"Don't worry, Director Wen, we have made enough preparations before the operation. If it is really impossible to perform ERAT, we will change it to the conventional Stryke 30-degree laparoscopy and three-hole method."

Qingping explained at the side.

"Since Dr. Qing is so confident, let's get started."

Wen Dalong snorted coldly and stopped talking.

In the operating room, in order to ensure the success rate of the operation, Tanglou naturally used diagnostic techniques before the operation:

[Patient: Cao Xiaodou, male, 7 years old

Symptoms: Due to persistent pain in the right lower quadrant, accompanied by nausea, vomiting, confusion, low energy, acute illness appearance, no yellow staining on the skin and mucous membranes of the whole body, pathological murmurs in superficial lymph nodes, flat and soft abdomen, tenderness in the right lower quadrant, and rebound tenderness.

Positive, localized muscle tension, no obvious abnormal mass was palpable, Murphy's sign was negative,

Percussion revealed tympanic sounds, negative shifting dullness, physiological curvature of the spine, free movement of the limbs, physiological reflexes, and no pathological reflexes.

Routine blood count: white blood cell count 12.3 ×109/L, neutrophil count 0.81; B-ultrasound showed "enlarged appendix in the right lower abdomen".

Diagnosis: acute appendicitis, pinworm appendicitis

Special reminder: The main cause of appendicitis is obstruction by parasites. The scientific name of pinworms is Intestinal nematode vermiformis. Pinworms are parasites formed by ectopic parasitism. The eggs are lodged in the appendix, causing pinworm appendicitis.

ERAT can be used to suck out the pus. Due to obvious inflammation, a plastic stent needs to be inserted, and a lithotomy basket can be used to completely remove the worm bodies and eggs.】

In order to ensure the success rate of the operation, nurses have been arranged before the operation to prepare the intestines with 3 cleansing enemas of 1,500 mL of warm water, and intravenous infusion of antibiotics 30 minutes before the operation.

After everything was ready, the natural step was to perform anesthesia first. Due to the small child, Tanglou naturally adopted a new method of anesthesia: general anesthesia and tracheal intubation.

Chen Wenhao followed Tanglou's request and quickly completed the anesthesia on the child.

After everything was done, he stepped aside and handed the operating table to Tang Lou.

Tanglou was naturally very skilled in his first step. He directly used the transparent cap of the endoscope to push open the Gerlach's (ch) valve. Before the experts could react, the appendix opening was exposed.

"So easy?"

In the observation room, all the bosses were a little surprised. From Tanglou's action, many things were reflected. The first was that he was familiar with the anatomical structure of the appendix, and the second was his fingertips and wrists.

For the control of the endoscope, the strength and angle have been perfected.

"Without hundreds of surgeries, there would be no such instinctive operation."

Dr. Huang is the most knowledgeable about ERAT. Looking at the neatness and cleanliness of the tenement building, I feel a little envious!

"Are these surgeries really performed by Tang Lou alone?"

Wen Dalong also had a ridiculous idea, but he still insisted that it was impossible for one person to complete so many surgeries in five days. The only possibility was that Cheng Jian had been preparing early, and these surgical case materials had been prepared

for a long time.

In the observation room, when you have different thoughts.

Tanglou gave another command that surprised everyone: "LoopTip guide wire..."

Since Tanglou's understanding of ERAT has exceeded the three-star technique, he can make adjustments and modifications to specific cases as soon as possible.

He used zebra guidewires in previous ERATs, but this case is a bit special. The patient is younger, the appendix has a thin wall, and a large opening. If a zebra guidewire is used, it will be a relatively harder straight guide.

It easily penetrates the tender internal oral mucosa of the appendix in children and enters the false lumen.

The second reason is naturally that the patient's appendix is ​​caused by parasites. If an ordinary straight guidewire encounters the parasites and eggs in the appendix cavity, its tip may tear the parasites and crush the eggs.

, can cause secondary infection and unpredictable contamination.

However, the LoopTip looped guidewire has good bending resistance and can easily pass through the gap in the obstruction site in the appendiceal cavity to achieve deep intubation.

In the observation room, several experts naturally only knew one thing but not the other, but it was amazing enough!

"It is conceivable that the straight head of the zebra guidewire may penetrate the tender internal orifice of the appendix in children. Tanglou has really worked hard on ERAT."

"If I remember correctly, the LoopTip guidewire has not appeared in any previous case data, which means that this time it was Tanglou's on-the-spot decision again."

Professor Liu squinted his eyes, unable to see through this young man. His on-the-spot reaction ability in the operating room was really mature.

After listening to Professor Liu's narration, the other experts remained silent, but there was a hint of appreciation in their eyes.

"Even if Tanglou's surgery volume is indeed slightly exaggerated, his surgical talent and on-the-spot reaction are still worth cultivating. This kid has a bright future."

Dr. Huang, who was completely cherishing talents, set up the stairs in advance.

"Medical skills are important, but medical ethics cannot be neglected."

Wen Dalong whispered with some dissatisfaction. He was naturally unhappy with Dr. Huang's sudden defection.

"Catheter placement..."

In the operating room, Tang Lou's hand movements did not pause and he went directly to the next step. After the catheter was inserted, purulent secretions began to pour out.

"Appendiceal cavity flushing..."

Tanglou continued to issue the next order, and Ma En was already familiar with it after dozens of times of cooperation.

Moreover, for some reason this time, besides working as an assistant, Ma En also had a deeper understanding of the operations of Tang Lou, the surgeon in charge. He had a feeling that if he continued to work with Tang Lou like this, he would have the confidence to be the surgeon on his own.

Ma En became more and more motivated when he thought that he might be able to complete an ERAT independently. In the past, he would have felt that he had lost points for being a resident doctor in a tenement building, but now he could only feel happy about getting a bargain.

Sure enough, lick the dog, lick the dog, lick it until the end!

"Contrast agent, plastic stent ready..."

Tanglou's next order was issued non-stop. Ma En, who was about to lose focus, immediately dismissed his random thoughts and continued to focus on cooperation.

Of course he knew about contrast agents, but he had never used plastic stents before.

Ma En was slightly confused and looked up at Tanglou, who explained casually:

"For patients with a lot of pus in the appendiceal cavity or with stenosis of the appendiceal cavity visible on angiography, a plastic stent is inserted along the guide wire under X-ray and endoscopic monitoring. The stent drains the pus and supports the narrowed lumen.

Continuously reduce intracavity pressure in the appendix.”

Of course, what Tanglou did not say was to provide enough operating space for the next step of using the stone extraction net to remove parasites and eggs.

"F8.5 plastic bracket, straight with side wings, length 5cm."

Tanglou added another sentence.

The equipment nurse on the side nodded immediately.

Dr. Tang is considerate and can always understand the whole scene. When he is the first assistant, he can think in front of the chief surgeon. When he is the chief surgeon, he can also take into account the emotions and reactions of all the assistants.

Soon, Tanglou had prepared the plastic stent and contrast medium.

As for the foreshadowing of the tenement house, the big guys in the observation room naturally did not fully understand it. Of course, they were embarrassed to say it out loud, so they all remained silent, waiting for the first person who couldn't hold it in any longer.

"Prepare the stone net..."

After another unexpected instruction from Tanglou, everyone finally couldn't bear it any longer.
Chapter completed!