Surgery Godfather

Chapter 128: Chapter 0125: High Precision Puncture

When Tan Boyun shook hands with Professor Yu, Professor Yu said, “Director Tan is really skyrocketing now!”

Tan Boyun laughed heartily: “I must thank Director Yu for his hard training!”

Both were smiling on the surface. To those unaware of the circumstances, it would seem like they were good friends, greeting each other warmly.

But to those in the know, it was clear that there was more to their words, each subtly taunting the other.

Their relation has become so bad that despite not being in the same hospital and having no direct business with each other, they cannot help but compete when they meet.

In terms of robotic orthopedic surgery, Fuyi is at the forefront, with over five hundred procedures performed. If we consider only the volume of robotic orthopedic surgery, it is undoubtedly in the top three nationwide.

Yet Fuer has not yet started orthopedic robotic surgery, offering only robotic surgeries in thoracic surgery, general surgery, urological surgery, and obstetrics and gynaecology.

In just over a month, thanks to strong support from Director Han, Tan Boyun has already launched more than ten robotic surgeries in Sanbo Hospital. With this aggressive momentum, Sanbo is indeed catching up with Fuyi.

If Sanbo acquires a second robot, the hospital could start carrying out surgeries in spine, joint and sports medicine. It would then be in a fierce catch-up mode.

Full of energy and ambition, Tan Boyun dares to embark on the cutting edge of the industry, aiming to challenge Fuyi’s trauma orthopedics and carve out a niche nationwide.

Now under Director Han, he can get whatever he wants, without any restrictions, and freely display his abilities.

“Director Tan launched it later, but has done more than a dozen surgeries in a month,” Professor Su praised.

Although Tan Boyun is often arrogant, he doesn’t dare to show any pride in front of Professor Su. Not only because of Professor Su’s outstanding academic and moral qualities, but also because Professor Su has once helped him.

“This robot is exclusive to our micro-trauma orthopedics department, so it is used very frequently. We have surgeries scheduled for tomorrow, and five for this week. We need to learn more from Fuyi — compared to Fuyi, we’re merely infants,” Tan Boyun briefed them on the progress of robotic surgery at Sanbo Hospital, with a look of respect towards Director Han before starting.

“We have performed about a dozen surgeries, involving the pelvis and four limbs. Our goal is to carry out all types of trauma orthopedic surgeries using robots,” Tan Boyun introduced his blueprint.

The dozen or so surgeries so far were just a warm-up. The real show was yet to come.

Professor Su was deeply impressed in his heart. Han Jiangong knew how to use his talents. Tan Boyun, who found it hard to make progress in Fuer, was able to advance rapidly in Sanbo. This man was sure to make extraordinary contributions in the future.

The patient, Mr. Ning from the Overseas Chinese Building, has already been sent to the operating room, just next to where Director Tan had just performed surgery, because this room contains the navigation equipment — computer-assisted surgical navigation system.

Su Nanchen considered using the robot to complete the puncture, but he gave up. The puncture operation not only requires high precision but also needs excellent touch when inserting the guide wire. The successful placement of the catheter can only be adjusted according to the touch.

The precision of robot-assisted surgery is extremely high, but it lacks feedback from physical contact with the tools, which means it lacks the sense of touch. This is its biggest drawback.

Su Nanchen completed the mock puncture and mastered the best puncture point, angle, and depth from it, becoming thoroughly familiar with the relations of various anatomy.

Yang Ping took Su Nanchen to the operating room, with Song Zimo following behind.

Su Nanchen and Wen Rentao are both Song Zimo’s targets. He has always been making secret efforts to surpass these people who are hailed as the stars of tomorrow.

Song Zimo followed silently. He’s not unsociable, just indifferent to socialize, always appearing nonchalant.

“The aunt that we just met in the garden, the one with the limp right knee, did you perform surgery on her?” Su Nanchen took the opportunity to ask.

Yang Ping nodded, “The surgery was just done this morning. She’s due to be discharged tomorrow. Why, do you know her?”

Su Nanchen said, “My old patient, her second surgery was done here. The treatment result wasn’t good. I just met her, and this time, her symptoms were completely resolved.”

Yang Ping hadn’t expected that this patient was his. The patient had mentioned that the second surgery had been performed by Dr. Su from Fuyi, but Yang Ping didn’t pay much mind to it: “This patient had popliteal tendon hiatus synovial band impingement syndrome. I found the synovial of the popliteal tendon hiatus and removed it, and naturally, the patient’s symptoms were relieved.”

“You’ve never heard of this disease?” Su Nanchen asked, surprised by the unfamiliarity of a disease, even with his extensive knowledge.

Yang Ping laughed: “I hadn’t heard of this disease either; I found the anomaly on her Magnetic Resonance Imaging (MRI) scan.”

“Can we take a look at the MRI scans together when we are free?” Su Nanchen, always eager to learn, asked.

They had arrived at the operating room. They change shoes, put on clothes, and donned masks and caps.

The patient was already in position, prone. Zhang Lin and Little Five had already helped with disinfection and draping, and instruments were also prepared.

Professors Su and Yu, and Director Han had already put on lead gowns and were chatting inside.

“Nanchen, hurry up and scrub!” Professor Su urged.

“Xiao Yang, scrub. You’ll assist Dr. Su in the operation.” Director Han instructed.

