godfather of surgery

Chapter 1204 Either Stupid or Bad
Every time President He spoke to Yang Ping, he would bow slightly and lean forward, as if he were leaning over to listen, which made him appear extremely humble and subservient.

Actually, President He had no ulterior motives. He just wanted to appear sincere in front of Professor Yang, but he didn't know how to express it, so it naturally turned out this way.

The surgery went smoothly. Mr. He and the engineers he brought only stood in the operating room for two or three hours and did nothing. The laser pointer was completely useless. They had probably never been involved in such an easy surgery before.

After the surgery, the patient will be sent to the ICU for monitoring for one or two weeks. If no postoperative complications occur, the patient can be transferred out of the ICU.

While implanting an artificial heart is not technically difficult, the procedure is very challenging because it involves the heart itself, and even a slight mistake can be life-threatening.

The difficulty of a surgery depends not only on the procedure itself but also, and more importantly, on the location of the tumor. For example, a hemangioma in the brainstem is an extremely high-risk and complex surgery. In contrast, a hemangioma on the back of the hand can be removed even by a resident surgeon. Both are hemangiomas, but their different locations result in vastly different risks, and the consequences of surgical errors also differ. A mistake in the former can be fatal, while a mistake in the latter might at most result in incomplete removal, excessive bleeding, or severing of a cutaneous nerve.

Take finger replantation as another example. The surgery seems very difficult, but because it involves the finger, many small private hospitals and township hospitals can perform it. The threshold for finger replantation surgery is actually very low. Many doctors in private hand surgery hospitals can start performing surgeries after only a few years of training under a master for a few months, and can start their own practice after a few years.

However, neurosurgery, cervical spine surgery, and heart surgery all have very high barriers to entry. The high barriers are firstly for hospitals, as no small private hospital or township hospital can perform brainstem, cervical spine, and heart surgery. Moreover, the barriers for doctors are also very high. Almost all surgeries require at least an associate chief physician, and some require a chief physician. There are also regulations on the time spent as a first assistant and the number of surgeries a first assistant participates in. In addition, various professional training is required.

Even if finger replantation fails, the loss is only one finger. However, brainstem, cervical spine, and heart surgeries can result in death even with the slightest mistake.

After the patient was sent to the ICU, Yang Ping and Xia Shu went to the ICU together to observe the patient's postoperative condition. After the patient was sent back to the ward, the surgeon must go to the ward to check on the surgical patient after completing a day's surgeries. This is a habit and a system.

President He followed along, but he couldn't get into the ICU, so he waited at the door. When Yang Ping came out, he followed behind Yang Ping.

"Professor Yang, Dr. Xia, how about we invite the guys in the department for a casual dinner after get off work tonight? It's nearby! Thanks for your hard work today." General Manager He said, forcing himself to speak. He really was an engineering guy; the company was full of engineering guys, and not many of them were in sales, so he was always a bit awkward when it came to handling these kinds of things.

The reason their products couldn't be promoted was related to their tech-savvy attitude. They believed that as long as they mastered the technology, the products would naturally sell. But reality is not that simple. After so many years, they lost money every year. They used to be able to attract some investment, but now they can't even get investment. If it weren't for Ruixing's sudden investment, they probably wouldn't have been able to survive.

President He really wanted to thank Yang Ping, but he didn't know how to express his gratitude, so he followed along and arranged to treat him to a meal.

"Don't mention it. The surgery is over. You should all go back and rest. You've all worked hard." Yang Ping hadn't expected President He to stay with them.

"Alright, we'll be available whenever you need our products. Feel free to give us any suggestions, and we'll improve them immediately." President He couldn't keep following Yang Ping around, so he had to back down.

Yang Ping checked the time; it wasn't lunchtime yet. He decided to take a walk around the lab first. Yang Ping used to perform more surgeries, which required both mental and physical labor. Now, his main focus was on scientific research, which was more physically demanding. Yang Ping didn't advocate working overtime or staying up late, so the workload in the lab wasn't actually that heavy.

Just as Yang Ping stood at the elevator door, the elevator door opened, and Director Zhao from the medical affairs department rushed out. Upon seeing Yang Ping, he immediately said, "Professor Yang, may I speak with you in your office?"

