Chapter 418: Hepatectomy
Translator: EndlessFantasy Translation Editor: EndlessFantasy Translation
“The liver is crushed. It’s a Level 3 injury at the very least.” When Huo Congjun performed the laparotomy, he saw the massive accumulation of blood inside the abdominal cavity. After two young doctors aspirated the blood, the liver was finally somewhat visible.
Right then, Zuo Liangcai only craned his neck forward and asked, “It’s blunt hepatic trauma. There’s irregular trauma, and the inferior vena cava has ruptured too.”
“The duodenum is ruptured too.” Huo Congjun frowned when he looked from the top all the way down of the abdominal cavity.
“Blood loss is happening very quick,” the anesthetist reported.
Huo Congjun hummed and said, “The gallbladder has ruptured, and it needs to be removed.”
“No other way but to remove it,” Zuo Liangcai agreed.
Huo Congjun quickly and gently took a look at the condition in the abdominal cavity. He began to repair the inferior vena cava and said, “The right lobe of the liver is seriously damaged. What do you think we should do?”
“Block the hepatic portal. Use hemostatic forceps to bluntly rupture the liver tissue, ligate, and cut the blood vessels and bile duct, followed by a hepatic trisegmentectomy,” Zuo Liangcai answered quickly.
However, the doctors on the spot smiled after they heard that, including a young attending physician by the side who could not even become the third assistant.
The smile on everyone’s face was definitely not of encouragement for Zuo Liangcai. Zuo Liangcai loved to read motivational books and always tried to grab any possible chance that presented itself. That trait of his was not very favored by most of the young middle-ranked or junior-ranked doctors.
The smile on everyone’s face showed that they had the same reason for disliking Zuo Liangcai. ‘This man sure has a lot of little tricks up his sleeves.’
For example, he had skipped mentioning the Pringle maneuver when he answered Huo Congjun, but no one knew whether it was intentional or not.
The blunt rupture of liver tissue could be handled using the Pringle maneuver. The blocking of the hepatic portal could also be handled using the Pringle maneuver.
Everyone could easily guess the reason why Zuo Liangcai did not talk about the Pringle maneuver. Ling Ran’s barehanded bleeding control was so famous that he even published a research paper on it. If the Pringle maneuver were to be applied right then, Ling Ran’s ability to compete for a spot to perform the surgery would become much greater.
However, little tricks were just that—tricks. They were never useful.
If everyone could see through Zuo Liangcai even when he attempted to hide the Pringle maneuver, it meant that all the doctors, who originally never thought that the Pringle maneuver was better, had begun to think deeply of its advantages…
Huo Congjun would, of course, not forget Ling Ran’s skills just because Zuo Liangcai did not mention it.
In fact, Huo Congjun thought about things further than he did.
“If we do that, it’ll be a standard hepatectomy,” Huo Congjun concluded what Zuo Liangcai said in one go. Then, he faced Ling Ran and asked, “What do you think? Do you want to perform a standard hepatectomy?”
“Laparoscopic debridement of the hepatic region would be more suitable,” Ling Ran answered.
Zuo Liangcai pursed his lips. ‘If Huo Congjun asked the question that way, then it’s obvious that he already had an answer in his mind. He didn’t even need to answer.’
“Doctor Zuo, please tell us the advantages and disadvantages of a standard hepatectomy and laparoscopic debridement of the hepatic region,” Huo Congjun suddenly called out Zuo Liangcai’s name.
This question was a bit harder. Those who did not study would not be able to answer it. Only those who studied could answer it easily.
Zuo Liangcai finally felt that the world was slightly fairer, and he said, “Standard hepatectomy removes the parts of the liver according to the region. Overall, the removed area is larger. If the patient can’t withstand it, he’ll encounter postoperative complications and even death. Laparoscopic debridement of the hepatic region is irregular. The debridement will not be performed according to the liver segments or lobe distribution. The surgery requires continuous ligation on the blood vessels and bile duct. This can ensure that the liver tissue is greatly maintained, but it will pose a challenge, because the different domains of the liver will be affected differently…”
“There’s one more point. Standard hepatectomy requires higher skill. If the surgeon’s skill isn’t very good, mistakes will easily be made. Huo Congjun paused for a moment before he said, “We need to race against time. So, we’ll use laparoscopic debridement of the hepatic region. Ling Ran, you’ll become my assistant. Doctor Zuo, you’ll handle the duodenum.”
“Yes.”
The junior doctors answered very quickly. Some of their expressions appeared normal, while some of them did not feel satisfied in their hearts.
Ling Ran stood across Huo Congjun and worked as the first assistant.
Huo Congjun looked at the monitor and talked to the anesthetist, “Pay close attention to the acidity level…”
“Yes, currently, it’s at six,” the anesthetist answered.
“Remember to refill the sodium bicarbonate,” Huo Congjun said before he lowered his head and added, “Emergency hepatectomy, we need to hurry up.”
