The puncture would be performed without any visual assistance. It was up to experience and luck.
Luck played a huge factor in TIPS surgeries, regardless of the skill of the surgeon.
That was why it was the crown jewel of interventional surgical achievement.
Zheng Ren was trying to figure out how to minimize reliance on luck.
As someone who had not even bothered trying his luck with the System's treasure c.h.e.s.ts, Zheng Ren was not willing to let it determine his success at the operating table.
Su Yun was a step behind him and noted his slower pace. Zheng Ren seemed deep in thought. "Are you sure about this?"
"No one can be 100% sure about anything," Zheng Ren replied.
"Professor Rudolph Wagner is sleeping in Shangri-La Hotel," Su Yun reminded him.
"Oh…" Zheng Ren had forgotten about the professor.
The professor was one of the world's top interventional surgeons. It would be wise to invite him to assist in the surgery.
Zheng Ren nodded and pulled out his phone.
It rang for a good 30 seconds before the professor picked up. "Professor Rudolph, it's Zheng Ren."
Zheng Ren ignored the sleepily-mumbled German greeting and got straight to the point.
"We have a TIPS surgery now. Please come and have a look."
He hung up without any additional explanation.
Chapter 298 - A Series of Failures (Part 2 of 4)
"Your brutal honesty never ceases to amaze me. Can't you be a little bit more tactful when speaking to a world-renowned professor?" Su Yun needled Zheng Ren.
"Heh." Zheng Ren huffed out an unamused chuckle. He made another call to Xie Yiren and Chu Yanran, instructing them to prepare for the surgery.
Once that was done, Zheng Ren called Feng Xuhui again to check on the status of the delivery and remind him of its urgency.
Lastly, he called up Old Chief Physician Pan to provide an update on the situation.
Zheng Ren and Su Yun arrived at the doors of the operating room just as the last call ended.
They changed their outfits in silence.
The patient had yet to be moved, so Zheng Ren did not rush. Seeing that Su Yun had already changed into surgical scrubs, he said, "You go on and help with the setup. I'm gonna light a smoke."
It was common to have a cigarette to calm one's nerves before a surgery. Su Yun made a noise of acknowledgment and headed into the operating room.
Zheng Ren went into the tiny smoking room and lit a cigarette. He took a long drag before entering the System.
Without any hesitation, Zheng Ren exchanged all his experience points for training time on top of the time he had been awarded before.
The System's operating room rose from the ground, fully equipped with simulation mannequins.
Zheng Ren began his intensive training.
Jugular vein catheterization was effortless.
The guide wire traveled down the vein and into the heart, and then the hepatic vein. All was going well.
Journeying through the venous network was easy for someone who could maneuver a guide wire into the smallest arterioles of the prostate.
However, the most difficult step was coming up.
From the hepatic vein, he made an estimate and proceeded with the puncture.
Failure…
He switched positions.
Failure…
Another position.
Failure…
A dozen attempts later, he had still not established a connection between the hepatic and portal veins.
How demanding…
How arduous…
No wonder it was the crown jewel…
After the 42nd failed attempt, Zheng Ren took a break.
Training time was precious but there was no guaranteed success if he continued stabbing in the dark.
The portal vein had a large lumen. Even its branching venules were wider than most other vessels.
It required a lot of luck to accurately pinpoint the position of the portal vein within the liver from the hepatic vein, and more so to successfully puncture it.
What other skills did he require?
Zheng Ren rifled through the library in his mind.
A dozen failed attempts would not lead to the patient's death.
The liver was a solid organ that could withstand the small-bore punctures of the puncture needle. The pressure within the organ would stem the resulting bleed.
However, there was a limit to the number of failed punctures before the liver became irreversibly damaged.
Zheng Ren ballparked the number at anywhere between 20 to 30 tries.
Hence, each TIPS surgery entailed up to 30 attempts at blind punctures. No wonder the average completion time was 4 hours and 23 minutes. The surgeons were all trying their luck.
Were Zheng Ren handling a real patient and not a simulation mannequin, he would not be as bold in his blind attempts.
He decided to pause practical work in favor of the theoretical.
After all, one ought to sharpen their axe before attempting to chop wood.
Zheng Ren left the System's training grounds and sifted through the volumes of information stored in his brain.
The memories of medical books and journals came to the forefront of his mind at the snap of a finger.
His Grandmaster rank in interventional surgery was essential for understanding and digesting the copious amount of information that he had once struggled to make any sense of.
Zheng Ren's proficiency in liver dissection was also a boon in this case.
All knowledge and skill were made possible by countless trials and errors throughout history, and the many lives that were sacrificed in the name of science.
The System had its downsides.
First, it was stringent with time. It counted each second that passed and once his time was up, Zheng Ren would be kicked out of the surgical training room. There was no negotiation.
Secondly, it expected the host to be independent. There was no guidance provided, no wise guru to pass on words of advice.
It was just Zheng Ren alone, fumbling through literature, knowing full well that some experiences were hard to put down in words.
