Surgery Godfather

Chapter 165: Chapter 0159 Gauss’s Story

At noon, after having lunch with Xiao Su at the cafeteria, he spent the afternoon sleeping in the office of the department.

With the usual daily rewards, his score is now 51,000 points, enabling him to proceed with the surgical training.

Yang Ping spent 10,000 points to purchase 500 cases of ACL reconstruction surgery, and another 20,000 points for 500 cases of knee multi-structure reconstruction surgery, leaving 21,000 points. He finished training for these 1,000 surgeries after spending about ten days in system space.

The mall has a vast variety of surgical training packages. All you could want is available for purchase, as long as you have enough points. The only drawback is the progression in training. You must take it step by step, completing one advanced training session before progressing to the next.

After completing surgical training, Yang Ping carried out anatomy training in the system space, using his knowledge of anatomy for human brain mapping exercises.

When he woke up, it was already after four in the afternoon. Song Zimo was sketching in the office, images of knee joint pentad injury. He drew the reconstructed structures on the images. Once he finished a sketch, he would cross it out and begin anew.

“I’ve operated on the four-incidence reconstruction for ordinary people, but the pentad reconstruction for professional athletes is really hard to balance. How can we accurately determine the start and end points of these ligaments? And how do we adjust the tension among so many ligaments?” Song Zimo was very troubled.

This type of surgery involves many structures to reconstruct: dual beams of the anterior cruciate, dual beams of the posterior cruciate, three structures of the posterior external side, three structures of the posterior internal side, a joint capsule that needs repair, patellar external supporting belts that need to be released, internal supporting belts that need tightening. After all these structures are reconstructed, it’s still not over. The tension for all these structures must be adjusted until they are satisfactory and balanced.

Let alone performing such a surgery, even a sports medicine specialist may feel dizzy at the sight of it. Most of them would rather not go through the trouble, as in front of such surgery, the confidence that most doctors accumulated over time would be shattered.

Not to mention that Song Zimo rarely came across such situations, even Su Nanchen from the First Affiliated Hospital seemed to feel powerless. After all, the number of cases were too few–hard to accumulate. Only a national sports medicine center like the third hospital in Beijing could accumulate a large number of cases.

For Song Zimo to be able to manage ordinary people’s four-incidence reconstruction and for Su Nanchen to be at the doorstep of the veteran surgeons in Beijing’s third hospital with his expertise in four-incidence reconstruction in professional athletes – these achievements alone makes them exceptionally gifted.

“When the time comes, you will comprehend after observing one surgery. Tell Jiahui to prepare the surgical instruments. As this is a large operation, prepare at least 10 allograft tendons for reconstruction,” Yang Ping instructed Song Zimo.

“As soon as the patient came in, I notified Huang Jiahui. She has already prepared all the surgical instruments. As for the allograft tendons, I have readied twenty, from Shanxi Medical Tissue Bank, one of the suppliers listed by our hospital. They’re available for immediate use. Sports Medicine Centers use theirs too. Huang Jiahui has a flu and is getting intravenously rehydrated in the emergency department. I told her not to attend the procedure but she is insistent and will be there no matter what,” said Song Zimo, having made thorough preparations for the operation, leaving Yang Ping with nothing to worry about.

“Was the Singaporean patient’s surgery successful?” Yang Ping asked caringly.

Song Zimo confidently replied, “Yes, it went very smoothly. I have the follow-up scan results. Whenever you’re free, you can take a look at them. I sketched a three-dimensional model before the operation, simulated the scraping off of the necrotic bone. During the surgery, we should have scraped off all the necrotic bone.”

“Well done!” Yang Ping gave a thumbs up.

Song Zimo was a little embarrassed, “Well, I ought to learn something from you. Compared to you, my spatial localization ability is vastly inferior.”

This indeed was a complex surgery. Watching Yang Ping’s surgeries can become addictive. They often led to unexpected discoveries, just like a sudden enlightenment. For this reason, Director Han had become addicted. His general orthopedics department had just started recently, and yet they have already begun performing pentad injury reconstructions.

On Saturday, Xiao Su didn’t go home. Yang Ping accompanied her to play tennis in the hospital’s court. Xiao Su was professional, while Yang Ping only had some experience with the sport during college. Naturally, he was completely beaten by Xiao Su, and she became his coach.

On Sunday, Xiao Su went home, while Yang Ping stayed inside without going out. He studied and brought back some reference materials on the Gamma Knife to read.

On Monday, Director Han was in the operating room early. Normally he would not come in until the surgery had begun.

“Little Five, adjust the video system a bit. We need to take snaps later. I want to make a poster out of this surgery and hang it on the ward wall. This surgery, along with the multi-directional instability of the shoulder joint reconstruction surgery, rank among the most difficult surgeries in sports medicine,” Director Han directed Little Five as he sat.

Last time, during the anterior cruciate ligament reconstruction, the sculpture of the femoral intercondylar notch was like carving made by a sculptor. Relentlessly chiseling and chiseling until a perfect femoral intercondylar notch had formed.

Director Han had replayed the surgery video several times, and he firmly believed that Yang Ping must have studied sculpture and practiced sculpting the femoral intercondylar notch with a burr. Otherwise, how could he have done it so perfectly?

