Surgery Godfather

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Johns Hopkins Hospital, the surgery had just begun, but the meeting room was already in chaos.

"Are they planning to use local anesthesia to complete the surgery? It's absurd. I finally understand why so many people oppose this surgery. It's a disregard for life and a serious violation of medical ethics. Two living children are lying there, undergoing local anesthesia, having their skulls opened, and brain surgery performed. Can you imagine the pain these children are enduring? I can't stand it. This is not surgery; it's an execution!"

The neurosurgery director, Raymond, was the first to shout in anger. He felt that Taxol was hiding the conscience that belongs to a doctor.

Massimo calmed him down, "Stay calm and judge after watching the surgery. Being hasty is not your style, Raymond!"

"Is he planning to perform a craniotomy while awake? This brainstem surgery under awake craniotomy, is there anything more ridiculous than this? Does he even understand neurosurgery? Has he read any literature? Does he have any basic knowledge in neurosurgery? Morris is really a bastard, bewitched, and desperate, sending a bunch of daughters to this charlatan for surgery. We've repeatedly told him that surgery shouldn't be done, should not be done! Yet he wouldn't listen. Fine, now we see, letting someone perform a medical tragedy here!" Raymond pointed and gestured, and if it weren't for the public setting, he would have been cursing loudly.

"He's a Nobel laureate, not a charlatan. He's my teacher, not a charlatan!" Massimo sternly reminded him.

"His award is only in the field of genetics, not in neurosurgery. In the field of neurosurgery, he's an amateur. Just because I'm a neurosurgeon doesn't mean I can perform heart surgery, nor does it mean I can repair cars or play basketball in the NBA." Raymond stood by his opinion.

Massimo was unfazed, "Sit quietly, then shut your mouth. After seriously watching the entire surgery, I believe you will change your opinion. So please quietly watch the complete surgery. It won't take much of your time, and judgment should be based on full awareness, not hysterical shouting, what are you yelling about."

"Alright, for your sake, I'll give him two hours. If those two girls scream even once, tomorrow I'll fly to China and throw eggs on his face." Raymond said breathlessly, the anger earlier got to him.

In the video, the chief surgeon personally performed the local anesthesia for the patient. The technique was extremely adept. Soon, the local anesthesia of the scalp was complete.

After the local anesthesia was completed, there was a brief pause to allow the anesthetic to take effect, and then the surgery continued. The connection between the surgical steps was very smooth and rhythmic.

The technique for opening the scalp was so seasoned that it left one's eyes unresponsive. The cooperation of the assistant was also very coordinated. The chief surgeon's forceps gently lifted the scalp, and as the surgical knife moved across it, the scalp clamp immediately held it in place, leaving no chance for scalp bleeding.

The surgical knife was like a dexterous automatic tool, tracing a beautiful arc. By the end of the surgery, all the scalp clamps were in place.

Surprisingly, there was hardly any bleeding upon opening the scalp, and the gauze for hemostasis stood by unused. What was going on?

Moreover…

Throughout the process of opening the scalp, the two sisters remained cheerful, and their voices could be clearly heard in the video, completely unchanged.

Apparently, despite it being local anesthesia, the anesthesia was very adequate, and the effect was excellent, so the two sisters felt no pain at all.

Dr. Raymond's eyes fixed on the screen, the technique of incising the scalp was so adept, it was as if it could single-handedly draw perfectly precise circles, straight lines, and arbitrary shapes.

This is strange. Can local anesthesia have such a good effect? Could the sound in the video be dubbed?

The incision technique was so swift, and the hemostatic technique was so proficient that there was hardly any scalp bleeding. How could this be possible?

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Meanwhile, at the Mayo Clinic's meeting room, the atmosphere was very tense. The observing doctors were there with a learning attitude. As the surgery had just begun, this simple anesthesia had already been a lesson for them.

A brainstem surgery under local anesthesia, the first in the world, was set to create history in neurosurgery.