He committed his mind to memorizing the whole TIPS procedure and integrating that knowledge with his experience of liver dissection. Then, he noted down all reported attempts at the procedure.
He called for a new simulation mannequin.
The previous mannequin was unusable after dozens of failed punctures.
Jugular vein puncture, access to the hepatic vein, followed by an attempt at a portal vein puncture.
Failure…
Failure…
Failure…
F*ck!
Zheng Ren almost went crazy.
He thought he had all the information he needed to succeed. The TIPS surgery was a combination of interventional methods and general surgery.
Zheng Ren was a rare two-headed snake, being a Grandmaster in the former and a Master in the latter.
He even had almost a thousand cases worth of experience in liver dissections. Such an experience would not have been possible without the System.
Yet… It was still not enough for the TIPS surgery?
Impossible!
Zheng Ren refused to think that he was incapable.
If he could not do it, there was no way anyone else could.
He had to have taken a wrong turn in the heat of the moment.
Where was his mistake?
Zheng Ren waved and dismissed the training room.
There was a limit on his training time but outside the System, time was even more precious. The patient was already on his way to the operating table.
Zheng Ren sat by the lake. His eyes fell on the realistic fox statue as he recalled his every step during the surgery. What was there to improve upon?
A burning sensation shook him from his quiet reflection.
Exiting the System, he tossed away the ci
garette that had burned all the way to his thumb.
He called Su Yun; the doctor was to receive the materials from Feng Xuhui and then only ask for him once the patient was ready for surgery. Zheng Ren wanted some uninterrupted alone time.
Su Yun was perplexed but did not question Zheng Ren's decisions when it came to emergencies.
The call ended and Zheng Ren cleared his vision before entering the System once again.
What was his mistake?
Zheng Ren went through the steps of the TIPS surgery again. The difficulty was in that single step. The puncture needle was affected by blood flow in the portal vein.
Was the solution in radiology?
CT? MRI?
Suddenly, Zheng Ren remembered the reward from the mission, The First Stage of The Great Beginning. It was a passive ability, Integration.
Perhaps that was it?
It was worth a shot.
The simulation mannequin was a docile and compliant patient that could be maneuvered as he pleased.
Zheng Ren entered the surgical training room. He did not rush to perform the surgery, instead spending some time analyzing CT and MRI scans.
His time was ticking away but he remained calm and focused.
A sharpened axe was what he needed.
A few hours later, Zheng Ren's eyes ignited with understanding.
Chapter 299 - The First in the Hospital’s History (Part 3 of 4)
In the System's operating room, Zheng Ren focused on the scans of the simulation mannequin. From CT scans to the NMRI, the 64-slice CT scan with 3D-image reconstruction, the B-scans, and the supine c.h.e.s.t and abdominal fluoroscopy imaging, he went through them all.
There was some invariable connection between them.
However, Zheng Ren was met by one disappointment after another.
He had wasted almost half his surgery training time looking at those images.
What if… Zheng Ren rejected the thought. It was not possible. He was not able to fully consider all the symptoms as he was still fairly new to the System.
He would solve one problem at a time.
The life of the patient in front of him was crucial even though he knew the same thing would never stop happening in the real world.
Zheng Ren had never once thought himself capable of saving the entire world. Protecting his people and patients was enough.
He looked through the scans over and over again, performing punctures on the simulation mannequin with the angiographic needle.
Success came occasionally, but much more infrequently than failure.
Pulling it off was still a matter of luck.
Although all interventional surgeons in the world mostly depended on luck, Zheng Ren wanted to avoid it.
The NMRI was not practical for observing blood vessels. It was important when analysing the arterial vessels of tumor vasculature, but was not able to distinguish the venous channels.
What about CT scans?
Or 64-slice CT scans with 3D-image reconstruction?
Zheng Ren kept trying different combinations. He even included the positioning and landmarks of puncture sites with ultrasonography.
However, all his attempts were futile.
After countless puncture attempts on the simulation mannequin, Zheng Ren had gained lots of experience and drastically improved the success rate of the surgery.
On average, he got it right once for every twenty punctures.
It was not Zheng Ren's ideal outcome.
How would he solve this?
The System had provided him with all manner of convenience. Zheng Ren could experiment indefinitely if he had sufficient surgery time.
As the time passed, though, he felt as if his heart was oozing blood.
Had he used it to perform surgery, he could have earned 300 skill points for every TIPS surgery he completed.
It was much less rewarding than prostate interventional surgery. Zheng Ren speculated that it was because the latter was a novel method while TIPS surgery was already a m.a.t.u.r.e procedure.
Although the rewards were slightly fewer, it was still better than doing nothing in the System's operating room.
He was still not giving up. He did not want to depend on luck when it came to surgery. There had to be a way… maybe… perhaps…
Time was passing by, every minute, every second.
Tick-tock… tick-tock… it was like the rhythm of Zheng Ren's bleeding heart.
