My Medical Skills Give Me Experience Points Chapter 1400 - 556: Preoperative Assessment—The Two Most Easily Overlooked Types of Malignant Transformation (2)

The rare occurrence of dual-surgery typically happens only in dire, life-saving emergencies when operating on two areas simultaneously becomes unavoidable.

Otherwise, the typical approach prioritizes the most life-threatening surgical site, with less urgent procedures being postponed as far as the situation allows.

Undertaking surgery on multiple parts of a patient's body at the same time introduces significant harm and exponentially escalates the inherent risks for the patient.

It requires an exceptionally seasoned and highly skilled lead surgeon to even contemplate taking such a gamble.

In practice, it is far more common and safer to have distinct surgical teams alternate their efforts on the patient.

For instance, consider a pregnant patient experiencing an aortic dissection.

This scenario might necessitate obstetricians to first conduct a cesarean delivery to safely remove the fetus, after which cardiovascular surgeons can then proceed with the critical aortic dissection operation.

Currently, Zhou Can’s team is still in its nascent stages, possessing limited experience.

His ultimate ambition is to forge his vision of an ideal, all-encompassing surgical unit, comprised of numerous premier teams – such as specialized units for cardiac surgery, thoracic surgery, general surgery, orthopedics, anesthesiology, nutritional and surgical nursing, and comprehensive postoperative care, among others.

Achieving this grand vision still presents a substantial challenge.

For the present, it remains an aspiration, yet he is diligently working towards realizing this objective.

Consider, for example, the cardiac and thoracic teams, which are in the process of development.

In the future, once his capabilities are sufficiently realized, he envisions the direct integration of two elite cardiothoracic teams, with General Surgery following suit.

On that anticipated day, Tu Ya would boast the most formidable surgical collective in history.

Its collective surgical prowess could potentially ascend to become the preeminent force in the nation.

"During the previous esophageal repair surgery, the approach involved a left posterolateral thoracotomy, accessing the thoracic cavity through the fourth intercostal space."

Tan Shengli provided this detail from the side.

It appeared he had likely overseen the preceding operation.

"The incision was executed with textbook precision, and the suturing was impeccable. This indicates that your hospital's physician performing that surgery was of an exceptionally high caliber, and the lead surgeon displayed remarkable conscientiousness. I would venture to say that achieving such a level of skill is nigh impossible without at least twenty to thirty years of dedicated suturing practice."

Zhou Can offered this tactful commendation to the other party.

This was a form of praise devoid of specific attribution, often termed 'blind praise'.

It functions as a method of complimenting the completed work itself, rather than focusing on any single individual. By this means, it effectively sidesteps any suspicion of overt flattery, allowing the individuals involved to feel genuinely pleased.

Zhou Can had a strategic rationale for commending Director Tan prior to commencing the surgery.

Operating in an unfamiliar environment and needing to rectify previous work, securing the cooperation of the preceding surgeon could dramatically mitigate potential risks. Information that might elude formal reports, medical records, and surgical documentation would likely be promptly shared.

"You are unduly flattering me, truly. To be perfectly candid, during that patient's surgery, I personally oversaw both the initial incision and the final closure."

Despite wearing a surgical mask, Director Tan's eyes conveyed a clear sense of amusement.

Zhou Can's complimentary remarks had evidently filled him with considerable satisfaction.

"So it was you who performed the incision and suturing; it’s no wonder the quality was so exceptional! Were there any particular challenges encountered during the surgery?"

Seizing the moment, Zhou Can used this opportunity to inquire about the specifics of the prior operation.

Given that the patient was returning for further treatment, the previous lead surgeon, perhaps concerned about preserving their reputation, might have intentionally omitted certain critical details.

Yet, it could precisely be these concealed issues that held the key to the subsequent formation of the esophageal fistula.

"Regarding difficulties, yes, there were a few. Upon entering the thoracic cavity, if I recall correctly, the patient's thoracic space was quite congested with a considerable amount of food residue, mixed with alcohol and various foodstuffs, emitting a potent odor."

Director Tan made a concerted effort to reconstruct the specifics of the prior procedure.

"Cleansing the thoracic cavity demanded substantial effort; working alongside my assistant, we meticulously removed the food debris before irrigating the thoracic cavity. When it came to suturing the lacerated esophagus, it felt considerably tougher than a standard esophagus. Based on my experience, a hardened esophagus often indicates brittleness; consequently, I adopted a cautious suturing technique, employing closer stitch spacing to preempt any secondary tearing. Yet, unexpectedly, a fistula emerged on the third day following the operation."

