The xiphoid process is at the lower end of the sternum and is made of cartilage in most people.
For cartilage, you don't need an electric saw, you can use surgical scissors. It is a common strategy to choose to break through from the easiest place and then bite the hard bone. The same is true in the medical path. Removing the xiphoid process before sawing the sternum is equivalent to opening a breakthrough. As with the previous point, the most important thing is to clean up the "stuff" attached to the bones.
The assistant surgeon who was to assist the surgeon did not use a separating forceps this time, but used a clamp to pick up the small baffle of the xiphoid process, and then cleaned up the "heap of debris" behind the "baffle". It is like you want to dismantle a piece of the robotic arm without cutting the surrounding wires connected to the robotic arm.
The electric knife in the surgeon's hand made a squeaking sound while cutting and coagulating the exposed rectus abdominis muscle after the xiphoid process was lifted. This place is close to the abdominal cavity, so we must be very careful to prevent excessive dissection, so that the blood placed in the thoracic pericardium will flow into the abdominal cavity and cause complications to the abdominal organs.
After the incision, a gap was revealed behind the xiphoid process. The surgeon put down the electric knife and extended a finger of his right hand to go deep into the gap to the left rear side of the sternum. This position is close to the pericardium. The doctor's fingers gently pushed open the pleura on the left and right sides of the mediastinum, performing blunt separation.
If the child is younger, the doctor's fingers may be able to directly separate the upper part of the sternum. If the child is older, one finger cannot reach the upper part of the sternum. In this case, just like other engineering, tools can only be used to replace fingers, and they are inserted forward along the direction of the fingers. Doctors usually use long flat forceps close to the sternum for blunt separation.
Using tools instead, just like poking with fingers, you need to make sure you have poked where you are poking and whether you have poked through. For this reason, the end of the long flat tweezers needs to be connected after being inserted to confirm that the target position of the separation is correct.
To use an analogy, human tissue is like a cave with many caves hidden in the mountains, which are intertwined and complex. Long flat forceps are like a pole entering a hole in the cave. You need to ensure that the rope appears at the designated hole, and you need to connect the end of the pole at the designated hole.
On the operating table, the surgeon needs to free up his other hand to go to the incision at the upper end of the sternum. Since his right hand is occupied, he can only extend his left fingers and insert them from the top to try to connect with the long flat forceps that are separating the tissue upwards.
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This separation path is next to the rear end of the sternum. It is invisible to the naked eye because of the bone, so it is called the mysterious cave. Sometimes, after inserting for a long time, the left hand fingers and the end of the long flat forceps do not touch each other, and it is unknown whether the separation is in place. If this happens, the doctor can only withdraw the long flat forceps and measure the length just inserted and compare it with the length of the sternum to determine whether the depth of the insertion is in place.
You may find it strange. Logically, the distance between the upper and lower ports of the sternum is not long. They are behind the bones and cannot be seen. However, if the distance is not long, you can rely on your sense to connect them. How can the two ends not connect? Blunt separation has been mentioned in general surgery. Blunt separation is not hard cutting with an electric knife. To give another analogy, the doctor's fingers and tools are like tadpoles wandering in a cave looking for their mother. It is impossible to split the wall between the caves for you. You must walk on the correct path to touch it.
The best thing would be if they could touch each other so that the tadpoles can find their mother.
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