The two of them donned lead garments and began to scrub their hands.

Yang Ping and Su Nanchen hit it off well, unlike Song Zimo, who always emitted an aura of arrogance that kept people at bay with his aloof demeanor.

Yang Ping differed in that he exuded a powerful self-confidence, yet he was not haughty nor overly aggressive.

It’s often said that experts are lonely, being able to find a competent opponent is a fortunate thing.

The mutual admiration between these two talented young men made Su Nanchen regret not having met Yang Ping earlier. While they were scrubbing their hands, they chatted non-stop about the patient with a pinched gastrocnemius tendon and the puncture for this surgery, as if there wasn’t enough time for them to chat in doing so.

With everything prepared, the chief surgeon once again verified everything, started the operation, applied local anesthesia, inserted an intramedullary reference pin into the pedicle for navigational coordinates.

Dr. Su had great operating posture; the way he sat, stood, walked, and ate all had their unique styles.

His posture during surgery was no different, with some people having standard postures that made them look quite elegant, others hunched over and squinting closely at the surgical area; some twisted their bodies, which was not only unsightly but also potentially contaminated the surgical area; and some, for a simple fracture, awkwardly knelt, regardless of whether this was a special requirement or their first time in surgery.

Dr. Su’s surgical style revealed Professor Su’s strict demands on him. The large folds of the surgical gown were smoothed out, and the surgical instruments were neatly arranged in order of usage frequency.

He hunched over with his chest out, his hands a proper distance from the operating table, and his movements were within a definite range. Everything that could be done with his fingers was, and if the wrist joint needed to assist, it stayed within the wrist area. Even if the elbow joint needed to assist, that too was a minimal movement.

Every step followed standard protocols, it was all visually appealing, with a clear rhythm and steady progress.

The navigational screen displayed 3D anatomical structures, with reference points showing accurate coordinate relationships between the instruments and anatomical structures. The navigational cursor indicated that the puncture needle with its sheath accurately approached the target.

With Simultaneous puncturing and precise navigation, combined with Dr. Su’s talent and experience, the puncture was successful in one go. The needle passed through the pedicle root, penetrating the cortex at the best location, completed its journey through the bony passage. Ahead lay the target — the nerve root sheath.

Each step was flawless.

Su Qingyun’s son was indeed as talented as reputed. Professor Yu watched the entire puncturing process, and had to admire the impressive training Su’s son.

Even without Su Qingyun’s help, Su Nanchen would have qualified to enter Fuer on his own merits. Eight years at Xiehe gave him the highest academic achievement in the medical field in the country.

Moreover, Su Nanchen was the top science scholar in Nandu province in his year, he entered Xiehe as the top scholar. Regardless of the academic status of his department or his personal achievements, Professor Yu was humbled by Su Qingyun.

The puncture needle was withdrawn, leaving the sheath inside. The fine hollow puncture needle came out through the puncture sleeve. The needle tip touched the nerve root sheath. Despite having navigation assistance, this was an extremely difficult operation.

He’s a formidable young man! Everyone agreed unanimously.

The needle tip was ready to puncture the nerve sheath and enter the sheath. This step couldn’t be assisted by navigation, it had to rely on tactile sense. Song Zimo sat nearby. Su Nanchen indeed lived up to his reputation as a rising star alongside Wen Rentao, and this had nothing to do with his father.

The needle tip punctured the T2 nerve root sheath, a catheter with a guidewire traveled through the hollow needle into the sheath, with a bit of it exposed, but it struggled to continue advancing.

The puncture was obstructed in the final step of tubing.

Su Nanchen frowned. The tumor tissue had invaded, causing adhesions between the sheath and the nerve bundle membrane. The guidewire designed to enter the sheath was flexible, ideally suited for the natural gap between the sheath and nerves. However, this gap no longer existed due to the adhesions.

On attempting to advance again, the guidewire curved on the image and couldn’t break through the adhesion.

Professor Su stood up to look at the navigation image on the screen. The puncturing process had been perfect, but it met resistance in the last step.

He believed Su Nanchen could handle it, and Su Nanchen remained calm, he stopped operating and started thinking about a solution.

He had already considered adhesion before the operation. To solve this problem, he needed to adjust the angle of the puncture needle.

The puncture needle currently entered almost perpendicular to the nerve. He had to adjust the needle tip’s angle to create a certain degree of angle with the direction of travel of the nerve. This way, the guidewire could penetrate the adhesion better.

It was like splitting wood, it was difficult to split horizontally but easy to split vertically.

Hitting a cup with a missile was already impressive, but hitting it from a specific direction was even harder.

The range for adjustment was very small, the diameter of the bony tunnel was already thin. The finer puncture needle does have room for adjustment, but it was minimal.

He withdrew the guidewire and catheter and started puncturing the nerve root sheath afresh.

Su Nanchen was very familiar with spinal anatomy. He was still young, just 30 years old, but he had already accumulated experience from operating on hundreds of patients with scoliosis, which was very rare.

He had excellent tactile sensations; a slight adjustment to the needle tip changed the angle. However, as soon as the needle tip just touched the nerve root and he tried to push it forward, it slipped off.

“The angle is off; it needs to be adjusted by fifteen degrees.”

Yang Ping reminded him.

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