Director Han was right to assume that Yang Ping had practiced, but only in the system space. In the system space one could perform countless surgeries because there were no repercussions if you messed up — you just tried again. As long as points were accumulated, it continued to provide new cases. Regardless of whether it was pentamerous, hexamerous, septamerous, or even octamerous injury, they were all available to practice on. Even cases that one might never come across in real life could be simulated in the system space.

Yang Ping had previously used drills to practice in the system space, honing the art of intercondylar fossa shaping. He studied numerous books on carving, understood the theory behind the art form, used the patient’s intercondylar fossa as the raw material for practice, and the drill as the carving knife in this body sculpting exercise.

If Yang Ping was ever required to perform some plastic surgery involving bone carving, he could entirely rely on this trick and open up a clinic specializing in it.

Little Five was deeply interested in these medical devices. He was so adept at using this video system, he had become more familiar with it than the engineers who designed it. When the video system previously had a software bug, the manufacturers could not solve the issue despite their many apologies. Finally, it was Little Five who fixed the problem.

Huang Jiahui had stopped running a fever, but she still looked very pale. As Yang Ping passed her instrument trolley, she bowed to him, “Hello, Teacher Yang!”

“I hope you are feeling better. If you are not, you can take a rest. You don’t have to be here,” Yang Ping said with a smile.

To herself, Huang Jiahui thought how lucky she was to have met such a good-natured doctor. He had not shown too much discontent even the last time she was late.

The reconstruction of the anterior and posterior cruciate ligaments wasn’t very different from the previous surgery. The anterior cruciate ligament was anatomically rebuilt with an octuple-bundle technique to maximize its functionality, while the posterior ligament was also reconstructed with a double-bundle anatomical reconstruction method. The surgical principles were similar; only the positions of the bone tunnels were different.

The surgery seemed effortless as if a major procedure had been conducted with the same ease as a minor one. If one didn’t know better, they would think they are just making a minor surgery.

After finishing the reconstruction of anterior and posterior cruciate ligament, the posterior lateral and medial structures were rebuilt. There were three necessary structures for the posterolateral corner needed reconstruction: the lateral collateral ligament, the biceps femoris tendon, and the popliteo-fibular ligament. For the posteromedial corner, there were also three structures: the medial collateral ligament, the posterior oblique ligament, and the oblique popliteal ligament.

After reconstructing these eight structures, the joint capsule needed to be repaired. The lateral support band of the patella had to be loosened, and the internal support band had to be tightened, correcting the patella’s track.

The ligaments stretched alternately from the femur bone down to the tibia or the fibula. Each one was to be inserted into the bone canal with precision and appropriate tension. They should all be considered equally without any bias. If anyone ligament was poorly reconstructed, even if it was a bit loose or tight, the surgery would be compromised, which meant failure.

In the whirlwind of devices, the drill whirred on and off. One after another, the foreign tendons were handed over, and they became the patient’s ligaments stretching anterior, posterior, medial, and lateral– the entire joint was densely packed with inserted tendons.

The operators seemed to be very light-hearted and the viewers felt just as easy. After completion, they tested the knee joint for stability. It was incredibly stable–they had managed to perfectly balance stability and tension in one go. Song Zimo was left puzzled.

The patient was wheeled out by Little Five and Zhang Lin. Fatty was very cautious this time. He was afraid that the surgery had been too long so he used a lot of anesthetic. The patient’s operated leg was still numb when they left.

Song Zimo quietly approached Yang Ping and asked, “Where have you practiced such complex surgeries? Can you give me a convincing answer that is not too mystical?”n/ô/vel/b//jn dot c//om

Yang Ping was copying the video. “Do you know Gauss?” he asked.

“Yes, I do. But what does this surgery have to do with Gauss?” Though Song Zimo was intelligent, he couldn’t decipher the hidden meaning behind Yang Ping’s words.

Yang Ping stopped operating his mouse and said, “When Gauss was 19 years old and studying at the University of Göttingen, his teacher would assign him three problems every day. One day, his teacher only assigned two problems. But by mistake, a slip of paper with a problem on it, was stuck inside Gauss’s textbook. Gauss quickly solved the first two problems, but he struggled with the problem on the slip of paper. He spent the whole night working on it. The next morning, he handed in his homework and said guiltily to his teacher, ‘I’m sorry, but I spent the entire night on the third problem you assigned me. I’m afraid I’ve let you down.’ This problem had been a two-thousand-year-old mathematical mystery that neither Archimedes nor Newton could solve.”

After copying the videos and the pictures, Yang Ping stood up. Song Zimo seemed to be in a state of shock, for the answer was apparent in the story itself.

Yang Ping patted his shoulder and said, “Some people can learn the surgery by just watching it once, like you. Others can do the same by reading a book once and render the surgery perfect, like me. Believe it or not, it’s up to you.”

“There’s only one key to these kinds of surgeries; for single structural reconstructions, the position of the tunnel is crucial. For multi-structure reconstructions, you need both the right tunnel position and the right balance. Both are indispensable. To adjust the balance, you will need to rely on your instincts. The few centimeters listed in your textbook are useless. Finding your balance is something you need to figure out on your own. I think after doing a few operations, you’ll understand what I’m saying today.”

Yang Ping asked Su Nanchen for an email address through WeChat. He then sent the video of the surgical procedure for Su’s reference as his patient would soon require similar surgery.