Chapter 142: Don’t Use Knife In A Quarrel (Part I)
After telling Xie Yiren to summon the group of pleasure-seeking doctors for overtime, Zheng Ren stuffed the rest of the meat into his mouth.
In the emergency department located on the first floor, a woman helplessly stood in the resuscitation room, covered in blood with fear written all over her face.
Zheng Ren quickly reentered the emergency department and glanced at the patient on the bed. On the upper right corner of his vision floated the System panel with a diagnosis painted in light red—splenic rupture complicated with hemorrhagic shock.
“A forty-five-year-old man was stabbed on the left upper quadrant of his abdomen an hour ago. His blood pressure was at 80/60mmHg upon arrival at the hospital,” the emergency doctor on duty in the general surgery division reported, “An emergency B-scan ultrasonography revealed a 3.5-centimeter deep effusion that did not reach the thoracic cavity.”
The spleen was located below to the left diaphragm, so it was necessary to rule out a thoracoabdominal injury when managing a trauma patient.
If the patient had a collapsed lung and required artificial ventilation in the operating theater… Death would be imminent.
Even though the System did not report a punctured lung or traumatic pneumothorax, Zheng Ren remained vigilant and examined the man’s respiratory system with a stethoscope. Air entry was equal on both sides of the lungs without any crackles or rales.
This should be an uncomplicated trauma case.
“Where are his family members?” asked Zheng Ren.
“There she is.” The doctor furtively pointed at the stunned woman in the resuscitation room. “I heard she stabbed her lover in an argument.”
“…”
What a tough woman!
However, Zheng Ren had no desire to resolve a lovers’ quarrel. He called out to the woman and brought the patient to a thoracoabdominal CT scan to ensure the absence of pneumothorax before pushing him to the emergency operating theater.
Su Yun, who was already waiting at the entrance, wheeled the patient into the operating theater along with one of the Chu sisters while Zheng Ren proceeded to change out of his attire.
Judging from the patient’s blood pressure, his condition was actually not serious.
‘Perhaps I don’t have to remove his spleen,’ Zheng Ren thought after judging the situation.
He changed, performed a surgical scrub and put on a gown.
The Chu sisters had anesthetized the patient and Su Yun had performed all necessary preparations such as disinfection and application of surgical drapes on the operative site. All of them were solemnly standing by beneath the surgical lighthead and waiting for Zheng Ren to march into the battlefield.
Zheng Ren had a feeling that he was now a professor, something that he still had not gotten used to. After all, Su Yun’s current tasks had been his responsibility during his time in the first general surgery department, and the chief surgeon had occasionally disallowed his participation after surgical drapes had been applied.
He had decided on a course of action after thinking about it along the way.
A surgical scalpel was placed on his outstretched hand.
Zheng Ren then made a 20-centimeter incision along the left costal margin.
The surgery was broadcast live in Xinglin Garden at the same time.
[The god hasn’t broadcast his surgery in a while.]
[What’s this case about? Huh? It’s a rare case of splenic rupture.]
[It’s an uncomplicated case of splenic rupture and the blood pressure isn’t dangerously low either. Just perform a splenectomy and the patient can be discharged in a week, not a big deal at all.]
The first batch of viewers chatted leisurely before the surgery officially began.
A simple splenectomy posed no difficulty for all general surgeons.
After all, destruction was always easier than construction.
[That’s a big and wide incision. I think this host surgeon is different.]
[Who knows? You can actually see some similarities in their techniques.]
[Fast, isn’t it? It’s just a splenectomy, how slow can you go?]
In the livestream, an aspirator with suction tube was plunged into the peritoneal cavity once an opening was created on the peritoneum. Viscous, dark red blood gurgled up the tube.
The blood around the incision was soon extracted. Pushing the aspirator deeper into the cavity, the host surgeon opened the peritoneum and put protective measures on the peritoneal membranes.
[A surgical assistant really makes the operation much easier.]
[Of course, that’s why there is a saying, “you can’t perform a surgery alone.”]
[Watch the host surgeon’s past surgeries; most of them had been completed single-handedly. A surgical assistant would shorten the surgery by a few minutes at most.]
The doctors watching the livestream had an inexplicable confidence in the host surgeon, developed after observing hundreds of amazing surgeries.
When the peritoneal membrane was protected, it was time to expose the peritoneal cavity.
Su Yun aspirated the remaining blood in the cavity while Zheng Ren inspected the spleen and found a two-centimeter wound with blood constantly oozing out of it.
The wound was compressed with a sterile gauze to minimize blood loss before Zheng Ren quickly examined other abdominal organs such as the liver, pancreas, stomach, retroperitoneal blood vessels, surrounding intestines and duodenum.
Fortunately, it was just a simple splenic rupture; the same diagnosis given by the System.
Massive hemorrhaging had caused the ruptured spleen to shrink without adhering to the surrounding tissue. Zheng Ren took it out of the wound and carefully passed it to Su Yun.
[Wow, what is the host surgeon going to do? Repair the spleen?]
[Sure looks like it. This patient’s injured spleen can be surgically repaired.]
[Unless the spleen is severely ruptured, we would normally proceed with repair. A splenectomy is simply too easy.]
[Can you stop bullsh*tting? If something goes wrong during a splenic repair surgery, the patient would most likely have to go for reoperation.]
Many doctors watching the livestream had their own opinion on whether to proceed with surgical repair or the more violent method—direct removal of the ruptured spleen.
Doctors with slightly inferior skills rarely had the courage to repair a ruptured spleen.
The post-segmental nephrectomy hemorrhaging that Zheng Ren had treated a few days ago posed the same risks that now plagued this spleen.
Both the kidney and spleen were fragile organs. During repair, suture knots would not hold in mild injuries, and any unnecessary increase in strength would cause a secondary rupture in severely traumatized organs.
After passing the ruptured spleen to Su Yun, Zheng Ren used several pieces of large sterile gauze to fill the splenic fossa.
The entire procedure was done speedily and cautiously without causing any secondary damage to other organs.
Su Yun had already examined the direction and depth of the wound while Zheng Ren was busy compressing the splenic fossa.
The wound was located on the superior border of the spleen with a depth of approximately three centimeters.
After Zheng Ren filled the splenic fossa with gauze, he reached out again for a needle holder along with a suture thread.
A standard 3# suture needle was used, along with an absorbable suture thread size 1-0.
Su Yun held the ruptured spleen firmly for Zheng Ren to close the wound using the vertical mattress suture technique.
[Er… Why is the host surgeon moving so fast? Are they not worried about secondary tears?]
[They know what they are doing. After all, they have performed this procedure multiple times, so they can’t slow down even if they want to.]
[That’s still so scary. One time I repaired a ruptured spleen and accidentally tore it due to excessive strength.]
This was not a standardized surgical procedure. Some surgeons from lower-ranked hospitals had never performed surgical repair of a ruptured spleen in their entire career. They would usually proceed with a splenectomy to prevent secondary injuries that could require reoperation.
Following closure of the wound, Zheng Ren placed the needle holder beside the patient’s thigh. Xie Yiren then picked it up, wiped the blood off and placed it onto the instrument table while stealing a peek at Zheng Ren’s movements from time to time.
After a surgical knot was made, Xie Yiren gently placed a pair of scissors on Zheng Ren’s outstretched palm.
Excessive suture thread was cut and thrown away, and the wound was irrigated with warm normal saline.
Everything was done according to protocol.