Seeing his mysterious demeanor, Yang Ping knew he had something he couldn't say publicly, so he took him to his office. Director Zhao didn't intend to sit down; he started speaking while standing: "A patient was sent over from the Municipal People's Hospital. He has a right-sided cerebral embolism. When they were removing the arterial thrombus, the micro-guidewire broke inside. They tried to remove it, but unfortunately, they broke the guidewire again during the process. The patient's family is very upset. The medical affairs department discussed it with the family, and with their consent, the patient was sent here. Director Ji is currently performing surgery on him, but after several attempts, he hasn't been able to remove it. He would like to trouble you to come and take a look."

"I'll be right there." Yang Ping didn't hesitate for a moment and immediately followed Director Zhao to the interventional operating room. This was no joke.

Upon arriving at the interventional operating room, the two quickly changed clothes, put on lead aprons, and rushed inside. Through the lead glass, Director Ji saw Yang Ping and immediately nodded in greeting. Yang Ping then entered the interventional operating room.

Not only is Director Ji here, but Director Guan is also here. Director Ji is a versatile expert in interventional procedures, and he can do a great job in intracranial vascular intervention, cardiovascular intervention, tumor intervention, and so on. He is also an expert at cleaning up messes.

But Director Guan is different. He is an expert in cardiovascular intervention and rarely performs other interventional procedures.

"Professor Yang, thank you for your hard work." Director Ji was quite embarrassed, knowing that Yang Ping was usually very busy with both surgeries and research.

However, there was no other way. This patient had already gone through a lot of trouble at the Municipal People's Hospital. After being transferred here, he tried several times without success. He knew that things were not that simple. The guidewire and the coil must have become entangled. He was afraid that something might happen to the patient if he continued to try. So he thought it best to ask Yang Ping to come and help.

Yang Ping said, "Don't be so polite, let me see what's going on."

"The patient had a right-sided cerebral embolism and received intravenous thrombolysis at the Municipal People's Hospital. However, the thrombolysis was not effective, and a follow-up head CT scan showed that the original blood vessel was still narrowed and blocked. They decided to perform interventional stent placement, but unfortunately, the microguidewire broke during the procedure. The surgeon there was also an idiot. He didn't tell anyone about this and tried to handle it secretly. He spent three or four hours in the operating room, not only failing to remove the broken guidewire but also breaking two more guidewires inside during the removal process. That idiot went crazy and wanted to continue messing around. The circulating nurse and anesthesiologist couldn't stand it anymore and secretly reported it to the department head. The department head rushed over and, upon seeing the situation, exclaimed, 'Oh no!' He immediately came out and communicated with the family, saying that there had been an accident during the surgery and the microguidewire had broken inside, and it had to be removed now. The patient's family was shocked. The surgery hadn't been done properly, and now there was an accident. No wonder the patient hadn't come out of the operating room for so long, and no doctor had come out to explain. So the family was very upset..."

"The family members there made it clear that they no longer believed them and that they needed an emergency specialist from another hospital to handle the case, which is why they were transferred to our hospital."

“We’ve removed broken microwires from many patients sent from other hospitals, or from other hospitals, but we’ve tried several times without success today. If we keep trying, we’re afraid of puncturing a blood vessel and causing intracranial hemorrhage. So we have no choice but to ask you for help.”

Director Ji and Director Guan of the Interventional Radiology Department had a good personal relationship with Yang Ping. They were also quite honest and reliable, so when they realized their attempts had failed after a few tries, they didn't persist and immediately asked Yang Ping to call Director Zhao of the Medical Affairs Office. After all, this was an out-of-hospital patient, and there might be future disputes, so all actions had to be followed according to procedure and go through the Medical Affairs Office. "Stop rambling and get to the point! There are three guidewires broken inside. We just determined that the broken guidewires might be entangled with the coils, so we dare not touch them anymore, for fear of causing problems." Director Guan interrupted impatiently when he saw Director Ji's words. He and Director Ji were good friends, so he didn't have many reservations.

Director Ji retorted, "I'm not just telling Professor Yang the background of the medical history; the medical history still needs to be explained."

Indeed, there's no point in saying all that now. Regardless of who's right or wrong, or the cause and effect, none of that matters now. What they need to do now is figure out what the problem is and how to solve it.

Yang Ping stood in front of the imaging screen, carefully looking at the cerebrovascular angiography images preserved on the screen. There were three broken guide wire segments: one 10 centimeters long, one 5 centimeters long, and one about 3 centimeters long. The longest segment was folded back into the cerebral blood vessel cavity, while the other two segments were entangled with this long guide wire.

