On June 24, the Academic Week of "Dihgley"Minimally Invasive Medicine 2022 hosted by Wenzhou Central Hospital came to an end on June 24. Compared to 2021, this academic week had larger scale and broader impact.
During the 7-day period, more than 20 thematic forums and 30 live streaming surgeries were being staged in turn, with more than 270,000 people in total viewing them online. 20 departments participated in the whole event, carrying out academic exchanges and seminars online and offline in various forms such as scientific, technological innovation and transformation. In addition, Yang Minghuan, the academician of Chinese Academy of Sciences, and Fu Guosheng, the professor and director of the Department of Cardiology at Sir Run Run Shaw Hospital affiliated to Zhejiang University, and other "Specialists" in the related industries also make their appearance in the Academic Week to share their views on minimally invasive cutting-edge technologies.
Of course, the most eye-catching part of the Academic Week was the live streaming of the surgery, where the most experienced surgeons of "Medical Viewing Instruments" used skillful techniques to unclog blood vessels and remove tumors under the endoscopes, just like a blockbuster movie being played.
"Explore the way" in U-shaped blood vessels
"Seal" blood with spring rings
Department: Neurosurgery department team
Disease: Intracranial left posterior communicating aneurysm
"Intracranial aneurysm" is called a "bomb" in brain, which is usually not felt, but once ruptured, the mortality rate is extremely high. In fact, intracranial aneurysm is not a tumor, but an abnormal bulge on the wall of an artery within the skull.
A 77-year-old Granny Chen is an intracranial aneurysm patient suffering from heart disease for many years. Aheart pacemaker is installed in her body, and she takes anticoagulant medicine orally for a long time. Then due to dizziness, she did a cranial magnetic resonance imaging (MRI), which shows that she has had left posterior communicating aneurysm. The surgical team, led by Sun Jun, performed "stent-assisted spring coil embolotherapyof intracranial aneurysm" for her. The difficulty of this procedure was twofold: first, the medical spring coils were filled into the aneurysm from the inside of the blood vessel to "seal" the blood and reduce the impact of the blood flow on the aneurysm's vessel wall, thus reducing the risk of rupture. In addition, while sealing the blood from the aneurysm, the posterior communicating artery emanating from the aneurysm must be completely protected, otherwise there is a risk of serious "stroke" due to vascular occlusion.
Because her aneurysm was at the turning point of the blood vessel, which has a large turn equivalent to a U-shape. Protecting the posterior communicating artery required crossing the stent microcatheter over the U-shape turn into the posterior communicating artery and then releasing the stent through the microcatheter to protect the vessel, which was quite difficult. By repeatedly shaping the microcatheter and microguidewire tip, as well as making many attempts with extreme patience, Sun Jun's team was able to successfully deliver the microcatheter to the intended location and successfully place the stent. At the same time, a soft metal material called a spring coil was fed into the aneurysm through the microcatheter to seal the aneurysm so that blood could not enter the aneurysm.
During this surgery, Sun Jun's team acted as "bomb disposal experts", having remotely defused the dangerous "bomb".
Crush "stones" with "diamond drills"
Unblock vascular channels
Department: Cardiovascular medicine department team
Disease: Coronary heart disease
"Heaven forbid there is a calcification in the coronary artery." This is a phrase often said by cardiovascular physicians. Why? Calcification is hard as a rock, and it is difficult to unclog the blood vessels.
This year, 72-year-old Granny Sun is a patient with severe calcification of the coronary arteries. She has problems with three blood vessels in her heart, one is narrow and the other two are blocked due to calcification. In addition to high blood pressure, diabetes, and poor physical condition. It was found through examination thather heart had been enlarged, with heart function declined.
Vascular unclogging surgery is not difficult, while it is very difficult in the treatment of calcification. Ji Xiaojun comparedcalcification to a stone, he said, just like someone walking on a road, he stumbles upon a large stoneblocking the road in front of him. A common shovel can’t be used to remove the stone, and the only way will be breaking the stone into pieces, and then shovel them away. To unclog the blood vessel, a high-pressure balloon is needed to dilate the vessel and then implant a coronary stent. However, because of the serious calcification, the balloon can not pass. At this time, the "ultimatetechnique", "difficult coronary artery internal membrane rotating and grinding technology", will be used. Simply put, a tool similar to "diamond drill"is used to rotate and grind the calcified tissue to open the "channel" and then put in the stent. It sounds simple, but it is quite difficult to do so. The thickness of the blood vessel wall is less than one millimeter, and the rotational speed of the drill is 150,000 rpm, so you have to be very careful during the operation, or else the blood vessel will be drilled through, resulting in massive hemorrhage.
