Chapter 596: Chapter 543: Removing the Needle, It’s Not That Easy! Chapter 596: Chapter 543: Removing the Needle, It’s Not That Easy! Baby Minmin was admitted to the hospital ward, and even with Li Guodong’s help, the two elderly were a bit dizzy from the rush.
Nowadays, many activities require the use of smartphones and WeChat, which are inconvenient for the elderly now and hence cause so delay.
Once they reached the ward, the elderly couple was finally able to take a breath.
However, the baby started to cry, making the old grandfather hastily make so milk formula while the grandmother carried the baby back and forth to comfort her.
Seeing this, Head Nurse Cai imdiately took the child and was able to calm her down within minutes.
Since there are not many infants in the ward usually, Head Nurse Cai ordered an infant bed from the pediatrics departnt and assigned a nurse who was already married and had childcare experience to take charge of Minmin.
After Li Guodong, the attending physician, got the dical history, the old grandfather started to compile a list of paynts, count the cash he had, make a detailed record of the expenses in his notebook, and then calculated each expense twice with a calculator.
Luckily, the couple has pensions and are therefore not left utterly helpless in this situation, but their pensions were almost drained by their son.
Thinking of this, the elders were heartbroken. They have lived a lifeti and have been continuously upset by their own son.
The couple had their son when they were over forty and therefore overly adored him when he was little, spoon-feeding him every step of the way.
The son’s high school grades were dismal, but the elderlies invested money to send him to a private university. However, upon graduation, the son was too picky to settle for any job, preferring to stay at ho, playing video gas, and living on the savings of his parents.
The couple belonged to the working class and therefore had so savings and pensions. As they had only one son, they managed to get by in hopes that their son would mature and beco more responsible soday.
It wasn’t easy for their son to get married, and the old couple cobbled together whatever they had to buy a house for him.
After buying the house, they were financially strained and couldn’t afford a car.
The son held a knife to his throat to argue that he couldn’t continue living without a car when all his friends had one. Threatening to commit suicide, he knelt down and coerced his parents into making ends et.
Alas, there was no choice!
The couple, who had scrimped and saved all their lives for their son, gritted their teeth and used up their last saved money to buy a car for their son.
The son was quite picky about the cars and wouldn’t look at anything but high-end brands like rcedes-Benz and BMW.
Eventually, the last of the elderlies’ savings were spent.
The son had always been this way, stubborn, and always resorting to threats of suicide to get his demands fulfilled.
Every effect has a cause, the couple admitted that they had not disciplined their son properly, but what could they do now? It’s reaping what they have sown.
Finally, the old man calculated and recorded the costs clearly, and he was able to rest and check how much milk formula they had left.
After examining the milk formula, he then checked if the dications they brought, which they needed to take long-term for various conditions like hypertensions and diabetes, were enough for themselves.
The grandmother ntioned that they might not have enough diapers and asked the grandfather to buy so more from the hospital store.
It took the grandfather a few minutes to stand up and started to go downstairs to buy diapers with the help of a cane.
Just then, Head Nurse Cai saw him and, unable to turn a blind eye, she asked a nurse-in-training to buy so diapers and check what else they needed, to bring back with her.
Head Nurse Cai rarely saw elderly people bringing small children to the hospital alone, and the old couple themselves seed to be in poor health and could not withstand too much wear and tear.
As a result, she felt it necessary to arrange a rather flexible nurse-in-training to assist the elderly couple.
The couple appreciated this greatly.
—
In the doctors’ office, no one had left work yet, nor was there any plan to leave on ti.
Minmin’s X-rays were hung on the film viewing light screen, and everyone gathered around it in a semicircular arrangent.
Each needle’s location was analyzed individually. What anatomical structures are adjacent to each? Where does each needle’s removal procedure start? What path should it follow, and what potentially dangerous structures need to be avoided?
One needle was located in the intervertebral space of the fourth and fifth cervical vertebrae. How it got there is no longer relevant.
The task now is to figure out how to remove this needle.
Extraction via incision is the preferred course of action. If the intervertebral space of the cervical spine is entered from the front, many key blood vessels and nerves need to be bypassed.
If the posterior approach to the cervical spine is utilized, it enables us to bypass the blood vessels and nerves in the front. The needle can then be extracted through the small gap between the cervical spine plates.
This is a feasible operation but would require X-ray inspection, and the path for extracting the needle includes the spinal canal. The narrow spinal canal makes it challenging to adjust the direction of the needle, potentially leading to it getting stuck inside.
Open surgery also has a very high degree of difficulty, but Yang Ping suggested using surface ultrasound for minimally invasive surgery to remove the needle.
Professor Zhang wanted to hear the details of Yang Ping’s procedure, and everyone else was also eager to learn.
“Xiao Yang, can you explain how you would use ultrasound localization to perform minimally invasive needle removal?” asked Professor Zhang.
No one had used this thod for spinal surgery, especially cervical spine surgery. This was an innovation.
Yang Ping placed his finger on the X-ray where the needle was located on the cervical spine and said, “We can take the anterior approach. The puncture would be perford under ultrasound localization, inserting the working cannula to the front of the fourth and fifth cervical intervertebral space and aligning it with the direction of the needle. After inserting the endoscope, we can cut open the anterior longitudinal ligant and the intervertebral disc and remove the needle.”
The anterior approach would require confronting many blood vessels and nerves, and if damaged, the consequences could be severe.
Ultrasound localization could play a huge role at this point, as it could recognize soft tissues very effectively, particularly nerves and blood vessels.
“If you can truly remove it this way and reduce the trauma to the patient, that would be great. However, it’s very difficult. If you are not absolutely confident, I suggest opting for open surgery as much as possible, and avoid taking unnecessary risks,” reminded Professor Zhang.
