More than ten users went on long rants.
[A fatty, oh, the horror.]
[Three years ago, I did an appendectomy on a patient who had adipose tissue that was ten centimeters thick. There was fat liquefaction post-surgery and I did the dressing change for a month straight. I still have nightmares about it.]
[I feel you.]
[Same +1]
…
[Agreed +10086]
Fat liquefaction was a problematic issue. At certain levels, it could be even more troublesome than the appendectomy during pregnancy.
If an attending surgeon received a case of acute appendicitis in pregnancy, they could request for the chief surgeon to perform the surgery. No one would blame them.
However, if the patient was obese and the chief surgeon was requested to take on the case… Well, the attending surgeon had better be directly descended from the chief surgeon, or pray the chief surgeon was in an ecstatic mood from winning the lottery grand prize, or else they were in for a good lecture.
During the appendectomy on the pregnant lady, everyone was shouting praise as it was a rare and difficult procedure.
An appendectomy on a bariatric patient was something almost every doctor has witnessed and experienced. The barrage of live comments obscured the view of the operative field.
The continuous epidural anesthesia was set up efficiently. Zheng Ren began disinfecting the skin while Xie Yiren stood by the surgical tray, waiting for the start of a new battle.
The disinfection was complete. Zheng Ren held his hand out and a scalpel appeared.
A five-centimeter incision.
Just as the users were quieting down to watch the surgery, this decision gave rise to an explosion of live comments.
[Such a small incision. What is the god thinking?]
[Damn, such a small incision wouldn't even grant you a peek of the peritoneum.]
[Which hospital is this? I want to intern there.]
Every doctor watching the livestream had the same thought—a five-centimeter incision was adequate for a normal appendectomy. Some might even call it a smaller than average incision. On a patient with an adipose layer of ten to twelve centimeters thick, the incision granted no access to the appendix.
[Should be a laparoscopic procedure.]
[Agreed. Must be a laparoscopy.]
[Don't be stupid. Do you see any laparoscope set up? This god is challenging the human limit. Bow before him, trembling peasants!]
Zheng Ren was not aware that the laparoscope was not functioning, but had never planned to perform a laparoscopic appendectomy from the get-go. His appendectomy training in the System taught him that laparoscopy could not achieve the perfection he was aiming for.
This was because a laparoscopy relied on electrocutting and electrocoagulation to manipulate the adipose layer, resulting in a higher risk of fat liquefaction.
Hence, he decided to use a small incision to complete the appendectomy—something no doctor believed was possible.
To reduce fat liquefaction, the first step was to avoid electrocauterization. The second was to minimize contamination and the third was to apply negative pressure wound therapy for two to three days as part of post-surgery wound care.
That last step had been proven crucial to minimize fat liquefaction, but Zheng Ren could not go ahead with it. Once a negative pressure drainage tube was used, the case would be disqualified from being a perfect surgery.
Fortunately, he had other ways to ensure a near-perfect surgery.
After all, Zheng Ren was a man who had foregone food, water, and sleep to perform a thousand appendectomies!
Once the skin was peeled back, Zheng Ren plunged the scalpel deep into the adipose layer. His movement was confident and firm even as the scalpel handle disappeared beyond the layer of fat.
This maneuver shocked the audience as if the scalpel was aimed at their own hearts.
Old Chief Physician Pan's frown deepened. At the same time, the livestream exploded with comments.
[Are we witnessing a murder?]
[Is he that confident? Logically speaking, no matter how much presurgical prep was done, there would be changes when the patient is supine. This maneuver is too risky. A minor miscalculation and there will be damage to the intestines.]
[I've been shocked into respiratory arrest. If I don't turn up tomorrow, please inform my colleagues to pick up my corpse.]
Zheng Ren was oblivious to the whole discourse surrounding his method.
He pulled out the scalpel and asked for an iodoform gauze from Xie Yiren. Wiping his left middle finger with it, he then plunged the digit into the small incision. At the same time, a pair of large curved forceps held in his right hand followed suit.
The operative view became blank.
No matter how impressive the System was, it would not livestream the happenings in the patient's cavity. If it did, Zheng Ren would probably be called up for a chat by some department.
Old Chief Physician Pan, Chief Surgeon Liu, and the audience were silent as they watched Zheng Ren's imperceptible maneuvering of his finger and the forceps.
No one had expected this to happen.
As quick as it happened, Zheng Ren took out his finger and the forceps. He motioned for a sterile gauze and covered the incision to prevent contamination from pus.
It turned out he had been slowly separating the adipose layer, muscle, and fascia to reach the peritoneum.
Everyone was speechless as they watched Zheng Ren push two pieces of sterile gauze into the incision. No one could tell what was happening inside the patient, no matter audience or the surgeon.
Zheng Ren's next move stunned everyone.
He disinfected the same finger and reached in again, this time with a pair of extra-long curved forceps.
[I… am speechless. If the first surgery was anything like this, I would have called the cops and told them that someone was livestreaming a murder.]
[Is this the legendary blind operation? Can someone enlighten me?]
