The Surgeon's Studio c1-799

by Black Ursa Prime

  This was the only method to identify the hemorrhage site.

  It was the most viable option. He would rather spend a bit more time at the start of the surgery to identify the exact location than botch the surgery.

  10 seconds passed…

  20 seconds passed…

  The X-ray imaging system hummed to life. As time trickled by, the contrast agent in the patient's body bloomed on the imaging display.

  There!

  Zheng Ren spotted the source of hemorrhage.

  It was the left gastric artery.

  Zheng Ren and Su Yun quickly put away the scatter dr.a.p.es used in interventional radiology and started to reapply the sterile surgical dr.a.p.es over the patient's body in preparation for the laparotomy.

  Xinglin Garden was full of confused doctors.

  [Pancreatic pseudocyst? It's a pretty rare disease. What was the surgeon looking at just now?]

  [No idea.]

  [The surgeon was searching for the site of hemorrhage. Judging from the dr.a.p.e placement, it should be the left gastric artery. The patient's low blood pressure resulted in a blurry contrast image, which means that the surgeon must have ample experience detecting hemorrhaging under X-ray.]

  [Man… The experience one needs to perform such surgeries. The patient's blood pressure is almost undetectable and the heart rate is at 160 beats per minute with signs of atrial fibrillation. The heart might be giving up. The thought of such emergency surgeries makes my head hurt.]

  [Why doesn't the surgeon just embolize the bleed?]

  [Brother, this is the left gastric artery. Embolizing it will cause a good part of the stomach to necrotize. If the embolic agent travels to the superior mesenteric artery, blood flow to the colon would be affected. It would basically kill the patient.]

  [They're starting a laparotomy? What are they attempting? In my hospital, we would go for a laparotomy to search for the bleed… It's down to luck whether we get to it in time.]

  [That's not too bad. I spent half a year in imperial Capital and saw a few hybrid surgeries but none were as pressing as this.]

  Comments were popping up frantically in the livestream. The patient's rising heart rate and falling blood pressure were a source of suspense for every viewer.

  Every doctor in the audience had personal experience in the chaos and magnitude of emergency rescue. They watched the livestream with rapt attention, their hearts beating in sync with the patient's as their palms began to sweat.

  The nervousness made people want to chat more.

  The tension in the operating room would be too stifling otherwise.

  It was a habit cultivated by many surgeons over the years.

  …

  In Sea City General Hospital, the hybrid surgery was in progress.

  Zheng Ren tore off his sterile scrubs to remove his lead vest. He ordered an incision at the left lateral edge of the rectus abdominis and proceeded to scrub his hands.

  Zheng Ren had only been briefly exposed to pancreatic surgery in the System. He had not undergone any intensive training on this front.

  The discovery of the tetradecapeptide, somatostatin, had ensured near-total recovery from acute and chronic pancreatitis.

  Medicinal treatment was found to be more efficacious than surgery. Who would be willing to risk their lives on the operating table when there was a better alternative?

  Therefore, Zheng Ren had neglected learning pancreatic surgery in the System.

  Luckily, he had been hoarding all his skill and experience points like a squirrel caching for winter.

  Although the System had been tight-fisted with new missions, Zheng Ren had enough experience points saved up for a rainy day.

  While washing his hands, Zheng Ren entered the System to return the special lead vest and check on his stores.

  In the past few weeks, he had accomplished surgeries that contributed to the progress of the main mission. His general surgery skill level was at 3246 points. He had another 2025 skill points at his disposal.

  Without hesitation, Zheng Ren allocated 1742 points into the general surgery skill tree.

  A gentle breeze blew through the area and Zheng Ren felt a lightness in his body. Familiar images flashed through his mind. His fingers had a dexterity that was previously absent.

  Was this the general surgery Master rank? It was not as earth-shattering as Zheng Ren had hoped.

  The remaining 271 skill points caught his eye and he had to force himself to look away. He selected the option to purchase training time.

  After acc.u.mulating them, he had more than 250000 experience points.

