Chapter 422: Removed
Translator: EndlessFantasy Translation Editor: EndlessFantasy Translation
“Aspirate! Faster!” Ling Ran’s orders were clear and concise.
The removal of the right lobe of the liver was definitely considered a major surgery in all hospitals, regardless of their grade. Everyone in the operating theater was excited yet nervous.
Huo Congjun was still washing his hands outside. He was nervous as well, but definitely not excited.
But it would be useless if he entered without his hands being clean. He could only shout loudly, “What’s the situation now?”
“I’ve already used the Pringle maneuver to block blood flow,” Ling Ran replied.
The Pringle maneuver was the most common and easiest hepatic bleeding control skill during surgeries. The breakpoint was located between the hepatic pedicle and hepatic portal, but it could not fully control the blood flow from the ruptured section.
If they took into consideration the warm ischemia-reperfusion injury in the liver, then the Pringle maneuver could only be used to block blood flow for at most one hour. The doctors in the Emergency Department of the county hospital dared not use this method even if they saw the patient bleeding on and on. Because if they could not perform any follow-ups to the Pringle maneuver, they would only cause greater damage to the liver.
Huo Congjun was also full of worries.
However, he was outside, and he knew he could not pass his worries to Ling Ran.
Sometimes, the worst decisions were better than not making any decisions during emergency surgeries. Huo Congjun could only shout at the top of his voice and let his worries run wild. “How about now?”
“Blood loss is reducing.” Ling Ran stopped talking for a while before he said, “The situation of the liver is very bad now. We won’t have enough time to perform a normal right hemihepatectomy. ”
Huo Congjun’s heart missed a beat. He asked, “How bad is it?”
“Hemoglobin levels, 16, blood pressure, 45, and still reducing,” Ling Ran replied immediately. He was also thinking while looking at the display monitor.
A few seconds would not be sufficient for a student to answer questions, because that time was too short. But on the operating table of an emergency surgery, a few seconds was already enough to sow doubt.
Lu Wenbin, Yu Yuan, and Zuo Cidian looked at Ling Ran at the same time. Their gazes showed this question. ‘What should we do now?’
For them, the chief surgeon was the backbone of the surgery.
Everyone knew how to perform sutures, incisions, and using devices, but the guidance of a chief surgeon was needed for them to know where to suture, which part to make an incision, and which devices they should use.
Ling Ran’s thoughts flew.
He considered one plan after another.
He did not need to consider normal right hemihepatectomy. A normal regular hepatectomy required one and a half hours, but this patient might not be able to last for even fifteen minutes.
Therefore, what about a simple repair before the resection?
Ling Ran looked at the exposed operating field, and he did not think there was any plan that could be executed in a few minutes.
“How’s the situation?” The person who spoke this time was an attending physician from the Department of Hepatobiliary and Pancreatic Surgery. He asked the question while he rushed in.
“Where’s He Yuanzheng?” Huo Congjun was asking about the director of the Department of Hepatobiliary and Pancreatic Surgery.
The young attending physician seized the time to scrub his hands while he said, “A patient suddenly suffered from acute hemobilia, so he was readmitted. Director He went for the surgery. The other chief physicians are also busy performing surgeries.”
The prognosis of liver surgeries had always been a difficult problem. Once a problem was encountered, they needed to handle it immediately.
Department Director Huo pursed his lips. He glanced at the young attending physician whom he was not very familiar with, and he felt that Ling Ran would be better if he performed the surgery.
“Hemoglobin levels, 14… It’s 12 now,” Su Jiafu shouted loudly as a reminder.
He still could not see Ling Ran’s facial expression, so Huo Congjun became really anxious while he was still outside the door. “Why is it dropping so quickly?”
“The liver injury is very severe, so the gauze stuffed inside doesn’t work,” Ling Ran answered.
“Then, why did you remove the gauze so quickly?” The attending physician who was also standing outside the door had his facial expression changed too. A potentially poor decision like this might cause the patient to die if the surgery was not performed well.
Huo Congjun looked over swiftly. “If the gauze placed inside isn’t working, it’ll still be pushed out by the blood inside even if we don’t remove the gauze. We’re now in a race against time. Blood loss is 371 ounces, do you have the confidence to do it?”