[What is the surgeon doing? Such outrageous stunts have blinded my fragile eyes.]
Countless messages flashed across the stream as Zheng Ren asked for another pair of extra-long curved forceps. The two pairs of instruments occupied the open incision—it was difficult for even a finger to enter.
What was the significance of the two forceps placed inside the abdomen? That was the question on everyone's mind.
In the short period when the operative view turned blank, the surgeon had managed to make an educated guess based on his clinical experience and proceeded to ligate the ligaments and arteries.
The livestream was silent now—not a single comment came on the screen.
The unimaginable and the impossible just happened. This man must be possessed by the devil.
Comments? They were nonexistent as everyone stared dumbfounded.
Even the anesthesiologist beside Zheng Ren was wide-eyed. His jaw hung open as he watched Zheng Ren operate.
Only the lionhearted Xie Yiren disregarded what Zheng Ren was doing. She just followed her instincts, predicted what Zheng Ren would do next, and handed him the appropriate instruments.
She had faith in him.
There were no dazzling magic tricks in this operation. The doctors were familiar with every step Zheng Ren took. What step he would take next was also very clear, and yet, it was all completely unbelievable.
This was because he was performing the surgery blind.
The next step would be to cut the appendicular artery…
They then saw Zheng Ren hold the smallest scalpel with the tip of the extra-long curved forceps and plunge it into the abdomen.
Then…
Then…
If that was successful, the operation should be over.
As the audience wondered about the outcome, Zheng Ren retracted the forceps.
A blind operation without any visual assistance. Was the appendix removed? Was the appendicular artery ligation secure? Would there be bleeding?
/>
Chapter 24 - The Appendix Has No Soul
A fresh and mildly swollen appendix was pulled out by the curved forceps.
[Success!]
[My god, it's a miracle!]
[A blind appendectomy. My inferior intellect and experience limit my imagination. How did he achieve this?]
In a blink, the livestream burst into life once more.
Previously suppressed emotions erupted like a volcano. The livestream had broken the site record by having more than five hundred online viewers.
It was currently 12:25 am.
Who knew how many doctors had been woken by their friends, colleagues or classmates.
The unstoppable onslaught of comments marched on and dominated the screen. No one cared about the remaining procedure and, even if anyone was interested, the comments effectively blocked their view. Since the appendix had been removed, there was nothing much that could go wrong now.
Unbelievable: the word filled the collective minds of the observing doctors. This was a surgical method that could not be learned. What the surgeon did within the small incision hole, no one knew.
How skilled was the surgeon to be able to locate the appendix with a single digit and complete the surgery with curved forceps?
In the surgical demonstration classroom, Chief Surgeon Liu and Cen Meng were stupefied.
As it happened, even the battle-weary Old Chief Physician Pan, who had experience with appendectomies in non-hospital settings, was shocked.
It was clear to everyone that this had been a blind operation.
This surgical method was not in any textbook, periodical, or scientific journal.
In general surgery, precision and accuracy were of utmost importance. An operative view was the first requirement.
How could a surgeon operate if they could not see what they were operating?
And yet, Zheng Ren had performed the unbelievable—a perfect blind operation—right before their eyes.
"This…" Cen Meng's words stumbled as they tried to leave his mouth.
A warning resounded in his head. Stay silent if you can; anything you say can be used as sworn testimony.
Words should not be thrown out carelessly in the presence of Old Chief Physician Pan.
Comment and criticize in a professional manner.
However, Zheng Ren's outrageous blind appendectomy made Cen Meng want to cry.
How did the bastard become so skilled in surgical anatomy? Cen Meng would not dare attempt a blind appendectomy even if he had a year of experience performing autopsies on all the cadavers in the affiliated medical schools.
If he did not try…
Cen Meng mumbled something but a scrutinizing gaze from Chief Surgeon Liu made him think twice.
He held his tongue as his brain reached out for ideas to dismiss Zheng Ren's performance.
However… he could not even see the operative view, so what comments could he make?
That said, Chief Surgeon Liu's attention on him made staying silent a non-option.
Cen Meng's brain short-circuited and he spoke in a low voice, "To operate like this, the appendix will have no soul."
Chief Surgeon Liu wanted to puke blood.
Soul? Did an excised appendix have a soul? Had the quick-witted Cen Meng gone mad?
…
…
In the livestream, the screen was suddenly spammed with a repeating comment.
[Stop talking, watch the surgeon's next step.]
At the sight of the spammed message, the doctors were confused. This was just an appendectomy, not a complicated case of tetralogy of Fallot.
If the appendix had been removed, what other audacious techniques were there to showcase?
Following that message, the number of live comments dwindled.
Everyone refocused their attention on what Zheng Ren was doing.
With the appendix excised, the abdominal cavity was flushed and the peritoneum sewed back. Now, Zheng Ren had to deal with the twelve-centimeter thick adipose layer.
Under normal circ.u.mstances, as long as the blood vessels within the adipose layer were not electrocauterized and there was no contamination with minimal stitches, the risk of fat liquefaction was minor.
Yes, minimal stitches, not zero stitches.
