Operating room of Oriental Hospital.
Lin Sanqi was wearing a full set of surgical gowns, a disposable hat and mask, and was about to watch Cai Yangxian perform a thoracoscopic surgery.
Cai Yang, also wearing a full set of surgical gowns, prepared his tools while asking:
"Junior brother, you should have learned about the commonly used instruments and equipment for thoracoscopic surgery, how to choose the surgical position, preoperative preparation, and the choice of incision, right?"
"Yes, Senior Brother, I have learned all of this in school and during my internship, so you can skip it."
"Okay, then there's only one question left about the basic operating techniques for thoracoscopic surgery. You just reviewed this patient's medical records. Although this is a lobectomy for a malignant lung tumor, the principle is actually the same as your tuberculosis lobectomy. Could you please review it in full and show me how to do it?"
Lin Sanqi nodded: "Okay, Senior Brother."
Cai Yang then asked an additional question: "When you were learning in school, how many holes were made in a thoracoscopy?"
Lin Sanqi recalled: "When I was learning, we had both two-hole and three-hole methods, but during my internship I mainly learned the two-hole method."
Cai Yang smiled proudly and said:
"Our Oriental Hospital is much more advanced than the First Hospital of Huadu. We use single-port video-assisted thoracoscopic surgery, called uVATS in English. This technology is currently the most advanced procedure in the world and is expected to become mainstream in the future.
Compared with multiport approaches, single-port approaches have a series of benefits, such as direct vision, better lung exposure, ergonomic instruments, less postoperative pain, faster postoperative recovery, and shorter hospital stay.
Of course, the difficulty of the surgery will increase, but since you want to learn, you must learn the most advanced technology, right? You are also Dean Wang’s student, so you can’t embarrass your teacher.
Lin Sanqi laughed when he heard it. This kind of pretentious technique was what he liked most.
Think about it, if he goes back to 1961 and performs surgery on a Japanese patient, he won't need to open the chest or make a large incision. Just a small hole will be enough to solve the problem. How many foreigners will be shocked by that?
The four words "ignorance and backwardness" can be used to describe these doctors in developed countries.
"Okay, Brother Cai, I'll learn the single-hole technique."
Cai Yang used a scalpel to create a keyhole of approximately 3 cm in the patient's fourth intercostal space between the mid-axillary line and the anterior axillary line, while he kept saying:
"For other lobectomies, we choose to make the incision at the fifth intercostal space. This position allows the surgeon to approach the hilum at a slight angle, making it easier for hand instruments to operate along the longitudinal axis.
If the incision is made too high and the surgical axis approaches the hilum, although the anatomy is not a problem, the lack of angulation means that the hand instruments cannot bypass the vessels and are pushed onto the posterior hilar structures.
If the incision is too low, the shaft provides a good angle for the stapler, but the incision is far from the hilum and the instrument operation path is very narrow, making instrument operation complicated.
When you're doing a right upper lobectomy, the standard approach is to use the fifth intercostal space, but my personal recommendation is to use the fourth intercostal space because it allows for better exposure and handling."
Lin Sanqi thought that this experience and technique was simple. After all, he was writing an essay on a given topic, so he just had to remember that the incision was between the fourth ribs.
"Understood, Brother."
Lin Sanqi is a spectator today, not a practitioner, and does not need to be an assistant holding the mirror. He just needs to look at the display screen throughout the process.
The process of lobectomy is actually very simple. On the TV screen, the surgeon Cai Yang pulls the upper lobe backward, opens the mediastinal pleura, and exposes the upper lobe hilar blood vessels.
First, the apical and anterior branches of the pulmonary artery are freed and ligated and cut off respectively. Then, the apical, anterior, and posterior branches of the superior pulmonary vein are processed.
Then, the horizontal fissure and the upper part of the oblique fissure are opened. The posterior branch of the superior lobe artery is found deep in the intersection of the two fissures, ligated, and then cut.
Finally, the upper lobe bronchus is freed, the traction line is sewn, and the bronchus is cut off and the stump is sutured.
Cai Yang was performing a teaching operation, so he performed every step clearly, completely according to the textbook standards, and the operation was done very slowly, so that the junior fellow student could see it more clearly.
While performing the surgery, he also kept explaining some clinical experience:
"At this point, it's important to follow the 'flexed arm rule' by tilting the stapler to the left and identifying the middle lobe vein before beginning to dissect the superior lobe vein. This allows for adequate dissection of the superior lobe vein to optimize stapler passage."
"When there is no suitable angle to insert the stapler to divide the vein, the bronchus is divided. If the superior lobe vein remains difficult to divide, there are two unusual options.
