If he had been the one performing this surgery, he would need to brace himself and lyse the adhesions within the triangle of Calot very carefully. Otherwise, any iatrogenic perforation would end up killing the patient.
If the surgeon was a beginner… No, even if Cen Meng was the surgeon, the only solution upon seeing this would be to transfer the case to Chief Surgeon Liu as he simply lacked the courage to perform such a difficult surgery without supervision.
[Wow, this is actually a laparoscopic cholecystectomy!]
[Who said the god doesn't know how to perform laparoscopic surgery? Come out, I promise I won't kill you.]
[It seems like the host surgeon doesn't perform laparoscopic appendectomies because his incision is so small that he just simply doesn't need to use a laparoscope at all.]
The viewers were very excited to watch this surgery in Xinglin Garden. No matter how proficient the surgeon was at appendectomies, it was still a simple appendix resection and a normal resident surgeon's job after all.
There was a saying that only a master chef could cook simple Chinese cabbage with potatoes well.
The same phrase applied to appendectomy as well. Judging by the flawless appendectomies the host surgeon had performed in the live broadcast so far, the viewers had concluded that he was a demon with a high skill level.
Even so, everyone was born with different innate talents and it would be impossible to improve one's abilities any further once a certain standard had been reached.
Appendectomy observation was meaningless as it was impossible to use it as a reference in terms of skill level or… physical strength.
However, laparoscopic cholecystectomies were different.
At the beginning of the twenty-first century, domestic hospitals had just started performing laparoscopic surgery and many departments—thoracic surgery, general surgery, and gynecology—had also gradually begun to popularize minimally invasive surgeries.
When the older senior consultants of various departments resigned ten years later, the new generation who had mastered the art of laparoscopy became frontline surgeons and made laparoscopic surgery a common practice in the country.
The advancement of minimally invasive surgery with laparoscopy had been rapid since then.
In 2001, a surgeon from Imperial Capital took eight hours to treat a patient with esophageal carcinoma using a thoracoscope. Now, as long as the tumor was not situated at the higher level of the esophagus, the surgery could be finished within two hours.
Laparoscopic surgery had replaced traditional open surgery as the mainstay of modern medicine.
When the severe adhesions in the triangle of Calot appeared onscreen in Xinglin Garden's live broadcast room, countless comments began flooding the screen.
[The god really likes to perform difficult surgery, huh?]
[The triangle of Calot is in a chaotic mess. I'm guessing that the host surgeon will need around three hours to complete the surgery.]
[How is he going to separate the structures when the gallbladder neck is covered in adhesions?]
The closer they looked, the more anxious they felt. The gallbladder was almost completely covered by a thin membranous layer due to exudative inflammation. Forget the dissection of the anatomical structure, even the gallbladder itself was indistinguishable.
Chief Surgeon Liu and Cen Meng were instantly relieved and put on satisfied smiles upon seeing this.
Chapter 56 - Failed Public Humiliation Plan
There were severe adhesions around the gallbladder, wrapped in the omentum and a capsule formed by exudative inflammation, without any clear view of its anatomical structure,
Zheng Ren continued making two incisions—one below the xiphoid process and another two centimeters below the costal margin on the anterior axillary line—without hesitation after observing the condition of the peritoneal cavity through the laparoscopic camera.
Liu Tianxing smiled disdainfully as, in his opinion, Zheng Ren's consecutive movements had a completely different meaning.
Most experienced surgeons would give up on laparoscopic surgery and resort to open cholecystectomy after seeing such severe adhesions.
The operative view in open surgery was more direct, after all.
Watching Zheng Ren's dexterous finger movements and blunt separation techniques with a pair of hemostatic forceps, Liu Tianxing did not doubt that the man could complete an open cholecystectomy.
However… he was just a young man, after all. Adversity was a precious fuel for greatness, but in the medical field, especially in its current harsh environment, any mistake made during a surgery would damage the surgeon's reputation forever.
Liu Tianxing went down memory lane and a figure appeared before him.
It was that of an outstanding student with decent behavior and skill at surgery, but was also slightly arrogant at times.
What happened to him in the end? He was sent to a suburb to raise rabbits.
Young men were impulsive and radical. They simply did not understand that discretion was the better part of valor.
Time was required to understand that public opinion could obscure the actual truth.
During the period of the Republic of China, Liang Qichao was diagnosed with a malignant renal tumor after experiencing hematuria, undergoing nephrectomy afterward. The surgeon was the director of Union Medical College University and a demon from the urology surgery department at the time.
The result? There was a small tumor located on the right kidney and postoperative pathology determined that it was benign. However, his hematuria persisted and the symptoms were not alleviated despite surgical treatment.
The surgeon did not resect the wrong kidney and Liang Qichao agreed. Based on current diagnostic standards, he had probably been suffering rare autoimmune nephropathy, but it was impossible to diagnose this disease at the time due to limited diagnostic abilities and resources.
Liang Qichao acknowledged that result, but his students and friends remained unconvinced.
All of them were literati with great influential power, so new rumors were handed down that the demon from Union Medical College Hospital had resected the wrong kidney during the surgery on Liang Qichao, which had damaged Union Medical College Hospital's reputation since then.
