I, Aki Tomoya, will not be a simp.

Although the head of the department was still unsure whether he could resolve the matter, Yoshida Aoba was already taking precautions.

In any case, let Aki Tomoya accumulate experience in minimally invasive surgery first.

"But Dr. Yoshida really trusts me."

"If I trusted you, I wouldn't have reminded you."

Yoshida Aoba shook his head and then placed the patient report on Aki Tomoya's desk.

These are the patients he selected.

From now on, Aki Tomo will be this patient's surgeon.

"Male, 37 years old, weighing 70 kg, with rheumatic heart disease, mitral stenosis, tricuspid regurgitation, and left atrial thrombosis..."

The electrocardiogram also showed atrial fibrillation.

That's pretty impressive.

Yoshida Aoba really knows how to pick patients for him.

This means that he needs to resolve all of the patient's symptoms at once, and also find ways to deal with complications.

"This requires immediate surgery. Dr. Yoshida, what are your plans?"

"If you can come up with a surgical plan as soon as possible, I will schedule the surgery for him within the next few days."

"You really didn't give me any time to prepare!"

Akitomo was also a little depressed.

It's tomorrow, which means he only has these two days to prepare the surgical plan, and in between, there are surgical instructions and for the patient to sign an informed consent form.

"I hope you can come up with a preliminary plan for tomorrow afternoon's seminar."

Well, they really didn't give him any time to breathe.

I will be busy next time.

As for the surgical team, barring any unforeseen circumstances, it will likely still be the same few people.

……

At the surgical seminar on the second day, Yoshida Aoba arranged for Aki Tomoya's patient to be second in line.

Because Yoshida Aoba had already reminded Aki Tomoya, Aki Tomoya raised his hand and began to explain under the watchful eyes of all his colleagues in the department.

"The surgery can be performed using a fully thoracoscopic approach."

"Dr. Anki, are you planning to be the surgeon?"

Sasaki Ichiru, who was standing next to the head of the department, asked.

He glanced at Yoshida Aoba sitting next to Aki Tomoya.

"That's right, if possible, please let me be the surgeon."

Aki Tomoya couldn't back down at this point, even though the watchful eyes of Sasaki Ichinori and the head of the Monobe department were indeed quite intimidating.

At this moment, Sasaki Ichiru signaled to Aki Tomoya to continue speaking.

"I will expose the diseased mitral valve through the atrial septum, remove the diseased valve tissue, and replace it with a mechanical mitral valve."

What if atrial fibrillation is eliminated?

“Atrial fibrillation was treated using the Medtronic Cardioblate flushing surgical radiofrequency ablation system.”

Sasaki nodded, glanced at the treatment on the projection screen, and told him to continue and not stop.

"The left atrial thrombus was completely removed and the left atrial appendage was ligated. Because the patient also had tricuspid regurgitation, a DeVega repair was performed at the same time."

"Based on the advice of Dr. Aoki from the anesthesiology department, we will use peripheral cardiopulmonary bypass. For arterial perfusion, we will choose the right femoral artery. We will perform an ultrasound examination before the operation to rule out the presence of severe aortic sclerosis or aortic dissection aneurysm, so as to avoid serious complications such as cerebral embolism."

To explain this, Aki Tomoya was actually trying to tell Sasaki Ichiru that he also knew that thoracoscopic surgery was being performed, so the more traditional open-chest surgery, including cardiopulmonary bypass, had to be modified accordingly.

So there's no need to worry that he doesn't know how to perform thoracoscopic surgery.

After Sasaki entered, he asked a few more questions, which Aki Tomoya answered one by one.

A complete surgical plan requires further discussion and deliberation. After the surgical team is decided, the anesthesiologist and the extracorporeal perfusionist will discuss the plan together.

Basically, without any surprises, Aki Tomoya passed the surgical seminar smoothly.

The surgical team also followed the default arrangement.

The surgeon was Tomoya Aki, with Yoshida Aoba as the first assistant, Majima as the second assistant, Nishikino as the third assistant, and Dr. Aoki from the anesthesiology department as the third assistant.

"Develop a complete surgical plan as soon as possible, and then have the patient sign an informed consent form."

After the seminar, Yoshida Aoba patted Aki Tomoya on the shoulder and gave him a reminder.

"Dr. Yoshida, wouldn't it be better if you came to help?"

"I'm giving you a chance to learn, so don't take it for granted."

Chapter 508 Smoothly?

That makes so much sense, Aki Tomoya was speechless!

He couldn't even say "no" to himself.

Fortunately, Majima and Nishikino are still around.

This was my first time performing a thoracoscopic surgery. Although I lacked experience, there was still some medicine in my abdomen.

After discussion, a complete surgical plan was developed as quickly as possible, and Aki Tomoya and Yoshida Aoba successfully got the patient to sign the informed consent form.

At 9:11 a.m. on May 21, the patient was wheeled into the operating room for preparation.

At 9:32, the anesthesia was administered.

Anesthesiologist Aoki used intravenous combined anesthesia and double-lumen endotracheal intubation.

Three small holes, each 1-2 cm in size, were made in the patient's right chest wall.

The first port is located in the third intercostal space next to the right sternum, and the second port is located in the fourth intercostal space along the right midaxillary line. These locations have been marked in advance.

"Now we will begin the thoracoscopic mitral valve replacement. Please give me your feedback."

The chief surgeon, Aki Tomoya, nodded slightly in acknowledgment.

"Please give me more advice."

The surgery officially began.

"...The condition is stable."

"To make a hole".

The first foramen is located in the third intercostal space next to the right sternum.

The second foramen is located at the fourth intercostal space along the right midaxillary line.

The third foramen is located at the fifth intercostal space along the right anterior axillary line.

The holes are made one by one. The first and second holes are for operation, while the third hole is for inserting the endoscope.

……

"Perform the infusion."

Extracorporeal circulation begins.

Aki Tomoya stared at the surgical field on the monitor and began the surgery through the operating port.

"Look carefully at the top and get used to it as soon as possible. Thoracoscopic surgery feels different from when you use a scalpel yourself."

Yoshida Aoba whispered a reminder from the side.

Operating a thoracoscopic instrument and performing open-chest surgery using your own hands are two different procedures with different feel.

Since it was his first time using this technique, Aki Tomoya was somewhat unaccustomed to it.

But since he is the surgeon, Yoshida Aoba hopes that Aki Tomoya can adapt as quickly as possible.

"Dr. Yoshida, please give my surgeon some face."

Aki Tomoya's eyes were fixed on the display screen, and his hands were slowly operating the control panel.

In the operating room, the surgeon has the highest authority.

For Yoshida Aoba, as the top assistant, to say such a thing is a complete disrespect and undermines his authority.

In the operating room, challenging the surgeon's authority as a surgical assistant is a very serious matter.

Of course, the actual situation is not that serious.

Aki Tomoya's words seemed more like an attempt to relax the atmosphere.

Although the patient's condition was somewhat complicated, and it was his first time undergoing thoracoscopic surgery, the procedure was not as serious as it would have been if no one had made a sound.

The fact that he can still talk back shows that he is confident and that the situation is under control.

"Expose the diseased mitral valve and prepare for its removal. Dr. Nishikino, you will assist me."

As per the established surgical plan, the diseased mitral valve was exposed via the atrial septum, and then the diseased valve tissue was excised.