Chapter 3033: with translation of chapter title

Director Yan accompanied Peng lao in chatting, a few minutes later the thoracic department's Gu lao rushed over.

Lao He was busy with a dummy performance on one hand, while pricking up his ears to listen to what they were saying on the other. At times like this, it's high-level bigwigs chatting; for an anesthetist like me to butt in and chatter would be utterly boring.

But he wondered how Zheng Lao Ban had taken on such a big job. Usually other doctors treat Shou Bing for more important figures with greater caution; just now listening to Yi Ren, it seemed Zheng Lao Ban had been the one who persuaded them to come.

From the Conversation Lao He could tell that Gu lao actually didn't really approve of the Shou Bing, each time wanting to speak but stopping; he should have gone to the Shuai mansion the day before for a consultation and participated in the diagnosis.

However, Gu lao's opinion wasn't important; Lao He had nothing to worry about, and now he had an almost blind admiration for Zheng Lao Ban's skill.

Zheng Lao Ban's skill is definitely high; the key is stability! No matter what rare Shou Bing, Zheng Lao Ban will steadily pull it off, and Lao He has a kind of "illusion," as if Zheng Lao Ban had performed this Shou Bing countless times before.

Maybe it's just an "illusion," Lao He thought to himself. He was merely a little curious: after expert consultation, Peng lao and his wife had also given up on the Shou Bing and prepared to return to their hometown to settle in peace, yet Zheng Lao Ban must have had great confidence to keep them here.

Soon, the sound of a gurney rang out, and the patient was brought in.

Lao He helped lift the patient onto the Operating table and asked softly, "Zheng Lao Ban, do you have any special needs?"

"Left lateral position, forward tilt 30°, right side entry into the chest." Zheng Ren said in a low voice. While speaking, he inserted the patient's films into the viewer, habitually holding his arm to look at the films, without any thought of speaking to Peng lao.

"All right." Lao He lowered his voice and replied.

"Let's administer anesthesia; I'll go scrub up right away." Zheng Ren said.

"So urgent?" Lao He was taken aback for a moment.

"The Shou Bing must be completed within 45 minutes from the start of anesthesia, aiming for as light an impact as possible. The elderly patient is old; the faster, the better." Zheng Ren explained with a smile.

This time Lao He understood why Gu lao felt this Shou Bing was unnecessary; it was determined by the patient's own physical condition.

Including the 45 minutes of anesthesia, even a thoracoscopic Shou Bing would be too fast; Zheng Lao Ban really dared to think that.

Seeing Zheng Lao Ban go scrub up, Lao He glanced at Su Yun. Seeing Su Yun had already set up the stand and auxiliary equipment, he asked softly, "Yun Ge'er, may I begin?"

"Begin, after you intubate I'll start positioning the patient." Su Yun's voice came through three layers of masks to Lao He's ears, slightly muffled. Lao He knew Yun Ge'er might also be a bit nervous today, after all, even though Director Yan had driven away a crowd, there were still many bigwig-level tasks preparing the Observation Platform.

Intubation, anesthesia, positioning; after 4′22″, Zheng Ren had finished scrubbing, laid out the sterile drapes, and stood before the Operating table.

Lao He stared intently at Zheng Lao Ban's movements, and at the most appropriate moment began left-sided single-lung ventilation.

Zheng Ren placed the Thoracoscope at the 7th intercostal space along the posterior axillary line on the right side; the anterior axillary line 3rd intercostal space and scapular line 8th intercostal space were the two working ports. After inserting the trocar and scope, Lao He let out a breath; single-lung ventilation was perfect, with no impact on Zheng Lao Ban's Shou Bing time.

However, Zheng Lao Ban did not directly attack the mediastinum; instead, he began skillfully dissecting with a long forceps, and soon the azygos Vein arch appeared in the Operating Field.

A linear stapler was placed in Zheng Ren's hand; after cutting the azygos vein arch, he began dissecting the mediastinum, and soon a large diverticulum appeared on the screen.

At the level of the carina, he dissected out the esophagus and lifted it with a loop; Zheng Ren then dissected upward along the esophagus, exposing the lower end of the diverticulum.

In the Operating Room, only the song Good Luck Come was drifting; others stood behind Zheng Ren, watching the operation performed with bone-deep proficiency, no one speaking, only occasionally raising their heads to glance at the electronic clock hung on the doorframe.

12′22″, the diverticulum was fully exposed.

For esophageal thoracoscopic Shou Bing, this is already a time that leaves all operators speechless.

Normally, in such a short time all that could be done was finishing anesthesia and positioning; a slightly slower Medical Team might not even have laid out the Shou Bing sheet. Yet Zheng Lao Ban on this side had already seen the esophagus.

Soon, but it was still not enough.

Gu lao glanced at the time; beneath the Sterile Cap, his black-and-white eyebrows furrowed.

Only now has the true Shou Bing begun; can Zheng Lao Ban finish it?

He did not deny Zheng Lao Ban's Shou Bing plan, but he doubted whether the Shou Bing could be completed within one hour. Although he had once performed as lead surgeon on a 104-year-old patient, that was only when the patient's physical condition met the criteria.

Doctor Zheng's Shou Bing this time seems somewhat reckless.

Time was not an issue for Zheng Ren; after exposing the diverticulum, he used an electrocautery to make a small hole into the diverticulum from its lower end, sutured two stitches, then retracted. The limitations of the thoracoscope seemed not to affect Zheng Ren's technique; the suturing was clean and swift, and his coordination with the assistants and instrument nurses had reached perfection.

After suturing, the suture line was clamped by Su Yun with a forceps, left for traction.

On the horizontal plane at the base of the diverticulum, a small hole was made in the right wall of the esophagus; likewise, two stitches were sutured and then retracted.

Subsequently, Zheng Ren used an endoscopic stapler to enter the esophageal lumen and the diverticulum lumen through the esophageal opening and the diverticulum opening, performing a side-to-side stapling of the diverticulum and esophageal side walls.

The stapler emitted a creaking sound; although clean and swift, it still made everyone's hearts skip a beat.

Zheng Lao Ban didn't even bother to compare; after putting down the stapler, he went straight to work—this is too much confidence.

Shou Bing time 23′54″, the diverticulum was completely opened.

The incision between the diverticulum and the esophageal ridge created a common cavity between the diverticulum and the compressed upper thoracic esophagus.

This way of relieving esophageal compression is rare, but from the anatomical structure one can clearly see that the compressed esophagus has begun to regain the shape of its lumen. Simply put, if the Shou Bing succeeds, the patient should be able to eat.

The biggest problem with this approach is leakage.

Afterwards, the diverticulum and esophageal incision formed by the stapler were subjected to interrupted suturing.

Gu lao's brows furrowed tighter and tighter; this is the most critical part of the Shou Bing.

No matter how fast or meticulous the prior Shou Bing had been, if postoperative esophageal leakage occurred, for an 84-year-old patient in poor condition, it would be an unbearable blow.

Moreover, the esophagus's own anatomy and blood supply have repeatedly warned practitioners; the probability of esophageal leakage for doctors is high.

Is interrupted suturing alone sufficient?

It seems not enough; if that were the case, even postoperative jejunal feeding would hardly guarantee esophageal healing.

Zheng Lao Ban's suturing was very fine, consuming much time. When Gu lao looked at the electronic clock again, the Shou Bing time had already reached 33 minutes.