Chapter 360

Tian Jiaoshou's technique is very smooth.

Cut open the skin, expose the spinous processes and laminae; the vertebral bodies above and below the lesion, two each, are fully exposed.

To better expose the incision, the bilateral sacrospinalis muscles should be cut horizontally at the level of the diseased vertebra and then retracted laterally and medially.

Normally, at this point there should be at least 200 ml of bleeding.

Because during the process of exposing the spinous processes and laminae, a certain amount of periosteum must be handled, causing bleeding.

But today's surgery was unexpectedly smooth.

The bleeding was less than 50 ml, and the entire operative field looked exceptionally clean.

Tian Jiaoshou was very satisfied with his technique; it seemed his hand was steady today, and the surgical bleeding might be less than 3000 ml.

The next steps would involve heavy bleeding, so Tian Jiaoshou's hand became much gentler, slowing down carefully; all maneuvers were performed after careful identification to avoid accidental bleeding.

The bone-cutting forceps began to bite through the spinous processes and laminae invaded by the tumor.

With a "ga ba~" sound, a fragment of bone was bitten off by the bone-cutting forceps.

Because of the tumor invasion, the bone plate was not so hard, and the sound was like that of rotting leather.

Although the hardness was insufficient, the tumor's abnormally proliferating blood vessels gave the bone plate ample blood supply, causing bleeding to increase suddenly.

Heavy bleeding begins now.

A piece of lamina was bitten off by the bone-cutting forceps, and Tian Jiaoshou habitually covered it with a piece of dry gauze.

Strange...

In an instant, Tian Jiaoshou noticed that a full ten seconds had passed before the dry gauze became soaked with fresh blood.

Tian Jiaoshou's level is very high; although not yet master-level, he is a senior master-level, nearly a grandmaster-level orthopedics professor.

He has a deep understanding of vertebral resection surgery.

If the earlier bleeding was relatively low, it could be explained by his high level of dissection.

But biting through the lamina with the bone-cutting forceps makes it impossible for this step to have unusually little bleeding.

Generally, from this step onward, surgery is performed in a pool of blood.

The kind that even the suction device cannot clear completely.

And poor visibility leads to more bleeding, creating a vicious cycle.

On that side, fresh frozen red blood cells have already been hung up, waiting for Tian Jiaoshou's order, ready to be transfused into the patient's body at any time.

Strange, could it be some rare tumor? Poor blood supply?

No way, ah, Tian Jiaoshou somewhat cannot understand the situation before him.

Even if the tumor's blood supply is not rich, the blood supply of the vertebral body is quite rich. No matter how, it wouldn't happen that within ten seconds, bleeding would soak a piece of dry gauze.

"Teacher Tian?" Zhou Yisheng saw Tian Jiaoshou dazed, not knowing what had happened, and softly called out.

Tian Jiaoshou came to his senses from endless speculation, focused, and continued the Shou Bing.

Continue to bite through the lamina, exposing the nerve root.

The tumor invades the vertebral canal; intraoperatively, the dura can be seen gradually bulging outward without pulsation, epidural fat often disappears, and under pressure the dural sac is displaced or deformed.

The lamina bitten off by the bone forceps, Tian Jiaoshou did not continue to cover it with dry gauze; he wanted to see how much bleeding there was.

Indeed, the bleeding was extremely slight, only a few tens of milliliters.

It's a problem with the interventional surgery!

Tian Jiaoshou quickly figured out the truth of the matter. But, he could not accept this truth.

In Di Du, as an expert and professor of spinal surgery, I often cooperate with Intervention Department Doctors to complete vertebral body resection Shou Bing.

But have I ever encountered a situation with so little bleeding?

No, not even once.

With Intervention Department cooperation, there can indeed be a reduction in certain bleeding. It has some relation to the surgeon's technique, but not a major relation.

Just embolizing one lumbar artery, what's difficult about that?

If no Intervention Department Doctor can be found, Tian Jiaoshou himself, wearing lead clothing, can perform the embolization of the lumbar artery Shou Bing.

But whether it's an Intervention Department Doctor or he himself doing the embolization of the lumbar artery Shou Bing, it can only reduce bleeding from 5000 milliliters to 2000 or 3000 milliliters.

Even less, Tian Jiaoshou truly has never encountered.

Hai Cheng, such a small place, could there be doctors stronger than those in Di Du?

Impossible, completely impossible.

Tian Jiaoshou was thinking about these things in his mind, but his hands did not pause.

This Shou Bing has been done so many times that, without saying one could do it with eyes closed, at the very least one doesn't need to repeatedly recall regional anatomy as when doing it for the first time.

Using a nerve dissector, find the nerve root on both sides of the dural sac and protect it.

Then, Tian Jiaoshou began to dissect the tumor tissue, the lateral dural sac and nerve root, removing the superior and inferior articular processes together with the pedicle and the visible tumor tissue en bloc.

Generally speaking, before lamina resection Shou Bing, the purpose of embolizing the lumbar artery lies here.

Without interventional embolization, threatening bleeding will appear at this time.

What is threatening bleeding?

Some invisible tiny blood vessels, with a whooshing sound, spurt blood; the entire operating field is a sheet of crimson, and even the bleeding vessels cannot be found, let alone performing vertebral body resection Shou Bing.

No threatening bleeding, not bad.

But…… how is this no threatening bleeding? There isn't even any bleeding, okay!

If one insists there is no bleeding at all, that's nonsense.

But Zhou Yisheng, holding a suction device without a cover, easily sucked the blood clean, the operating field was very well exposed, so well that Tian Jiaoshou became a bit flustered.

This is not the familiar vertebral body resection Shou Bing……

Did I make a mistake?

He stopped his hand, recalled the entire surgical procedure, there was no problem at all!

Again look at the Operating Field, the anatomical structures had Clarity enough to serve as textbook illustrations—there was no problem either.

Really fucking saw a ghost!

The surgery went too smoothly, yet there was also a problem.

Tian Jiaoshou felt a little uneasy; since he first encountered vertebrectomy, he had never seen such an Operating Field.

If he were in Di Du, Tian Jiaoshou would have wanted to find a few colleagues, even invite his own Title: Teacher to the Observation Platform to see if he had made any mistakes.

But this is Hai Cheng.

Just grit your teeth and do it.

Exposure and resection of the lumbar transverse process went smoothly, bleeding……still little; normally bleeding at the lumbar transverse process is around 500 ml, taking 30 Minutes.

This is Tian Jiaoshou's experience.

But this damned surgery, the blood loss was only 30-50 ml, took 15 Minutes, and this step was completed.

Then Tian Jiaoshou began to expose the anterolateral aspect of the vertebral body Bone; the vertebra invaded by the tumor showed moderate enlargement, but its edges were clearly demarcated from surrounding tissue. Gentle dissection could push aside the surrounding tissue to perform the dissection.

Normally, this step would still have 200-300 ml of bleeding, taking……

But here it was still very smooth; the blood loss was only one-tenth of the usual; looking at Zhou Yisheng's hand holding the Suction Device tube, an estimated 20-30 ml of bleeding would be good.

After exposing the diseased vertebra up to the anterior longitudinal ligament, Tian Jiaoshou had Zhou Yisheng use a Hohman Retractor to pull aside the surrounding tissue, revealing the anterolateral approach to the vertebra.

The surgery……was too smooth; its smoothness made people dazed, made people feel dread.

Is this a vertebrectomy?

No way, how could the bleeding be so little? How could the surgery go so smoothly?

Really……really fucking saw a ghost!