Chapter 432
Chapter 430: Chapter 197: Considering the Living, High Risk and Rich Rewards Coexist_2
Tell everyone how to determine the tumor location and the extent of resection.
This kind of practical teaching is of great help to Zhou Can.
He listened attentively and learned earnestly, even having the nerve to ask Director Jia to let him move closer for detailed observation and physically press on the tumor site.
“We have now determined that the tumor is in this section. When resecting, we should appropriately remove some normal intestinal segments to ensure the tumor is completely excised.”
Once the cancerous colon is resected, Director Jia’s task is completed.
“Who will perform the anastomosis of the intestinal end? This anastomosis is much more difficult than the previous surgery.”
“I will!”
Before Director Jia could finish speaking, Zhou Can seized the opportunity.
“This hungry wolf is at it again.”
The other doctors looked depressed.
While they were still hesitating to go ahead, Zhou Can had already made his move.
This is competition.
In fact, Director Jia was not very willing to give this opportunity to Zhou Can.
Unfortunately, the other doctors were too slow to react, so he had no choice but to let Zhou Can take the training opportunity.
“Zhou Can! How do you plan to perform the anastomosis?” Director Jia deliberately made it difficult for him.
If Zhou Can answered incorrectly, his opportunity to train could be easily withdrawn. Mainly because a longer section of the colon was removed. The difficulty of anastomosis was too high, and there was a fear that Zhou Can might botch the procedure.
“I am planning to perform a side-to-side anastomosis, what do you think?”
After examining, Zhou Can turned around to ask for approval.
“Yes!”
Just as Director Jia agreed, Zhou Can immediately replied, “This is my first time performing this anastomosis technique, please give me your guidance!”
With that said, he had already taken the lead position and started the procedure.
Luckily, he had learned about side-to-side anastomosis during his intensive study of medical basics. This is an advanced method among intestinal anastomosis techniques.
The two segments of the intestine at hand were very suitable for this type of anastomosis.
Zhou Can first performed a purse-string suture close on the ends of the two segments of the intestine.
The specific method is to suture a purse-string around the circumference of the intestinal end, tighten the suture to close the end, and then perform another purse-string suture to invert and bury the stump.
This type of suture is neither too difficult nor too easy; what’s mainly needed is a high level of suturing and ligation skills.
In the following steps, Zhou Can was somewhat uncertain and looked towards Director Jia for guidance.
With the anastomosis already halfway done, Director Jia would probably find it embarrassing to stop him now.
“Your suturing and ligation skills are good, and the anastomosis level is on point, keep it up! Next, after sealing the two ends post-intestinal resection, bring the two ends about 10cm together and use intestinal clamps for control.”
As he spoke, Director Jia patiently guided him on how to proceed and the points to pay attention to.
Zhou Can’s aptitude and practical skills were strong, and he smoothly brought the two pieces of intestine together, with the overlapped length just about ten centimeters.
“Suture the seromuscular layer of the two intestinal flaps continuously with 3-0 non-absorbable thread approximately 4-5cm along the anti-mesenteric aspect about 0.8-1.0cm from the axial centerline. An interrupted suturing technique is also possible, but I recommend the continuous suturing method.”
Leakage is the biggest fear in intestinal anastomosis.
Leakage actually refers to fecal leakage.
The consequences are very serious.
Every year, there are patients who die from peritonitis and various infections caused by fecal matter entering the abdominal cavity.
Every surgeon knows that if a wound is contaminated by fecal matter, healing will be very difficult.
In ancient times, there were even imperial consorts who deliberately splashed ‘golden water’ (urine) on their rivals’ wounds.
The aim was to cause their death.
In fact, in ancient times, when medical standards were relatively backward, a consort who had been whipped would already be covered in wounds, and if fecal matter was then splashed on her, it basically amounted to a death sentence, as she would quickly die from infection.
Following Director Jia’s instructions, Zhou Can sutured the seromuscular layer of the intestines.
“Make full-thickness incisions on both segments of the intestinal walls directly into the bowel lumen along the central axis. Be very careful when making the cut, and don’t try to be strong if you’re not sure. The positioning of this incision, as well as its length, is crucial. The incision should be about 2cm from the closed stump to avoid circulatory problems that can affect the healing of the anastomosis site. If too much of the stump is retained, it might lead to symptoms caused by the retention of intestinal contents.”
Director Jia was reluctant to let Zhou Can perform the anastomosis mainly because of concerns about potential issues when cutting the intestines.
He must have already known that Zhou Can needed to use a side-to-side anastomosis.
Zhou Can picked up the scalpel and cautiously made incisions on the two sections of the intestinal wall following Director Jia’s advice.
Cutting through the intestinal wall feels very different compared to the abdominal skin layer.
As he cut, it felt light and lacked resistance but was very tough.
This is actually quite difficult to control.
It’s easy to make the incision too large.
Fortunately, Zhou Can did not mess up, and the incisions he made were just right.
[Cutting Experience +1, +1.]
[Congratulations on successfully making your first incision into the intestinal wall layers, constructing the anastomosis window, Cutting Experience +100, Anastomosis Experience +100.]
It wasn’t about the system being generous, but rather that constructing a window at the end of the intestine was very tricky to maneuver.
The difficulty and risk were even higher than the subsequent suturing.
Thankfully, Zhou Can managed to complete this high-risk, difficult operation.
In reality, every practical procedure on a patient carries considerable risk, especially when using a scalpel.
Performing surgery on the intestines entails even higher risks.
“Good, the young man has a good understanding and method, the cut was acceptable.”
Director Jia’s anxious heart was finally somewhat relieved.
If Zhou Can had messed up this step, the patient might have had to lose an extra 20cm of the intestines. The total length of the colon is only about 1.5 meters, and a portion of the ascending colon and transverse colon had already been removed; shortening it by another 20cm is unimaginable.