  It would be sufficient.

  Especially since his general surgery was at Master rank.

  He traded 200000 experience points for 55.5 hours of intensive training time.

  The System's operating room rose from the ground. The simulation mannequins lay ready for him.

  Each mannequin had a pancreas-related disease, so logically, Zheng Ren began with the ones with pancreatic pseudocysts.

  Pancreatic surgery was much more difficult than hepatic surgery.

  The anatomical and physiological make-up of the pancreas was unique.

  Within 55.5 hours of training, Zheng Ren only managed fewer than 100 pancreatic surgeries without needing to stitch up the bodies in the System.

  …

  When Zheng Ren left to wash his hands, Su Yun immediately started disinfection despite still wearing the lead apron.

  The matron opened up an abdominal surgery set while a scrub nurse checked the various tools.

  Taking stock of surgical items was one of the scrub nurse's duties. The scrub nurse had to keep track of all surgical tools, instruments and materials before and after the surgery. This was to prevent any unwanted items from winding up inside the patient's body… which would be a lawsuit in the making.

  Su Yun finished disinfecting the surgical site and applied the first layer of surgical dr.a.p.es. Then, he left to remove his scrubs and lead apron for a second round of washing. At this point, Zheng Ren had already put on a new set of sterile scrubs and began laying the second layer of surgical dr.a.p.es to cover all areas. The two surgeons worked in perfect tandem.

  "Scalpel." Once the dr.a.p.es were in place, Zheng Ren started the surgery.

  Zheng Ren was a few steps ahead of the matron and the new scrub nurse. His sudden request interrupted their counting.

  "Give him a curved forceps, a scalpel and some gauze. We'll count from there," the matron ordered as she understood the urgency of the situation. Still, she could not help but glare at Zheng Ren.

  "I'll also need an aspirator with the tip."

  The work dynamic faltered without Xie Yiren.

  At this moment, the said woman was sobbing in a corner of the control room. She was in no state to assist in the surgery.

  Zheng Ren disinfected the skin one more time. Then, he held the scalpel in a pencil grip and made a 15cm-long incision along the left flank of Miao Xiaohua's body. Referring to three other hospitals in the country.

  Chapter 165 - Race Against Time Part II

  There was no time for blunt dissection. Zheng Ren's scalpel cut through skin, subcutaneous tissues and adipose layers.

  Then, he parted the muscles with blunt instruments. A moment later, the peritoneum was visible.

  [The surgeon's brutal knife work reminds me of 'surgeries' 200 years ago…]

  [You remember the case where three people died?]

  [That was such a long time ago. The surgeon most likely evaluated the severity of the bleed and decided to open up the abdomen. From the looks of it, they might have to perform CPR soon.]

  The doctors on Xinglin Garden understood the urgency behind Zheng Ren's cruel incision but it did not stop their hearts from jumping up to their throats.

  In the early days of surgery, speed was of utmost importance as there was no anesthesia. There had been an amputation in which the surgeon sawed off a patient's leg and in the process, injured himself an
d his assistant.

  The surgeon, patient and the assistant soon passed away due to infection from the wound.

  The fatality rate of this surgery was 300%, the highest ever recorded in the history of surgery.

  With modern technology, minimally-invasive procedures were becoming the gold standard for surgery and incidents like those were few and far between.

  The audience of the livestream was simply taken aback by the unexpected barbarism in this new age.

  Zheng Ren placed the scalpel on the surgical dr.a.p.e that covered the patient's leg and took the curved forceps. He gripped the aspirator in another hand.

  The metal forceps pierced the peritoneum. The aspirator was immediately inserted into the cavity.

  Warm, dark blood flowed out of the body through the drainage tube.

  Within a few seconds, Zheng Ren completed the necessary procedures to safeguard the peritoneum. He did not wait for the pool of blood to be drained before accessing the peritoneal cavity.

  Stomach… Colon… Posterior…

  The bleeding site was correctly identified and without any hesitation, Zheng Ren used his fingers to locate the left gastric artery and plugged the leak.

