing a bony weld on the head and neck.

Bony welding, in spinal surgery, is "fusion," which is one of the basic goals of spinal surgery.

The underlying logic of spinal surgery is also its basic objective: decompression, stabilization, alignment. All surgeries revolve around these three goals.

Clearing hematoma and removed crushed atlas represent decompression by relieving existing or potential compression on the spinal cord.

Implanting an internal fixation device equates to reshaping the spinal stability. This stability is temporary, and ultimately, it is necessary to rely on the healing of bone to bone to create permanent stability.

Restoring the dislocated atlas-occipital joint and atlas-axis joint to the correct positions to maintain the normal anatomical alignment of the head and neck is termed as orthopedic correction.

In the eyes of those young standardized training students and graduate students, the surgery seemed smooth and uneventful, but August knew the true difficulty of some surgeries, especially the complete resection of the cyst that had just been performed, which required very high surgical skills.

Yang Ping stopped the surgery, waiting for Doctor Wen’s frozen section pathology results.

The current diagnosis of "bone cyst" was only an imaging diagnosis; whether it was truly a "bone cyst" or some other tumor needed to be confirmed through pathological examination.

If the pathology examination turned out to be benign, the bony tissue of the atlas other than the cyst could be recycled as bone graft material; if the examination revealed malignancy, the bony tissue of the atlas must be discarded, and Yang Ping would have to look for another "supplier," such as removing part of a rib or iliac bone.

"I’ve never heard of bony tissue being used for frozen sections; is this guy up to the task?" Zhang Lin was a bit skeptical.

Song Zimo had great faith in Doctor Wen: "This person may be a little quirky and traditional, but his level of expertise is unquestionable. If he says it can be done, he must be confident."

"To prepare a pathology slice from bony tissue or calcified tissue, it needs to be decalcified first and then the acid removed; not to mention the following steps, decalcification alone requires at least 24 hours. And he’s going to produce results in half an hour?" muttered Zhang Lin.

"He wouldn’t dare take on this delicate task if he didn’t have the right tools for the job," grumbled Robert, joining the conversation.

After considering for a moment, August said, "His decalcification method must be a new one; we’ve also been attempting frozen sections on bone tissue using 0.5% sodium hydroxide to remove the acid, which can be completed in a few minutes. I presume he has mastered this technique too."

In tumor surgery in Europe and America, it is the chief surgeon who is responsible for examining frozen section slides during surgery, not a pathology department doctor.

For instance, when August performs vertebral tumor surgery, if a frozen tissue section is needed after the tumor’s resection on the operating table, the pathology lab is located nearby the operating room, with some even next door. His assistant would prepare the frozen section, then August would remove his surgical gown and step into the pathology lab to examine the frozen section, confirming the pathological diagnosis before re-scrubbing and dressing to return to the operating table and continue with the surgery.

In Europe and America, learning to interpret pathology slides is a fundamental skill for surgeons performing tumor resections.

Indeed, in less than half an hour, the operating room phone rang; it was Doctor Wen on the line. His tone was serious and formal, lacking his usual banter. Doctor Wen reported the detailed pathology results verbally. Soon afterward, the electronic report and the paper report also became available.

To facilitate Yang Ping’s work, Doctor Wen captured microscopic images of the pathology slides, uploaded them to the computer so that Yang Ping could also see the images of the frozen section in the operating room.

On the high-definition electronic screen in the operating room, the images of the frozen section pathology were displayed. Yang Ping walked over for a closer look. The bony tissue in the frozen section was very clear, and the results were consistent with Doctor Wen’s report.

This was indeed a bone cyst, benign, not malignant.

Therefore, the bone quality of the atlas could be recycled. This meant there was no need to harvest rib or iliac bone for grafting. Zhang Lin and Little Five began to process the removed part of the atlas. They trimmed the large piece of bone into a columnar shape, then embedded it into the mesh of the internal fixation device, which was planted in between the skull base and the axis. Screws were used to secure the internal fixation, with the bone graft snug against the skull base above and the axis below, like a pillar wedged in front of the skull base and the cervical spine.

With that, the anterior approach of the surgery was concluded.

Yang Ping began the posterior approach surgery. Due to the seated position, the area above the shoulders was fully exposed on the operating table, making the posterior surgery more convenient and safer without the need for repositioning.

Conducting the posterior surgery in a sitting position required extensive experience, as it presented numerous inconveniences for the surgeon.

The backrest was adjusted to nearly ninety degrees, and the posterior surgery began.

"In a seated position, exposure from the posterior approach is very difficult---"

August began to have difficulties.

"Hook up another set of intervertebral foramen endoscope!" instructed Yang Ping to the patrolling nurse Zhou Can below the operating table.

"Endoscopic surgery again? How is that possible?"

Inside, August thought hard but couldn’t fathom how an intervertebral foramen endoscope might be of use in this kind of open surgery.