Although staplers have been widely used in modern intestinal anastomosis, manual anastomosis with needle and thread is still the basic function of general surgeons. If you can cleanly sew the severed intestinal tube with needle and thread in a short time, you are basically at the level of attending.

Kawei has been handling various surgeries in emergency surgery, and has long been familiar with the theory and operation of intestinal anastomosis.

In fact, as early as the 19th century, intestinal suturing methods had become increasingly mature [1], and many doctors who wanted to enter the field of abdominal surgery would test various self-created suturing methods on cadavers or animals.

Their suturing theory alone is actually quite good, but it is limited by the material of the suture and the amount of practice, and there is no concept of disinfection, so the success rate of intestinal anastomosis healing is not high.

Ignatz is better at operating on limbs, and fine suturing on intestinal tubes is obviously not his strong point.

He knew very well that when suturing the intestines, it was necessary to ensure the neatness and continuity of the intestinal serosa, and he also knew that the serosa needed to be aligned during suturing. But when it came time to get started, deviations would still occur, and the sutures could be brought to the intestinal wall.

Failure to align half of the time depends on luck.

The technique was lacking, but Ignatz's surgical intuition was still in place.

Looking at the intestinal tube that had just been easily severed by Morazo, he realized that there was indeed something wrong with his suturing technique. Even if he sutured it again now, the intestines would have difficulty healing and ulcers. By that time, he would have fallen into a "more and more difficult" situation.

It is an endless cycle that the more susceptible you are to infection during laparotomy, the more infected you are and the more difficult it is to heal."

After a brief hesitation, Kawei finally intervened. He needed to take over the assistant's seat and end the operation as soon as possible: "Teacher, this is the catgut you introduced in the book." [2]

Now Kawei is just a "beginner", and Ignatz needs to teach him some of the most basic things: "Well, it is made of sheep intestines. It can be absorbed by the tissue when used on the abdominal intestines."

"The teacher's drawing collection emphasized that the intestinal tube must be sutured according to the Lembert suture method, and the serosa must be aligned [3]." Kawei said, and the tweezers in his hand had easily turned over the intestinal tube to the surface of the serosa.

Film layer, "Is this here?"

Ignatz nodded: "But before suturing the seromuscular layer, the internal mucosal layer needs to be sutured first."

"Yes, I do remember the teacher wrote this. Use absorbable catgut for simple continuous sutures on the mucosal layer [4], and do not pull the thread too tight to prevent mucosal tearing. Use non-absorbable silk thread for the outer layer

, Perform interrupted inversion sutures, which is the method advocated by Professor Lembert."

Kavey seemed to be a die-hard fan with an extraordinary memory. He recited all these stitching points as if he had recited the entire text. Even Ignatz himself had forgotten that he had written these.

Of course, Kawei didn't know either, because they were all nonsense. Anyway, it didn't affect the timely reminder of Ignatz with these words.

Especially for the continuous suture of the mucosal layer, judging from the suture opening at the broken end, it is because the suture was too tight that the mucosal tear was caused. And when doing the Lembert suture [5], he was indeed a little out of shape, and there were many places.

There are too few sutures or insufficient distance, which eventually leads to the avulsion of the serosal layer under external force.

This was caused by lack of practice. I could only blame Ignatz for being unfamiliar with abdominal surgery, and no one else could blame him.

Ignatz's reputation as the best surgeon in Austria is not in vain. Since the thread was tightened too tightly just now, let's loosen it a little this time. Since the lumber suture was wrong, let's be more careful...

He has no option to give up and seek help. All the troubles he encounters need to be faced by himself, otherwise Ignatz will be ruined.

He didn't know whether it was because Elena's deflation made him feel good, or because of something else. To outsiders, the suturing seemed to go much smoother this time. To the outsider, the specific reasons for the success would not be clear to an outsider.

Ignatz's operation suddenly became smoother.

These are just physical sensations brought about by vision, but for the experts in the audience, Ignatz's speed changes were completely reflected in the time consumption.

The current anesthesia technology is unstable, and the speed of surgery is still the best indicator to measure a surgeon. Ignatz is a surgeon known for his speed of surgery, so every time he performs an operation, recording the time has become a common practice among his colleagues.

habit.

Although the entire operation was delayed for a long time, the anastomosis of the broken ends of the small intestine was completed very quickly, and it immediately became the focus of quiet discussion among everyone at the table.

"It's 15:14 now, and it only took 12 minutes? Is it possible that I saw it wrong?"

"That's right, it's more than twice as fast as before."

"The distance was too far to see the quality of the stitching, but the speed definitely broke the record."