Clinically, the cardiovascular medicine team has carried out many cases of this procedure, solving the treatment problems for patients with severe calcification and whose coronary arteries fail to dilate. This surgical live streaming was successfully completed without pause by the team.
Open two "windows"on the "stent"
Fit he arterial opening perfectly
Department: Vascular Surgery Department Team
Disease: Aortic Arch Aneurysm
Aortic arch aneurysm is one of the most dangerous and complex diseases in vascular surgery due to its high mortality rate and hidden incidence.
According to Li Chunmeng, traditional open surgery requires chest opening and extracorporeal circulation, which is more traumatic and has a higher complication rate, therefore, patients prefer minimally invasive surgery. However, minimally invasive surgery still faces great challenges due to the proximity of the arch lesion to the heart and the many important branch vessels.
Patient Wu, 71 years old, had a large aortic arch aneurysm with a complex morphology and location, which was near the left subclavian artery and the left common carotid artery. In the end, Li Chunmeng's team decided to perform endoluminal isolation of the aortic arch aneurysm by placing a coated stent into the lesion, which was just like putting a strong "protective net" on the large blood vessels and "hollowing out" the aneurysm so that no more blood flow would pass through, thus ensuring that the tumor would not continue to grow and rupture. At the same time, however, another difficulty loomed. When the stent is used for isolation, the left common carotid artery and the left subclavian artery will be covered. The key isthat cerebral infarction may occur if the left common carotid artery is occluded for more than 30 minutes.In order to quickly open the left common carotid artery, Li Chunmeng's team proposed an extracorporeal pre-opening method, which meant that two "windows"were opened on the overlaid stent beforehand, and after the stent was inserted, the two ports could be accurately aligned with the openings of the left common carotid artery and the left subclavian artery, which was more demanding on the doctor's technique and spatial stereoscopic thinking. After careful evaluation and precise measurement, the openings were successfully aligned with the incisions. This daring surgery made many experts who were watching the live streaming give two thumbs up!
"Squeeze" the tumor from the navel
Make the incision "invisible"
Department: Gynecologic Oncology Department Team
Disease: Uterine Fibroid
What is the highest realm of surgery? Scarless surgery should be one of them. This pneumoperitoneum-free transumbilical single-port laparoscopic uterine fibroid myomectomy performed by Huang Yitong's team has made minimally invasive surgery more and more "micro".
The patientMrs. Li, 40 years old, was seen for increased menstrual flow for more than 2 years. On examination, her uterus was significantly enlarged to the size of a pregnancy of more than 70 days, and ultrasound showed a uterine fibroid tumor with a diameter of nearly 7 centimeters. When surgery was proposed, Ms. Li was a bit worried, as she had heard that surgery would leave scars on her stomach. Huang Yitong told Mrs. Li that she could have a single-port laparoscopic surgery, which means that an opening is made here in the navel to remove the fibroid, and then the uterus is sutured into shape. After the surgery, the natural pits and folds of the navel can be used to hide the incision, making it "invisible".
After thorough preoperative evaluation and preparation, this surgery was broadcast live during the academic week. Originally, because of the small incisionand the narrow operating angle gap of single-port laparoscopic apparatus, it is easy to cause inconvenience while using surgical instruments, but since Huang Yitong team has performed this type of surgery time after time, she coulduse the surgical instruments with ease, and easily completed the operation.
It is worth mentioning that the team also made its own device to suspend the abdominal skin, which can remove the airtight device and does not require carbon dioxide inflation to make the abdomen bulge. It is convenient for the replacement and use of surgical instruments, and it is easy to take out the specimen, avoiding the use of the crusher. This surgical method is more suitable for uterine fibroids, and benign ovarian tumors, etc.
Source: Wenzhou Business Newspaper
Editor: Liu Yue Chen Xiang
Executive Editor: Hu Xiangyue Qiu Yinghui Chen Huanxiao
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