Surgery Godfather

Director Guan is different. Director Guan is proficient in cardiovascular interventions and hardly engages in other interventional surgeries.

"Professor Yang, thank you for your efforts." Director Ji felt somewhat embarrassed. He knew Yang Ping was usually quite busy with surgeries and research.

But there was no choice. This patient had been troubled for a long time at the City People's Hospital. After being transferred here, he tried several times unsuccessfully. He realized it wasn't simple; surely, the guidewire and coil were entangled. He was really afraid that further attempts might harm the patient. So he decided to ask Yang Ping for help.

Yang Ping said, "No need for formality. Let me see what's going on."

"Right-side cerebral embolism received intravenous thrombolysis treatment at the City People's Hospital, but the thrombolytic effect was not satisfactory. A follow-up CT of the head showed the original vessels were still narrow and occluded. They decided to implant a stent via intervention for the patient, but unfortunately, the micro-guidewire broke during the surgery. The chief surgeon there, honestly, was an idiot. Upon encountering this issue, he kept it a secret, thinking he could resolve it alone. He fussed in the operating room for three or four hours, not only failing to retrieve the broken guidewire but further breaking it into two more pieces during the process. That fool went crazy, wanting to continue fussing. The patrolling nurse and anesthesiologist couldn't bear watching any longer and secretly reported it to the department director. The department director hurried over, saw the mess, and rushed out to communicate with the family, explaining that there was an accident in the surgery and the broken guidewire must be retrieved now. The family got upset hearing this—a surgery that wasn't done well has now involved an accident. No wonder it took so long in the operating room without any explanation from the doctors; it naturally made the family very upset…."

"The family there explicitly expressed no longer having trust in them, insisting on an external specialist to handle it urgently before transferring the patient to our hospital."

"We have also dealt with retrieving broken micro-guidewires sent from other hospitals or rescued other surgeries at other hospitals. However, today, we tried several times unsuccessfully, and trying more would risk puncturing the blood vessels, leading to intracranial hemorrhage. Thus, we had no choice but to ask you for help."

Director Ji and Director Guan from the Intervention Department both had good personal connections with Yang Ping. They were decent people, so upon realizing their several attempts were ineffective, they didn't persist and promptly asked Yang Ping. So they called Director Zhao of the Medical Services Office since this involved an external patient, and there might be disputes in the future. All actions needed to follow procedures, requiring going through the Medical Services Office.

"Stop rambling, just get to the point! There are three broken guidewires inside currently. We just assessed that the broken guidewires might be entangled with the coil, and we dared not attempt more, fearing causing further issues," Director Guan interjected impatiently as Director Ji was narrating. He and Director Ji were like brothers, so he felt no need to hold back.

Director Ji was unsatisfied: "Aren't I explaining the medical history's causes and effects to Professor Yang? The medical history must be conveyed."

Indeed, talking too much now is useless. Regardless of who's right or wrong, what causes and effects there were, those don't matter now. The priority is understanding what's the issue and finding a solution.

Yang Ping stood before the imaging screen, examining the preserved angiography images of the head blood vessels carefully. There were three pieces of the broken guidewire: one 10 centimeters, another 5 centimeters, and one about 3 centimeters. The longest piece was bent inside the cranial blood vessel cavity, with the other two pieces entangled with it.

It's estimated that the doctor there tried using the guidewire-binding method to retrieve the broken guidewire, a common technique for handling such accidents, but sequential accidents occurred unexpectedly.

A thrombus was visible at the middle cerebral artery segment where the guidewire was, which wasn't easy to manage.

The current situation was indeed related to the chief surgeon. After encountering accidents, he fussed unsuccessfully for a long time and always tried secretly to solve it, thinking this approach would cover up the issue, which was evidently wrong.

In case of accidents during surgery, the family should be informed immediately.

This is the protocol ethically, legally, and procedurally in medicine. Whether the family can understand or if there will be trouble is another issue, but as family, they have the right to know.

Secretly trying to resolve it, even retrieving the guidewire, poses a risk of leaving other latent safety hazards.

For instance, the extracted guidewire might cause vascular wall injury during retrieval. If doctors do not inform the patient or family, the patient might die of cerebral hemorrhage post-discharge.

If the family is informed, preemptive measures could be taken, preventing such tragedies.

Moreover, trying unsuccessfully must not lead to forced continuity. Assistance should be sought from department directors, the medical office, or colleagues with stronger capabilities, leveraging collective strength to resolve it. While no irreversible incident can be undone, the harm caused by the accident can still be minimized.

The guy kept it hidden, clinging to solving it alone, proving he was either foolish or malicious.

The guidewire's current condition was obviously influenced by his multiple operations, making retrieval harder and causing vascular wall damage.

"What are the vital signs?" Yang Ping asked.

The anesthesiologist immediately reported the vital signs data. It seemed stable at present, allowing the surgery to proceed.

In fact, encountering guidewire fractures in interventional surgeries is seen sometimes, and often it can be retrieved. This particular guidewire appeared entangled with the coil, forming a locking mechanism difficult for retrieval.

Director Ji said, "I tried using a homemade snare to no avail—it either couldn't grip it or if it did, pulling back didn't work, and excessive force risks rupturing the blood vessel. It's likely the guidewire is entangled with the stent wall."

In intracranial vascular interventions, scenarios like coil escape, forced microcatheter retention, wedged or fractured micro-guidewires constitute tricky and serious issues. There are numerous solutions, and Directors Ji and Guan have extensive experience in these cases, even assisting in surgeries at other hospitals at times.

Reports claim guidewire fracture probability is low, but actual incidence is likely understated since many such cases aren't documented in published papers.

Even if Director Ji attempts a few more times, the likelihood of retrieval is high, yet for the patient's sake, he opted to involve Yang Ping. If repeated attempts fail, further trials only worsen the situation; requiring Yang Ping's eventual help unnecessarily increases the difficulty for him.

Yang Ping analyzed the images mentally and concluded the guidewire entanglement method was necessary. Considering catheter balloon compression methods, the catheter's delivery at that site was difficult. While the entanglement method of the guidewire might risk further fractures—making existing complexity worse—the homemade retrieval device seemed relatively straightforward and less risky.

The homemade retrieval device resembles a lasso, and the front end has a loop that contracts to lock. This loop is used to seize the broken guidewire's proximal end. Once secured, a gradual retreat pulls the guidewire out.

Yang Ping scrubbed up and got on the stage, with Director Ji assisting. Yang Ping reviewed the instruments on the table, "Let's use your homemade loop device. I'll give it a first try."

Yang Ping inserted a guidewire with a loop, extending to the tail end of the broken guidewire. The loop extended and ensnared the broken guidewire's tail, tightening it as he gently pulled back. Indeed, the broken guidewire had formed an entanglement with the coil. Extracting the guidewire required either disentangling from the coil—nearly impossible—or retrieving the coil alongside it, a plausible but highly challenging task, posing severe risks to the vessel. Such coils are designed for permanent implantation, with no plan for retrieval, making it extremely difficult.

If it weren't challenging, Yang Ping wouldn't have been asked for help; Yang Ping understood that clearly.