After countless attempts and various test results, Zheng Ren was on the verge of conceding.
There were so many doctors in the world that had failed to come to a conclusion. How could he do that in just a few days? Even with the help of the System's operating room and simulation mannequins, this was too far a stretch.
…
…
Professor Rudolf Wagner was thrilled.
This was the first time Zheng Ren had personally called for him, possibly for help.
Zheng Ren was very skillful, but not necessarily in all fields of interventional surgery.
Everyone had their limits. Professor Rudolf Wagner was sure that TIPS surgery was Zheng Ren's weak point.
This was also part of why he had chosen to stay in Sea City.
He had put in his best efforts to close the distance between him and Zheng Ren, hoping the man would agree to follow him back to Heidelberg for research.
The workload here was too heavy. Professor Rudolf Wagner had almost broken down after one night shift.
Zheng Ren's determination to continue in such working conditions was perplexing.
Did he not know the value of his own gift?
Professor Rudolf Wagner stood in front of the mirror for a full minute after changing quickly, ensuring his scholarly appearance was authoritative and convincing enough before leaving Shangri-La Hotel. He then took a ride to Sea City General Hospital.
In order to adjust to the lifestyle in China, he had taken some time to chat with Chang Yue earlier in the day.
Professor Rudolf Wagner thought her an adorable girl with a warm personality.
She had helped him download ride-hailing and payment apps, converting 100 euros for the professor, and also taught him how to book a ride so that he could go anywhere he wanted.
Professor Rudolf Wagner was very pleased with the convenience it brought.
Even though he had only been here for less than two days, he had already fallen in love with the place.
On his way, the professor mentally ran through the TIPS surgery. He would be putting all of his energy and focus into it, giving his best to showcase the perfect TIPS surgery to Zheng Ren.
To be partners and not get pushed aside during surgical research, he needed to demonstrate that he was the man's equal.
Unless he was comparable to Newton, he would not be able to claim someone else's research as his own.
Such a thing was not his domain. Professor Rudolf Wagner wanted to get ahead on his own expertise.
The car reached Sea City General Hospital shortly. He alighted from it and rushed towards the operating room.
As he was not registered for the fingerprint lock on the changing room, he could only ring the doorbell.
The camera lamp on it lit up. "Who's there?"
Professor Rudolf Wagner angled his face towards the light and gave his most winning smile.
"Please hold, Professor," Xie Yiren said from inside.
Since it was an interventional surgery, Xie Yiren did not stand by at the operating table after preparing a sterile surgical pack.
With the exception of endovascular stenting and thrombolytic surgery, interventional surgeries did not require the presence of nurses.
They depended greatly on the surgeon's skill alone.
"Professor, I'll get the door." Xie Yiren soon appeared to let the professor in.
"Thank you, pretty lady," Professor Rudolf Wagner said gracefully, "Are you guys ready to start?"
"The surgery has started," Xie Yiren said casually.
>
The smile on the professor's face became even more charming. Knowing this was Zheng Ren's personal scrub nurse, he had to leave a good impression.
"Zheng called me to join in on a TIPS surgery. What step are they in now?" Professor Rudolf Wagner asked.
"Oh, they have just begun," Xie Yiren answered.
Hmm? Why had they not waited for him? Professor Rudolf Wagner was a little surprised.
"Have you guys done this before?" he asked.
"No, this is the first time," she said gently. "They are taking it very seriously. This is our first TIPS surgery in the history of our hospital."
Professor Rudolf Wagner felt slightly relieved.
TIPS surgery was extremely difficult. Even with Zheng Ren's exceptional talent, the man would not be able to succeed on the first try.
Chapter 300 - The Brave Fear Nothing (Part 4 of 4)
After he finished changing, Professor Rudolf Wagner entered the console room outside the operating theater.
Through the leaded glass, he saw the patient positioned at a strange angle. Before he could take a closer look, a tiny woman asked, "Who are you?"
Chief Xia from gastroenterology was confused by Professor Rudolf Wagner's entrance.
"Chief Xia, this is Professor Rudolf Wagner from Heidelberg University." Xie Yiren made the introductions, being familiar with the professor after he had assisted in Zheng Ren's surgeries the night before.
Chief Xia was at a loss for words. When had a German professor come to the hospital? Normally, the hospital's publicity would be off the charts when a professor came for a visit and exchange.
Could the man be a fraud?
She stared at Professor Rudolf Wagner doubtfully.
"I'm here for Zheng, beautiful lady," Professor Rudolf Wagner explained in stiff Mandarin.
"You're looking for Dr. Zheng? Why?" Chief Xia asked without thinking.
"Zheng has God's own hands," he answered, "I wish to form a research team on a novel surgical method with him, but Zheng has rejected my offer."
Chief Xia began sweating profusely.
Her first instinct told her that this foreign-looking expert was a fraud conspiring with Zheng Ren.
However, on second thought, it was pointless to be in denial.
Was he telling the truth?
She hesitated.
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