Zheng Ren had decided to forgo stitching the fat layer in this case. He took a bottle of protein-based surgical glue and applied an even layer of it across the adipose tissue. Then, he started suturing the subcutaneous tissue.
What was this technique?
The previous blind excision was an undoc.u.mented procedure, and now, this application of protein-based surgical glue on the adipose layer was unknown to every doctor watching.
Protein-based surgical glue was typically used to stop bleeding; its effect was mild and its use narrow, and smaller hospitals with tight budgets did not even provide it.
What was he doing?
The surgeon Immediately stitched up the subcutaneous tissue after applying the surgical glue. What was this black magic?
Behind their phone screens, everyone was thunderstruck.
Based on this devil surgeon's way of operating, there were no hasty decisions. That meant beyond stopping bleeds, protein-based surgical glue was effective in preventing fat liquefaction!
This was a huge discovery!
As all doctors knew, sildenafil citrate had initially been developed as a cardiac drug. It had then been repurposed to bring joy and happiness to middle-aged men, becoming one of Pfizer's best-selling products.
Did the insignificant protein-based surgical glue have other, more important functions?
A few hundred doctors were going mad at this point.
If surgical glue could really solve the fat liquefaction problem… Clutching their phones, hundreds of hands trembled at the significance of this revelation.
It would be a revolutionary discovery.
Tomorrow… No, today, it had to be tested!
The notion sprung up in the minds of the doctors watching the livestream.
…
…
Finally, it was done. Zheng Ren let out a breath.
He did not have to wait for another few days. With the final stitch, the System's evaluation turned 100% at the upper right corner of his vision. Zheng Ren knew the patient would definitely not suffer fat liquefaction.
The more surgeries he did, the more he appreciated the System's intensive training.
Cadavers? They were unnecessary when the System could provide unlimited, realistic, and fresh simulated mannequins. The smell of blood from the simulated mannequins was much better than formalin which came with all cadavers.
From the blind operation to the use of protein-based surgical glue, all the never-seen-before techniques he just used had to be established with the simulation mannequins.
The key factor to his success was that his experiments had had no waiting time. The System would instantly report success or failure.
In a real hospital setting… Zheng Ren would never have had the chance to practice his ideas and theories.
"Chief Zheng, were you operating blindly just now?" Xie Yiren asked as she sorted the surgical instruments.
"Yes."
"Very cool!" Xie Yiren complimented without hesitation.
Off to the side, the anesthesiologist finally woke from his stupor. His brain registered what he had just seen.
"Chief Zheng, that was amazing." He gave Zheng Ren a thumbs-up.
"Heh." Zheng Ren gave them both a dry smile. He cleared the operating table hurriedly and began transporting the patient.
He was ready to get some rest.
Surgeries that carried on past midnight were not unusual.
That was when he was at the level of an attending surgeon, when the required surgery rating was 'good'. Now, Zheng Ren's expectations of himself… No, the System's expectations of him were too high. Every surgery had to be perfect.
The surgery had been effortless from an onlooker's persp
ective, but Zheng Ren was exhausted.
He severely needed a nap to relieve his fatigue.
As he wheeled the patient out of the operating room, he raised his head and saw the patient's family. There was also a slender figure.
Huh? Why was she here?
Chapter 25 - This Chief Resident Was Undoubtedly Blind!
"Why are you here?" Zheng Ren asked.
Standing by the door was one of the twin sisters he had met while eating crayfish. Zheng Ren vaguely remembered their names were Chu Yanran and Chu Yanzhi.
As someone terrible at recognizing faces, Zheng Ren could not identify which sister this was.
Her shoulder-length black hair was tied up into a ponytail that swayed as she moved. It was all very adorable. A pair of animated eyes stared at him, making him uncomfortable.
Hehe, this was a straight-faced man who could not get a girlfriend.
"Chief Zheng, was it?" She walked gracefully over to Zheng Ren's side as he wheeled the patient back to his room. "I'm Chu Yanzhi."
"Oh. Hi."
"My mother's results are out. As you said, she has acute anterior wall myocardial infarction," Chu Yanzhi said.
"I see. That's good." As Zheng Ren felt some joy in being vindicated, the tiredness he felt leached from his body.
Based on his observation, if the condition had not been diagnosed early, the patient might have suffered a heart attack. The worst scenario was a heart attack in her sleep. By the time her family members discovered what had happened, it would be likely that she was dead.
Diseases that had nonclassic symptoms were hard to diagnose, but once they were ascertained, treatment was not difficult.
A whole family getting to eat crayfish together was a nice picture.
"The blood test is only a reference. It's best you do a 256-slice CT scan of the coronary arteries to confirm it after work today," Zheng Ren said.
"Yeah, we did the 256-slice just now. The left anterior descending artery had 90% blockage. The right coronary artery and circ.u.mflex artery are fine."
The arteries Chu Yanzhi listed were the three main branches that supplied oxygenated blood to the heart. If the blockage had only been in the left anterior descending artery, the patient simply had to avoid vigorous exercise and take some medication.
The Surgeon's Studio c1-799 Page 16
