Chapter 1089: Chapter 886: The Good Things That Can’t Be Found Even with a Lantern_2 Chapter 1089: Chapter 886: The Good Things That Can’t Be Found Even with a Lantern_2 Professor Yang probably wasn’t that interested in this kind of Surgery, Director Fang thought.
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This surgical technique was designed by Yang Ping, and it was the first ti Director Fang was performing it, so Yang Ping’s guidance was essential.
It was the sa old routine, having Yang Ping “lead” Director Fang through the Surgery, a model that had already achieved trendous success in the past.
The Patient was under General Anesthesia, in a supine position with a pillow under the shoulders, which allowed for good stretching of the surgical area and more ample exposure of the surgical field.
With Yang Ping standing opposite, Director Fang felt brave enough to perform any surgery, brimming with confidence, as if he had activated “Invincible Mode”.
Starting from the original Incision, he extended it bilaterally to the appropriate length, layer by layer, cutting through the skin, Subcutaneous Tissue, and the platysma, steadily making his way down to the surgical target—the recurrent laryngeal Nerves.
Director Fang intended to impress with a “One-Stroke Flow,” but his lack of skill ant the strokes were either too deep or too shallow, with the latter not even piercing the skin.
There was no choice but to make a few additional cuts, a task that seed easy yet proved challenging to execute.
After opening the platysma, Director Fang separated the strap muscles at both sides of the white line of the neck and freed the anterior edge of the right sternocleidomastoid muscle.
At this point, the Assistant used a double-hook retractor to rotate and pull the larynx. Although there was extensive adhesion inside, with Professor Yang present, no adhesion posed a problem.
Under Professor Yang’s assistance, Director Fang’s anatomical layer was very clear. Advancing step by step, the larynx was retracted, and Director Fang severed the cricothyroid muscle attached to the left edge of the thyroid cartilage, then separated the paraglottic space, which was all adhesions—what exactly was the situation at that ti.
Seeing the severe adhesions inside, Yang Ping frowned, deducing from his vast experience that these were not adhesions caused by radiation therapy but rather by harsh Surgery at the ti.
Once Director Fang clearly separated the paraglottic space, he noticed the significant atrophy of the left arytenoid muscle. He then began to retrograde dissect the left recurrent laryngeal Nerve from behind the left cricothyroid joint, aning he dissected in the opposite direction of the Nerve’s path.
After dissecting a portion, they observed that the recurrent laryngeal Nerve was noticeably thinner, and 2.5 centiters from the cricothyroid joint, it was severely compressed by scar tissue.
No wonder the Patient’s symptoms were significantly more severe than those of unilateral recurrent laryngeal Nerve damage, affecting breathing noticeably. It all made sense now.
With one side of the recurrent laryngeal Nerve severed and the other compressed, it was as if both Nerves were damaged. The severe compression on the left side ant that if it wasn’t dealt with promptly, the left recurrent laryngeal Nerve would beco entirely nonfunctional after a while.
If the damage on the right side was truly 8 centiters, this surgery was indeed challenging. It’s no wonder that the doctor surnad Qian was reluctant to take on the case himself.
“Just releasing the left side should suffice, right?”
Director Fang sought Yang Ping’s opinion; at the crucial mont, consultation was key.
“Slice open the epineurium to check; it likely hasn’t degenerated. After release, it should recover,”
Yang Ping instructed Director Fang.
Carefully cutting open the epineurium of the Nerve, Director Fang noted the endoneurium structure inside was still relatively intact and clear, indicating the Nerve had not degenerated. A simple release would do, no need to excise and then suture.
With the left Nerve treated this way, it could be considered as having completed a part of the Surgery.
Director Fang was learning Yang Ping’s hemostasis technique, and at this mont, he rembered to use bipolar electrocoagulation precisely for hemostasis. Of course, he was very careful; bipolar electrocoagulation would never co close to the nerves.
The left recurrent laryngeal nerve had already been treated, and Director Fang began to reveal the right recurrent laryngeal nerve. Since the original surgery was not led by Yang Ping or Director Fang, they did not know the exact location of the nerve’s severed end. If the chief surgeon had been conscientious, they would have marked the right recurrent laryngeal nerve for easier identification during subsequent nerve repair.
