N-M Chapter 944: Co-casting Plan (Part )
Chapter 944: Co-casting Plan (Part )
Hepatobiliary Surgery Center, Kyoto Hospital, Kyoto.
In the strategic conference room, which has top-notch sound insulation and image transmission systems, the atmosphere is like a taut bowstring.
Thomas Wilson's latest liver enhanced CT three-dimensional reconstruction images and color Doppler ultrasound dynamic images are clearly displayed on the huge high-definition projection screen.
The tumor entrenched in the vital area of the liver portal was precisely marked, colored, and enlarged on the screen, like an insidious and deeply rooted demonic fortress.
Its "tentacles" (infiltrated parts) tightly entangle, compress and deeply invade the main trunk of the left portal vein (PV-L), causing this key blood vessel to be distorted and deformed in the image, with narrow lumen and disordered blood flow signals.
The top forces in the field of hepatobiliary surgery in China and the United States gathered around the oval conference table.
Sitting in the main seat was Dr. Borg, the world's top hepatobiliary surgery expert who performed the operation. Next to Borg was Chen Yang, the core partner of the operation.
On Borg's side are his core Mayo team: Emily Ross, a senior instrument nurse with 20 years of experience known as the "Golden Hands"; and Dr. David, a world-leading expert in extracorporeal circulation and vascular surgery.
On Chen Yang's side were the pillars of Kyoto Hospital's hepatobiliary surgery department - chief physician Zhong Dongyang and members of Kyoto Hospital's hepatobiliary surgery department, two deputy chief physicians, three senior attending physicians, Professor Liu Zhenhua, director of the anesthesiology department, and Wang Lan, the head nurse with the most experience in the operating room.
Yuan Zhengmin and Wen Rongxuan attended the hearing as important witnesses and supporters. Jiang Yan served as the translator throughout the hearing, ensuring that every professional term and subtle intention was accurately conveyed.
Except for Zhong Dongyang, other experts from Kyoto Hospital did not participate in the operation, but they could sit in as observers and make suggestions at the planning meeting, mainly for the purpose of learning.
Being able to communicate with experts from the Mayo Clinic is also a rare opportunity for the hepatobiliary surgery department of Kyoto Hospital.
"Dear experts, this is a strategic deduction that integrates the top medical wisdom from the East and the West to save lives. There is only one goal: to develop the best, safest, and most risk-controlled surgical plan for Thomas Wilson."
The person who spoke was Wilson's personal assistant.
"On behalf of Mr. Wilson, I would like to thank all the experts and hope that everyone will give their best in this operation."
"Dear colleagues..."
After Wilson's assistant expressed his gratitude, Borg, as the surgeon in charge and initiator of the meeting, spoke first.
"Everyone has already learned about the patient's information in detail. The core difficulty is self-explanatory: How to safely treat this 0-centimeter-long left branch of the portal vein invaded by the tumor while ensuring complete removal of the tumor (R2.5 margin, i.e., no cancer cells remain under the microscope)? There are only two options: direct removal followed by end-to-end anastomosis? Or must autologous blood vessels (preferably the great saphenous vein) or artificial blood vessels be used for transplantation?"
The laser pen in Borg's hand circled the healthy areas at both ends of the invaded PV-L segment (point A and point B) and the length that needs to be reconstructed: "If we choose direct end-to-end anastomosis, how can we ensure the long-term patency and tension-freeness of the anastomosis in such a limited operating space? The relationship between the tumor and the left branch of the hepatic artery (LHA) is equally dangerous. How can we avoid accidental injury? The right hepatic duct has also been partially invaded. How can we repair it to ensure smooth bile drainage after surgery? Any mistake in any link may lead to catastrophic consequences."
Borg's questions were like cold bullets, hitting the vital points one by one, and each one was a matter of life and death.
David from Mayo hesitated for a moment and expressed his opinion first. He pointed to the 3D model of blood vessels and the ultrasound blood flow simulation on the screen and said, "Based on the latest high-resolution images and intraoperative ultrasound plan simulation, I insist that the risk of direct end-to-end anastomosis is extremely high."
"The vascular wall structure of the PV-L segment invaded by the tumor is bound to be destroyed and brittle. After resection, the length of healthy blood vessels available at both ends is likely to be less than 1 cm. Forcible anastomosis under tension may lead to stenosis due to edema and inflammation in the early postoperative period. In the long term, due to scar contracture and hemodynamic changes, the probability of thrombosis or stenosis is very high."
"So I strongly recommend the use of autologous great saphenous vein transplantation. Although the surgical steps increase, the time is prolonged, and an additional lower limb incision is required, it can ensure that the blood vessel length is sufficient and the anastomosis is tension-free. The long-term patency rate is supported by a large number of successful cases, and it is currently the safest choice."
Zhong Dongyang pondered for a moment and slowly said, "Dr. David's opinion is very professional. Autologous vascular transplantation is indeed a mature and reliable gold standard solution."
"But the problem is, although Mr. Wilson's physical condition has greatly improved after two weeks of effective Chinese medicine conditioning by Dr. Chen, his overall reserve and tolerance are still not good enough to withstand the extended operation time. You should know that this plan will increase the operation time by at least 1-1.5 hours, and will also cause greater surgical trauma."
"Autologous blood vessel harvesting itself also has risks such as infection and hematoma. Should we pursue a more 'simple' but technically demanding and relatively risky solution - direct end-to-end anastomosis? This requires us to accurately assess the patient's tolerance limit and the surgeon's technical limit."
As one of the top hepatobiliary surgery experts in China, Zhong Dongyang has a very sharp vision.
Others also expressed their opinions, and the focus of the debate was firmly on the method of vascular reconstruction.
"Chen, what do you think?" Borg looked at Chen Yang.
At this time, all eyes were focused on Chen Yang.
The final outcome of the plan will largely depend on the young doctor who will be responsible for the most core and dangerous operations.
Chen Yang was the doctor in charge of the most dangerous operation. At the same time, Chen Yang was responsible for Wilson's preoperative recovery during this period. The effect was remarkable, which made everyone very convinced of Chen Yang.
Previously, the experts at the Mayo Clinic had somewhat looked down on Chen Yang, thinking that Borg had overestimated Chen Yang. However, Wilson's data during this period was like a heavy punch, leaving everyone at the Mayo Clinic speechless.
So Borg asked Chen Yang, and everyone became quiet, looking at Chen Yang, waiting for Chen Yang to speak.
Zhong Dongyang looked at this scene and couldn't help but sigh with emotion. Last year, when Chen Yang was studying in Kyoto, he and Chen Yang performed surgery together for the first time. He didn't expect that in just one year, Chen Yang had become such an authority in the field of hepatobiliary surgery.
You have to know that this conference room is filled with the world's top hepatobiliary surgery experts. Being the focus in this conference room means that your success is extremely valuable.