Zheng Ren disinfected the skin and covered the area with surgical drapes, then washed his hands again and placed a second layer of drapes.
He did not have to say a word; whenever he extended his hand, the correct tool would be placed in it by Xie Yiren.
Their synchronicity was astounding!
Zheng Ren decided to start with a 15 cm incision on the left side of the rectus abdominis.
Yang Lei and Zheng Ren had experience working together in the general surgery department, although they were dealing with simple appendectomies and hernias back then.
A scalpel was handed to Zheng Ren.
Incision, followed by a blunt dissection. The peritoneum was gently parted to gain access to the peritoneal cavity.
Yang Lei increased retraction to provide a better view for Zheng Ren to begin his work.
As the patient had not been eating or drinking much for the past two weeks, his gut was mainly filled with coagulated blood.
Zheng Ren recalled the imaging post-embolization and identified the part of the intestine that likely contained the bleed, pulling the segment free so that it rested above the body.
“Warm saline gauze.” It was his first spoken instruction.
It was an unusual surgery, requiring unusual procedures.
Xie Yiren nodded and got the circulating nurse to obtain gauze soaked in saline solution.
Zheng Ren was not rushing the surgery. He simply covered the segment of the intestine with the gauze and the surgery came to a pause.
The three department chiefs in the control room had their jaws on the floor.
What was this procedure?
Normally, warm saline gauze was used to cover the incision when there was an abnormality observed partway through the surgery, requiring the surgeon to step out to inform the patient’s family. It was also used in intraoperative frozen section procedures to stall the surgery as they waited for the test results before proceeding with the next step.
Lastly, saline-soaked gauze was also used in situations where the surgeon had lost control of the procedure and had to wait for someone else to take over.
Zheng Ren’s application of the warm saline gauze did not fall into any of those categories.
The chatroom in Xinglin Garden exploded.
[What is the surgeon doing? Why did the surgery pause again?]
[Maybe there’s a switch and they’re waiting for another surgeon to assist?]
[Come on, I put down my beer and snuck into the nightclub toilet to watch this. And I’m using mobile data. What’s this pause for?]
Dissatisfaction festered in the livestream.
The general consensus was that the current surgeon was not the same one from the previous videos and the surgery was on hold, waiting for assistance.
The intestines were filled with blood and it was impossible to find the source of it all!
How ridiculous!
The audience expressed their anger through their comments, something they could not possibly do were they present in person.
If they judged the situation wrongly online, they could just log off the platform with a stung sense of pride, but that was not possible in real life. They would not offend a surgeon whose methods they could not even understand.
Zheng Ren waited for 30 minutes. This was a slow surgery, a contrast from his usual pace.
The warm saline gauze was replaced three times. Whenever Xie Yiren delivered the new gauze, Zheng Ren’s eyes crinkled above the mask and they exchanged a glance of good cheer.
“It’s great to have your own scrub nurse back, huh, boss?” Su Yun suddenly muttered from behind him.
Zheng Ren felt his body tense.
“Relax. I think the necrosis is almost done. Resection can start soon, but try to minimise it; I’ll look over the patient in the ICU.” With that, Su Yun walked out of the operating room without a backwards glance.
Once he had understood what Zheng Ren was doing, he did not bother watching the rest of the surgery.
He knew where the man stood in terms of surgical skill.
A few minutes later, Zheng Ren removed the saline gauze.
There were two distinct colors visible on the segment of intestine.
The pink, fleshy part indicated that the tissues there were still alive and well.
Pale grey denoted the dead segment.
After the embolization of the mesenteric artery branch, a part of the intestine had necrotized due to lack of blood. Zheng Ren was identifying the affected parts.
Necrosis required some time, so Zheng Ren was not in a rush.
The slow surgery was approaching its climax.
Zheng Ren reached out and a scalpel was handed to him.
Based on the difference in color, Zheng Ren made a decisive cut in the intestine 0.5 cm away from the pink segment.
The cut was clean and neat. Within 10 minutes, Zheng Ren managed to remove 40 cm of necrotized intestine and reattached the live sections.
Chatter on the Xinglin Garden livestream had died down. The occasional comment popped up but there was 90% less activity on the stream.
No one spoke in the control room. The three department chiefs with their varying stances on the ongoing procedure were absolutely shocked by what they were seeing.
Even Old Chief Physician Pan could not believe his eyes.
It was a last resort[1]: to embolize the artery and cut off all the necrotized parts of the intestine.
Although collateral damage was significant, there was no better alternative.
Better this than letting the patient waste away in the ICU.
They watched as Zheng Ren expertly performed the general surgery. Department Chief Sun was almost blinded by all that potential…
Zheng Ren’s method was simple and straight to the point. Department Chief Sun would do the same if he was the surgeon.
However, Department Chief Sun could never match Zheng Ren’s speed and accuracy.
The old department chief felt a pang of grief in his heart as he lamented his old age.
Even if he had the speed, he lacked the synchrony Zheng Ren had with the scrub nurse. Zheng Ren only had to reach out and the right tools would appear almost instantly in his hand.
Even a weathered department chief such as himself had never met someone who could work this well with him.
It was… exceptional!
With the resection complete, the cavity was rinsed and suctioned. A final check was done to ensure there was no active bleeding before the abdomen was closed up.
A large part of the surgery had been spent waiting for the segments to necrotize.
[I think I just went blind for a second there.]
[I salute the surgeon for being able to perform such a surgery.]
[I can conclude that every decision the surgeon makes is the right one. He has never gotten anything wrong since the first appendectomy livestream.]
[Where are the skeptics and naysayers now? Come out and explain this!]
[Amazing. Such an innovative procedure; perhaps I can try this if I encounter a similar case.]
[Don’t be naive. The surgeon has guts and skill. If you make a mistake in a surgery like this, it’ll turn into a huge lawsuit.]
Once the abdomen was sealed, the livestream ended and comments flooded the screen.
The procedure was not Zheng Ren’s own. He had read about it in various medical journals discussing similar case studies.
However, his advantage over his peers lay in his expertise in both interventional and general surgery.
Others had to rely on an interventional radiology specialist to perform the imaging before passing the baton to the general surgeon. Having the same person perform both procedures was a completely different matter.
Under Zheng Ren’s knife, the patient was treated swiftly and thus the risk of post-surgery complications was greatly reduced.
“Ding dong~” The System rang, signaling a completed mission.
[1] The original text for “last resort” is 死中求活 (lit. “dying to live”), used in reference to a move in the Chinese board game Go equivalent to sacrificing one’s own pieces to achieve a larger victory.