Especially for beginners like you, you need to rotate the upper lobe longitudinally and orient the stapler tail or separate it with two conventional thoracoabdominal staplers."
"When we dissect the pleura above the bronchus intermedius, we need to identify the bronchial artery. If it is cancer, we need to clear the lymph nodes to facilitate the insertion of the stapler from the front."
"Gently dissect the A2 region, as excessive traction without the support of the bronchus may result in avulsion of this branch leading to massive bleeding."
"During this procedure, you need to identify the fissures by placing the upper lobe in its anatomical position. Usually, there is a contoured fissure between the lobes, but if this is not present, the middle lobe vein is an important landmark for demarcating the horizontal fissure."
After all, Lin Sanqi is an undergraduate student at a top medical university. He has no shortage of theoretical knowledge, but what he lacks is experience.
Now that a chief physician is teaching him step by step, sharing all his surgical skills and clinical experience without hiding or holding back, Lin Sanqi's level is improving rapidly.
At least that's what he thought.
This teaching model allows not only undergraduate students but even technical secondary school graduates from a medical school to become highly skilled doctors performing lobectomy in the shortest possible time.
After three consecutive lobectomies that morning, Cai Yang took a break and asked:
"Well, Junior Brother, now you should understand the steps and essentials of thoracoscopic surgery, right?"
Lin Sanqi was a little excited:
"Brother Cai, I'm not bragging, but I feel incredibly strong right now. If you dare to let go, I can perform an operation right away for you to see."
Cai Yang's expression was playful:
"Oh, huh? We surgeons don't brag, so don't be like those PowerPoint doctors who talk a lot but are completely clueless when it comes to actually performing the surgery. Now that you're confident, you can hold the scope."
Lin Sanqi was eager to try: "Okay, holding the mirror is so easy, I think any freshman can do it."
Operating room mirror support refers to the process during minimally invasive surgeries such as laparoscopy, where the surgeon uses microscopic instruments to perform the main surgical operations and a surgical assistant is required to hold the laparoscope next to him.
The assistive mirror plays a very critical role in the operation. A well-trained assistive mirror can allow the surgeon to have a very good field of vision during the operation, making the operation safer.
Obviously Lin Sanqi thought too simply.
As the fourth operation began, the atmosphere in the operating room immediately began to plummet, with Cai Yang's scolding voice heard from time to time:
"The mirror is crooked!"
"You need to observe the fluid in the abdominal cavity, such as effusion, irrigation water or even blood, as a marker of the plane."
"Put my operating point in the middle!"
"The central field of view of the laparoscope lens is often brighter. If the operation is performed outside the field of view, there is a risk of accidental injury, which may go undetected and lead to serious consequences. Do you understand?"
"Don't shake the camera!"
"Hold the lens slowly and steadily, and avoid shaking it violently. Also, avoid moving the lens too quickly to expand or focus the field of view, as this may cause the surgeon to feel dizzy!"
"How can I see clearly when the mirror is stained? Deal with it immediately!"
Lin Sanqi was sweating profusely. He had already realized that he was not qualified to be a surgeon, let alone a surgeon holding a microscope.
Because he couldn't keep up with Brother Cai's surgical progress at all, he had no idea what to do next. He was either too slow or too fast, and the surgical field of view could not be fully displayed on the screen.
During the operation, the surgeon is the most important person in the world. Even though Cai Yang was trying hard to hold back, his tone was becoming increasingly harsh.
In other words, Lin Sanqi has a special status. If it were any other resident doctor or resident doctor, Cai Yang would have scolded him long ago.
There are really few surgeons with good tempers.
In the operating room, several other assistants and young nurses all covered their mouths and chuckled. Isn't it fun to watch the newcomers getting busy?
Just when Lin Sanqi was sweating profusely, Director Wang also came leisurely into the operating room.
Head Nurse Kong from the operating room rushed out upon hearing the news: "Hey, Dean, why are you here to inspect our work?"
Dean Wang must be cool in front of his subordinates:
"I came to see how my new apprentice's surgery was going. By the way, which operating room is Cai Yang from the thoracic surgery department in?"
"Director Cai, he's in Operating Room 11. Just now, when I was patrolling, I saw him teaching a student. But the student must be quite stupid. Director Cai kept scolding him, haha~~~"
While reporting the situation, Head Nurse Kong quickly took out a brand new surgical gown from a compartment in the changing room and helped the director put it on.
Anyone who can become a head nurse must be versatile and observant, and must be aware of every detail that happens in the operating room.