“Yes.”
“Endotherm knife.” Huo Congjun cut along the area where the liver was ruptured. He had his head lowered when he said, “Now I’m going to remove the liver tissues that no longer have any blood circulation. Ling Ran, do you know how to do it?”
“Ligate the ruptured vessels and bile duct,” Ling Ran said, and he started to do what he just described.
For a candidate who had carried out more than hundreds of finger replantations, suturing blood vessels was as simple as eating and sleeping. The doctors by the side were confident in Ling Ran too.
Everyone had seen the patients who received finger replantations come and go. If anyone mentioned Yun Hua Hospital’s Hand Surgery Department now, they would automatically add Yun Hua Hospital’s Emergency Department and even mention Ling Ran’s name.
The frequency of any normal person requiring finger replantations was really low. Otherwise, Ling Ran’s reputation would not have been limited to the industrial area.
However, doctors had their own abilities to judge the skills of other doctors.
Doctors cared a lot about the time taken for a surgery, the surgical outcome, surgical difficulty, prognosis, and so on. Besides, the number of surgeries performed was also another important benchmark. Now, even though Ling Ran was young, there was no one who would question his expertise on finger replantations or the M-Tang technique.
Hence, there was no need to even mention reconnecting the blood vessels.
Huo Congjun also had great confidence in Ling Ran. He did the incision on his own and allowed Ling Ran to complete the more important task, which was to ligate the blood vessels.
Ling Ran’s fingers flew.
He did not need an additional assistant as he did the suturing and ligation with his own hands. His movements were as fast as Huo Congjun’s.
Huo Congjun just thought that Ling Ran was racing against the clock, so he approved of Ling Ran’s actions in his mind.
The most important thing in a hepatectomy in the Emergency Department was speed.
Once the incision was made, the rupture would become even greater. Furthermore, due to the high blood supply in the liver, the patient could lose hundreds of ounces of blood at any moment.
At that moment, suture speed became very crucial.
If the suture was not good enough, the surgeon could go back and perform a double ligation later; it would not affect the situation too greatly.
“I’ll make another incision, then we’ll check again later.” Huo Congjun performed very quickly as well and told Ling Ran what he wanted to do.
Ling Ran nodded. His fingers still moved very fast while he ligated the exposed blood vessels and bile duct.
Both of them became very tense, and it caused the room to suddenly turn silent.
“You can’t just do it for the sake of speed,” Zuo Liangcai mumbled again. He could not see the situation in the abdominal cavity. He could only see that Ling Ran and Huo Congjun’s movements were very fast. He felt that Ling Ran was being too rough and careless during the suture.
Huo Congjun did not oppose his statement. He nodded and said, “We still need to ensure the ligation quality of the great blood vessels.”
“Yes,” Ling Ran replied. But even though he said that, his movements and speed did not change at all.
As the saying went, “You take care of your part, and I’ll take care of mine.” In Ling Ran’s case, if he always listened to what others said, his life would be a mess. There were too many people who wanted to give him suggestions.
Huo Congjun did not comment much anymore. He would use up a lot of his mental strength if he wanted to complete the hepatectomy while trying to retain the liver tissues to the best of his abilities.
Huo Congjun threw away the scalpel when he finished all the incisions. Then, he started to check the blood vessels and bile duct Ling Ran had ligated.
“Are all the small vessels ligated?” Huo Congjun was surprised.
“To prevent recurring symptoms,” Ling Ran said.
“Hmm… let me take a look…” Huo Congjun felt like he was a plasterer, and Ling Ran was a painter. The plasterer was tasked to plaster the wall, and the painter followed suit by finishing off the painting right after him.
The most amazing thing was that the details painted by the painter were almost perfect.
“Your hepatic debridement is outstanding,” Huo Congjun could not help but exclaim when he looked at the vessels that had been ligated.
“It’s a bit different compared with the blood vessels in the four limbs. But I just needed to get used to it,” Ling Ran concluded based on his experience.
This time, Huo Congjun chuckled.
The process of blood vessel anastomosis may be quite similar, but there was no way Ling Ran did not consider the characteristics of the liver and its anatomy when he did that. He would not have been able to perform the ligation so quickly, otherwise.
“Have you practiced this before?” Huo Congjun asked.
Ling Ran said, “I tried to understand it a bit.”
“Okay…” Huo Congjun did not want to ask more. When he saw that the bleeding had stopped, he said, “I’ll leave the rest to you as well.”
“All right.” Ling Ran did not try to decline modestly at all. He started to clean the wounded area as soon as he took over.
Zuo Liangcai was jealous because he never got a chance like this.
“Doctor Zuo, come over and help too.” Department Director Huo gave Zuo Liangcai the position of the second assistant again with just an order.
“Yes…” Zuo Liangcai could not reject it, and he returned to stand next to the surgical field.
