Chapter 381: Quick Knife Method Advancement, Complete Decentralization
The patient who underwent urethral dilation was sent to the recovery room, and while waiting to wake up from anesthesia, a new patient was soon brought in.
The patient who came was a female patient in her forties, with a sallow face and walked very slowly.
Zhou Can had read her information. The main symptoms of this patient when she was admitted to the hospital were jaundice, weight loss, nausea and vomiting. After examination, it was found that she had a tumor in the head of the duodenum.
This operation requires complete removal of the tumor and is considered a level 3 major operation.
Duodenal surgeries are basically level three or four surgeries, which are difficult and risky.
The emergency department's assessment of Zhou Can, the previous urethral dilation was just an appetizer. Now is the real highlight.
Dr. Xu is a senior attending physician. According to the surgical safety access system, senior attending physicians are qualified to perform level 3 surgeries. Junior associate chief physicians can perform level 3 surgeries and gradually carry out level 4 surgeries under the on-site guidance of senior physicians.
Therefore, this duodenal head tumor resection surgery is already the limit of what Dr. Xu can do to assess Zhou Can.
He can't perform any higher-level operations.
If Zhou Can completes this operation successfully, he will have sufficient supplies for level three operations in the emergency department in the future.
It was still the anesthesiologist who performed the previous operation. He guided the patient to lie on the operating table and began to anesthetize him step by step.
"Call me when you're done here!"
Dr. Xu went to the operating room outside to perform the operation.
In order to maintain the total number of surgeries each month, the surgeons in the emergency department worked very hard. Even so, due to the lack of surgical experts like Zhou Can, Dr. Xu had to do it himself.
He works very hard every day.
In fact, Dr. Xu is quite old. He is in his fifties and cannot compare with the physical strength and energy of young men.
Even so, he still worked desperately to expand the emergency department's operating room bit by bit.
The hospital only looks at the department’s performance and the quality of surgery.
If the number of surgeries in a department is small, the number of surgical staff will also be small. At the same time, various hardware resources will also be greatly reduced.
Look at the 10,000-level operating rooms in cardiothoracic surgery, neurosurgery, and general surgery, with top-level configurations, endoscopes, laser scalpels, high-frequency radiofrequency scalpels, etc. I even heard that neurosurgery is building a top-level hybrid operating room.
Looking at the emergency department, it only has one dedicated operating room.
The equipment is also quite backward.
If you want to get a better surgical environment and high-tech equipment, you can only rely on your own efforts.
How to fight for it?
Help the hospital earn enough money to perform more surgeries and improve the quality and quantity of surgeries.
"Qiao Yu, you do the preparation work first, I will study the patient's examination data carefully!"
"OK!"
Qiao Yu agreed readily.
She has to take on multiple responsibilities at the same time, and her job as an instrument nurse is quite hard.
Typically, there are at least two surgical nurses in a level 3 surgery.
If it is a more fancy surgical team, three nurses are normal.
Zhou Can's surgical team has just started. Strictly speaking, there are only two people, her and Zhou Can, so hard work is inevitable.
After more than 40 minutes, the preoperative preparations were completed, and Zhou Can had a deep understanding of the patient's condition. He had already worked out the most suitable surgical plan in his mind.
"I'll go ask Dr. Xu to come over!" Qiao Yu took the initiative to run outside to ask Dr. Xu to come over. He waited until Dr. Xu finished the operation and then informed him that everything was ready.
From these details, we can see that Qiao Yu is very sensible in doing things.
It is a blessing to have such an excellent nurse in the surgical team. In the future, during the coordination process of the surgical team, she can become Zhou Can's good wife and help him coordinate the cooperation of the entire surgical team.
This can save Zhou Can a lot of unnecessary trouble and improve the unity and tacit understanding of the surgical team to a certain extent.
Before the operation officially began, Zhou Can first placed a nasogastric tube in the patient.
According to the surgical requirements, a nasogastric tube should be placed in the patient during the ward rounds at around 7 or 8 in the morning.
In addition, endoscopic surgery is now often used for duodenal head tumor resection when conditions permit, especially in type B cases.
The surgical conditions in the emergency department are very simple. There is no endoscope, and it lacks some advanced examination equipment in the operating room.
This will undoubtedly add some difficulty and trouble to the operation.
Zhou Can returned to the emergency department this time to lead the surgical team, and then strive to obtain surgical resources step by step to directly expand and strengthen the operating room of the emergency department.
As long as the operating room becomes bigger and stronger, other departments of the emergency department will be pulled along and develop together.
After Zhou Can finished examining the patient, he stood at the operating position and started the operation.
After careful consideration, he did not choose a straight incision.
Instead, we choose to make an oblique incision below the costal margin in the right upper abdomen of the patient, reaching the anterior axillary line on the outside and slightly crossing the midline on the inside.