After changing his clothes, Director Wang walked towards Operating Room 11 and said leisurely as he walked:
"This rather stupid student is my new graduate student..."
Head Nurse Kong paused in her hurried steps and really wanted to slap herself twice. This flattery had backfired.
Outside the operating room, through the glass, Director Wang saw Cai Yang performing surgery while constantly teaching the details of the operation, so he nodded slightly.
"Xiao Cai's skills are beyond reproach. He is indeed a young and promising man."
The head nurse also took a look and asked cautiously:
"Director, your student is studying very hard on his first day in the operating room. And you can see he's already holding the scope right after arriving. He's quite talented."
Dean Wang was delighted when he heard this:
"My student will be in the operating room for the next month, so please take good care of her."
The head nurse understood immediately and immediately expressed her loyalty: "Don't worry, Dean, I will let everyone keep an eye on it."
The doctors, nurses, and anesthesiologists in the operating room are all kind and friendly in front of the dean, but in front of interns or residents, they are all ferocious and it is absolutely difficult to talk to them.
Especially those who can become head nurses are basically strong women. They can order the young doctors around and scold them at will. Even if the chief physician has something to do, he can only discuss it with the head nurse.
Dean Wang came over specifically to take a look around, actually to warn the medical staff in the operating room not to bully his beloved apprentice.
In the locker room at noon when getting off work.
While Cai Yang was changing his clothes, he kept reminding her:
“If the small vessel doesn’t fit through the anastomosis angle, my personal recommendation is to use a polymer clip…
"The 450° angle clip applicator allows the clip to be placed around the entire circumference of the vessel before closing, avoiding any vessel damage..."
"Two clips are placed proximally at the vessel, and an energy device seals and divides the distal end. During specimen handling or fissure division, one of the clips on the distal stump may become dislodged..."
"Junior brother, why are you..."
Cai Yang was talking as he walked. Halfway through, he realized why his junior brother didn't answer. Then he turned around and saw that the corridor behind him was empty.
So Cai Yang hurried to the locker room again, only to find that Lin Sanqi was holding his waist with one hand and moving slowly.
Cai Yang frowned:
"Junior brother, your waist strength and physical strength are not good enough. Our old director was still able to perform the operating table at the age of 80. He could perform 10 operations a day and his hands were still steady. You just this morning..."
Lin Sanqi was also at a loss whether to laugh or cry, thinking to himself, you are juggling between two wives and paying two taxes, just try to see if your waist can handle it.
The key point is that Cai Yang is different from other doctors. Other doctors' assistants stand behind the surgeon, on the same side.
Cai Yang's habit is to have his assistant stand on the opposite side to hold the mirror, so that the assistant has to bend over and turn sideways when holding the mirror, so that he can see the display screen clearly and continue to follow the movements.
During the entire process of holding the lens, the assistant's hands must be balanced. If the hands shake slightly, the long front lens will shake violently.
The feedback on the display screen is blurry, making surgery impossible.
Not to mention Lin Sanqi, with such awkward postures, bending, leaning forward, and sideways, an operation would take half an hour at the fastest and one or two hours at the slowest. Who could endure it?
Other people's assistants have all practiced specially, but Lin Sanqi has not.
This caused his waist to be almost broken after half a day, and the fact that he usually "exercised too much" made the situation even worse.
"Brother Cai, it's okay. I just twisted my waist a few days ago and haven't fully recovered yet. Don't worry, I can hold on!"
Tsai Ing-wen was also helpless, but he also knew that he couldn't push too hard, as there was still time.
"Alright, alright. You should continue to observe the surgery this afternoon. Let someone else hold the endoscope. As I said before, when you're operating on someone else, be as slow as possible and wait for the endoscope assistant. Don't make any mistakes."
At the end of the day, when Lin Sanqi returned to his lounge, he was exhausted and lay down on the bed without moving.
It is called a lounge, but it is actually the VIP ward on the top floor of the hospital.
The wards here are all single-person rooms. In addition to normal medical equipment, the rooms are fully equipped with large beds, large sofas, and home appliances. They are decorated entirely according to the design of a five-star hotel.
Of course, the daily bed fee is not a small amount, 2,800 yuan a day.
The only people who could stay in the VIP ward were high-ranking officials, entrepreneurs, or those idiots who didn't work all day but had endless money...
Although Lin Sanqi was the dean's last disciple and had spent a lot of money in the thoracic surgery department, he had no intention of taking advantage of the situation and still paid the room fee obediently.
Anyway, he doesn't need this little money, and there is no need to embarrass his mentor and senior brothers.
