Surgery Godfather

Chapter 190: Chapter 0181: Switching People Halfway

Dr. Yao and Dr. He had already prepared for the surgery. Not only had they connected all the tubes, but they had also adjusted the focal length of the camera.

Yang Ping stepped up, tested the camera, and found the adjustment very suitable.

He himself was indeed in a rush. Since Su Nanchen had already assigned two instrument nurses and two doctors, he shouldn’t be polite and would proceed as swiftly as possible without undermining the quality of the surgery.

He cut an incision with the scalpel, making the anterior medial and anterior lateral portals in one go. So skilled was he, he pierced the skin, joint capsule, and synovial membrane in one action, stopping the scalpel just as it broke through the synovial layer to avoid any injury to the structures within the joint cavity.

Normally, people make one incision with a scalpel, insert the camera, and then guide another incision with a syringe needle for more precision.

But Yang Ping didn’t need that, he cut two portals directly because he didn’t need the guidance of a syringe needle. He could perfectly place the portals in their best positions.

Lin Hao frowned. This was against the standard protocol—a wild approach.

As the arthroscopy probe with the sheath went in, Dr. Yao had already connected the inflow and outflow tubes in advance. The probe encountered no resistance, indicating not only were the portals well cut, but also the operator was very familiar with the passage of these portals. There would be no obstacles due to the relative movement of the layers, particularly the synovial layer which can slightly hinder the entry of the arthroscope or instrument, requiring a little exploration to find the direction of the passage.

But Yang Ping didn’t need to explore. He entered in one go without any obstruction and easily accessed the joint cavity. He started arthroscopic examination and thoroughly irrigated the joint cavity before closing the outflow tube.

The size of the portals had to be very precise. If too narrow, the instrument couldn’t get in; if too wide, the water in the joint cavity would flow out from the gap around the instrument. Accumulated leakage could fill up the bag used for collecting the dripping water.

Yang Ping cut the portals perfectly. Not a drop of water leaked out from the gap which indicated that the instrument just passed through and the surrounding gaps were perfectly sealed by the synovial membrane. Hence, the surgery was so clean that not a single drop of water spilled out onto the operating table, under the table, or into the collection bag.

Some people left a mess of water all over the operating table after an arthroscopy surgery. These details were not mastered by everyone and were a higher pursuit beyond the surgery itself.

Starting with the supra-patellar pouch, he inspected every region within the joint, strictly in order, one by one. Each movement of the arthroscope was spot-on within the gap, causing no abrasion to the cartilage, and reached the best position in the target area in one move, providing the best field of view.

Yang Ping himself held the arthroscope in one hand, while holding the patient’s calf with the other, constantly adjusting the positions with impeccable coordination.

Different positions required different limb postures. For instance, the supra-patellar pouch required a straight position while the medial joint space required a flexed knee at 20-40 degrees, with abduction and external rotation. The lateral joint space needed to be in a figure-four position.

Movements of the arthroscope and changes in limb postures were almost simultaneous. Absolutely not any limb change would cause compression, obstruction, or friction on the moving arthroscope. Everything was very smooth as if a fish darting around deftly through aquatic plants without touching a single one.

“Dr. Yao, Dr. He, start processing the tendon!” Su Nanchen commanded.

Without his command, even more staff could not have been useful. Out of all, particularly the two nurses seemed not to have realized that the pace was getting faster and faster.

“You prepare the guide needle and drill for the next step: tibial tunnel! You guys should measure the size of the tendon soon!” Su Nanchen instructed the nurses and the doctor.

If it weren’t for Su Nanchen’s reminder, they really couldn’t have reacted in time.

“Tibial tunnel, drilling guide needle!”

They were still alternating between the electric planer and plasma knife to clean the intercondylar fossa when Yang Ping notified them in advance to avoid wasting time. Nôv(el)B\\jnn

As soon as his words fell, the intercondylar fossa was cleaned up, but the drilling guide needle was not yet in hand because Yang Ping had not accommodated their pace with several people setting up the table.

Yang Ping was looking at the screen, not the instrument table. His outstretched hand didn’t find what he wanted, and then he gestured up and down a few times with his palm, signaling to hurry up and not to dawdle.

The drilling guide needle arrived and Yang Ping immediately said: “For anatomical reconstruction with eight-strand double-bundle, report the size of the two tendons to be implanted in the anterior cruciate, then drill the tibial tunnels.”

Although Su Nanchen had commanded just now, the two nurses hadn’t paid much attention and hadn’t fully adapted to the pace yet. Now, with the pace racing, they tried to catch up but it was hard. This kind of coordination, if one step was not well bridged, it would affect the next one, unless the surgeon intentionally paused and waited.

Goodness! He was just talking about needing things, and the moment his words fell, he really needed the things.

He didn’t even need a tibial locator, the guide needle directly pierced the portals of two tibial tunnels for the anterior cruciate, one for the anterolateral bundle and one for the anteromedial bundle.

There were many methodologies for an anterior cruciate reconstruction, such as the single-bundle, double-bundle, isometric reconstruction, anatomical reconstruction, with the most advanced being the eight-strand double-bundle anatomical reconstruction. This is because studies showed that both functionally and anatomically, the anterior cruciate is divided into two bundles–the anterolateral and anteromedial. Only the double-bundle, reconstructed at the anatomical location, could recover to the maximum functionality.

