How much could they learn from this surgery? Well, it would depend on their individual talents.
[Are you stupid? How can he perform laparoscopic surgery if he can't do an open surgery well?]
[Not exactly. Nowadays, many junior attending surgeons start their practice in laparoscopic surgery. Hey, both of you have inadvertently exposed your age group.]
[The gallbladder had been resected. I've a feeling that there will be at least three to five gallstones of over three centimeters in it.]
The anatomical structures could be seen very clearly. After the gallbladder had been resected, the common bile and hepatic ducts were exposed in the operative field, and any surgeon could easily identify them.
Even so, Zheng Ren wanted to minimize risks of medical error and requested a 5-milliliter syringe so that he could confirm the common bile duct by bile aspiration.
After traction was applied to stretch the duct, an aspirator with a suction tube was then gently placed on Zheng Ren's palm.
The aspirator was plunged into the common bile duct as soon as it was incised.
It was done without a moment's hesitation. The huge amount of bile that had acc.u.mulated in the duct was aspirated before it was forcefully ejected by high intraductal pressure.
This detail attracted the attention of the doctors of Xinglin Garden.
Generally, the area around the common bile duct would be protected to a certain extent as bile leakage was inevitable.
However, the host surgeon had not taken any safety precautions at all. The incision on the common bile duct was the same size as that of the aspirator, preventing any bile leakage.
Everything was done perfectly. It appeared extremely simple and easy, but only those who had performed similar surgeries would understand the difficulty behind it.
[I suddenly feel sad. A few years ago, I performed an incision and drainage of an acute obstructive suppurative cholangitis. Bile leakage occurred during the surgery and resulted in postoperative infection. Initially, it was just a bacterial infection but it was further complicated by a fungal infection. The patient recovered only after one month of aggressive treatment.]
[The feeling is mutual. The host surgeon's manipulation is indeed stable. That incision had been made about the same size as the aspirator. Is it possible to master such a superb hand- and eyesight-based judgment through sheer practice?]
[That's talent, so curb your enthusiasm.] The Kwantung Army was formed in 1906 as a security force for the Kwantung Leased Territory and South Manchurian Railway Zone after the Russo-Japanese War and was expanded into an army group during the Interwar period to support Japanese interests in China, Manchuria, and Mongolia.The Chinese city tier system (Chinese: ) is a hierarchical classification of Chinese cities. Cities in different tiers reflect differences in consumer behavior, income level, population size, consumer sophistication, infrastructure, talent pool, and business opportunity.
Chapter 63 - Parasites In The Biliary Tract
The doctors in Xinglin Garden understood everything that had been done up to this point.
It did not matter if they could perform the exact same procedures, but it would be humiliating if it had all been Greek to them.
Doctors who had received professional training still possessed this basic quality, at least.
'It's time to extract the gallstones.' Everyone had the same thought on their minds. Since the common bile duct had been incised, the next step would be gallstone extraction to alleviate the patient's obstructive jaundice symptoms.
A pair of custom-made lithotomy forceps, a conventional but rarely-used instrument in the operating theater, was then placed in Zheng Ren's extended palm. Xie Yiren had been attentively observing Zheng Ren's movements and necessary instruments would be handed over whenever required.
Many viewers in the Xinglin Garden live broadcast room were envious.
The host surgeon's scrub nurse was competent and far better than their own. Not only were theirs bad-tempered, they even needed to be reminded to pass the lithotomy forceps during unconventional surgical manipulation.
In most cases, they would realize that they had not prepared the lithotomy forceps and circulating nurses would be instructed to retrieve a pack of sterile lithotomy forceps from the sterilization room.
Inevitably, this trip would delay the surgery for a few minutes, but this was not the case for the host surgeon, who could perform the operation in a relaxed manner.
There was a more outrageous possibility—that the nurses returned with a pair of unsterilized lithotomy forceps! That was a nightmare!
Despite the doctors' envy, life still had to go on, right?
The forceps entered the common bile duct. One, two, three… Something was wrong. Why were the gallstones oddly shaped? Was it possible that those were not stones?
[Based on my decades of clinical experience, it seems like a biliary parasite.]
[Decades of clinical experience, are you bullsh*tting me? I don't even think experienced, elderly senior consultants know how to log into Xinglin Garden.]
[I'm now fifty-nine years old, so I'm actually a senior consultant with decades of experience who keeps up with the times. What are you going to do about it?]
The subject in the Xinglin Garden live broadcast room changed in that instant.
However, judging by the strange shapes that emerged, they did not seem to be ordinary gallstones.
After removing the gallstones in the cystic duct and left and right hepatic ducts, the host surgeon began irrigating the ducts with warm normal saline while aspirating more sediment-like stones.
Then, a rare event occurred—the surgery came to a halt.
[Mayday, mayday. Did the live broadcast just crash? Anyone who sees this comment, please respond. I repeat, please respond.]
[Same. I feel so much better after seeing your comment.]
[It isn't a crash. The host surgeon is preparing the next equipment. I'm guessing a choledochoscope.]