Dr. Xu was assisting nearby, and when he saw the incision method he chose, he couldn't help but nod secretly.
The advantage of this incision is that it has good exposure. Although the abdominal wall muscles need to be cut, postoperative incision dehiscence is rare. There is no small intestine under this incision, so complications such as postoperative adhesive intestinal obstruction are rare.
This also shows that Zhou Can has extremely rich surgical experience.
Three years of experience have transformed him. Not only his medical skills have been improved, but also his medical knowledge, clinical surgery experience, comprehensive predictive ability, and so on.
At the same time, Dr. Xu was shocked when he saw his new knife technique that combined fast and steady knife techniques into one.
It also gave him a new way of thinking about fast knife techniques and steady knife techniques.
I used to think that the fast knife method and the steady knife method were incompatible, but now I see that my apprentice has successfully integrated these two knife methods. They check and balance each other, but there is no conflict. Instead, they make the scalpel more stable.
It really surprised him.
After opening the chest and abdominal cavity, Zhou Can first performed a comprehensive exploration of the patient.
He found a metastatic nodule in the liver, and along the duodenal ligament of the liver, he also found enlarged lymph nodes. It seemed that this would be a tough battle.
If the patient's tumor metastasizes and is not completely removed, his or her survival period after surgery will definitely not be long.
It's easy to relapse.
After having a clear idea in mind, he touched the size and range of the duodenal papilla with his hand to ensure that he would have a clear idea during the operation.
Next, he made a Kocher incision on the lateral side of the duodenum.
Kocher's method, also known as Kocher's method, is a method of reducing shoulder dislocation.
The incision requirements at this time are similar to those of the Koch method.
[Experience points for fast knife skills +1, experience points for steady knife skills +1. ]
[Congratulations on your quick knife skills reaching the skilled level. ]
After completing the Kocher incision, Zhou Can clearly felt that his knife skills seemed to have made a major breakthrough and improvement.
His quick knife skills had always been at the entry-level, and now that he had reached the next level, it was really not easy.
I should have reached the proficient level long ago.
The main reason was that he had been in internal medicine training for a year and a half, and he rarely performed surgeries. Then, the time he had to practice his knife skills in the dormitory every day was extremely limited, so his experience accumulation naturally slowed down a lot.
Fortunately, I studied with Director Hu Kan in the Department of Cardiothoracic Surgery for nearly a year, and was able to perform one or two surgeries every day. I could even occasionally serve as the lead surgeon. This is how I gradually accumulated experience in the fast-surgery method.
[Quick Knife Technique, current experience value: proficient level 1/100000, win by speed, correct other surgical shortcomings by speed, can skillfully use the Quick Knife Technique in various complex surgical procedures. Can be integrated into all surgical techniques involving knife handling. ]
He calmed himself down, suppressed his excitement, and proceeded to the next surgical step, cutting open the retroperitoneum.
As soon as he cut with the knife, he immediately felt the benefits of the upgraded quick knife technique.
I can’t explain it, I just feel very relaxed.
It feels like lifting a heavy weight with ease.
At the same time, he also noticed that after the upgrade of the quick knife method, the steady knife method was significantly weakened. The stability of the scalpel was affected to some extent.
If I have to describe it in detail, it's like the invisible mountain pressing down on the scalpel has become lighter.
If the steady knife method is regarded as a means to check and balance the fast knife method, and the fast knife method advances but the steady knife method does not, this will definitely have some adverse effects and increase the risk of errors during surgery.
To put it bluntly, the higher the virtue, the higher the evil.
The quick knife technique is extremely powerful, and without the steady knife technique to restrain it, it would be easy for Zhou Can to follow Dr. Xu's old path during the operation.
For a surgeon, a medical error is a terrifying thing.
"Um?"
Doctor Xu's eyes lit up, a hint of surprise appeared on his face, and his eyes showed admiration and relief.
With his level, he naturally noticed at the first moment that Zhou Can's quick knife skills had improved significantly.
However, he did not interfere with Zhou Can's surgery, but silently served as Zhou Can's assistant.
After cutting the retroperitoneum, Zhou Can began to free the descending duodenum.
The small scalpel seemed alive in his hands, with measured depth and extraordinary agility. The whole process of freeing seemed to be a display of art.
…
Nearly an hour and a half later, Zhou Can looked at the nodules, lymph nodes, and duodenal head tumors that had been removed, and his heart was filled with a sense of accomplishment.
The patient has successfully completed the operation, the cavity has been closed, and his vital signs are in good condition.
"Not bad, very good! It seems that you have not wasted these three years. Your surgical ability, diagnostic ability, medical knowledge, and judgment level have all improved. Did you make a major breakthrough and improvement in your quick knife skills just now?"
Dr. Xu asked about this matter only after the operation was over.
