Chinese medicine: from rural hospitals to top three hospitals in Kyoto

In the afternoon, the academic exchange officially kicked off in a modern lecture hall at the Faculty of Medicine, University of Tokyo.

The lecture hall, which can accommodate hundreds of people, was packed. In addition to doctors from the University of Tokyo and Juntendo, there were also experts and scholars from other top hospitals in Country R, ​​as well as many media reporters.

Obviously, the R side paid great attention to this exchange, or in other words, they were expecting some kind of "victory".

The first report was on the topic of cardiothoracic surgery.

The representative sent by Party R was Deputy Director Ryosuke Ishii, who gave a detailed introduction to the "brilliant achievements" of the University of Tokyo Hospital in heart transplantation, minimally invasive coronary artery bypass grafting, and correction of complex congenital heart disease. The data and surgical videos displayed in the PPT were indeed first-class, drawing applause from the audience.

At the end of the report, Ishii changed the subject and turned his attention to the Chinese delegation.

"As we all know, Professor Chen Yang of Huaxia has profound expertise in off-pump total arterial coronary artery bypass grafting. We very much look forward to Professor Chen sharing more of his valuable experience, especially regarding the corrective heart surgery for a child with double-outlet right ventricle and pulmonary artery stenosis that we will be performing tomorrow. I wonder what Professor Chen's insights are?"

Double outlet right ventricle is itself an extremely complex congenital heart disease, and the combined pulmonary artery stenosis makes the situation even worse. Surgical correction is extremely difficult and has a high mortality rate.

For a moment, everyone's eyes were focused on Chen Yang.

Chen Yang calmly stood up and walked to the front of the stage. He didn't even use PowerPoint. He just picked up an electronic pen and drew a concise and clear diagram of the heart's anatomy on the interactive screen while explaining in fluent English:

"Thank you, Dr. Ishii, for sharing your experience. The key to tomorrow's surgery is to accurately determine the direction of the coronary artery and design the optimal connection between the intracardiac tunnel and the external conduit."

Chen Yang writes with great ease, analyzing the heart structure, blood vessel direction, possible variations, surgical incision selection, key points in constructing intracardiac tunnels, selection of artificial blood vessels and anastomosis techniques... layer by layer in a simple and easy-to-understand manner.

Not only did he point out the difficulties of conventional surgical ideas, but he also proposed several innovative improvement plans based on fluid mechanics and cardiac embryonic development theory. Some of the details and angles he handled made many senior cardiac surgeons present shine, and even reveal a thoughtful look.

"…Therefore, I believe that preserving the patient's pulmonary valve function as much as possible and minimizing long-term complications, while ensuring complete correction, is more important than simply pursuing surgical speed. Of course, the specific plan needs to be flexibly adjusted based on the actual situation during the operation."

After Chen Yang finished speaking, there was a brief silence in the audience. Many experts from Country R whispered to each other, with shock written on their faces.

Chen Yang's explanation not only reflects his profound knowledge of anatomy and pathophysiology, but also demonstrates a deep understanding of the nature of the disease and the long-term quality of life of patients that goes beyond the technical level.

This has completely gone beyond the scope of "communication" and is more like a master-level teaching guidance.

Ishii Ryosuke's face turned a little ugly. He originally wanted to give Chen Yang a warning, but he didn't expect that the other party would take the initiative and completely suppress him theoretically without any hesitation.

Logically speaking, this kind of explanation is rare in the medical field.

But many things depend on how you think.

If a top student explains a problem to a poor student, the poor student may think it is good that the other person is willing to explain it to him/her, and even if he/she is unwilling to listen, he/she will not feel it is an insult.

But if you suddenly think that a poor student is explaining a problem to a top student, the top student will first feel that this is an insult to himself.

Obviously, in the medical field, Country R considers itself a top scholar.

For a moment, everyone at the scene had different reactions.

Ichiro Yamamoto's face was full of excitement, and he looked at Chen Yang with admiration.

In the afternoon session on hepatobiliary surgery, He Yonghua, on behalf of the Huaxia team, gave a report on precise liver resection and radical resection of hilar cholangiocarcinoma. The report was solid in content and cutting-edge in technology, especially the precise anatomical concept combining intraoperative ultrasound and fluorescence navigation, which inspired the experts from the R team.

When the R-side expert again brought up the difficult case of hilar cholangiocarcinoma invading the portal vein for "advice", Chen Yang appeared again.

He combined the patient's imaging data with a detailed analysis of the complex relationship between the tumor and the surrounding blood vessels and bile ducts, and proposed a bold and precise "extended left hepatectomy with combined portal vein resection and reconstruction" plan.

"Portal vein invasion isn't an absolute contraindication for surgery. The key lies in accurately assessing the length and extent of the invasion, as well as safe, tension-free vascular reconstruction techniques." Chen Yang pointed to a subtle area on the CT image. "Here, the tumors appear to be adjacent, but there's still a potential separation gap. We can first free the left liver, control the blood flow into the liver, and then proceed from there..."

Chen Yang's analysis was meticulous, his procedures clear and feasible, as if he had rehearsed a precise surgery countless times in his mind. His in-depth knowledge of the anatomy and precise control of the surgical rhythm amazed the hepatobiliary surgery experts present.

"Gentlemen, Professor Chen Yang is truly... unfathomable." An elderly hepatobiliary surgery authority from Country R sighed to his colleagues in a low voice.

......

On the second day, the exchange entered the core part - surgical observation.

The first one was a corrective surgery for complex congenital heart disease in a young child, performed by Ryosuke Ishii.

The atmosphere in the operating room was solemn. Under the operating light, the patient's tiny chest cavity was opened, revealing the delicate beats of its unusually complex heart. Ryosuke Ishii and his team performed meticulous, methodical procedures, truly demonstrating world-class cardiothoracic surgery.

However, when the operation reached the critical step - constructing an intracardiac tunnel, trouble arose.

Because the cardiac anatomy was more complex than expected and the reserved space was very small, Ishii's team tried several times but failed to establish an ideal connection between the left ventricle and the aorta. Moreover, if the operation was not careful, the important conduction bundle could be damaged, leading to serious arrhythmias after the operation.

The atmosphere in the observation room was tense. The R experts frowned, and some began to discuss quietly.

"The situation isn't good. This tunnel is too difficult to build."

"Doctor Ishii seems a little hesitant..."

Ichiro Yamamoto had sweat on his forehead and couldn't help but look at Chen Yang who was standing beside him with a calm expression.

Chen Yang was watching the surgical footage intently on the live-streaming screen. Seeing this, he suddenly picked up the intercom and spoke in a calm and clear voice, "Doctor Ishii, I suggest you try to free the right ventricular surface of the ventricular septum from below the tricuspid valve. As a backup, establish an extracardiac conduit along the right ventricular surface of the ventricular septum. Be careful to protect the septal branch of the left anterior descending coronary artery."

Chen Yang's voice was clearly transmitted to the operating room through the internal communication system.

Ishii Ryosuke froze, and subconsciously observed the angle according to Chen Yang's suggestion, and his eyes suddenly lit up!

This idea cleverly avoids the most crowded areas and uses extracardiac tube connections. Although it increases the difficulty of anastomosis, it greatly improves safety!