Yang Ping had been to Mayo many times for surgery, becoming a spiritual mentor in the hearts of these doctors. In their minds, Yang Ping was the embodiment of the pinnacle of medical skills in the world.

There was no argument, no doubt here, only pairs of focused eyes. They didn't dare miss any details, as each might contain high-level medical techniques unknown to them.

When they saw the awake craniotomy under local anesthesia, their eyes widened. Professor Yang did not use ordinary local anesthesia but precise nerve blockade techniques. He relied on his extremely familiar anatomy to block the nerves upstream, requiring only a minimal amount of anesthetic to maintain the anesthesia for a long time.

This refined surgical thinking has conceptually surpassed other doctors, marking them as targets for every doctor's learning.

The entire meeting room was exceptionally silent. One could even hear the breathing of colleagues nearby.

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After the scalp was opened, the next step was to cut the periosteum, then lift the bone flap, revealing the brain tissue along with its membrane. The pulsations of cerebrospinal fluid were clearly visible. Upon opening this membrane, the brain tissue inside became visible, which is the brain's core region responsible for human life's governance, often referred to as the life center.

This region was once referred to as a forbidden zone because lesions involving the brainstem bring great challenges to surgical treatment due to its deep location and adjacency to vital nerve and blood vessel structures.

The proximity to vital nerve and blood vessel structures means that approaching the brainstem requires avoiding these critical nerves. In this process, the safety of these nerves and blood vessels must be ensured.

The brainstem contains numerous nerve nuclei, located deep within. To reach the target area during surgery, one must navigate through many nerve nuclei, which govern life activities, hence the surgery cannot damage these nerve nuclei and must enter through the gaps between these nuclei.

With the continuous advancement of neurosurgical techniques, correctly choosing the surgical approach to the brainstem has become the key to improving surgical efficacy and reducing complications. These safe surgical approaches rely on in-depth research of brainstem anatomy.

Today, the approach used by Yang Ping is referred to as the suboccipital transcerebellar approach. The patient is positioned prone, with a midline incision chosen, exposing the suboccipital area down to the posterior arch of the first cervical vertebra. The dura mater is cut in a Y-shape to expose the cerebellar tonsils. By retracting the cerebellar tonsils and the posterior inferior cerebellar artery laterally, and dissecting the choroid plexus and inferior medullary velum, the rhomboid fossa and the lateral recess are exposed, thus allowing the safe operative zone near the facial colliculus to be placed within the surgical field.

This is merely the approach to the brainstem. Entering the brainstem involves a route not belonging to any existing approaches. If necessary, it can be called Yang's No. 1 approach. The reason it's called No. 1 is because similar new brainstem approaches include No. 2, No. 3, and many more.

From the scalp incision to the exposure of the brainstem, the actions are seamless, employing layered local anesthesia: anesthetizing one layer and cutting one layer, the entire process flowing smoothly like clouds and water.

Thus far, the rhythm of the surgery is excellent, making it a pleasure to watch. Whether they are neurosurgeons or other types of surgeons, they must admit that such surgical fundamentals are unparalleled.

The rhythm of the surgery gives a sense of artistic beauty, with no superfluous actions, no repeated motions.

Song Zimo was the first assistant, Xu Zhiliang the second. They saw Yang Ping's adept start and couldn't imagine that despite not having performed surgery for a long time, the professor's hand skills were still so superb, with not the slightest hint of unfamiliarity, hardly resembling someone who hadn't operated in a long time, rather someone who performs a dozen surgeries a day.

The concerns before the surgery were completely unnecessary. The professor's confidence indeed had a foundation. It seems the professor's surgical talent is innate, undoubtedly bestowed by the founding master. There's no helping it; despite not performing surgery for so long, he's still more adept than the two of them, who operate from dawn to dusk daily and trained extensively for this particular surgery.

It seems diligence cannot compensate for the gap in talent.