It is estimated that the doctors there wanted to use the guide wire entanglement method to remove the broken guide wire, which is a common method for dealing with such accidents, but unexpected accidents occurred one after another.

A thrombus was found in the middle cerebral artery segment where the guidewire was located, which is really difficult to handle.

The current situation is actually related to the surgeon. After experiencing complications and failing to remove the part after a long period of unsuccessful attempts, he tried to secretly remove it, thinking that doing so would cover it up. This is clearly wrong.

If any complications arise during surgery, the family should be informed immediately.

This is the proper course of action, whether morally, legally, or in terms of medical procedure. Whether the family members can understand or cause trouble is another matter. As family members, they have the right to know.

If you try to resolve this secretly, even if you manage to remove the guidewire, what if it leaves other potential safety hazards?

For example, if a broken guidewire is removed, and the process damages the blood vessel wall, and the doctor does not inform the patient or their family, the patient is very likely to die from a brain hemorrhage after being discharged from the hospital.

If the family had been informed and preventative measures had been taken in advance, this tragedy could have been avoided.

Furthermore, if you fail to succeed on your own, you must not force yourself to continue. You must seek help from the department head, the medical affairs department, or colleagues in the department who are more capable than you, and use everyone's strength to solve the problem. The accident has already happened and cannot be undone, but you can try to minimize the damage caused by the accident.

This guy kept it a secret and tried to solve it himself; he's either stupid or malicious.

The current condition of the guidewire is clearly related to his repeated procedures; the more he manipulates it, the harder it becomes to remove, and it also damages the blood vessel wall.

"How are your vital signs?" Yang Ping asked.

The anesthesiologist immediately reported the vital signs data, which appeared to be stable, and the surgery could continue.

In fact, there are cases where guidewires break during interventional surgery. They can usually be removed. However, the guidewire is probably entangled with the coils, forming some kind of locking mechanism, which makes it difficult to remove.

Director Ji said, "I tried using a homemade grabber, but it didn't work. Either I couldn't grab it, or even if I did, I couldn't pull it back. If I used too much force, I was afraid of rupturing the blood vessel, and the guidewire might get tangled with the stent wall."

In intracranial vascular interventional therapy, whether it is coil escape, forced placement of microcatheter, microguidewire entrapment, or microguidewire breakage, these are all thorny and serious problems. There are many ways to deal with these problems. Director Ji and Director Guan are very experienced in this area and sometimes they even go to other hospitals to perform emergency surgeries.

According to reports, the probability of guidewire breakage is very low, but the actual probability is probably higher than reported, because many cases of this happening do not result in papers being published.

If Director Ji were to try a few more times, the chances of removing it would still be high. However, for the sake of the patient, Director Ji chose to ask Yang Ping for help. If it still didn't work after a few more attempts, trying too many times would only make things worse. Asking Yang Ping for help again at that point would undoubtedly add a lot of difficulties for Yang Ping.

A doctor must have self-awareness and should never force himself to do something, let alone act recklessly for the sake of saving face.

After examining the images and making some analysis in his mind, Yang Ping concluded that the only option was to use the looping method. If he used the catheter balloon compression method, it would be difficult to deliver the catheter to this position. If he used the guidewire winding method, it would be difficult to wind it up now, and if the wound guidewire also broke, the broken guidewire left inside would only become more and more complicated. The homemade retrieval device was relatively simple and the risk was not so great.

The homemade lasso is a lasso-like device with a loop at the front end. This loop can be contracted and locked. Use this loop to grab the proximal end of the broken guide wire. Once it is tightened, slowly pull it back to remove the guide wire.

Yang Ping scrubbed his hands and went up to the stage, with Director Ji assisting him. Yang Ping looked at the equipment on the stage and said, "Let's use that ring toss you made yourself. I'll try it out first."

Yang Ping implanted a guidewire with a loop, extending it all the way to the end of the broken guidewire. The loop extended once to encircle the end of the broken guidewire. He tightened the loop and gently pulled it back. Indeed, the broken guidewire had become entangled with the coil. To remove the guidewire, either it would have to be untangled from the coil, which was almost impossible, or the coil would have to be removed as well, which was possible, but extremely difficult and could easily damage blood vessels. This type of coil was designed for permanent implantation and was never intended to be withdrawn, making it extremely difficult.

If it weren't difficult, Yang Ping wouldn't have been asked to save the day; Yang Ping himself knew this.