Song Zimo said from the side, “Professor Zhou Yue from the Third Military dical University’s XinQiao Hospital once ntioned that minimally invasive is to leave the difficulties and risks to the doctors and bring good results to the patients. If it can be minimally invasive, I support the attempt. With proficient surface ultrasound positioning, we can avoid blood vessels and nerves, but it would be difficult to locate the fine needle. If unsuccessful, converting to an open surgery may also work.”
The difficulties and risks of minimally invasive surgery lie in the switch from traditional open surgery to surgeries under a microscope and endoscope, etc.
Performing complicated operations in a tiny channel of only several milliters to a few milliters requires very high requirents on doctor’s surgical skills.
Spine surgery is inherently risky, filled with the spinal cord and nerves, a milliters difference could cause lifelong impact on the patient.
Therefore, minimally invasive surgery is like dancing on the tip of a knife, requiring more from the surgeon than an open surgery.
This kind of surgery to remove the fine needle, without an utmost level of minimally invasive ability, is absolutely daring not to be attempted.
In open surgery, you can toss around in the surgical area, if necessary, the incision can be extended.
In minimally invasive surgery, if your skills are not up to par, you don’t even have the chance to throw about.
“Surface Ultrasound— tily guidance, can the ultrasound departnt— doctor— assist?” Xu Zhiliang posed the question.
Yang Ping responded to Xu Zhiliang, “I will operate the ultrasound probe myself.”
Xu Zhiliang forgot, Yang Ping himself is capable of performing surface ultrasound, and he excels at it.
If two people were to coordinate, one guiding with the surface ultrasound and one performing the surgery, this separation would make the complex operation highly risky.
But if Yang Ping himself were to operate with the guided surface ultrasound, the risk would be sowhat less.
“If you are confident, I agree.”
Professor Zhang affird Yang Ping’s innovative initiative of combining the surface ultrasound with an endoscope, using the surface ultrasound for positioning, helping the endoscope establish an accurate route to the intervertebral space, and then extracting the fine needle with the help of the surface ultrasound guidance.
“I am very confident!”
Yang Ping was very confident.
Since Yang Ping said so, Professor Zhang also had a clear idea, stating, “If there are no objections for this needle, then let’s settle for this.”
Without any objections, they proceeded to discuss the next needle: the one in the pericardial cavity of the chest.
“Thoracoscopy combined with surface ultrasound, is it feasible? Use surface ultrasound for positioning, cut open the pericardium with the thoracoscopy monitoring, and remove this needle?” Professor Zhang still favored the combination of the thoracoscopy and surface ultrasound.
If the needle in the cervical spine can be extracted with minimally invasive guidance, then this needle could also be attempted the sa way.
“The X-ray shows that the outline of this needle is not smooth, implying that it has already rusted.”
Song Zimo had scanned the X-rays several tis and was certain that it was a rusted needle.
If it’s already rusty, this undoubtedly increases the difficulty of extracting the needle, with the high possibility of accidentally breaking the needle.
“Correct, this needle has already rusted. The direction of thoracoscopy entering is extrely strict, it must line up with the planned extraction path, otherwise the needle could easily break.”
Yang Ping found that Song Zimo’s reading technique had improved again.
Judging from the needle’s outline on the X-ray that it’s rusted, requires very high reading skills.
Xu Zhiliang glanced at Song Zimo, then at the X-ray, and then leaned closer to take a careful look at the needle.
“Should we ask for Thoracic Surgery’s assistance?”
Professor Zhang was very straightforward.
These doctors are all orthopedics, the hospital gave them the surgical authority for the whole surgery departnt, but that was for the convenience of the surgery.
Yang Ping and Song Zimo have shown their skills in full body trauma surgery, but everyone has their specialities.
“In theory, it’s needed. In actual operation, it’s not necessary.” Song Zimo’s response was very dialectical.
With Yang Ping’s capability, would he need the help of Thoracic Surgery? His skills in thoracoscopy and laparoscopy are quite proficient.
Song Zimo’s skills were personally taught by Yang Ping, so no one knows better than him how capable Yang Ping really is. This person is so strong, it seems as if there are no blind spots in his skills, and no ceiling either.
Anyway, so far, Song Zimo hasn’t seen a surgery that Yang Ping asserted he could handle that he didn’t pull off.
Professor Zhang adjusted his glasses: “Well, in that case, there’s no need for multi-departnt collaboration, you guys can work on your own.”
Actually, inviting Thoracic Surgery or General Surgery to assist is not only for technical reasons, but also to share the risk, in case there is any problem, everyone accepts the responsibility together.
If soone else was the Chief Surgeon, Professor Zhang would still invite other departnts to collaborate, to distribute the risk for the younger people.
Now that Yang Ping is the Chief Surgeon, then there’s no need to invite others. Professor Zhang knows exactly how much Yang Ping is worth.
With the surgical plan for these two most dangerous needles determined, the rest is not yet utterly devoid of any difficulties.
The positions of the remaining needles are not as dangerous as these two, but the difficulty of their operations is not less than these two.
For example, the few inside the abdominal cavity: going inside with a laparoscope, it’s hard to locate the needle. With the intestines’ peristalsis, the needle could move around. The X-ray shows it in the abdominal cavity, but who knows which part is it specifically inserted into, maybe on the intestinal wall, or maybe on the peritoneum.
Even if the operation is open, revealing the abdominal cavity, turning it upside-down, it’s hard to find exactly where the needle is.
Let alone a minimally invasive surgery?
Don’t judge the tiny needle, when it cos to removing it, it’s not that easy!
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