For a double-bundle anatomical reconstruction, to ensure the strength of the ligament, one bundle requires four strands of the tendon. The task of drilling two tibial tunnels and two femoral tunnels well was very challenging. Not only did they need to be drilled at the anatomical site, but they should also not interfere with each other.

Dr. Yao and Dr. He had started to sweat. They had anticipated this, so it was slightly better for them. However, neither of them had ever worked on Yang Ping’s team. Su Nanchen had repeatedly told them to keep pace and that Yang Ping performed surgeries very quickly.

How fast was it exactly? They had no mental experience of it, but seeing such a terrifying speed now, they naturally felt pressured. After all, with so many people watching, it would be embarrassing for the two of them to be unable to keep up with the pace.

Measure, quickly measure! Two bundles of tendons, two people were processing and suturing at the same time. They barely finished on time. This was because they had prepared in advance and started as soon as the operation began. The tendon processing for the next step wouldn’t be so quick.

Dr. Yao and Dr. He each reported the dimensions, they dared not rest, or say an extra word. Su Nanchen had already laid the required tendon in front of them, and they immediately went back to work.

A row of drills of different sizes lay out on the instrument table, and the nurses began to look for the correctly sized drill, finally understanding the pain of falling behind in pace.

Having warned them a few times before, Su Nanchen was slightly angry that they still did not take it seriously. He was patient and would not lose his temper at a nurse, but he already felt discontentment deep within.

“Prepare the femoral drill guide!” Su Nanchen ordered another nurse.

More surgical instruments were prepared for today’s surgery than usual, including several drills. They had even laid out two instrument tables.

Finding it tough, the nurse finally set up the drill and handed it to Yang Ping. Yang Ping directly drilled two tunnels in the tibia and was now about to drill two in the femur. Thanks to Su Nanchen’s prior instructions, the femoral guide pin was prepared in good time.

Yang Ping positioned the drill against the femur entry point, drilled in and out repeatedly. This process was repeated twice and within seconds, two tunnel paths were made. No devices were needed for positioning. Not anymore.

“Measure depth!”

After Yang Ping measured the depth of the femoral tunnel, based on the reported size of the tendon, he determined the width and length of the two femoral tunnels.

“Broad drill! Narrow drill! –”

They were out of sync again. Two nurses were preparing at the same time, one arranged a broad drill, and the other a narrow one. The femur and tibia were different; each tunnel was broad at the beginning to accommodate the tendon, and narrow towards the end for threading through the suspension plate and wires.

“Both sets of drills, please?” Yang Ping had extended his hand for too long without receiving anything. He lowered his hand to take a break.

Having not observed this end of the proceedings, it turned out things were not ready yet. It would be bad to keep urging when things were not done. It would embarrass Su Nanchen. He reassured them, “It’s okay. Go slow. No rush.”

For two tunnels, two sets of drills were required, both broad and narrow. That meant preparing four drills at once.

Su Nanchen’s concern was realized. It seemed that they were already controlling the speed of the surgery back at Li Quan Hospital, but now they were still unable to catch up with the pace. It was a bit humiliating.

At this moment, the head nurse entered, like a gust of wind. “Nanchen, can we switch out one of the instrument nurses? Can we get the one from Professor Ye’s side and send one of ours there?”

What did she mean?

Su Nanchen was polite and had a good temper, but he was still human. The surgery was not going smoothly, and he was slightly unhappy. But now they wanted to replace his nurse.

With a stern face, Su Nanchen said, “We’re already short-staffed here. You want to take one of our nurses? Look for yourself!”

The head nurse could see what was happening. The chief surgeon was waiting, everyone on the operating table was busy, but they were not keeping up with the pace. What was going on?

If it were anyone else, she would have asserted her authority as the head nurse. With the power to schedule surgeries in the operating room, even senior doctors would show her some deference.

But towards Su Nanchen, could she afford to lose her temper?

No, she wouldn’t dare. After all, his parents were respectively the Hospital Dean and Head of the Nursing Department.

On seeing her boss’s three stripes insignia on the cap, no one would dare to offend him.

The head nurse said in a low voice, “Professor Ye is angry and says the nurses aren’t cooperating well. He wants a replacement. Nanchen?”

There were professors with good temper and those with bad temper. When encountering those with a bad temper, if the surgery went well, everything was fine; if the surgery went wrong, all the doctors and nurses were blamed for everything from poorly placed hooks, incorrectly positioned legs to ill-prepared instruments.

“We’re at a critical stage here!” Su Nanchen retorted unhappily.

“There’s no need to switch, let’s just send one over directly. We only need one nurse, this is still early.” Yang Ping noticing the tension, intervened to mediate. He had felt awkward that two nurses were being used on this side.

If it were not necessary, the head nurse wouldn’t have asked this of Su Nanchen, her face flushing red, speaking in a low voice with a tone of seeking advice.

These nurses were the most experienced in arthroscopic surgery, switching them with others would only generate more criticism on the operation table. In fact, the one who was assisting Professor Ye was already the best among them, better than these two.

“Alright, you arrange it.” Su Nanchen nodded.

In a dilemma about whom to offend, hearing Su Nanchen’s consent, the head nurse heaved a sigh of relief.