Chapter 166 163. The first radical breast cancer surgery was successfully completed

The reason why Watman dared to take on this breast cancer surgery was because, as the president of the Imperial Academy of Foreign Studies, he could not avoid the treatment task; the other was that there was almost no danger in breast cancer removal. According to the operating range of previous surgery, you only need to cut off the breast glands and surrounding fat tissue, and you could hardly touch the large blood vessels.

But Giustina's identity and fear of tumor recurrence forced him to agree with Kavey's radical surgery plan. The scope of the surgery expanded to the muscles under the breast, and more blood vessels needed to be processed.

Perhaps he had confidence in his skills before and could do anything to bury his head in the operation. But now, when he barely avoided the surgical error, a strange feeling that was indescribable slowly emerged from his mind.

Giustina is the countess of France after all, and the Earl of Camey is by her side. Although she has no real power, she is a very popular astronomer and writer. She is under her name, the Flamarion Publishing Group and the first president of the French Astronomical Society.

In the distance, there was French diplomatic ambassador Edward, and everyone's eyes were watching the operation.

No matter how amazing the sentinel lymph node staining and lymphatic metastasis pattern that Kawi showed before was, as long as the surgery failed, the radical surgery advocated by the two will become a laughing stock in Europe. Even if Giustina can get off the operating table alive, the empire is likely to lose this ally of France.

The operation is never allowed to fail, and even any mistakes cannot be allowed to occur. Watman did not think that it would fail at the beginning. The block just now allowed the operation to proceed smoothly, but it also blocked his confidence in quickly using the surgery.

He stopped the movement in his hand and turned his face to let the nurse wipe the sweat off his cheek.

Maybe it's really old

As the main surgeon, Watman is under pressure that others cannot feel. Once this pressure occurs, it is difficult to clean it up.

He breathed a sigh of relief, looked at the wound that had just been stripped, and then turned to the audience and said, "The Countess' body structure is different from that of ordinary people, and there are rare vascular mutations. Now Dr. Kawei is separating this group of thoracic acromion arteriovenous arteriovenous, and after the sewing can be cleaved, the connection between the pectoralis major muscle and the clavicle can be cut off." [1]

The appropriate amount of commentary created time for him to cushion his emotions. When Watman leaned over and lowered his head, the pressure he had just now was completely hidden in his heart.

Kawei knew that it was not easy to overcome the pressure, and he also knew that he now suggested taking the position of the main surgery. But thinking about Watman's previous care and the slightly lower risk of the surgery, Kawei decided to "help" him.

He quickly cut off the artery and vein and made a sewing with silk thread: "The blood vessels were solved."

Watman nodded, clamping the muscles with pliers with one hand, and cutting the pectoralis major muscles along the clavicle with the other hand. His movements slowed down much less than just now. He chose to cut two or even three times, and slowly separate.

Kawei continued to bluntly separate the humeral tuberosity of the pectoral muscle in the direction of his arm, and then took another scalpel to break the pectoral muscle at the proximal tendon.

Watman put down the scalpel and asked Damirgang to step forward and continued to explain: "We use three tissue clamps to clamp the pectoralis major muscle, pull it aside while cutting, which can reveal the pectoralis minor muscle below." [2]

"Give me the scissors." Kawei took the surgical scissors and began to deal with the fascia on both sides of the pectoralis muscle.

Seeing this, Watman naturally used his hands to visualize the fascia as much as possible: "First cut off the fascia on both sides of the pectoralis minisculum, separate it bluntly, then lift it up and separate it to the attachment point of the coracoid process, and cut off the pectoralis minisculum here. Come, wet the gauze." [3]

There will be bleeding at the broken muscles, but the amount is not large, so it can stop the bleeding by simple compression.

To outsiders, the operation seemed to be going smoothly and not affected by the mutated blood vessel just now. But a discerning person like Edinson still saw some clues: "Why did the two change hands?"

"Hmm? Dr. Altinson, what did you say just now?"

Aidinson is not a gossiper. The surgery in front of him not only affects the ability of the Academy of Surgery, but also affects the future of the empire. It has long surpassed his personal grievances. Moreover, the interchange operation of the main surgeon assistant is not a big deal, and Kawei's personal level can be handled.

"Uh, nothing," Edinson said with a smile, "I just lamented that Dean Watman was too fast and the operation was half over."

"It's already half over?"

"Yes, the next step is to determine whether the armpit needs to be treated or muscle removal is done directly."