As he recounted the post-operative complications, Director Tan displayed palpable signs of vexation.

His sentiment leaned more towards a sense of frustration and disappointment.

Sometimes, the realities of the medical field unfold in just such a manner.

It is possible for the lead surgeon and the entire medical team to have performed their duties with utmost diligence, executing the surgery flawlessly with extensive experience. Post-operative care, too, might have been administered with meticulous attention. However, the unpredictable hand of fate can intervene, leading to the development of postoperative complications in the patient.

Such outcomes are, regrettably, often beyond avoidance.

"The information you've provided is exceedingly valuable. I suspect the patient’s esophageal fistula is not a result of surgical quality; rather, it stems entirely from the patient’s own physical constitution. Has an endoscopy examination been performed on the patient?"

While offering reassurance to the other party, Zhou Can grew increasingly certain that the patient's esophagus presented underlying issues.

If this were not thoroughly investigated, executing a hasty repair of the fistula might inadvertently lead to the formation of a secondary esophageal fistula.

Drawing upon his extensive clinical surgical experience, he deemed it prudent to examine both the esophagus and the stomach.

"We were genuinely focused on preserving the patient’s life at that critical juncture and did not proceed with an endoscopic examination."

Director Tan’s eyes flickered as he expressed this, shaking his head.

When a patient's esophagus is torn, performing an endoscopy also presents considerable difficulty.

"Hmm, I observe that a nasogastric tube has not yet been inserted for the patient. How about I conduct a gastroscopy examination first? Director Hei, would that be acceptable?"

Skillfully sidestepping the need to solicit opinions from Song Qian and Director Tan, Zhou Can opted to directly address the anesthesiologist.

To be more precise, he recognized that his guard was never truly lowered at First Hospital.

In reality, it wasn't solely him; every doctor on duty maintained a heightened sense of caution.

This was especially true when surgical intervention was necessary.

"Yes."

Director Hei gave her assent with a nod.

"However, exercise extreme caution during the procedure; the patient’s esophageal wall may be quite fragile and susceptible to perforation."

Out of a sense of responsibility towards the patient, she offered this kind reminder.

Had she been aware of Zhou Can’s exceptional talents in endoscopic surgery, she might have reconsidered her cautionary words.

The gastroscope was promptly retrieved, requiring minimal supplementary preparation. With steady hands, Zhou Can guided the endoscope’s probe into the patient’s esophagus.

During this examination, it is advisable to ensure the patient's head is tilted backward.

This is because the human throat possesses an inherent curvature.

Tilting the head back helps establish a straighter pathway through the throat, trachea, and esophagus, which aids in examinations or the insertion of feeding tubes, among other procedures.

As the endoscope advanced deeper, Zhou Can focused intently on the display screen.

The condition of the inner esophageal lining became clearly discernible.

"There are ulcers present within his esophagus!"

Zhou Can identified distinct ulcerative markings, postulating that these were a primary factor contributing to the esophageal fistula's formation.

The human esophagus is, in truth, significantly narrower than one might anticipate.

This is due to its inherent elasticity.

When individuals chronically abuse alcohol and frequently consume spicy foods, their esophagus gradually forfeits its elasticity, becoming delicate and vulnerable under repeated damage.

The state of this patient's esophagus represented the most severe Zhou Can had ever encountered.

As the gastroscope progressed further, the condition of the stomach also came into view.

Consistent with the results from previous ultrasounds and CT scans, the stomach's condition remained relatively satisfactory.

No particularly critical issues were detected.

A few superficial gastric ulcers were noted, which could be managed with medication and a suitable postoperative diet, allowing for gradual improvement.

If gastric ulcers persist over an extended period, they carry an increased risk of developing into cancerous growths.

This assertion is not an exaggeration; it's attributable to their unique internal environment.

Should ulcers within the mouth consistently appear in the same spot without healing, elevated vigilance is advisable, as oral cancer can readily develop.

According to research conducted by the International Health Organization, individuals experiencing prolonged oral ulcers often exhibit a compromised immune system.

Consequently, these patients are more susceptible to developing oral cancer.

The habitual chewing of betel nut is widely recognized both domestically and internationally as a significant contributor to oral cancer, as it induces fibrosis within the oral cavity.

In many advanced cases, by the time cancer is diagnosed, the mouth opening can be reduced to half its normal size.

Similar to oral cancer, stomach cancer frequently goes unnoticed.

Many individuals simply endure occasional stomach discomfort, bloating, and a burning sensation, oblivious to the fact that these could be precursors to incipient cancerous changes.