Chapter 225: Scar-free surgery, a rare entrance!
As expected, Xu Qiu nodded.
He took out the ultrasound film of the patient's abdominal cavity and analyzed: "If you want to leave no scars, just use the natural orifice approach."
"Natural accent?"
Yan Na was stunned for a moment and guessed: "Esophagus?"
This place is very close to the gallbladder area, so it is theoretically possible.
Using ERCP minimally invasive lithotomy, the duodenoscope is used to pass through the mouth, esophagus, and stomach in sequence, and enters the duodenal papilla through the gastrointestinal anastomosis input loop. Reverse lithotomy can also be performed.
However, because the lens is reversed and the lenses on the screen are all reversed, subsequent treatment is quite difficult. In addition, the instrument itself is defective, making it difficult to expose the gallbladder, so it is rarely used.
Xu Qiu naturally took this into consideration.
Therefore, he chose another path.
"Vagina." Xu Qiu said calmly.
"Is this... okay here?" Yan Na was a little surprised.
Xu Qiu spread out the patient's abdominal CT film and moved his fingers on it: "Make an incision from the posterior wall of the vagina, use a flexible gastroscope and a double-hole endoscope to return from the bladder and cervix into the abdominal cavity, and finally establish pneumoperitoneum here. , arrived at the gallbladder area.”
Surgery is inevitable.
However, Xu Qiu’s plan hid the incision inside the vagina.
Even if you have a scarred physique, it doesn't hurt to have some wrinkles in that place.
"It's amazing!"
"Dr. Xu, I admire your approach. Entering from Qionglong, according to your route, the path is very short!"
"The difficulty is not low, but it is doable by avoiding the equipment defects of the esophageal approach!"
Everyone couldn't help but applaud.
The operation was confirmed.
…
"Yin... If you go in there, will it stretch out?"
In the ward, Du Lingling heard the surgery plan, raised her legs, and asked through gritted teeth.
Xu Qiu shook his head: "The diameter of the instrument is very small, only 3.2mm."
"That's it...it really won't leave any scars."
Du Lingling suddenly laughed.
She was surprised and realized why Xu Qiu asked her if she had sex during the ward rounds in the morning.
Did he think of this surgical plan at that time?
Du Lingling originally thought that Xu Qiu's words of "leaving as few scars as possible" were just a casual remark.
Unexpectedly, he really took it to heart and gave a solution...
…
3pm.
Preparations for surgery begin.
Operating staff: resident doctor Xu Qiu, attending physician Yan Na, resident doctor of hepatobiliary surgery, etc...
instrument:
Flexible gastroscopy.
1 multi-curved double-channel therapeutic endoscope.
The latter is very commonly used in gynecology. It has two working channels with a diameter of only 3.2mm, but can enter two accessories at the same time to complete under the microscope operation.
There are three control knobs on the handle, and the lens has a wide range of movement directions.
In addition, the double-channel endoscope is equipped with a high-frequency generator and aspirator, and combined with the insulated IT knife at the front, it can treat blood vessels and gallbladder with almost no disadvantages.
Three fifteen.
Du Lingling was adjusted to the lithotomy position, and after endotracheal intubation and intravenous anesthesia, the operation officially began!
Routinely disinfect the abdomen, vulva, and vagina.
Lay down sterile drape.
"Pull the hook." Xu Qiu whispered.
After pre-operative discussions, everyone in the operating room was very clear about the entire process, and they were all familiar with which step to do.
As soon as she finished speaking, a retractor was used to expand the vagina.
Xu Qiu chose the posterior fornix approach and incised the vagina and various layers of tissue layer by layer.
"It's a bit... troublesome!"
Yan Na glanced at the screen and her expression changed slightly.
Du Lingling had severe adhesions between the posterior wall of her uterus and the anterior wall of her rectum.
Considering that the patient had undergone cystic surgery, this situation occurred either because the cystic surgery was not done well at the time, causing postoperative adhesions, or because she did not take progesterone drugs such as dienogest tablets regularly.
With the passage like this, it’s not that easy to enter the abdominal cavity!
"Stitches."
Xu Qiu's expression did not change.
He quickly closed the incision in the posterior dome with absorbable sutures and then created a new path in the anterior dome.
Cut open the vaginal mucosa…
Cut the vesicocervical ligament…
Then bluntly separate the bladder-cervical space...
boom.
As if with a soft sound, the road suddenly became brighter and brighter!
"So decisive!"
Yan Na and others were amazed.
On the anterior fornix side, if you are not careful, you can damage the ligaments and cause uterine prolapse.
Or it may damage the bladder and cause sequelae of the urinary system.
If it were them, they would never dare to make such a decision as Xu Qiu - it is extremely dangerous, and who would dare to use the knife unless they are completely sure?
"So fast!"
In the picture, Xu Qiu has already returned to the peritoneum from the bladder and cervix, cut open the peritoneum, and completely entered the abdominal cavity.
"Endoscopy."
"5mm stamp card."
Xu Qiu spoke one after another.
Soon, the curved double-hole inner diameter and the small poke card were placed into the patient's surgical area through the anterior fornix, and then pneumoperitoneum was successfully established.
Xu Qiu adjusted the field of view of the endoscope to explore the abdominal cavity and other structures.
"There are no abnormalities in the abdominal cavity."
"No bleeding from the vaginal incision."
"There is no damage to the peripheral organs!"
Yan Na stared at the screen while reporting the report.
At this time, two foreign body forceps were sent through the dual channels of the endoscope, and under Xu Qiu's control, the bottom of the gallbladder was successfully grasped.
Immediately afterwards, the laparoscope was inserted through the vaginal poke card, and the gallbladder was pulled upward and to the right with forceps.
Under endoscopic surveillance, the gallbladder was completely exposed to the public.
Then, the IT knife was also sent in.
This is a high-frequency electric knife for endoscopy. Its advantage is that it can slide flexibly while cutting and prevent deep mucosal damage.
The old version of the IT knife has no insulation protection on the tip, so it is very easy to cause accidental injury and perforation during peeling.
Of course, after the improvement, only the insulated IT knife is basically left on the market.
…
The 93rd minute of the operation.
Xu Qiu used the IT knife to free the gallbladder duct and gallbladder artery, clamped, combined forward and reverse dilation, and crushed the stones.
Da Da Da!
Pieces of yellow and green gravel fell on the tray.
After checking that there was no bleeding on the wound, Xu Qiu gradually withdrew the instrument and sutured the vaginal incision with 1-0 absorbable sutures.
The operation finally took one hour and forty minutes, and there was no obvious bleeding during the operation.
The night after the operation, Du Lingling was able to get out of bed and move around.
There was no pain or bleeding even after the operation!
Even the hepatobiliary surgery department did not expect that the other party could heal so quickly.
If the endoscopic lithotomy is performed through a conventional approach, the patient may have to stay in the hospital for a week!
However, when they saw the name of the surgeon, they felt a little bored.
"Is it Dr. Xu?"
"Let's go, let's go. I'll believe Dr. Xu's patients if you tell me they can be discharged from the hospital and participate in a marathon tomorrow!"
"Hey, by the way, Dr. Xu will come to our hepatobiliary surgery department next month, right..."
"Director Wang is really shameless. He said he would punish Xu Qiu by making him work in the emergency department for three more months. Let's do the same!"
Squeak.
The door of the hepatobiliary surgery meeting room was pushed open.
"Director Wang, this patient has such an obvious amputation, it is probably pancreatic head cancer... Hey, why did you change your face?"