In the elevator, the door opened with a ding-dong, and Yin Lianyi came out with a few lunch boxes in her hands, then walked towards the VIP ward.
I stopped by the nurses' station:
"Hello, which way is room 28?"
One of the nurses pointed and said, "Go this way and turn right."
"Thank you."
The nurses in the VIP ward were carefully selected from the entire hospital, with the best figures and looks, but these nurses were still far behind Yin Lianyi.
After Yin Lianyi left, several young nurses quickly gathered together and started gossiping.
"Hey, did you think that girl looked familiar?"
"Yes, yes, I felt the same way just now. Do you think she looks like Sister Tianxian?"
"Ah, now that you mentioned it, I think it's her too. Hurry up and check, who's living in bed 28?"
"Bed 28 is a hanging bed. There's a young, handsome guy there. Could he be Liu Tianxian's rumored boyfriend?"
A few young nurses started chattering and gossiping, and Yin Lianyi had already walked to the door of the ward and knocked.
"Come in!" The voice was weak.
After Yin Lianyi walked into the ward, she was surprised to see the luxurious facilities inside:
"Of course, Lin Sanqi. No wonder you don't want to go home. I didn't know the hospital even had such a five-star ward. Wow, poverty really limits my imagination."
Lin Sanqi looked up and saw his girlfriend coming, and his mood improved a lot:
"Alas, starting from the Oriental Hospital and returning to the Yide Mansion, we have to cross almost half of Huadu. Add in the traffic jam, and it will take more than an hour. Look, I've been standing all day. How can I have the energy to go home?"
After Yin Lianyi took a look around, she laid out the lunch boxes one by one on the table:
"Come on, Master Lin, you didn't want to run halfway across Huadu, but you let a little girl like me run halfway across Huadu to deliver food. How dare you do that? Come on and eat. I cooked all this myself!"
Lin Sanqi sat up and looked at his girlfriend with a strange expression when he saw the dishes on the table:
"If I hadn't been to Beiyuan, I would have thought you made this honey-glazed barbecued pork and roasted pigeon yourself."
Yin Lianyi blushed when she heard this:
"No matter what, I brought it myself. You can eat the love dinner or not. If not, I'll take it home. Humph! You know how busy I am at work during the day. I'm not like you who just sits there and does nothing."
"Eat, eat, eat. Even Miss Yin's farts smell delicious, let alone this delicious food. Sit down and eat together. By the way, do you think I should hire some assistants?"
As Lingnantang Company began to expand, it now has a Chinese herbal medicine sales company, a Chinese medicine clinic, a southern pharmaceutical factory, three branches, and is also preparing to build a drug research laboratory.
The beach is getting bigger and bigger, and Yin Lianyi, as the financial director, is getting busier and busier.
Because of Lin Sanqi's time travel, he has to purchase things today and collect information tomorrow. These are all very tedious and detailed tasks. It would definitely not be appropriate to let Yin Lianyi do them.
In the company, mutual supervision and checks and balances between Lin Tianhua and Yin Lianyi are essential.
Just like in historical dramas, it is not a good thing for the prime minister or the queen to have the most power.
Lingnantang Company's turnover this year is sure to exceed 10 billion. It is obviously very scary to test human nature with such a huge number.
"Looking for an assistant?"
Yin Lianyi reported while eating:
"I've personally screened and preliminarily selected two of my junior colleagues. Both will graduate in June this year and are currently in the internship stage. One is majoring in administrative management, and the other is majoring in financial management. Both are stunningly beautiful."
Lin Sanqi rolled his eyes and said dissatisfiedly:
"Rather than saying she's my assistant, it's better to say she's your spy. Don't your junior sisters all listen to you? Humph, I don't know if you trust your man too much or too little? With two delicate beauties around you, aren't you afraid I'll eat you up?"
Yin Lianyi pinched Lin Sanqi's waist fat:
"Thirteen o'clock, don't forget, I kicked a man in school and made him a eunuch. Do you want to enter the palace too?"
"If you don't want to, just let go, you bitch. Also, let me warn you, all the employees you've hired recently are girls. Having too many women in a company is not a good thing. I won't be able to handle a fight.
I don't care about other things, just recruit more male employees for me in the future. I don't care if they are your old classmates or old lovers, as long as I don't find out that you are having an affair. "
Upon hearing this, Yin Lianyi kicked Lin Sanqi onto the bed next to her.
"Asshole, you have an old lover, you..."
Just as Yin Lianyi was about to tame her husband, she suddenly heard a fierce quarrel outside. One of the voices sounded particularly familiar. (End of this chapter)
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