signingbooks Chapter 945 Co-casting Plan (Part )
Chapter 945 Co-casting Plan (Part )
Chen Yang stood up calmly, walked to the huge screen, and took the laser pen handed to him by Borg.
Chen Yang did not refute anyone immediately. Instead, he placed the laser point precisely on points A and B that Borg had marked before, and called up a higher-definition local tomographic image and a dynamic blood flow diagram simulated by intraoperative ultrasound.
"Everyone, please look here,"
Chen Yang's voice was not loud, but it was clear and steady, with an unquestionable penetrating power.
"Although the tumor is severely encapsulated and invaded, according to the latest 1 mm thin-slice CT angiography (CTA) and our accumulated experience in intraoperative ultrasound (IOUS) simulation in Shen City, there is a relative 'safe zone' of about 0.8-1.0 cm near the bifurcation of the liver portal (point A) and near the intrahepatic branch at the distal end of the tumor invasion (point B). "
"Although the blood vessel wall here has also been squeezed and pushed, imaging shows that its layers are still there, the wall structure is relatively intact, and the texture is assessed to be a healthy blood vessel that can be anastomosed."
As he spoke, Chen Yang looked around the whole place and said slowly, "I carefully evaluated the direction of this blood vessel, the diameter of the vessel, and the estimated distance from point A to point B after resection. Combined with my experience in handling smaller and worse blood vessels in liver transplants in Shen City, I believe that if the operation is delicate enough and the freeing is sufficient, there is a possibility of direct end-to-end anastomosis! Moreover, this is the best surgical precaution!"
In fact, before today, Chen Yang had used a simulation card to simulate Wilson's situation, so Chen Yang had a better understanding of Wilson's situation.
"The key lies in three core links, which are closely linked and cannot be missed."
Chen Yang continued: "We must use the most sophisticated 'skeletonization' freeing technique. This requires us to 'defuse a bomb' in a minefield full of blood vessels and nerves, using microscopic instruments, with the assistance of a magnifying glass or surgical microscope, to patiently and millimeter-by-millimetre peel off the dense adhesions between the tumor tissue and the PV-L vascular adventitia."
"The goal is to 'save' the precious healthy blood vessels at both ends of point A and point B (try to save 1 cm each) and structural integrity to the maximum extent possible without damaging the blood vessel wall itself. This requires the surgeon to have extraordinary patience, steady hands and a deep understanding of vascular anatomy. Any impatience or mistakes may lead to blood vessel rupture and massive bleeding or damage to the blood vessel wall, leading to postoperative thrombosis."
"The precise vascular occlusion strategy abandons the traditional Pringle Maneuver, which causes ischemic damage to the entire liver."
"I think more precise regional blood flow control can be used, with a pre-placed vascular occlusion band to selectively block only the blood flow of the left branch of the portal vein (PV-L). This can protect the right liver (with good functional reserve) from ischemia to the greatest extent, significantly shorten the overall ischemia time of the liver, and reduce the risk of postoperative liver failure."
"Innovative anastomosis technique. I will use the improved 'continuous-interrupted hybrid suture method'."
As Chen Yang spoke, he called up an excellent simulation animation based on his previous surgical records, which clearly demonstrated his anastomosis concept.
"The posterior wall of the blood vessel is sutured continuously, such as a continuous horizontal mattress suture. The advantages are fast suturing, good airtightness, and effective prevention of leakage. It is especially suitable for the posterior wall, which is relatively easy to expose and has less tension."
“The anterior wall of the blood vessel is sutured with precise interrupted sutures, which is the key to dealing with tension!”
"At the point where the central tension of the anterior wall is expected to be the greatest, a key interrupted horizontal mattress suture is sutured and knotted to bear the main longitudinal tension. Then, a simple interrupted suture is sutured 1-2 mm to the left and right of this central tension point. The main function of these two stitches is not to bear tension, but to accurately align the vascular intima, ensure the smoothness of the intima, reduce turbulence and the risk of thrombosis, and provide a firm 'anchor point' for the subsequent continuous suture."
“Starting from one of the ‘anchor points’, perform a short continuous suture towards the central tension needle to quickly and tightly close the gap between the anchor point and the central tension needle…”
Listening to Chen Yang's explanation, Borg's eyes sparkled. He leaned forward, carefully studying every detail of the animation, repeatedly pondering the feasibility and risk points.
"Chen!" Borg raised his head, his voice filled with irrepressible excitement and recognition.
"Your confidence stems from your unparalleled microsurgery skills and vascular surgery talent! I agree with your judgment! If the direct anastomosis is successful, it will undoubtedly be the best solution in terms of operation time, reduction of complications (related to transplanted blood vessels), and long-term patency!"
"but......."
Borg changed the subject and glanced sharply at David, Zhong Dongyang and others.
“We must have a foolproof Plan B! If it is found during the operation that the healthy blood vessel released from point A or point B is not long enough, or the texture of the blood vessel wall does not meet the requirements, or if it is found that the tension cannot be overcome during the anastomosis, it must be immediately converted to autologous great saphenous vein transplantation!
"David, please make sure you are fully prepared to obtain and transplant autologous blood vessels. Professor Zhong, please prepare spare high-quality artificial blood vessels. Although the long-term effect is not as good as autologous blood vessels, it is a life-saving solution in an emergency!"
"Understood. The autologous blood vessel acquisition equipment and plan are ready!" David responded immediately.
"Please rest assured, Dr. Borg, high-quality artificial blood vessels and supporting equipment are ready!" Zhong Dongyang also assured firmly.
The preliminary plan for the operation has been finalized.
Next, the meeting entered into a more in-depth and almost rigorous detailed deduction, with every step being examined under a microscope.
The scope and strategy of tumor resection were determined to be centered on the liver hilum, with combined resection of the left inner lobe (S4 segment) and caudate lobe (S1 segment) invaded by the tumor, striving to achieve R0 radical resection.
For the invaded right hepatic duct (RHD), the plan is to first perform local resection of the bile duct wall and fine ductoplasty. If the invasion is too large to be formed, a Roux-en-Y anastomosis of the hepatic duct and jejunum will be performed decisively. Intraoperative frozen sections will confirm whether the resection margin is negative in real time.
The hepatic artery treatment plan clearly states that if the left hepatic artery (LHA) is tightly wrapped and invaded by the tumor and cannot be safely separated, it should be ligated and severed decisively. Preoperative evaluation showed that the right hepatic artery had good blood supply, and the right liver had sufficient volume and functional reserve (assessed by CT volume measurement and ICG clearance rate), which was sufficient to compensate for the ischemia of some areas of the left liver.
General plan for bleeding control, injury to the portal vein system, hepatic artery injury, injury to large veins such as the inferior vena cava, etc.
The entire meeting lasted a whole morning. When Zhong Dongyang walked out of the meeting room, he felt a little dizzy.