Translator: EndlessFantasy Translation Editor: EndlessFantasy Translation
Out of various surgical methods, an endoscopic sphincterotomy to clean the biliary tract left the fewest injuries to the patient.
Although the procedure was minimally invasive, international journal articles had reported a very high rate of recrudescence—approximately 30%.
The patient was already old; if recrudescence occurred within five to ten years, he would be in his seventies. General surgery came with great risk.
Hence, Zheng Ren ruled out an endoscopic sphincterotomy.
He not only had current symptoms to consider but also the long-term effects of treatment.
He entered the operating room just as Xie Yiren finished scrubbing in. She opened a sterile surgical bag with assistance from the circulating nurse and began preparing the machine.
“Zheng Ren, what surgical method are you using?” she asked.
In the operating room and the entire emergency ward, only two people could call Zheng Ren by his first name—Old Chief Physician Pan and Xie Yiren.
“Sphincteroplasty of the sphincter of Oddi, biliary tract cleaning and liver abscess drainage.”
Xie Yiren nodded. Having multiple surgical methods was no issue to her.
She asked the circulating nurse to retrieve several instruments that could be required. If they did not have any ready to use, they could simply sterilize others with a high-pressure cooker.
Zheng Ren felt a sense of comfort as he watched Little Yiren busy organizing and saving him plenty of trouble.
He transferred the patient onto the operating table with Su Yun and Yang Lei before Chu Yanzhi1 commenced anesthesia. The professor did not offer any help; perhaps he thought it outside his scope of duties and stayed aside out of habit.
After anesthesia was administered and the sterile sheets applied, the surgery began.
Ding dong~ The System chimed in a new mission as Zheng Ren stood before the operating table.
[Emergency Mission: Sump Cleaner
[Mission Task: Complete the surgical treatment of a patient with sump syndrome.
[Mission reward: 2,000 skill points, 25,000 experience points.
[Mission Time: 4 hours]
The mission was rather ordinary and not too difficult for Zheng Ren. He had just completed the first stage of The Crown Jewel and was thus swimming in resources.
He checked the mission and its allocated time, then reached out with one hand. A hemostatic clamp with iodine bandages was placed in it.
The surgery was broadcast as scheduled in Xinglin Garden.
[What is today’s surgery about?]
[I just found out. Sump syndrome… The surgeries are getting stranger every time. I’m still familiar with most general surgical methods despite not being from the specialty, but this is my first time hearing of this.]
[It’s not that rare. It’s rather common in general surgery and gastroenterology departments. They will encounter this disease several times a year, mostly in patients who underwent a side-to-side choledochoduodenostomy.]
[It sounds so high-end. I’m new to this surgical method, too.]
[There are many more strange things that you’ve never heard of. Montreal General Hospital is one of the five largest medical institutions in the world. I’ve seen almost all rare cases and my guess is that were this more common, they would not have this surgery broadcast. It’s a shame that, as a neurosurgeon, I only get to watch general and interventional radiology surgeries on my phone. When will I get the opportunity to watch a brain surgery broadcast?]
1
The broadcasting room bullet screen began crawling with comments once viewers were aware of the condition being operated on. The initial steps were nothing special: the surgeon made a 15 cm subcostal incision on the right side of the torso.
Since the patient had an old surgical wound, the incision was a little unusual in order to avoid scar tissue.
What followed was blunt dissection. It would only be worth watching after the opening of peritoneum, and commenters used this window to flood the bullet screen.
The neurosurgeon’s words had resonated with many and they began chatting together.
In a live surgery broadcast, doctors benefitted much more from the perspective of the operating field instead of the normal observation deck. It offered a better view than even the first assistant’s
Modern medicine was an empirical science. All the doctors watching the live surgery broadcast in Xinglin Garden were aware of how rare the opportunity was to watch a skillful surgeon demonstrate surgery of so many rare diseases.
Until today, the demonstration had only involved general and interventional surgeries. Some of them were disappointed, but at the same time had greater expectations.
After a few minutes of non-stop comments, the viewers concurrently ceased talking to pay attention to the surgery as the peritoneum was exposed.
The anatomical structure of the peritoneal cavity had been altered by the previous surgery.
Furthermore, the disease had resulted in inflammatory edema and several unidentifiable adhesions.
[If I were him, I would have given up already. I’d just close it up in case the patient does not come out of the surgery alive.]
[The adhesions are so extensive; would it hurt the proliferated blood vessels?]
[Yeah, it is impossible to identify the tissues… This condition would make anyone feel like throwing in the towel after one look.]
Zheng Ren was not perturbed by the condition of the peritoneal cavity. He extended his hand and Xie Yiren placed a pair of blunt scissors on his palm.
The blunt end of the surgical scissors was used to separate the proliferated connective tissues, either by peeling them apart or cutting them off. He did it at a steady pace, neither too fast or too slow.
Su Yun frowned.
How was Zheng Ren differentiating the locations of abnormal blood vessel growth under such extensive tissue adhesion?
Such knowledge was definitely not in any textbook.
This was too peculiar.
At the same time, although he had requested to learn Zheng Ren’s skills and techniques, Yang Lei realized he could not understand Zheng Ren’s surgical methods now that he was at the table with the man.
After Zheng Ren separated the tissues, clamped them down and stitched up a rather thick vessel with a #4 suture, Su Yun piped up: “How did you manage to locate the vessel?”
“I felt it,” Zheng Ren answered coldly.
His entire focus was on the surgery. He had no time to explain to Su Yun that the proliferated blood vessel also had pulsation. If one’s tactile senses were sharp enough, they could feel it beating.
Zheng Ren had mastered this technique after countless practice runs in the System’s operating room.
Most importantly, he did not know how to describe this minute yet extremely important technique.
[I suddenly have a feeling that this surgeon has laser-guided eyes and can see proliferated blood vessels hidden within the connective tissues.]
[Yeah, I thought that too. There is no other explanation for how they could perform blunt separation of the connective tissues without harming any blood vessels.]
[Until now, blood loss is below 5 mL. This is a display of skill at its finest.]
The doctors in the Xinglin Garden were intrigued. However… they could not figure out how Zheng Ren operated.
As he dissected the tissues layer by layer, the complicated anatomic abnormalities became clearer.
Even though Su Yun could not comprehend how Zheng Ren had managed to locate the vessels, he still understood the intention behind each step.
The appendix retractor and small surgical hook in his hands appeared without fail at the appropriate location every time to help Zheng Ren open up the next surgical field.
Finally, after five minutes, Zheng Ren separated the last connective layer and the room was instantly filled with the rotten, foul odor of pus.
