Chapter 2404 【2404】Tools and Hands

The xiphoid process is at the lower end of the sternum, and most people are cartilage.

For cartilage, there is no need for a chainsaw, but surgical scissors. It is a common strategy to choose to make a breakthrough from the easiest place to start, and then to gnaw the hard bone in the end, and it is the same on the path of medicine. Removing the xiphoid process before sawing the sternum is equivalent to opening a breakthrough. As with the previous focus, the most important thing is to clean up the "stuff" attached to the bone.

In order to cooperate with Yisuke, the chief surgeon, instead of using the separating forceps this time, use the tongs to clamp the small xiphoid-process baffle, and then clean up the "debris pile" behind the "baffle". For example, if you want to disassemble a robotic arm, it is impossible to do so without cutting the surrounding wires connected to the robotic arm.

The electric knife held by the chief surgeon creaked and coagulated the exposed rectus abdominis muscle after the xiphoid process was raised. The location here is close to the abdominal cavity, so we must be very careful to prevent the fluid placed in the thoracic pericardium from flowing into the abdominal cavity when the anatomy is excessive, which will cause complications in the abdominal organs.

After incision, a gap was exposed behind the xiphoid process. The chief surgeon put down the electric knife, stretched out a finger of his right hand from this gap to the left rear side of the sternum. This position is next to the pericardium, and the doctor's fingers gently and slowly push away the pleura on the left and right sides of the mediastinum, doing blunt separation.

If the child was younger, the doctor's fingers might be able to separate directly to the upper end of the back of the sternum. If it is bigger, a finger cannot reach the upper end of the sternum. Like other engineering, in this case, only tools are used instead of fingers. Put it in and insert it forward along the direction of the finger. Doctors usually use long flat forceps close to the sternum for blunt dissection.

Using a tool instead, is the same as poking with your fingers, you need to determine where it went and whether it went through. For this reason, the end of the long flat tweezers needs to be connected after being inserted in this way to confirm that the direction of the separated target is correct.

To use a metaphor, the human body tissue is like a large cave with many caves hidden in a mountain, intertwined and complicated. Long flat tweezers are like a pole entering a mouth of a large cave. You need to ensure that the rope appears at the designated opening, and you need to connect the end of the pole at the designated opening.

On the operating table, the surgeon needs to free up the other hand to reach the incision at the upper end of the sternum. Since the right hand is occupied, the fingers of the left hand can only be extended and inserted from the upper end in an attempt to meet the long length of the separated tissue from below. Flat tweezers.

This separation path is the separation next to the back end of the sternum. The doctor's naked eyes are covered by the bones and cannot be seen, so it is called the Great Cave of Mystery. Sometimes it may be inserted for a long time, but the fingers of the left hand and the end of the long flat tweezers are not in contact, so I don't know if they are separated in place. If this is the case, the doctor can only withdraw the long flat forceps to the outside, measure the length just inserted and compare it with the length of the sternum, so as to determine whether the depth just inserted is in place.

You may find it strange, logically speaking, the distance between the upper and lower ports of the sternum is not long, and you can’t see it behind the bone, but the distance is not long, and you can rely on your feeling to catch it. I have talked about blunt dissection in general surgery before, and blunt dissection is not hard cutting with electric knife. To use another analogy, the doctor's fingers and tools are like little tadpoles swimming in the cave looking for their mother. It is impossible to say that they will forcefully split the wall between the caves for you. You must walk on the correct path to touch it.

It's best to be able to touch the top, so that the little tadpoles can find their mother.