That had happened in the era of the Republic, but what about now? There were actually plenty of irresponsible reports about anal suturing and other random things as well.
Chief Surgeon Liu smiled lightly and picked up his phone.
"Little Wang, it's me, your Brother Liu.
"Yes. There is something I need to tell you. I've a subordinate who disobeyed direct orders from his superior and is currently performing a surgery that he can't possibly do well with his standard yet. He has someone powerful at his back but is actually acting with utter disregard for human life.
"Yes, that's true. I'm very angry as well, but there's nothing I can do about it. I even had a myocardial infarction due to rage and I'm hospitalized for observation right now.
"Yes, that's exactly what I mean. This immoral phenomenon mustn't be condoned and justice needs to be served so that the public in Sea City will believe in our medical system again!
"Alright, thank you very much."
After hanging up, Chief Surgeon Liu smiled. "This kind of person should be punished via public humiliation."
Cen Meng was obviously distracted and did not respond. His face sank and appeared slightly pale under the light.
'Little Cen, what kind of attitude is this?' thought the annoyed Chief Surgeon Liu, but he merely expressed his dissatisfaction with just a word. "Huh?"
"Chief… chief, he is separating…" Cen Meng stuttered.
Chief Surgeon Liu had forgotten to watch Zheng Ren's surgery while focusing on the phone call earlier.
This was the kind of surgery that even he had found particularly difficult to deal with, so was it necessary to watch any further?
He raised his head and saw that Zheng Ren was performing
blunt dissection of the adhesions around the gallbladder with the dexterous manipulation of both the laparoscopic dissecting forceps and grasping forceps as if they were extensions of his b.a.r.e hands.
Basically, the gallbladder had been freed while he was on the phone…
This… How could he be so skilled?! Was this not his first time performing laparoscopic cholecystectomy?!
Blood started surging to Chief Surgeon Liu's brain and caused his vision to become blurry, so he quickly shut his eyes and calmed his emotions.
At the same time, comments proclaiming '666' flooded the live broadcast room in Xinglin Garden.
[He is so good with the forceps, it's like he is performing surgery under direct vision.]
[Who said this demon doesn't know how to perform laparoscopic surgery? This operation is by far the best surgery that I've ever seen.]
[Those movements are nimble. I wouldn't even dare lyse the adhesions with a scalpel. Is he not afraid of damaging the hepatic duct at all?]
[Young man, your low standard limits your imagination. You can learn a lot from this video.]
In the livestream, the gallbladder, sticky mess around it and all, as well as the anatomical structures of the triangle of Calot had been exposed after merely a few minutes of manipulation with the grasping and dissecting forceps.
Everything had become clear and distinct.
With that, the difficulty of the surgery dropped from an S rank to a D rank. A surgeon with any kind of experience with this sort of surgery would be unlikely to make a mistake with such clear anatomical structures.
[That was impressive. The adhesions were so severe but it took him only a few minutes to completely expose the underlying structures.]
[This separation process can be written into medical textbooks as every step was done very clearly. I assume the surgery can be finished within the next five minutes.]
[It seems like a dream, I'm asleep right now. From the moment the laparoscope was inserted until now, it has only been around eight minutes and the surgery is finishing soon.]
Yes. The surgery was almost over.
Zheng Ren had tackled every complicated issue in the surgery in a very simple manner within a few minutes. The only thing he needed to do right now was to separate the gallbladder from the gallbladder bed with an ultrasonic dissector, clamp the cystic duct and cystic artery, and finally remove the gallbladder.
The surgery was uneventful with an estimated blood loss of less than 10 milliliters. Any possible doubts were handled without hesitation, the manipulation was done confidently and the whole process was smooth sailing.
Only experienced surgeons who had performed hundreds of similar operations would understand how skillful this surgeon was in these few minutes of performance.
Excellent knowledge of anatomy, proficiency in surgery, stable hands, meticulous personality… and expertise in laparoscopic surgery.
That was amazing!
It was truly outstanding!
Innumerable comments going '666' overwhelmed the live broadcast room in Xinglin Garden.
It was a pity that the website was not meant for entertainment and had no virtual gifts in the system. Otherwise, even if Zheng Ren had kept quiet about it, he would have earned more than ten thousand yuan in profit for a surgery completed within twenty minutes.
In the special demands ward, Chief Surgeon Liu closed his eyes and tried to calm his chaotic mind and heart.
'Don't be angry. Don't be nervous,' Chief Surgeon Liu warned himself. This body belonged to him. What would he do in the future if something went wrong with it due to rage?
He felt calmer a few minutes later.
Silence hung in the air and the only sound that reached his ears was Cen Meng's heavy breathing.
Chief Surgeon Liu lacked the courage to open his eyes and watch the surgery progress; he worried that his blood pressure would skyrocket again after witnessing Zheng Ren's proficiency in lysing the adhesions around the gallbladder and in the triangle of Calot.
"Little Cen, is his surgery going smoothly?" asked Chief Surgeon Liu.