After ensuring that there was no connection issue or livestream problem, this particularly uncommon surgery having an interlude was instantly barraged with comments.
All of them were guessing what had actually happened.
[I think the host surgeon is having diarrhea. I once suffered from acute enteritis and had to visit the toilet eight times while performing an appendectomy. Every time after I scrubbed up and changed into a surgical gown, diarrhea struck me again. That was indeed a tragic experience and makes me feel uneasy even until now. I'm looking for consolation.]
[Perhaps he wants to check if there is any malignant transformation after opening the gallbladder.]
[Maybe the host surgeon fainted.]
Hundreds of comments flooded the screen, which reflected the joyful atmosphere of the moment, but none of them worried about the surgery at all.
What a joke. Disregarding everything else, the blunt dissection and profound anatomical knowledge of the host surgeon were more than enough to fuel speculations that they were an elderly professor in their sixties. How was it possible that they could not complete a tier-three surgery?
In the operating theater, Zheng Ren had temporarily stopped the surgery to allow Chu Yanzhi to unpack the equipment he had purchased in the System, place the fiberscope on the surgical instrument table and put the connector on Zheng Ren. That way, he could see the operative field through the imaging in the fiberscope with his n.a.k.e.d eyes.
Chu Yanzhi's height was the same as Zheng Ren's—172 centimeters. Therefore, she had to use a stool in order to put the connector on Zheng Ren's head.
"Chief Zheng, where did you get this equipment?" Chu Yanzhi had assisted in similar surgeries in West China Hospital but had never seen such tools.
"I made it myself." Zheng Ren shut down the whole conversation with a simple sentence.
"What a stingy person," Chu Yanzhi said, annoyed, "I'm not going to take it from you, so why can't you tell me?"
Zheng Ren felt helpless. He could not possi
bly tell her that he bought it from the System's Shop, and perfunctorily made-up a place was not a viable option either. What would happen if she decided to visit it for equipment purchase? Deception was a better course of action in this case.
His imagination suddenly ran wild like a dog that had broken its leash. If women had access to the System's Shop, would there be a big sale on Double Eleven?
After assisting Zheng Ren with the equipment installation, Chu Yanzhi said with excited curiosity, "Sis, we can perhaps write an SCI if this surgery is successful."
"It's possible as the impact factor should be equal to or more than three." Chu Yanran, who was sitting beside the ventilator with an anesthesia monitoring form in her hands, quietly observed the various data displayed on the ventilator and monitors, adjusting the drug dosage accordingly.
The Chu sisters would behave distinctively only during a surgery.
Zheng Ren was unsure whether this was the only odd way to accurately distinguish them.
The image in Xinglin Garden distorted for a moment before it switched to the fiberscope view.
[What the f*ck, it's a fiberscope!]
[That's indeed high class. We normally use a size-five urinary catheter for continuous irrigation to ensure that there aren't any residual stones in the ducts.]
[I have professors who know how to handle a fiberscope, but they seldom use it. Most people can't use it well, especially with forceps integrated with a fiberscope for the removal of residual tiny stones. This kind of microsurgery is on the same level as neurosurgery.]
The fiberscope advanced deeper and the atmosphere in the live broadcast room became tense and quiet.
The comments disappeared as everyone stared at the white silk thread attached to the walls of the common bile duct in shock.
They were not gallstones, but parasites!
These white silk threads were clearly not suppuration caused by inflammatory exudation, but rather elongated parasites dwelling in the common bile duct.
The gallstones that had been extracted were likely the end products of these parasites that had been wrapped and organized by inflammatory reactions.
[Who can guide me on the treatment in a parasitic infestation? I'm waiting. It's urgent.]
A junior doctor sought guidance in the livestream.
Generally, if someone took the lead, others would follow suit. This was a common phenomenon in the operating theater, but in the live broadcast room, not only was the situation similar, it was more unbridled.
However, this time, an eerie silence reigned in the live broadcast room. The lone comment flew from the right side of the screen to the left with no response.
The junior doctor was smart enough to remain silent.
Every doctor watching the livestream had a bad feeling. This surgery would very likely end in failure.
Was it possible that the host surgeon would observe the condition, performatively try to remove the parasites and give up after realizing that they had embedded themselves into the mucosal layer? After all, they could accidentally damage the common bile duct during parasite removal.
It was highly probable.
However, everyone was greatly satisfied after seeing the parasites cl.u.s.ter like dense, white silk threads.
Moreover, many viewers blindly trusted the host surgeon because they were omnipotent! Since they dared to broadcast their surgery live, they must have anticipated this condition.
They were again astonished upon recalling the earlier intermission in surgery.
Could it be that the host surgeon had diagnosed the patient with parasitic biliary obstruction and the necessary instruments had been prepared in advance?
Even if the instruments had been prepared, though, nothing could be done in this situation.
Parasite removal surgery was still in the preliminary stage in the current medical trend. After all, the risk of parasitic infection was low in developed countries, and most parasitic diseases remained in Africa.
Besides, expecting random medical experts to specialize in the surgical removal of parasites… was basically impossible.