  Su Yun had just put on new scrubs and was about to take his position as the assistant surgeon.

  He figured the surgery was still at its opening stages but when he came back into the operating room, Zheng Ren already had his hand inside the patient.

  'That was quick!' Su Yun was shocked.

  Zheng Ren's surgical skill was beyond Su Yun's initial estimates.

  How long had he been gone? Ten seconds? Twenty seconds? How was Zheng Ren already plugging the leak?

  What was this man's upper limit? Su Yun eyed Zhen Ren suspiciously as the man worked with fervor.

  Zheng Ren noticed Su Yun was standing idle and demanded, "You. Press here."

  His tone brooked no dissent.

  It was a direct order from a senior doctor.

  Su Yun was snapped out of his daze.

  This was an emergency surgery. A misstep could lead to the death of the patient.

  Su Yun immediately took up his duty as an assistant surgeon and helped Zheng Ren with the bleed.

  His hands free, Zheng Ren took the scalpel and made a 6cm incision on the anterior wall of the stomach.

  He got down to business once the leak on the left gastric artery was controlled.

  His hands were quick, accurate and steady as if he had done the procedure a thousand times.

  Su Yun's eyes were locked onto the unwavering movements of Zheng Ren's hands.

  Su Yun knew Zheng Ren was incredibly skilled in surgery but firmly believed he could surpass the man.

  As a savant who could perform any surgery after witnessing it only once, he was truly surprised to find someone that he could not outdo here, in Sea City.

  The past-him would have laughed at the thought. A person who outskilled him? In their dreams!

  Impossible!

  And yet.

  This man and this surgery was happening right before his eyes.

  Incredulity filled Su Yun.

  Oblivious to Su Yun's inner thoughts, Zheng Ren was fully focused on the surgery at hand.

  In one fell swoop, he sliced open the serous membrane and muscle layer. He proceeded to use a 1-0 surgical suture to ligate the branching arteries beneath the mucosa layer.

  As the surgery progressed, Su Yun came back to reality.

  He decided to do what a perfect assistant surgeon would do. With a hand on the leak, his other hand worked together with Zheng Ren to speed up the process.

  This was an emergency procedure, so the patient did not fast before the surgery. There was still a significant amount of stomach content even though gastrointestinal decompression had been conducted.

  Zheng Ren moved the drainage tube into the stomach and ordered, "Get me another drainage tube."

  The matron opened a new kit and moved another aspirator machine to the operating table. Most of the stomach contents were removed after the second drainage tube was set up.

  Then, Zheng Ren made an incision at the posterior wall of the stomach and the anterior wall of the pancreatic pseudocyst. Using the aspirator, he drained the pseudocyst before widening the stoma. A 3cm x 2cm opening would ensure a good connection between the stomach and the pseudocyst.

  The bleeding was stopped by ligating the arteries on the pancreatic pseudocyst that branched off from the left gastric artery. Everyone let out a sigh of relief.

  Zheng Ren took a look at the patient's vital signs. The patient was receiving 7 to 8 units of blood as the surgery went on. Miao Xiaohua's blood pressure was stabilizing and the signs of atrial fibrillation disappeared.

  [This godlike speed…]

  [Preparation is key. If they hadn't used radiological methods to detect the bleed and went with the traditional method, the patient would already be dead.]

  [This surgeon is hasty! But I guess that is the essence of an emergency surgery. How I admire the teamwork and sharing policy among the departments in this hospital. In my hospital, you would have to go through protocol and request a consultation.]

  [How about you try it without consulting the specialists? As if you would know what to do.]

  Once the bleed was stopped, the Xinglin Garden livestream came alive with comments.

  At this point, there was a chance the patient would get through this.

  There was heavy blood loss which had led to hemorrhagic shock. The patient's survival would likely depend on post-surgery treatment.

  The surgeon's decision to use interventional radiology to locate the bleed was ironclad.

  Many of the doctors who were watching the livestream knew that had they been in the surgeon's position, the patient would already be dead.

