There were two surgeries arranged by Chen Bing today. The original plan was to connect Liu Deqian to the operating room after Liu Deqian's surgery. Unexpectedly, he was able to have a separate operating room, so he was able to go to the operating room early for surgery.

According to Chen Bing's idea, after Liu Deqian completed the two operations, he would definitely go there in the afternoon. He would perform one operation and leave another one for Lu Cheng. Even if it took a little time, it wouldn't matter.

However, since things have changed, then the thinking can be slightly changed. Today there are two surgeries, one is shoulder arthroscopy for rotator cuff suturing, and the other is shoulder arthroscopy for frozen shoulder debridement.

With plenty of time, Chen Bing wanted to see how far this young boy he had brought out had gone. Last time in the youth sports medicine competition, Lu Cheng shined, but after all, it was just a simulation instrument. That's it, that was a competition, and today's surgery is a real person's surgery.

After getting dressed, Chen Bing looked at the time and said, "Xiao Lu, can you handle the two surgeries today?"

When Lu Cheng heard this, his eyes suddenly lit up. Director Chen was giving him experience points and gold coins.

He immediately said: "You can give it a try."

Chen Bing is not a junior doctor. His current technical level is probably at the same level as that of Chang Weilong and others, and he does not need much practice at all. Among Chen Bing’s followers, the only one whom Chen Bing trusts the most is Guo Xiaoyong, but It seems that Guo Xiaoyong's pre-operative preparations are quite difficult, and he probably hasn't reached the stage where he can practice surgery yet.

There are specialized instrument nurses responsible for arthroscopy in the operating room, but they are all in Liu Deqian's operating room. However, the instrument nurses do not have to do many operations. Chen Bing only needs a little teaching to complete the arthroscope operation. .

After doing this, Chen Bing said: "Our mirror may be different from the mirror you use at the Second Xiangya Hospital. You can take pictures by yourself on the operating rod, so you don't need a particularly professional instrument technician to cooperate." .”

"You come on."

Chen Bing gave up the surgeon's position and walked between the hand-washing nurse and the operating table.

Shoulder arthroscopy is usually carried out in the lateral decubitus position with the upper arm suspended, so the assistant does not really need much help. However, Chen Bing was afraid that the nurses in the vascular surgery department would not know some of the instruments used in total arthroscopy, so he simply served as a semi-part-time assistant. , a semi-part-time device nurse assigned to Lu Chenglai.

Lu Cheng immediately changed his position, and as soon as he reached the operating position, he immediately said: "Xiaoyong, did this patient have an accessory kidney when he was sent for surgery before surgery?"

Guo Xiaoyong glanced at Chen Bing, as if he didn't understand.

Lu Cheng understood and said, "Then take a tube of saline."

Chen Bing said: "It's time to go around and get a syringe."

Then he explained: "The preparation of the accessory kidney and normal saline can reduce the bleeding of the wound. It is a standard operation before doing the arthroscopic approach. I usually feel that it may not be very useful, so I am too lazy to do it."

"Xiaoyong, when you want to learn arthroscopy in the future, you should learn it with Xiao Lu. My current path is a bit wild."

It is true that people who are particularly good at arthroscopy may not be suitable for junior teaching, because generally such doctors or professors have enough experience and confidence to perform very large-scale surgeries.

However, for beginners, if the preoperative preparation is not sufficient, the field of vision during the operation will be extremely poor, so it is not suitable to learn from experienced people.

Guo Xiaoyong perked up immediately after hearing this: "Okay, Director Chen."

Then he gave Lu Cheng a mysterious smile, meaning you are my eldest brother! It is your responsibility to take care of your younger brother.

Lu Cheng's current arthroscopic handoscopy skills are sufficient, but Lu Cheng still feels that following the standard steps is the most appropriate and can obtain a better field of view.

Fill the joint cavity, open it, and bluntly penetrate the shoulder joint capsule.

This series of operations has become Lu Cheng's instinct, so basically Lu Cheng broke into the joint cavity with a sharp knife and straight pliers.

After picking up the arthroscope and having a conversation, Lu Cheng was dumbfounded. Looking at the clear portrait in the arthroscope, he said, "Director Chen, the field of view of this arthroscope is so good?"

The clarity on the display screen of this arthroscope is at least twice that of the arthroscope performed by Lu Cheng at the Second Xiangya Hospital. Even the pores on the face can be seen.

Chen Bing then smiled and said rather shyly: "I told you before that I usually don't do arthroscopic augmentation. It will be the same when you get out of the water later. In fact, this arthroscopy was brought in by Liu Deqian.

All are the latest models.”

"And the arthroscopic instruments you used at the Second Xiangya Hospital are probably the ones that were used more than ten or even twenty years ago. Of course they are not as good as those now."

The development speed of sports medicine in each hospital is different. For example, the arthroscopy of the Second Xiangya Hospital of Xiangya Hospital has been developed for at least 20 to 30 years. The equipment will definitely not be replaced easily. A set of equipment can cost at least dozens of pieces.

Thousands or even millions.

Except for high-end private hospitals, no one can afford to buy new equipment, but newly developed sports medicine hospitals will definitely buy the latest equipment.

So this is actually an advantage.

Wearing the arthroscope sleeve, Lu Cheng inserted the arthroscope into the shoulder joint cavity and immediately saw a clear view of the shoulder joint. This is definitely the kind of high-end camera that can see even extremely small rough spots.

See.

This patient had a rotator cuff injury and had been in the hospital for a short time, so the synovitis was very mild.

