The next step was confirmed. Department Chief Qian went to speak with the patient’s family.
Zheng Ren and Su Yun returned to the emergency department.
As they walked, Zheng Ren was deep in thought.
He did not like to rely on luck. Much like the TIPS surgery, where most doctors had historically relied on chance, Zheng Ren had spent countless hours of training time to increase his probability of success and minimize his dependence on the fickle Lady Luck.
The adenomyosis had been initially viewed as a minor disorder that could be treated once the patient was stable, even though it would leave her without a womb.
There was a low chance the interventional procedure could truly save the woman from pain and misery.
Zheng Ren had made some mental calculations and realized his estimation from a few days ago had been too optimistic. The success rate of the surgery was less than 20%.
He did not like the numbers.
Once he arrived at the emergency wards, Zheng Ren gave out some instructions before quickly heading for the on-call room; there, he laid on the bed and entered the System.
The air in the System was cool and refreshing.
The water in the lake rippled with life.
The fox statue was on its four limbs before the thatched cottage, its eyes gleaming in the light. Zheng Ren felt its gaze follow him wherever he went.
He tried to communicate with the little fox, to no avail.
The System had always been distant and that was not about to change today.
Zheng Ren shrugged. He bought some training time and entered the System’s operating room.
Adenomyosis was considered a non-deadly disorder, but in Zheng Ren’s eyes, it was comparable to cancer. Both were debilitating diseases that deserved his full attention.
It was especially so when those infirmed were getting younger and younger, affecting women who had yet to have children.
He could spare some time to experiment in the System in hopes of finding an alternative to a hysterectomy.
The training room rose from the ground, a simulation mannequin lying ready on the operating table. Zheng Ren did not rush to the surgery but looked through the patient’s presurgical tests and scans.
The scans showed that this case of adenomyosis was confined to the cervix.
With that in mind, Zheng Ren could visualize the path of least resistance to the target site.
It was a path to victory; he was sure of it.
The surgery began.
The System conjured up a string of simulation mannequins with focal adenomyosis at the cervix.
From the System’s behavior, Zheng Ren postulated that interventional surgery was not suitable for the diffuse variant of the disorder.
Being in the System’s space did not mean Zheng Ren could make just any procedure work.
The cause of adenomyosis was unknown to this day. The general consensus was that the thinning submucosal layer of the uterus triggered endometrial tissue proliferation in the myometrium.
Zheng Ren performed artery superselection and studied the contrast image for any signs of abnormality.
Tissue proliferation would often be accompanied by angiogenesis.
During superselection, contrast agent was administered to color the blood vessels. They appear black against the bright background.
Zheng Ren successfully located the vessels supplying blood to lesions in the uterus.
The subsequent steps were simple. He proceeded with injection of the embolic agent, then follow-up imaging to confirm that the vessel was completely blocked. It was a successful surgery, in Zheng Ren’s opinion.
However, the System disagreed. The completion bar was at only 60%!
Barely a pass.
The whole procedure had taken less than 20 minutes.
Barring any life-threatening emergencies, this would have been a straightforward surgery that Zheng Ren could perform with his eyes closed.
Su Yun had implied something similar during the emergency surgery to address the pelvic fracture hemorrhage.
However, Zheng Ren was worried about complications as that patient was not in a stable condition.
Now, he was sure he had made the right choice. What was he missing?
The 60% kept haunting him.
Where was the problem?
Zheng Ren took a break from the surgery and went to sit beside the lake, ruminating on the task at hand.
Just like the TIPS surgery, it was best to sharpen one’s axe before chopping wood.
At this stage, he was stuck at 60% completion for surgical treatment of focal adenomyosis.
What would he do next?
Zheng Ren took a trip down memory lane, revisiting books and journals he had read.
Many of them were largely to do with general surgery, especially the liver. There was little that contributed to adenomyosis.
He spent a long time thinking, his mind calm and collected.
Department Chief Qian was handling patient communication and that would need at least half an hour to an hour. This was not a life-or-death surgery like the TIPS surgery had been.
Adenomyosis… problem… surgery…
A question popped into his mind. Could it be the imaging?
Zheng Ren’s method of imaging had always been superselective. He would only begin it at the third or fourth branch of artery.
Many doctors did not like this method because superselection was time-consuming and meant prolonged exposure to radiation.
However, it allowed the surgeon to be more accurate.
Why was the surgery still incomplete? Perhaps there was more than one site with adenomyosis.
There were possibly clusters of cells spread across the myometrium that had yet to grow into a pronounced mass.
Like seeds of grass, some clusters were still dormant. The procedure only addressed the fully-grown weeds, not the seeds deep within the soil.
Right!
Zheng Ren smacked his thigh in realization.
The pain was a jolt to his senses.
He regretted his action and swore to keep his excitement at bay in the future.
His precise imaging method could be the cause of the incomplete surgery.
Zheng Ren chuckled as he called forth the operating room again.
This time, he did not overdo superselection.
Once the guide catheter was in the uterine artery, Zheng Ren began imaging.
As expected, a complex network of vessels appeared onscreen.
The more condensed network indicated the initial embolization site while the less concentrated networks were potential problem areas.
Zheng Ren would try to embolize the remaining vascular networks.
The vessels feeding into the adenomyoma were larger than the capillary network that Zheng Ren had treated during the prostate interventional surgery. This would be an easy task.
One by one, Zheng Ren delivered the embolic agent into the feeder arteries. The progress bar at the top right corner of his vision ticked towards 100%.
60%… 65%… 70%…
After 2 hours and 12 minutes, the surgery was finally complete.
100%!
A grim smile was on his face when he saw the time.
He had turned a minor procedure into a major one.
Despite the laborious process, Zheng Ren was glad to thoroughly complete treatment of adenomyosis.
Only he could achieve such precision and accuracy.
A Grandmaster rank in interventional surgery was no joke.