More troubleso adhesions!
Yang Ping did not understand how the surgery had been done. In principle, the level of Affiliated Hospital No. 4 should not be bad, but judging from the current situation and deducing backward from experience, it felt like the surgery had been perford by a novice—it was an absolute ss.
“Both surgeries were done using the Da Vinci Robot, not counting other treatnt costs, just one surgery costs over a hundred thousand,” Director Fang explained.
Yang Ping really didn’t understand, “Perform this kind of surgery with the Da Vinci Robot? Would it have better results than traditional surgery?”
“Who knows? You might not be aware, but when it cos to surgeries in the General Surgery Departnt of Affiliated Hospital No. 4, if they can use a robot, they definitely don’t use traditional thods. Hence, their use rate of the Da Vinci Robot is extrely high,” Director Fang couldn’t help but let out a hint of a sneer.
Amongst the ss of adhesions, Director Fang finally uncovered the severed end of the nerve. There were no markings, and the placent of the nerve was haphazard, potentially leading to accidental severing by an inexperienced chief surgeon with one careless cut.
The right recurrent laryngeal nerve was truly missing a full 8 centiters. Director Fang thought to himself, if it weren’t for Professor Yang providing a plan beforehand, what would he have done if he suddenly encountered this situation on the operating table?
He would have hastily found a nerve to graft, but as for the effects, who could say?
Following the procedure Yang Ping had prepared in advance, Director Fang directly dissected the severed end of the right recurrent laryngeal nerve from underneath the brachial plexus and anastomosed it to the vagus nerve behind the carotid artery and near the throat.
Since they had not seen the patient’s pathological report, Yang Ping, in the interest of caution, instructed Director Fang to take tissue from different parts of the operative area for pathological examination after the surgery. The PET-CT had not shown any signs of tastases throughout the body. Now, taking tissue from so many spots for pathological examination, if they still did not find tumor tissue, they could confirm that no treatnt aid at the tumor was needed after the surgery; only thyroid replacent therapy would be necessary.
With Yang Ping’s assistance, Director Fang earnestly completed the surgery.
After the surgery, Director Fang tentatively asked Yang Ping, “Professor Yang, when the ti cos, you could write a paper about this case.”
Yang Ping had no ti to write such papers, as he had many other research projects to work on. Therefore, he said to Director Fang, “I don’t have the ti. If you’re interested, go ahead and write it. Don’t worry, I won’t claim intellectual property rights.”
At this mont, Director Fang was overjoyed. This was a rare opportunity that wouldn’t co by even if one searched with a lantern, and for Yang Ping, it might not an much, but for Director Fang, it was a major innovation. If this paper could be published in an international journal, then in the field of recurrent laryngeal nerve repair, Director Fang could claim to be the national leader and even the world leader.
The world leader! How could that not be thrilling?
After Yang Ping left, Director Fang cald himself down in the changing room for a full half-hour before regaining his composure. He imdiately called the fruit shop downstairs at the hospital and ordered two boxes of the best cherries to be sent to the Surgical Research Institute right away. No, two boxes were not enough to show his sincerity, so he rounded up four boxes of cherries and had them delivered to the Surgical Research Institute.
Which journal had this paper been published in? Director Fang began to ponder this question; he was determined to publish in an international top-tier journal.
Having been a doctor for twenty years, he had never felt such a sense of achievent—not only solving a problem that others couldn’t but also about to publish a paper in an international journal. Among his peers, he must be at the top, right?
After resolving the recurrent laryngeal nerve issue, Yang Ping started reviewing Nong Tiesheng’s illness. What exactly was the classification and staging of his thyroid cancer at the ti? Without a pathological report and no staging or classification on the case records, this was highly irregular. Especially after a radical surgery, how could there be no staging or grading?
Moreover, from the analysis of nurous imaging pictures, this patient did not appear to have thyroid cancer, but rather looked more like a benign thyroid tumor. If that was the case, how could radical surgery have been perford? This was completely contradictory, no matter how you looked at it, it just didn’t make sense. Better to wait for the pathological report to co out.
No matter the previous surgeries, if the pathological report cos back clear, then the patient could be considered temporarily cured, which was also good news.
As for the follow-up targeted therapy, that was completely unnecessary.
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