Surgery Godfather

Chapter 126: Chapter 0123: Sniping through the Wall

The silence was brief, the discussion continued, tense and heated.

In academic discussions, there’s no room for diplomatic twists and turns. Sometimes arguments can escalate, with table pounding and faces turning red. No one would concede to another.

The presence of Professor Su prevented such explosive situations from occurring, but debates were inescapable.

“Director Han, do you have any thoughts?” Director Zhao asked.

Director Han stood upright, akin to a general initiating a war meeting, “The best method is still to carry out a nerve root block. However, in order to avoid anesthesia leakage, it’s essential to insert a cannula into the nerve root sheath, which is incredibly challenging. Yet, it is feasible.”

The subject was steered towards the nerve root block. The director of the oncology hospital scanned his tablet with one hand and rested his chin in the other. After a moment of contemplation, he said, “The difficulty of a nerve root block is indeed immense. From what I see, the tumor has a rich vascular supply, and the patient’s coagulation function is also not ideal. If a mispuncture occurs penetrating into the tumor tissue, it could lead to uncontrollable hemorrhage, formation of epidural hematoma, spinal cord compression, and in turn, respiratory depression. Eventually, we would have to resort to a respirator. As you can see, the surrounding soft tissue is entirely tumor, leaving limited space for puncturing, a mispuncture, and subsequent bleeding can happen quite easily.”

“Indeed, that’s the case. This type of puncture is like sniping—it must be accurate and not miss, as a single error could result in serious consequences.” Director Yu of Fuer’s orthopedics department agreed with the oncology hospital’s view.

There was an outline to the plan – nerve root block. It seemed like no one else could think of other alternatives, but considerable challenges lay forth.

Everyone’s gaze rested on Professor Su, handing the difficult problem over to him.

Professor Su steadied his tablet with his left hand, rested his right elbow on the table, took off his glasses, and said, “Everyone has explained their views in detail. It seems that nerve root block is the only choice and no one seems to objective. The difficulty lies in the puncture. It’s indeed challenging, but not impossible. We need to leverage CT and MRI for 3D reconstruction and find a way to choose the correct puncture path. With the help of computer-assisted navigation technology during surgery, punctures can be achieved.”

The puncture is challenging, but feasible. That was Professor Su’s conclusion.

“What if it fails? What are the rescue measures?” Director Yu of Fuer expressed a different opinion.

Professor Su took a cloth to clean his glasses and said, “This is an excellent question. Every medical procedure carries inherent risks. Faced with these risks, we must strive to prevent, but also prepare rescue measures. If the puncture fails and penetrates the tumor causing bleeding, we abandon the puncture and install a drainage tube along the puncture path. We can use negative pressure to discharge the blood and avoid spinal cord compression due to hematoma.”

Professor Su demonstrated quick thinking and meticulous planning. In a short time, he organized the plan selection, risk control, and remedies for the worst-case scenario. Director Yu admired him.

This kind of puncture is far from simple to achieve and reflects a person’s cognitive ability and accumulation of knowledge and experience.

Just like firing a sniper rifle, it’s never as simple as pulling the trigger. Each trigger pull is the result of painstaking efforts.

“Are there any other opinions?” Director Zhao, as the moderator, asked.

Director Han smiled and said, “What about the two young fellows? Do you have any thoughts? Don’t keep silent.”

Ordinarily, Professor Su wouldn’t ask Su Nanchen to speak at such an occasion. It was enough for him to listen. But as Director Han suggested, it would be a harmless chance for the youngsters to gain experience. Professor Su turned to Su Nanchen who was sitting next to him and asked, “Your seniors are affording you such a precious opportunity. Do you have any brilliant ideas?”

Confident yet humble, Su Nanchen said calmly, “Thank you, Professor Han, for granting me the opportunity to speak. The puncture indeed resembles sniping, and the target is hiding in a bunker. The puncture needs to avoid both the tumor and bone tissue, leading to very limited options for puncture paths. If possible, we can use 3D printing technology to recreate the spine, tumor, nerves and vessels. We could use a precise one-to-one model for puncture path planning and simulate the puncture. We might even temporarily design a locator tool. In combination with navigational equipment during surgery, the success rate of punctures would greatly increase.”

This young man’s cognitive ability is impressive. Being able to integrate advanced 3D printing technology with puncture operation and according to him, the success rate could potentially multiply.

