Chapter 353: A Surgery So Successful That Sends Chills Down The Spine
Professor Tian had a great technique.
He made a skin incision, exposing the spinous process and lamina. The 2 lower vertebrae from the pathological vertebra were also fully visible.
In order to better expose the incision, he should cut both sides of the sacrospinalis adjacent to the pathological vertebra and separate them by proximal and distal retraction.
Under normal circ.u.mstances, the patient should have around 200 mL of bleeding.
The reason was that the surgeon would breach the periosteum in the process of exposing the spinous process and lamina.
However, the surgery today went surprisingly well.
The bleeding was maintained below 50 mL, the entire surgical field was exceptionally clean.
Professor Tian was very satisfied with his own technique. He felt that today’s surgery would be smooth sailing, the bleeding volume might be capped under 3 liters.
The following steps would cause the bleeding to be heavier. Professor Tian’s movements became slower and gentler. He carefully checked each procedure to prevent accidental hemorrhage.
He started to gouge out the spinous process and lamina that got invaded by the tumor with a rongeur.
“Crack,” a small piece of bone was removed.
The lamellae were not as compact due to the tumor infiltration, producing a cracking sound like a defeated army.
Even though it was brittle, the tumor angiogenesis allowed the lamellae to receive sufficient blood supply, which would also lead to a sudden increase in bleeding.
The patient would usually bleed profusely starting from this step.
After removing a piece of the lamina, Professor Tian covered it with a dry gauze out of habit.
Strange…
Professor Tian noticed that it took a full 10 seconds for the dry gauze to be soaked in blood.
Professor Tian was skillful, but he was not as good as the Legend level. Nevertheless, he could be considered to be an orthopedic professor with a higher Master level, approaching the Grandmaster level.
He had an in-depth understanding of vertebral resection surgery.
It was still plausible to account for the minimal bleeding prior to this step to his excellent dissection skills.
However, it was not possible to have such a low amount of bleeding after removing the lamina with a rongeur.
Normally, the surgery would be continued in a pool of blood from this step onwards.
This was beyond what the aspirator could manage.
Moreover, the bleeding would cloud the surgical field and the vicious cycle continues.
Fresh frozen red blood cells had been prepared, awaiting Professor Tian’s orders to start the transfusion.
This was weird. Could it be a rare tumor? Insufficient blood supply maybe?
That would not be the case either. Professor Tian could not fathom the situation in front of his eyes.
Even if there was insufficient blood supply to the tumor, the lamina should have a rich supply of blood vessels. It would never take 10 seconds to soak the gauze entirely in blood.
“Professor Tian?” Dr. Zhou noticed Professor Tian drifted away, not knowing what happened, he called him softly.
Professor Tian came to his senses from his endless speculations. He set himself on his feet and proceeded with the surgery.
He continued to chip the lamina off to expose the spinal nerve roots.
The tumor invaded the spinal ca.n.a.l. The dura mater was bulging without a pulse, epidural fat was absent, and the dural sac was distorted and compressed.
Professor Tian did not continue covering the gouged lamina with dry gauze because he wanted to see the extent of the bleeding.
As expected, there was very little blood, only a few millimeters.
It must be the interventional surgery!
Professor Tian quickly identified the reason behind it, but he could not accept the truth.
As a spine surgery specialist and a professor in Imperial Capital, he frequently collaborated with interventional doctors to perform a vertebral resection surgery.
Had he encountered a surgery with such minimal bleeding?
None, not even once.
With the support of interventional surgery, they were able to reduce a certain amount of bleeding. It could be related to the surgeon’s technique, but not that much.
How difficult could a lumbar artery embolization be?
If there were no available interventional doctors, Professor Tian could just put on the lead ap.r.o.n and perform the lumbar artery embolization surgery himself.
However, no matter who did the surgery, they could only reduce the bleeding from 5 liters to 2-3 liters.
Professor Tian had never seen a volume lower than that.
Was there a better doctor in Sea City than Imperial Capital?
Impossible, definitely impossible.
Professor Tian’s mind was wondering about all these things but his hands continued working.
After performing the same surgery for so many times, he could do it even with his eyes closed. At least he would not need to repeatedly recall the topographic anatomy during his first surgery.
He used the nerve dissector to search for the nerve roots from both sides of the dural sac for protection.
After that, Professor Tian started to dissect the tumor, dura mater, and lateral nerve roots. He then removed the tumor together with the surrounding vertebral arch, superior and inferior articular processes.
This particular step was the reason they performed the lumbar artery embolization prior to the vertebral resection surgery.
Life-threatening hemorrhage would occur without the embolizations.
What life-threatening hemorrhage meant?
Bleeding of unnoticeable tiny blood vessels that would drown the surgical field in red, making it impossible to find the ruptured vessel, not to mention continuing with the vertebral resection surgery.
It was good that there was no life-threatening hemorrhage.
Not only there was no life-threatening hemorrhage, there was no bleeding at all!
Of course, to say that there was no bleeding at all would be an exaggeration.
Nonetheless, the uncovered aspirator Dr. Zhou was holding was able to suction the blood cleanly, providing a great exposure of the surgical field. The exposure was so clear that Professor Tian was a little fl.u.s.tered.
This was not the vertebral resection surgery that he was familiar with…
Did he do something wrong?
He stopped and retraced the entire surgical procedure. There was nothing wrong!
He stared at the surgical field, the anatomical structures were so clear that they could be reference pictures in textbooks.
What the h.e.l.l was going on?
Who knew that surgery this successful would be a problem.
Professor Tian was quite worried. He had never seen a surgical in such a condition since he first started out on vertebral resection surgery.
If he was in Imperial Capital, he would have asked a few of his colleagues or even his mentor to observe the surgery and check for mistakes.
But this was Sea City.
He had no choice but to continue.
The exposure and resection of the lumbar transverse process were carried out smoothly. There was still very little bleeding. Usually, it would take 30 minutes to reach this step and the bleeding volume would be around 500 mL.
This was from Professor Tian’s experience.
However, in this freaking surgery, it only took him 15 minutes with 30 to 50 mL of blood loss to complete this step.
After that, Professor Tian began to expose the anterolateral vertebra. The vertebra that was invaded by the tumor was moderately enlarged, but the tumor boundary was very distinctive. It could be removed by gently peeling the surrounding tissues.
Normally, this step would bleed around 200 to 300 mL of blood and time of…
Oddly, the surgery was still smooth sailing, with only 10 percent of the usual blood loss. Judging from Dr. Zhou’s aspirator, it would be safe to say that there was 20 to 30 mL of blood loss.
After Professor Tian dissected from the diseased vertebra all the way until the anterior longitudinal ligament and let Dr. Zhou retract the surrounding tissues with the Hohman retractor, the anterolateral pathway of the vertebra could be seen.
The surgery was… too successful. It went so smoothly that it made people anxious and fearful.
Was this a vertebral resection surgery?
How could the patient bleed so little? How could the surgery be this successful?
…Freaking h.e.l.l!