All of the above situations would scare ordinary doctors away. As long as the cervical scraping results were suspected to be cancer, ordinary doctors would not dare to take the risk and would directly remove the entire cervix. They are most afraid that if the cervix is not removed completely, the recurrence will be more serious.
A skilled doctor will bravely go through hardships for the sake of his patients, provided he has the ability to do so.
When Zuo Liang asked this question, he was actually considering whether to perform a total cervicectomy. A total cervicectomy also preserves the uterus for the patient, but only closes the cervix, making it impossible to have children in the future. The patient is old and should not need to preserve fertility, so it is fine to remove the cervix.
It is better to have less trouble than more.
However, before the operation, Du Haiwei approved the surgical plan provided by Geng.
The plan submitted by Geng Yongzhe was cone biopsy instead of complete resection.
"Teacher Zuo, Yingying and I have discussed and decided to cut within this range." As he spoke, Geng Yongzhe took out the notebook he had prepared and showed the surgical anatomy diagram he had drawn to the surgical teacher.
Zuo Liang had actually seen this picture before, and now he used his eyes to check it carefully again, and asked: "How did you determine this range?"
"The size of this tumor is about 1.9 centimeters, which is just the critical value. So the range of the cut should be expanded. We must ensure that the distance between the cut negative margin and the cut tumor reaches the standard of 3 millimeters."
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The numbers sound impressive, but they are difficult to achieve. Let’s go back to the key issue of micro-difference. Three millimeters is a micro-difference. To ensure this standard micro-difference of three millimeters, the doctor’s naked eye must first be able to accurately determine the actual edge of the tumor. Secondly, when cutting, it is best to cut to this value of three millimeters, so as not to cut too little or too much.
Thinking about it this way, it seems not as refreshing and easy as cutting it all off.
Don't think like that. If the incision is done correctly, it will be done in one go, which is very labor-saving and time-saving. A full incision involves many steps and may cause a lot of bleeding, which is very troublesome. So the biggest difference between the two is whether the doctor chooses to tire his brain or his hands.
Zuo Liang felt that he had no choice. With his relatively limited clinical experience, he was not sure whether he could cut very accurately.
A 1.9 cm tumor is not small. Experienced doctors know that such a tumor is like a decayed tooth. It may be just a black spot on the surface, but it may actually be rotten to the root after opening the black spot. The electric knife is eliminated because it cannot cut deep enough, and the traditional cold knife is used. The cold knife cuts deep in a circular shape to dig out the tumor completely. This knife method is too difficult.
Zuo Liang frowned, not knowing how to express himself. Geng, who answered him, failed to answer the key point and help him achieve the above requirements.
It's not the students' fault. The difficulty lies in holding the scalpel, which the surgeon has to do himself. Others cannot replace the surgeon's hands and certainly cannot help at all.
"Teacher Zuo, why don't you let Geng use a cotton swab to draw a cutting range around the tumor for you?" Xie Wanying, who was watching from the side, took the initiative to suggest.
Zuo Liang looked at her deeply: I can guess what classmate Xie is thinking just by listening to one of his questions.
Unlike Geng, she has worked with many teachers on the operating table and has a better understanding of how to observe and understand the surgeon's thoughts.
Du Haiwei stood by and said nothing, and it seemed that he did not object to the two interns' suggestions for trying the experiment.
The superior's opinion remained unchanged. Zuo Liang turned to Geng and said, "Okay, you draw it."
The teacher made way and Geng Yongzhe sat on the bench. He took a cotton swab dipped in gentian violet and carefully marked the incision position along a circle around the tumor in the exposed surgical field.
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