After the tendon of the pectoralis muscle was incised, the structure of the axillary was revealed in the field of vision. According to the steps of radical breast cancer surgery, it is time to clean the lymph under the axillary and all surrounding fat tissue.

But Kavi was not in a hurry to do it: "Teacher Ignaz, is there any result in the pathological microscopy?"

“We are still sealing the wax.”

The three of them have adjusted their speed to the fastest, but they still have not caught up with the operation progress. Considering the top-down process of the operation, Kawei decided to re-check the flap on both sides that Watman had just done. [4]

Because it is close to the breast and fat tissue, the flap should not leave any other tissue. The flap needs to be thinned, leaving only the capillary layer that supplies the flap: "The operation needs to be over, and Dean Watman can rest for a while. I will carefully check the thickness of the surrounding flap to ensure that there is no tumor tissue left."

The ideal thickness of the flap is that it will not cause necrosis after the operation, and there are no cancer cells remaining subcutaneously. To truly achieve this goal, it is very challenging to operate.

What Kawei can do now is to solve the problems left by Watman quietly, and at the same time give a wake-up call to his colleagues who were preparing to challenge radical surgery in the audience: "Flag cutting is an important first step in the surgery. I need to give a supplementary explanation for Dean Watman's operation just now.

When separating the flap, the tip of the scalpel needs to be slightly facing upward and cannot be cut flat. Once it is cut flat, a lot of tissue will remain."

While thinning the flap and cutting off many tissues with a scalpel, Kawei excused the dean: "We are human hands and there will definitely be unevenness, so it is necessary to confirm repeatedly during the operation to prevent different thicknesses. This not only affects the aesthetics of the final suture, but also affects the chance of recurrence after the operation."

"Three lymph nodes, one with tumor tissue."

Ignaz has never liked to drag, so he simply reported the results of the inspection: "You have to clean your armpits."

Kavey put down the scalpel, looked at the flap carefully, and nodded: "Damirgon and Amor will clamp the broken ends of the chest and small muscles, pulling them downwards, fully revealing the clavicle sternum fascia covering the axillary cavity and the axillary sheath surrounding the axillary artery vein [5]. Come on, who can help me adjust the operating table?"

The nurse squatted down and looked at the angle in the audience: "It's already reached its limit."

"Then bring a soft pad."

The patient's arms and trunk angles were readjusted, and the vision was fully exposed, and the operation continued.

The axilla has a complex anatomical structure, with blood vessels and nerves walking here, mixing with fat and lymph nodes. Therefore, dissection is the key and difficulty in the entire operation, and requires extremely detailed anatomical skills. According to the previous plan, as long as there is no problem in the middle, Watman should be the one who takes the surgery to the end.

But now things have changed. The previous change has caused him to rise in pressure. Although he can continue the surgery, his confidence has been lost. In addition, breast cancer removal is not his strength, and the operation is easy to deform and make mistakes.

If it was a normal operation, Watman still had a chance to adjust his mentality, but now the situation around him is completely different. The gaze from two hundred pairs of eyes made him breathless.

Kawei looked at Watman's somewhat stiff hands, understood what he meant, and gently tapped the back of his hand with the tissue pliers in his hand. At this point, the two characters completely exchanged. Under the armpits with more blood vessel nerves, Kawei became the main surgeon, and Watman became the assistant and commentator:

"We first clean the axillary vein, lift the clavicle sternum fascia and axillary sheath with the camera, and start cutting it open from the under clavicle to reveal the axillary vein inside." [6]

"Then, we will clear the surrounding fat tissue one by one. When stripped down the axillary blood vessel, the venous branches from the chest wall and the arteries of the chest wall, especially the thoracic and small muscles, are ligated one by one near the main trunk." [7]

Kawei followed his explanation and moved down step by step. He tried to be careful in each step while maintaining hand speed, carefully removing fat and lymph nodes around the blood vessels.

"Then we started to process the fat on the top of the armpit, lymph nodes."

Kavey took the hemostasis forceps and continued to perform separation. During the process, he could not injure the axillary artery, vein and brachial plexus nerves.

In the previous surgical plan, Watman could only avoid blood vessel damage, and the nerves could only depend on luck. Now that he has taken over his hands, the nerves must also be avoided, so that he can leave a beautiful postoperative experience for the Countess.

Especially when the separation continues toward the outside of the chest wall, there will be thoracic long nerves and thoracic dorsal nerves here.