Even if any doctor was willing to learn for the sake of boundless love, to improve their medical skill and for nobility, medical device companies would never invest in or design equipment specifically for surgical removal of parasites.
Even if the equipment was manufactured, Africa had limited financial power to purchase it.
This surgery had evolved from an incision and drainage of a "simple" obstructive suppurative cholangitis to an unfamiliar procedure.
What would the host surgeon do to complete this surgery with an unknown difficulty level?
Perhaps he just wanted to observe the situation and give up in the end?
Chapter 64 - New Surgical Technique
In the fiber-optic choledochoscope view emerged a tiny forceps-like instrument. Even though there were thousands of doctors watching the livestream, none of them could identify this device.
[Forceps? That's so small. How does the host surgeon plan to operate with it?]
[I'm completely confused. I'm going to watch the video replay a hundred times after the surgery is over.]
[Shut the f*ck up and watch the surgery!]
A few comments expressing their surprise were soon suppressed. This may be a new surgical technique and was likely more advanced than endoscopic transrectal appendectomy.
Perhaps this was the first appearance of a new surgical procedure.
Silence hung in the air as numerous pairs of eyes stared at the operative field, where delicate forceps grasped a white thread, only a few microns thick, with deadly hawk-like accuracy.
It was done without touching the mucosal layer of the common bile duct, which stunned the audience.
However, none of them spoke because the most crucial step was coming soon.
The parasites had tough filariform extremities that allowed firm adherence to the common bile duct. Since their fine hairs had embedded themselves into the mucosal layer of the duct, forceful removal would result in irreversible damage to the layer.
Severe injury would result in postoperative complications such as bacteremia or toxemia.
Thousands of eyes stared unblinkingly at the live broadcast with curiosity and anxiety tormenting their hearts.
However, to everyone's surprise, there was a slight twitch in the forceps and the parasite was pulled off.
What of the injury to the mucosal layer of the common bile duct that they had feared? It did not even exist!
[What the f*ck, what did I just see?]
[Is the host surgeon also working as an animal trainer? Did they raise those parasites?]
[Please respect the host surgeon. They may be the teacher of your teacher's teacher. If you don't want to embarrass yourself after their identity is disclosed, don't use derogatory words. Thank you, my name is Lei Feng.]
The viewers were going crazy in the live broadcast room.
The preconceived nodus had been thrown out the window as the parasite was removed without any difficulty.
The forceps retracted and then extended again, presumably for parasite removal from the body.
The repetitive, mundane procedure and the host surgeon's precision were like that of a machine. Aside from the surgeon's accurate manipulation, the parasites were unusually obedient as they relaxed all their hair immediately after being clamped, allowing for smooth extraction. It was why the mucosal layer of the common bile duct remained unharmed thus far.
[Who can tell me what the hell the surgeon is doing?]
[Is he an alien?]
[Impossible. That's just ordinary equipment made of nickel-titanium alloy, judging from the familiar metallic l.u.s.ter.]
[Then why didn't the parasites adhere to the wall? Does the nickel-titanium alloy possess any property that intimidates them?]
[Oh my God. Host surgeon, please accept my worship.]
Parasite removal with forceps was a delicate task, and there were hundreds of p
arasites residing in the common bile duct, so complete removal was not easy either. No matter how fast or precise Zheng Ren's movements were, it still took him fifteen seconds to remove a single parasite.
In Xinglin Garden, a few experienced doctors with profound knowledge about equipment gradually noticed something peculiar with the procedure.
[I'm not sure if it's just my imagination, but the parasites seem to be spasming after the host surgeon grasped them with the forceps.]
[I noticed it too. The twitch was mild but that should be the key here.]
[I'm a postgraduate student who studies parasites, and I've been working on a related topic recently. I suspect that there is some mild bioelectric stimulation that caused the parasites to spasm.]
The doctors in Xinglin Garden had gotten closer to the truth in less than half an hour.
Xinglin Garden was indeed a professional website!
[That's awesome! Is this a new surgical technique?]
[The-Surgeon's-Name Biliary Parasitosis Removal, how does that name sound?]
[If you have enough data and your English level is up to par, write an article and publish it in The Lancet.]
The Lancet was a magazine published by the Elsevier Publishing Company in collaboration with Reed Elsevier Group since 1823.
The journal had founded that year by Thomas Wakley, an English surgeon who named it after the surgical scalpel called a lancet, as well as after the architectural term "lancet window", which was a window with a sharp, pointed arch to indicate the "light of wisdom" or "to let in light".
The Lancet was the top journal for surgery, similar to other magazines for science and nature.
Regarding the impact factor… The Lancet had achieved up to 33.6.
This concept could be difficult to understand, so to simplify comparisons, the impact factor of ordinary medical journals was between 0 to 0.1.
Medical journals in China had an impact factor between 1.0 to 5.0.
Thus, the fact that The Lancet had achieved an impact factor of 33.6 was truly impressive.
Article publishing in The Lancet, though?
It was a tempting idea as whoever managed to do so would have access to national research funds, a humongous supply of resources, academic status…
The Surgeon's Studio c1-799 Page 37