"..." Cen Meng remained silent because he was unsure how to respond to that question.
"How is it?" Chief Surgeon Liu was displeased.
"Chief… Chief Surgeon Liu, the surgery is complete," answered Cen Meng softly after a few moments of hesitation.
What? Finished?
No way!
That was impossible!
Chief Surgeon Liu ignored his control of his blood pressure and snapped his eyes open, only to see that the image on the television was way beyond his expectations. It was not adhesiolysis, the separation of the gallbladder from the gallbladder bed, or even the clipping of the cystic duct and artery with an absorbable or titanium clip.
Zheng Ren was aspirating the residual bile in the gallbladder fossa with an aspirator…
That was… too fast…
Chapter 57 - The Demon In Sea City
[I'm speechless. God, are you accepting any disciples?]
[Which hospital is the god working at? I can't fight the urge to further my studies anymore.]
[My fifty-meter surgical sword is craving blood. I'm going to surgery now. Wait for my good news, everyone.]
The live broadcast room in Xinglin Garden was barraged with '666'.
The subsequent procedures were nothing new as they were similar to surgical wound closures in open surgeries. The battle would be over in two to three minutes.
Only a few viewers stared at the operation on the screen in distress. They were veterans of this live broadcast room who had witnessed this surgeon's idea of using protein-based surgical glue to close the subcutaneous layer, and were worried about missing any details in this surgery.
However, the following surgical steps were plain and simple, pure textbook, with no additional moves.
If they had to pick out a difference, it was that the host surgeon was very stable in his manipulation, and every step was done clearly and purposefully.
The host surgeon had actually finished a surgery with a difficulty level of 9.5 without making any mistake, and many viewers failed to grasp what had just transpired.
Of the attending doctors and deputy senior consultants, who had performed dozens or more surgeries so far, only a few of them could understand the essential steps of this operation.
"He didn't even have an assistant. Who was the camera holder just now?" mumbled the perplexed Chief Surgeon Liu who was shutting his eyes tightly to avoid watching Zheng Ren's surgery for a split second further.
The camera holder was basically a surgical assistant whose job was to ensure a clear operative view by holding the laparoscope. It was the same as a surgical assistant holding the retractor in open surgery, but a camera holder was much more important in comparison.
If a surgical assistant was unavailable, a self-retaining retractor could at least be used.
However, a laparoscope could not be fixed, and if the camera holder was unable to keep up with the surgeon's pace, the operative process would be affected.
Chief Surgeon Liu was unable to come up with an explanation despite racking his brain. How was Zheng Ren able to finish a laparoscopic cholecystectomy in less than twenty minutes when he did not even have an assistant?
Cen Meng was momentarily stunned after listening to Chief Surgeon Liu's mumble. Then, he took out his phone and sent a WeChat message.
He received a reply shortly.
Cen Meng smiled bitterly upon reading the message. In the absence of a surgical assistant, the camera holder turned out to be a scrub nurse—Xie Yiren…
He finished a laparoscopic cholecystectomy just like that?
Yes, that was it.
Zheng Ren began suturing the surgical wounds. Even though the three incisions were less than one centimeter each, he still had the habit of using absorbable sutures to close the wounds with the running subcuticular suture technique.
"Chief Zheng, do you have obsessive-compulsive disorder?" Xie Yir
en had begun tidying up the surgical instruments and, upon noticing it, found Zheng Ren's choice of wound closure funny.
A reverse cutting needle with a size seven or four suture thread was more than enough to suture this sort of incision, but Zheng Ren was willing to spend more time to perform a running subcuticular suture technique instead.
"Haha, I want to do everything perfectly," replied Zheng Ren with a smile.
The surgery progress bar on the upper right corner of his vision reached 100 percent after the last surgical wound was sutured.
Zheng Ren was satisfied.
The intensive training in the System's operating theater had proven to be very effective.
Zheng Ren was aware of the difficulty of this surgery, but he had performed more than a hundred cholecystectomies with similar difficulty levels in the System.
Practice made perfect—that was the moral of the story.
At the end of the operation, the patient woke from his general anesthesia. Patient transfer was initiated and the resected gallbladder was sent to pathology.
The patient's family member was sitting on a hard plastic bench outside the operating theater, visibly anxious and restless.
One of his classmates led a group in a Class Three Grade A Hospital in Imperial Capital, but they had recently fallen off contacting each other. Would it be inappropriate to seek him out only when trouble arose? After hesitating for a few seconds, he opened WeChat on his phone and started consulting his classmate.
Soon, he received a response—It was very difficult to perform surgery on this type of cholecystitis, especially when the B-scan report showed a severely edematous gallbladder wall, indicating that it had been inflamed for a few days.
His heart sank immediately.
"It can't be helped. That's the most common complication of acute toxic liver injury, and antibiotics can't prevent this occurrence either. I once encountered a patient whose liver was badly damaged due to pesticide consumption and was on conservative treatment with antibiotics. In the end, he developed fungal infection complicated with cholecystitis," his classmate shared.
It was framed as advice but just made the man's heart sink deeper into the ground.
The Surgeon's Studio c1-799 Page 33
