Chinese medical team completes first thoracotomy operation in Guinea

On a morning in October, 2017, the doctors of the China-Guinea Friendship Hospital were as busy as usual. A middle-aged Guinean woman knocked on the door of the chest surgery clinic. Wang Yang spoke with her to learn about her situation.

The patient's name was Keita, 40 years old. She had been experiencing chest pain for more than two years. After vigorous activities, she felt a shortness of breath. This particular symptom had lasted for more than ten years. The patient was diagnosed as having a right lung giant cyst at several hospitals in Conakry. Since hospitals in Conakry and elsewhere in Guinea had never done such an operation, she came to the chest clinic with a last hope of finding medical experts from China. 

Surgical treatment of huge lung cysts is not difficult in China, but in this West African country where thoracotomy experience is scarce, the doctors felt it might be hard to deal with. First of all, anesthesia was a problem. Furthermore, the hospital lacked the necessary surgical instruments. However, if not treated pro-actively, the patient might lose the life-saving opportunity. Wang Yang therefore firmly determined to meet the challenge. 

"This will be the first truly open thoracotomy in Guinea. We have to go all-out with Chinese experts!" Dr. Hashi, director of the Department of Thoracic Surgery at the Chinese Hospital, said excitedly. With the support of the medical team captain Li Xiaobei, the president of the Chinese hospital, Kamala, and its relevant experts the Chinese medical team carried out preparation work and held an operation discussion to talk about the possible problems and solutions.  

The hospital lacked the necessary anesthetics and had limited monitoring methods, which increased the difficulty of implementing general anesthesia. In this regard, the medical team anesthesiology expert Li Zhigang designed a program of "thoracic epidural anesthesia combined with double-lumen tracheal intubation general anesthesia". Nurse Chang Jia stayed in the operating room for several days, and selected alternative surgical instruments from those of other departments. The intensive medical specialist Wang Shuo developed a detailed response plan for the possible changes the patient might experience. At the same time, the other medical team members were actively cooperating to provide the required equipment and medicine. 

On the morning of October 25th, Li Zhigang performed anesthesia according to the established plan. "According to the CT results, our surgical incision was selected on the posterolateral side of the fifth rib, which is convenient for surgery..." Wang Yang expertly performed the operation while guiding the doctors in several hospitals. Soon, the cyst was found. The volume of the giant lung cyst was close to 2/3 of the right thoracic cavity. The mediastinum and pericardium were completely displaced to the left side, and the right middle and lower lobe had undergone complete atelectasis. The cystic fluid was nearly 4000 ml. After Wang Yang and Li Zhigang discussed how to proceed, a method of splitting the liquid was adopted, and the infusion was accelerated simultaneously. Booster medicine was prepared to protect the vital signs of the patients during the operation.

The operation was proceeding in an orderly manner, when suddenly the lights in the operating room were extinguished and the room was completely dark. However, the lighting was soon back. In the dark the doctors had used mobile phones and emergency lights, which provided just enough illumination for Wang Yang to continue the operation. 

Finally, after 5 hours, the operation was successfully completed by everyone's joint efforts, and the patient was sent to the intensive care unit. Although the process was a bit horrifying, all the difficulties were solved by the medical team members. The president of China Hospital, Kamala, and the doctors present at the scene expressed their sincere admiration for the exquisite medical skills and professionalism of the Chinese experts. 

This case created a precedent of thoracotomy operations in several hospitals throughout Guinea. It has played an important role in improving the level of professional diagnosis and treatment of thoracic surgery in several hospitals, and it has also made the flower of friendship between Chinese and Guinean people more beautiful.