"Well, I do have some insights. I have gained more experience and a deeper understanding of the knife skills and knife manipulation techniques."
Zhou Can admitted it frankly.
He knew that the quick knife technique was what Dr. Xu valued most, and he had always hoped that he could inherit his legacy.
"Just now I saw that you were fast but steady during the operation, which is very good. This shows that the steady knife technique taught by Director Hu Kan can indeed be integrated with the fast knife technique and benefit each other. Now Director Hu is gone, and you are the most talented among his successors. You can practice the steady knife technique more when you have time."
Zhou Can almost thought he had heard it wrong. For the first time ever, Dr. Xu asked him to practice steady knife techniques.
It was really unexpected.
Is this an alternative mourning for the death of Director Hu Kan, or a recognition of Director Hu Kan's bold innovation in medical skills?
The idea of combining steady knife technique with fast knife technique was first proposed by Director Hu Kan, but it was .
On this point, whether Dr. Xu admits it or not, Director Hu Kan is definitely better than him.
"Seeing that your surgical skills have improved to such a high level, there is actually not much I can teach you. The master can only lead you to the door, but the practice depends on yourself. In the future, you can boldly explore on your own during surgery. If you encounter something you are undecided about, you can ask me at any time. But I suggest that you ask me as little as possible. Every surgeon's surgical thinking, diagnostic methods, and treatment plans may be different. The best one is the one that suits you."
Doctor Xu was filled with joy and felt relieved to see his apprentice grow so quickly.
"Teacher, I still have a lot to learn..."
Zhou Can disagreed.
He doesn't want to start his apprenticeship so soon.
As soon as he opened his mouth, Dr. Xu raised his hand to stop him from continuing.
"Don't worry, I will teach you everything I need to. You are my only successor, would I take those medical skills with me into my coffin?"
After being rebuked by Dr. Xu, Zhou Can was speechless.
"There are many ways to Rome. Everyone has his or her own surgical path and style. I only need to teach you the basic methods and some important surgical experience and skills. The rest you have to understand and explore on your own will be more beneficial to you. When educating children, if we require them to do things according to their parents' thinking, they will definitely not be as good as their parents when they grow up. Only by letting them go and taking risks can they go far and fly higher."
Dr. Xu really has good intentions towards Zhou Can.
Just so that he can achieve greater success in the future and not be confined by the shadow of his teacher.
"I understand! Thank you for thinking so hard about me."
Zhou Can nodded vigorously, a relieved expression on his face.
"I'll call an intern to assist you. From now on, you can use as much force as you can. As long as you can ensure the safety of the operation, you can do whatever you want. If you don't understand or are unsure, you can call me at any time. I'll be outside."
Dr. Xu completely delegated authority to him.
It means the assessment has been passed.
And achieved extremely high scores.
This is normal. Apart from anything else, the fact that Zhou Can achieved a breakthrough in quick knife skills during surgery and reached the proficient level was enough for Dr. Xu to look up to him.
The master and apprentice have been dealing with each other for a long time, and Dr. Xu has a deep understanding of his personality, surgical style, and character.
Naturally you can rest assured.
After Dr. Xu went out, he quickly called an intern in.
He is a young man of twenty-two.
Because he was wearing a hood and a mask, we could only roughly see the young man's appearance.
"Hello, Teacher Zhou, my name is Luo Shishen. I am a clinical general practitioner. I have been interning at Tuya for almost half a year. Thank you for your guidance." The young man respected Zhou Can very much.
Before he knew it, Zhou Can had gone from being an intern to completing the training program, becoming a formal resident physician, and even a teacher in the eyes of the interns.
Of course, this is a polite term.
"Do you know how to make pinky promises or something?"
"I have basically learned the simpler techniques such as hook-pulling and leather sewing. If you need anything, just tell me."
"Okay! I'll tell you what you need to do later."
Zhou Can nodded. Qiao Yu had already brought in the third patient for surgery.
Oh my god, a patient with acute appendicitis came directly.
The emergency department doesn't have an endoscope, so we can't do laparoscopic surgery. So we can only do traditional surgery.
The preoperative conversation and other things must have been taken care of.
Otherwise, it would be impossible to enter the operating room.
Zhou Can did not ask too many questions, such as why the patient did not go to a specialist for laparoscopic surgery, but chose to go to the emergency room for traditional surgery. He just looked at the patient's examination data carefully, confirmed that there was no problem, and then waited for the anesthesiologist to anesthetize the patient.
The new guy named Luo Shishen is quite diligent. He is busy running around and will help with many things without being asked to do them.
This made Zhou Can feel quite satisfied.
During the operation, Luo Shishen seemed a little talkative and kept asking questions.
At first, Zhou Can patiently answered his questions one by one for the sake of face. But this guy had no insight at all, and he kept asking questions even when Zhou Can was performing some extremely risky surgical steps.