“Three hundred and seventy what?” The young attending physician stopped scrubbing his hands.
“371, soon it’ll be 405 ounces.” Huo Congjun snorted and asked, “Are you confident?”
“Department Director Huo, this patient already had all his blood exchanged twice, I…” The young attending physician dared not say he was confident.
“I’ll start separating the right half of the liver!” Ling Ran shouted. This was an announcement. He was now the chief surgeon in the operating theater, so he owned the strongest power to make clinical decisions. He could not see the situation outside the operating theater anyway, and the patient on the operating table will have his condition deteriorated the longer he waited, and it also meant that his chances of survival will drop the longer he waited.
Huo Congjun had not even put on his surgical gown just yet. When he saw the timid look of the young attending physician from the Department of Hepatobiliary and Pancreatic Surgery beside him, he felt rage burn in every part of his body. He looked down on such irresponsible doctors the most.
When a doctor stood beside the operating table, he needed to save a life from death’s door. If the doctor was afraid of everything, he would not be able to save any lives.
When he recalled the liver surgery that he had just completed with Ling Ran, Huo Congjun shouted from outside the door, “First, check if there’s any injury on the hepatic vein before you separate the round ligament and falciform ligament of the liver…”
Ling Ran did not mind the guidance from Huo Congjun. At the moment, if a newbie took his place in the operating theater, they would definitely be prostrating themselves on the ground and thanking Huo Congjun for his guidance.
Of course, if a newbie were in Ling Ran’s place right then, he or she might not be able to find the location of the round ligament and falciform ligament of the liver anyway.
Huo Congjun had taught many newbies before, and he was also worried that Ling Ran would be nervous and make newbie mistakes, so he continued saying, “Look for the falciform ligament of the liver first, then work along the hepatic portal vein…”
The young attending physician of the Department of Hepatobiliary and Pancreatic Surgery scrubbed his hands gloomily. He was indeed fearful of the surgery. Therefore, although he knew that Huo Congjun wanted Ling Ran, who was inside the operating theater, to be the chief surgeon, he did not voice any protests.
He did not want another death under his hands.
At that time, the discussion about the cause of death alone will be enough to kill him.
However, this young attending physician of the Department of Hepatobiliary and Pancreatic Surgery also did not feel too optimistic about Ling Ran. He knew Ling Ran well, there was probably no one in the hospital who did not know Ling Ran. But a blood loss at 371 ounces was not a joke. Yun Hua Hospital’s highest blood transfusion record as of now was for a woman in labor who encountered amniotic fluid embolism and needed 608 ounces of blood. Still, the Gynaecology Department tried their best to save the woman, and they even used their personal network to get the blood. With a great stroke of luck, they saved the woman. However, the women in labor who suffered from amniotic fluid embolism they encountered after this successful were not as lucky as the one who was successful.
The young attending physician of the Department of Hepatobiliary and Pancreatic Surgery started making guesses with ill intentions. ‘This patient was sent from another county. It might be because the blood bank at their blood station was running out of blood…’
“Round ligament and falciform ligament of the liver have been separated.” Ling Ran’s voice was heard from the operating theater.
“Separated?” The young attending physician was surprised.
Without waiting for him to think of anything else, Ling Ran’s voice was heard again. “Perihepatic ligament has been separated.”
“Superior and inferior vena cava remain together.”
“Removed the deactivated liver tissues.”
Continuous sentences could be heard from the operating theater, and it made everyone feel more secure.
Huo Congjun finally finished washing his hands. He used his foot to open the airtight access door to enter the operating theater. He saw Ling Ran by the operating theater holding the ruptured liver with one hand while he removed the deactivated liver tissue and the liver tissues that did not have good blood circulation piece by piece along the edge of the rupture.
From the point of view of an outsider, his actions would be considered rough. But both Huo Congjun and the young attending physician from the Department of Hepatobiliary and Pancreatic Surgery were stunned when they saw this scene.
“Have the universities nowadays started to teach this?” The young attending physician remained dumbfounded.
