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

Chen Yang stood up, walked to the screen, and the red dot of the laser pointer landed on the heart image: "What do you all think is the most difficult part?"

He Yonghua said: "First, it is difficult to establish extracorporeal circulation. The heart and major blood vessels are wrapped by the tumor, making it difficult to find the insertion site and easily causing massive bleeding. Second, when separating the heart malformation, it is unavoidable to damage the lymphangioma tissue. Third, the risk of postoperative lymphatic leakage and infection is extremely high."

"So, what if we try a different approach?"

Chen Yang smiled and said, "Why not address the lymphangioma issue first, or... address them simultaneously?"

"Solve them at the same time?" The group was taken aback.

"Correct."

Chen Yang drew his laser pointer across the junction of the heart and the lymphangioma: "We can try a 'stepwise combined surgery in a hybrid operating room'."

Chen Yang explained in detail: "The first step, in the hybrid operating room, is not to open the chest immediately. We use interventional techniques to selectively embolize the main blood vessels supplying the lymphangioma, thereby reducing its blood supply."

"At the same time, under the guidance of DSA, a sclerosing agent is precisely injected into some tumors with relatively clear boundaries to promote partial fibrosis and shrinkage."

"The second step is to make a midline sternal incision, provided that the extracorporeal circulation team has made full preparations."

“But our goal is not to directly treat the heart, but to prioritize the treatment of the lymphangioma tissue in the mediastinum that is most severely compressing and most prone to bleeding. Using equipment such as bipolar electrocoagulation and ultrasonic scalpel, we perform extremely delicate ‘sculpting’ resection, peeling the tumor away from the surface of the heart and major blood vessels bit by bit. This process may need to be carried out in stages and by region, like defusing a bomb.”

"The third step is to establish extracorporeal circulation within a relatively 'safe' area before addressing the heart's malformation itself. Although radical surgery for tetralogy of Fallot complicated by pulmonary atresia is complex, it is technically feasible for us."

"The fourth step is to carefully treat any remaining lymphangioma after the heart malformation is corrected, and use materials such as biological protein glue and autologous tissue to meticulously repair any possible lymphatic vessel damage."

Chen Yang paused, then looked at Wen Haodong and Xun Jiahong: "Throughout the perioperative period, traditional Chinese medicine needs to be deeply involved."

"Before the operation, the focus is on supporting the body's vital energy, strengthening the spleen and eliminating dampness, and softening and dispersing masses to improve the child's constitution and enhance surgical tolerance. After the operation, the focus is on promoting wound healing, reducing swelling and diuresis, preventing infection, and helping the child recover smoothly."

This plan once again demonstrates Chen Yang's unconventional thinking and multidisciplinary integration concept, seamlessly connecting interventional procedures, surgery, and traditional Chinese medicine to form a meticulously planned, interconnected system.

He Yonghua and the others listened with gleam in their eyes.

Once a new perspective is developed, the seemingly hopeless situation seems to have a glimmer of hope.

"Of course, this approach places extremely high demands on teamwork, intraoperative response, and postoperative management."

Chen Yang looked around at everyone: "If any link goes wrong, the whole thing could be lost. We need everyone to work together."

He Yonghua took a deep breath and was the first to express his opinion: "Although it is extremely difficult, Director Chen, you have pointed out the direction, so we dare to give it a shot!"

Zhong Dongyang and Qu Haoran nodded emphatically. Following Chen Yang, they had witnessed too many impossibilities become possible.

Wen Haodong rubbed his hands together, eager to get started: "We guarantee we won't let you down in the area of ​​traditional Chinese medicine!"

"it is good."

Chen Yang's face showed a satisfied expression: "Director Gao, we are officially replying to Mayo that this case has been accepted by our Kyoto International Medical Center!"

"Please ask them to arrange for the patient and their parents to come over as soon as possible. At the same time, share our preliminary plan with them and solicit their opinions."

"Yes, Director Chen!" Gao Anliang replied immediately, his spirits lifted.

.......

Mayo Clinic was surprised by Kyoto International Medical Center's swift and bold response.

After carefully studying the "hybrid operating room step-by-step combined surgery" plan proposed by Chen Yang's team, a heated debate broke out within Mayo's top team of cardiac surgeons, interventional and oncology experts.

Some considered this absurd, arguing that performing such complex and invasive surgery on such a vulnerable child was tantamount to murder. In particular, the prioritization of lymphangioma treatment was criticized by a senior professor as "putting the cart before the horse and increasing unnecessary risks."

However, some people, especially several experts who were familiar with Ayako Ishikawa's case, believed that Chen Yang's approach, though risky, was not entirely without merit.

At the meeting, a promising young interventional specialist bluntly stated: "Perhaps this is precisely the time when we need to break free from conventional thinking. Dr. Chen's approach may seem unconventional, but each step has its own internal logic."

Ultimately, Mayo Clinic decided to send a three-person observation team, led by senior cardiac surgeons Stevenson and Smith, to China to accompany the child and his family for in-depth face-to-face discussions and to ultimately decide whether to proceed with the surgery.

A week later, Stevenson and Smith arrived at Kyoto International Medical Center. Chen Yang had met Stevenson in New York, but this was their first meeting with Smith. This expert, around fifty years old, was tall with sharp, eagle-like eyes. He was one of the leading authorities in cardiac surgery at the Mayo Clinic, known for his rigor and even demanding standards.

"Chen, we meet again."

Stevenson warmly shook hands with Chen Yang and introduced his colleague to him: "This is Professor Smith, a pillar of our cardiac surgery department."

After exchanging pleasantries, Smith went straight to the point, requesting a detailed understanding of the plan devised by Chen Yang and his team, and demanding an on-site discussion. His tone was clearly skeptical, as if he wanted to find flaws in this audacious plan immediately.

The atmosphere in the meeting room immediately became tense.

Stevenson and Smith sat on one side, while Chen Yang, along with He Yonghua, Zhong Dongyang, Qu Haoran, and other core members, sat on the other side. Gao Anliang, Wen Haodong, and others were also listening in. A silent contest filled the air.

“Director Chen…” Smith got straight to the point, his English fluent but imposing, “I must say frankly that the proposal put forward by your center has caused a great deal of controversy within our organization.”

He gently placed the documents in his hand on the table, staring intently at Chen Yang: "Putting the treatment of lymphangioma before correcting cardiac malformations violates the fundamental principle of cardiac surgery to prioritize cardiac function."

"How can we ensure that during the removal of those fragile tumors, we don't cause catastrophic bleeding that would prevent the child from undergoing subsequent heart surgery?"

The conference room was silent; everyone held their breath, waiting for Chen Yang's response.

“Chen, that’s just Smith’s personality, don’t mind him,” Stevenson said with a smile, trying to smooth things over, but his eyes also held a hint of scrutiny.

Chen Yang calmly met Smith's questioning gaze and said with a smile, "Precisely because our priority is cardiac function, we must first resolve this fatal shackle that is binding the heart..."