The directors looked at Su Nanchen with newfound respect. Even without the help of Su Qingyun, he could make significant contributions to the field of medical science.

Professor Su put on his glasses again, “Xiao Yang, do you have any thoughts?”

Professor Su had a good memory. Director Han introduced him only once, and he had already remembered the name. Whether it was for nurturing the younger generation or for giving a token of appreciation, it was appropriate to invite him to express his views.

Director Han encouraged, “Professor Su called on you, please say a few words.”

“Xiao Yang, what do you think?” Director Zhao also encouraged.

Yang Ping calmly said, “Thank you, Professor Su and everyone else! I think that the puncturing needle does not need to avoid bone tissue, instead directly passing through the bone tissue and pedicle. Bone tissue is actually the safest area. There would not be any risk to blood vessels as long as the puncturing needle is in the bone tissue, we don’t need to know where the hidden danger lies, just where there aren’t any.”

The pedicle is a bony tunnel connecting the front and back of the vertebra, with hard cortical bone on the outside, and loose spongy bone on the inside.

This point of view is very novel and breaks conventions.

“Since the enemy has hidden in a bunker, a dead angle for our trajectory, we will accurately calculate the enemy’s position in the bunker, fire at the bunker wall, pierce through the wall, and then let the bullet pass through the hole on the wall to snipe the enemy. Thank you everyone.” Yang Ping finished speaking.

Professor Su looked once again at the three-dimensional reconstruction image on the tablet. This idea is indeed imaginative. The entire puncture path is within the bone tissue, only piercing through the bone tissue in the last step. This not only reduces the chance of mistake but completely eliminates it. The chance of injury is almost non-existent, the rest is just a matter of how to hit the enemy.

Puncturing through the pedicle is a basic procedure for any spinal surgery. It is highly unlikely to fail. However, the routine pedicle approach cannot be used and needs to be tilted. The target is inside the spinal canal, not inside the vertebra itself.

Professor Su is interested, “Xiao Yang, your idea is imaginative and very feasible.”

“If we combine penetrative bone puncturing and pedicle puncturing with Dr. Su’s 3D printing to simulate puncturing, the success rate would be very high and the feasibility would be beyond question.” Director Han combined the ideas of both.

The director of the tumor hospital laughed, “Indeed, young people have a good imagination. One of them brought up 3D printing and another proposed sniping through walls, interesting. It seems we are getting old.”

Director Yu joked, “I see you’re still sitting here after drinking two bottles of water and you don’t seem to need the bathroom, where have you grown old, I can’t see it.”

Everyone laughed, relaxing the tense discussion.

“Now that we are clear about the puncture path and methods to increase the success rate of puncture, it’s time for action. Does anyone have other suggestions?” Professor Su asked everyone.

After discussing this issue to such an extent, everything has become very clear.

“Bone puncturing avoids the risk of tumor injury and significantly reduces the likelihood of bleeding, but it does not completely avoid bleeding. The puncture path includes all the cancellous bone, which may bleed and the puncture needle will not enter the vertebra but tilt and break through the bone tissue into the spinal canal. The blood may flow into the spinal canal from the puncture tube, causing a hematoma compression. Although this is unlikely, there is still a possibility, so there needs to be a contingency plan.” Director Yu pointed out the flaws in our plan.

“This kind of bleeding is different from blood vessel rupture. It is a small amount of blood infiltrating from the bone surface. The catheter with a balloon at the end can be used. Calculate the distance, coat the balloon with bone wax and place it into the bone canal, then inflate the balloon to compress the bleeding area.” Professor Su immediately suggested. Clearly, with little thought, he had come up with this on-the-spot solution, showing his vast knowledge in the field.

“Brilliant!” exclaimed Director Yu.

Now there was a contingency plan for unexpected situations and the proposal was very comprehensive.

“Any questions, professors?” Director Zhao asked.

Everyone just shook their heads and drank water.

Finally, Director Zhao concluded, “So the plan is set: perform a Thoracic 2 nerve root block, place a tube using the bone penetrating method, preoperatively simulate the puncturing using 3D printing, and use computer navigation assistance during the operation!”

“Professor Su, what do you think about this?” Director Zhao sought Professor Su’s opinion. Though he presided over the meeting administratively, it was ultimately Professor Su who made the professional decision.

“Yes, the ‘Sniping through Wall’ plan will be utilized!” Professor Su decisively concluded.