Lu Cheng walked around the shoulder joint and only used a planer to polish off some small rough objects, thus completing the joint debridement of the shoulder joint capsule.

Lu Cheng took pictures of the long head tendon of the biceps brachii, bankart and other locations one by one, and said: "Director Chen, it is so exciting to perform arthroscopic surgery. I have never seen such clear joints.

The view inside the mirror is also strong enough for Izuku.”

"No wonder the steps of joint filling and accessory kidneys are no longer needed."

All the details are actually to facilitate the operation, expand the field of view, reduce bleeding, etc. But this arthroscopic instrument itself can avoid so many things, so Lu Cheng's previous operations seemed a bit redundant.

This made Lu Cheng feel like he came from the countryside.

Chen Bing said: "That's not entirely the case. Your operation is still necessary. In addition to reducing bleeding in the joints, the accessory kidney can also reduce bleeding from the approach, which is quite good. Xiaoyong, you must remember to take care of yourself in the future.

Make it a habit."

Then Chen Bing said: "Xiao Lu, you can go a little slower during the arthroscopy. We can see clearly, but we can give Xiaoyong a little explanation."

Lu Cheng thought for a moment and then said: "Director Chen, I am thinking about cleaning the next frozen shoulder. It must be done in detail, so I will try to save some time on this one. I will definitely want to do it on the next one."

You can see the structure you see.”

Surgery for frozen shoulder can be said to be simple or complicated.

Chen Bing nodded and said no more.

Guo Xiaoyong suddenly felt that he was redundant.

Then Lu Chengcheng moved the arthroscope directly to the subacromial space. The rotator cuff can only be seen in the subacromial space. This patient has a tear of the supraspinatus, so the supraspinatus must be inspected under the acromion.

Suture the gaps.

When it comes to sewing routines, Lu Cheng's thinking is particularly clear.

After reaching the subacromial space, Lu Cheng made another opening for the operating position, and at the same time made a third opening directly, which was the opening for the sleeve.

While doing this, Lu Cheng explained: "Director Chen, I am used to directly making the hole for the sleeve first, because it must be placed, so I can have one more approach to clean the joints in advance, which can save some money.

Time can also avoid opening another mouth."

Chen Bing smiled cheekily, but he cursed in his heart, you bastard, I don't believe you. What if you just opened the third hole? What if you don't do it right? Then you have to open the fourth or even the fifth hole.

A hole?

Chen Bing nodded and said: "Yes, but Xiaoyong, just skip this step. Don't follow him. This is also a wild way."

Only when you are almost absolutely sure about the rotator cuff suturing, will the sleeve insertion approach be done from the beginning.

The level of surgery and skills of a person can actually be seen from these details. Chen Bing instantly raised his assessment point of Lu Cheng.

However, when Lu Cheng put the planer into the gap under the shoulder, Lu Cheng's speed immediately increased.

While cleaning the synovial membrane, he said: "Xiaoyong, help me pull the shoulder joint a little more, just use a little strength."

Guo Xiaoyong was still at a loss. Chen Bing immediately took Guo Xiaoyong's hand to where it should be, and at the same time cursed: "Read more books when you go back. You just learn surgery on the stage. When do you want to learn it?"

Go? Be sure to understand all the surgical procedures and principles in advance."

Guo Xiao nodded bravely and thought to himself, Alas, the gap between Brother Lu and me is getting farther and farther. Lu Chengdu has already started surgery, and I can't even memorize the surgical steps.

Lu Cheng didn't care so much and started cleaning up directly.

This was a fresh injury, so there weren't many things to clean. Immediately afterwards, Lu Cheng used the probe hook to dig into a certain position of the rotator cuff from the third approach, and he immediately hit the 'soft spot'

Click on it, apply some force inside, and it will break through, and the torn rotator cuff will poke out.

This is an incomplete rupture of the supraspinatus muscle, but with only a small amount missing, it is impossible to maintain the stability of the shoulder joint and fully perform its proper abduction function of the upper limb.

Lu Cheng then said, "Director Chen, you're pretty lucky. It's not completely broken. You just need to sew it up."

"Um."

"It's time to nail the outer row." Although Chen Bing was surprised that Lu Cheng found the location of the fracture point so quickly, he still had auxiliary information such as MRI before the operation, and it was still normal.

Lu Cheng quickly used the plasma knife to hit two spots where the outer row should be nailed, and then said: "Tourist, nail the outer row."

"Hole Punch!"

Chen Bing had already given the hole punch to Lu Cheng, and then walked to a pile of equipment to point out what the outer row of nails were.

By the time Lu Cheng punched out the holes for the outer row of nails, the two wired nails had already reached the stage.

This combination was so satisfying. Lu Cheng felt that this surgical procedure was invincible.

After screwing in the two outer row nails, Lu Cheng was about to call for the patrol to get stitches, but Chen Bing mysteriously handed over something again and said, "Xiao Lu, this suture bag is mine."

Name, this is the special suture device I bought."

"Would you like to try? You just need to thread the thread here, then click here and the suture will pass through the tendon, and then you can take the thread again."

Chen Bing said this while letting Lu Cheng test this thing.

Lu Cheng was petrified on the spot.

MLGB, what is this?

Is there such a thing?

The most difficult part of rotator cuff suturing is to sew the thread through the sleeve and bring the thread out from the opposite side. This is also a key point in the rotator cuff suturing process, and it also depends on a person's depth of understanding of rotator cuff injury suturing.
To be continued...