  The majority of their time would be wasted searching for the source of the bleed through traditional surgical methods.

  The few doctors who had criticized the surgeon's method were silent now. They watched the livestream with mixed feelings.

  In the end, their suspicion of the godlike surgeon was a joke to all.

  When the pancreatic pseudocyst was located, Zheng Ren's hands slowed down.

  Chapter 166 - Race Against Time Part III

  Zheng Ren probed the pseudocyst to assess the situation. He wanted to know if there were multiple cysts or signs of malignancy.

  It was standard procedure to rule out the possibility of ripping a vessel on the tumor.

  There were no signs of malignancy or bleeding, so Zheng Ren started to connect the pseudocyst to the stomach.

  He used the size 0 catgut suture to stitch the pseudocyst to the posterior wall of the stomach.

  Then, using a 1-0 suture, he performed an interrupted inverted suture to close the incision on the anterior wall of the stomach. The same technique was used to stitch back the muscle and serosa layer.

  The whole procedure from incision to suture took eight minutes.

  The matron was caught off guard when she found Zheng Ren suturing the layers. She had just been cleaning some surgical tools with the scrub nurse and the next thing she knew, the surgery was over?

  "Saline," Zheng Ren said softly.

  "Oh…" The matron was aghast. She spoke with a bit of fear in her tone, "The saline is not ready yet."

  If the lead surgeon had been a department chief, a haranguing would have been unavoidable.

  Without a hint of anger in his tone, Zheng Ren told the matron, "Go get it ready."

  He did not blame others for not being able to keep up with the pace of the surgery.

  He was the one at fault for being too fast.

  The general surgery Master rank was no joke. Even Zheng Ren found it difficult to adapt to his newfound abilities.

  The "genius" across him was wearing a mask that shielded his expression but Zheng Ren believed that he was equally stunned by the speed of the surgery.

  Su Yun could only watch in envy.

  Chu Yanzhi went t
o assist the matron with saline preparation while Chu Yanran monitored the ventilator, occasionally making notes with a pen.

  While waiting for the saline solution, Zheng Ren checked to see if he had missed any bleeding spots.

  He found no signs of bleeding at the stomach, intestine, pancreas and spleen.

  A few minutes later, the saline solution was ready.

  The surgical site was rinsed and drained repeatedly. He made a final survey to ensure there was no active bleeding before closing the abdomen.

  Zheng Ren exhaled a long-held breath.

  With his Master-level general surgery skill and nearly 100 practice surgeries under his belt, Zheng Ren had been able to complete the emergency surgery in less than 20 minutes, giving Miao Xiaohua a chance at survival.

  Whatever came next was minor compared to the emergency hemostasis procedure.

  Zheng Ren had done what he could. He had spent a month's worth of points for this.

  It was worth it.

  He started to stitch back the abdomen.

  The mood of the operating room was more relaxed now.

  Sutures were applied to the layers and layers of tissue. The catgut suture was used to sew together the skin layer to minimize the scarring.

  Every girl was conscious of their appearance. It would be costly to get cosmetic treatments.

  At the last stitch, the System chimed to signal the completion of its mission.

  [Continuous Mission: Unbreakable Support Part I completed. Xie Yiren's wish was achieved. Host shall be rewarded.

  [1. Passive ability: Limitless Charm. For every completed surgery, the host will gain the respect of others and increase their charm. Charm is dependent on the host's reliability and will power.

  [2. 100 skill points, 1000 experience points and 1 gold c.h.e.s.t.

  [Additional time on the clock is converted into 4450 experience points.]

  This was the first time the System had granted a passive ability.

  In the chaos before, the System had given him two missions that rewarded him with 4 luck points in total.

  To this date, Zheng Ren had no idea how the luck points worked.

  Now, accomplishing Xie Yiren's mission had given him a passive charm skill.

  He was somewhat put off by the System. He would prefer to have something surgery-related to boost his other skills to Master rank or unlock his skill trees rather than this charm skill.