Generally, the thoracic nerve is located 2 cm behind the lateral thoracic artery, while the thoracic dorsal nerve is located on the lateral thoracic nerve. It is necessary to carefully remove the fat tissue and lymph nodes around it that may be invaded by tumors. [8]

This stage lasted about 20 minutes, and Amor even asked Justina to renew some ether in the middle.

"The armpits are basically cleaned."

Kawei cut off the last piece of fat tissue, looked at the clean armpit repeatedly, and after confirming that it was correct, he took two balls of wet gauze from the nurse and covered the area that had just been cleaned: "After processing the armpit, we then cut the pectoralis major and pectoralis minor. First find the attachment of the sternum, then slowly separate the muscles and join the center.

Here you need to pay attention to the chest wall below. When separating the muscle chest wall, all blood vessels that pass through the chest wall should be ligated one by one. Smaller bleeding can be compressed." [9]

Watman's suture and ligation speed is far faster than Kawei. The silk thread that Kawei just proposed for clinical use is thinner and tougher than the previous intestinal thread. To this end, Kawei gradually slowed down the speed of cutting and separation. At the same time, in order to concentrate Watman, he also took over the right to understand:

"Our movements must be standardized here, be gentle, and it doesn't matter if we would rather be slower. We must not hurt the pleura. And when separating the lateral side, we cannot cut the fibers of the serratus anterior muscle."

The operation entered the repetitive operation stage. For the next twenty minutes, Kawei kept cutting the muscles, while Watman kept sewing the small blood vessels until the pectoral and large muscles, subcutaneous fat, breast tissue, and axillary lymph nodes were removed in a whole piece. [10]

The entire piece of tissue, along with blue lymphatic vessels, lymph nodes and tumors, entered the nurse's tissue metal plate.

Watman had completed all his work and left the surgical area completely. His forehead was covered with sweat, and he felt that his whole body was soaked. His slightly trembling legs couldn't even stand. He could only find a baffle in front of the audience to rely on his body and have a simple rest.

He didn't know why he was like this, and he always felt that the whole operation completely exhausted his energy.

Maybe it was the pressure on your back, or maybe there was something else.

What is it?

Watman looked at the 17-year-old child and had an idea inexplicably: Could it be that he was leading the pace faster and his speed could not keep up.

Just when the old dean suspected his ability, the operation completely entered the final stage.

Kawei was still standing by the operating table and maintaining his final work: "Take the normal saline and prepare the rubber drainage tube."

The nurse who delivered the equipment had already prepared the equipment for the end stage and handed it to two other assistants as soon as possible: "Give it."

"Considering the possible metastasis of the tumor, we must rinse the wound with saline before finishing the operation to remove the clots and fat particles generated by the surgery just now."

Kavey gave up his seat for Damiergaon and Amor, and asked them to rinse and drain, and then walked aside and began to look for the opening of the underarm drainage tube: "The underarm tissue is very easy to accumulate liquid oozing, so we made a shearing incision on the top of the axillary cavity, put in the rubber tube for drainage, and then used sutures to intermittently." [11]

At this step, he reserved Watman many rest time, because the final skin stitching must be done by him, the plastic surgery master.

"Dean Watman"

“Is the drainage tube ready?”

"Um."

Watman took another deep breath, stood up straight, and then slowly walked towards the operating table step by step, while summing up the previous surgery: "The complexity of the surgery exceeded expectations, but the results of the surgery were quite satisfactory. The breast tumor was completely removed, and if nothing unexpected happened, the Countess' chance of recurrence after surgery would be less than 10%.

There was warm applause in the audience, and Kamiy, who was standing beside her, also shed tears as before the operation began: "Thank you, thank you so much, thank you for everything you did for Justina!"

The pressure turned into nothingness in the applause, and Watman gradually regained his strength: "This is only a first-stage operation, and there will be a second-stage Rufang remodeling surgery. So while trying to ensure the aesthetics of skin sutures, we also need to prevent infection of subcutaneous tissue."

Preventing infection is a very general saying, and it is really what Kawei is doing now.

"I will gently squeeze the armpit cavity and flow out the residual gas and liquid. Then when the assistant bandages it, I choose to use a lot of gauze to fill the armpit, subclavian and anterior chest wall to make the flap and chest wall close to it, promote healing, and reduce effusion at the knife edge. But at the same time, it is necessary to ensure that the pressure cannot be too large. Too much pressure will also cause insufficient blood supply to the flap and necrosis."

The operation is completed.

There are a little more steps, and I have deleted many details. Let's take a look. I'm a little tired of summarizing it, so I have to go to bed as soon as possible. If there are typos, I will change it tomorrow.
Chapter completed!