"It is outdated to talk about speed aside from quality. Personally, I still value quality more. However, based on his requirements for himself, the quality should not be too bad."

"I don't agree. The suturing just now is not satisfactory. Let's take a look at the postoperative period. The slowest is one month, and the fastest only takes two or three days."

"So, you guys have been discussing it for so long and still haven't gotten to the point. Why did he suddenly speed up?"

After being simply surprised and a little jealous, they began to look for the real reason why Ignatz could speed up.

We are all doctors working on the operating table, and we are very aware of the difficulty of intestinal suturing. All the surgeon has to do is to use a needle and thread to penetrate the intestinal wall tissue and then tie the thread. Every link is closely related to practice.

In this case, it is impossible to double the speed in a short period of time. An improvement of 1-2 minutes is already an extraordinary performance.

Since the surgeons at the front and back are both Ignatz, and the instruments used have not changed, the only factor that can cause drastic changes in speed is the assistant who just came on stage.

"So, Ignatz's pauses have indeed become less frequent."

"The sutures of interrupted sutures are one span and one knot. The assistant needs to expose the needle entry and exit positions when he is suturing, fix the silk thread during the knotting process [6], and cut it immediately after knotting.

Thread. If the thread is used up, he needs to hand over a new needle and thread. At the same time, he must always maintain the direction and distance of the candlelight..."

"No need to analyze, it's just that young man who cut down his time."

"Who is that guy?"

"Ignatz just said that he is a graduate of Vienna University Medical School."

"Graduates? Why have I never seen them before?"

"I haven't seen it either..."

Kawei really saved Ignatz a lot of trouble and time, making the connection of each of his movements extremely smooth.

To be able to do this requires not only decades of surgical experience, but also a pair of eyes that are good at observation. When he was standing in the preparation area just now, Kawei was not in a daze, but was seizing the time to observe Ignatz's surgery.

behaviors and habits.

Each surgeon has his own fixed knotting technique and surgical speed, and also has requirements for the angle and intensity of light.

By silently recording their original surgical rhythm, you will be able to appear where they want you to be when they need it most, and deliver what they want most.

In fact, Kawei has done a very outrageous job in some aspects. Whether it is finding anatomical levels or inserting needles, he is better than Hills. This difference is so obvious that even Elena and her niece can see it.

There were some clues, and even the voice was much softer due to the influence of the audience.

"Auntie, is Dr. Ignatz's surgery really that fast?"

"How do I know this?"

"What Auntie said does make sense."

"What words?"

"The success of the operation has a lot to do with the assistant." The girl said with a smile, "The suturing just kept stopping and it looked very awkward. Now that I have an assistant, I feel much more comfortable. Dr. Ignatz is like

It’s like a different person.”

Elena said no more.

Her mood was very complicated. The person on the operating table was her biological brother. She naturally hoped that his operation would be successful. But compared to incarcerated hernia, which has a recurrence rate of 90% and an average mortality rate of 50%, Elena hoped more.

That son, Berget, who was hiding in the corner, could come on stage and make his mark.

Morasso thought the same way before, but it was a pity that the apprentice took all the limelight away.

His movements were steady and his techniques were experienced, and there was no stranger in his eyes that looked at Ignatz, but rather a battlefield veteran who had seen through every move of the opponent. It gave Elena the feeling that Morazo was

When teaching Bergert swordsmanship.

However, compared to the one-sided confrontational practice at that time, Kawhi is now more like giving tricks.

In the eyes of outsiders, her acquiescence was the greatest compliment to the two masters and apprentices on the operating table, but more than half of this compliment was given to Kawei. The woman's intuition told her that this young man was not simple.

...

It is said that the authorities are confused but those on the lookout know clearly. This is absolutely true.

While others were praising the assistant, Ignatz, the surgeon, was concentrating on the suturing and did not realize the importance of Kavi. After all, after climbing the mountain of intestinal anastomosis, he still needed to face the suturing.

To another mountain, the suturing of the hernia gap.

"Everyone, I have completed the anastomosis of Count Morasso's small intestine. The stitches are smooth and the sutures are firm. I am sure this is the smoothest and most confident suturing experience I have ever had in my life."

Ignatz reported his results as usual, and the staged success once again stimulated his enthusiasm: "Next, I will use the suturing method used by Dr. Cooper at the time, first narrowing the inner ring of the hernia, and then closing it.

The abdominal fascial layer and inguinal ligament are sutured."

The suturing itself is not difficult, but the recurrence rate after surgery forces all surgeons to choose to lie flat, and Ignatz is no exception: "Although Dr. Cooper's treatment method cannot reduce the recurrence rate, at least I cut off

The necrotic intestine saved Count Morasso’s life.”
Chapter completed!