"Professor, you specialize in…" Chief Xia asked.
"Interventional surgery," Professor Rudolf Wagner said. "I began performing TIPS surgery twenty years ago. To date, I've completed more than three hundred TIPS surgeries and am probably one of the doctors in the world with the most under their belt."
This was an impressive number and the professor knew it.
It was rare to find an interventional surgeon who had done more than a hundred TIPS surgeries, but he had accomplished thrice that.
In terms of experience, no one could match him.
Especially since TIPS surgery required experience and luck… Professor Rudolf Wagner felt slightly disappointed as he thought of luck.
Many years ago, he had tried to improve the surgery to reduce its reliance on luck, but failed.
Perhaps it was a test from God. The adage placated him somewhat.
Chief Xia's eyes widened upon hearing Professor Rudolf Wagner's words.
If… if the professor was telling the truth, there was hope for her old classmate.
Truthfully, Chief Xia doubted that a young doctor like Zheng Ren could complete a TIPS surgery, especially an emergency one.
The possibility of that happening was near zero.
There was a vast difference between an emergency and non-emergency surgery, especially one that involved hematemesis and ascites.
An ordinary TIPS surgery required the patient be in the supine position with local anesthesia on the neck region. If the patient felt pain during the puncture, a dose of Dolantin would easily solve the problem.
On the other hand, patients in emergency TIPS surgery vomiting blood could end up choking on their own blood in that position.
That was why the patient had been placed in the lateral position for surgery, even if it was a little awkward…
Professor Rudolf Wagner was surprised to see the goings-on in the operating room.
Zheng was too daring!
This was TIPS surgery. A tiny mistake would lead to failure.
This was the man's first time performing it and he had still chosen to use such an awkward position.
Professor Rudolf Wagner could foresee Zheng Ren's disappointment after failing the surgery.
Let me save you, Eastern boy.
He kept the lid on his smugness.
In the operating room, the puncture on the jugular vein and insertion of the jugular sheath had been completed as they were not difficult.
What came next was crucial. Professor Rudolf Wagner wrapped his arms around his body, his entire focus on the screen.
After angiographic catheter insertion, suction commenced at an exceedingly slow and cautious pace due to the patient's constant spasms and blood-soaked retching. This emergency surgery was incomparable to any ordinary surgery.
At the same time, the live surgery broadcasting room of Xinglin Garden went insane.
Hemostasis with emergency TIPS surgery! This was the most difficult surgery streamed yet.
A few did not understand the hype around TIPS surgery, but were soon clued in by ecstatic general surgeons and interventional doctors.
The procedure was not very clear, but portal-azygos disconnection was a textbook method, known to all physicians who had been through medical school.
[The surgeon's about to defy fate!]
[They're going to perform an emergency TIPS surgery with the patient in a lateral position… if every surgery in the past hadn't been successful, I would have called this a failure already.]
[Just wait for the news of success, whelp. I have a hunch that this surgeon will achieve victory again if no accidents happen.]
[On that note, post-operative complications of TIPS surgery can be a handful. A few days ago, I received a patient who underwent TIPS surgery three months ago; he had been suffering from hepatic encephalopathy ever since the procedure.]
[There's usually no choice. It's between surgery and death. What would you have done?]
[Let's play a game; those who guess correctly will get a reward. How many punctures do you think the surgeon will have to perform before they succeed?]
Most doctors present did not even understand the question. It was too technical and would never even come close to the domain of those not from general surgery or interventional radiology.
Locally, only hospitals at a provincial level or higher could perform such a surgery.
Failing that, they would invite experts and professors to come over and perform it. One or two successful cases would be sufficient for them to brag about for a year.
Meaningless as it was, it was clout.
It was also part of their culture.
[Twenty times!]
[I think the surgeon will fail. The patient kept moving onscreen and is probably vomiting blood.]
[How would one even develop the images with lateral positioning…]
[The machine can be adjusted. However, the angle makes the surgery more difficult. I'm starting to pity the surgeon who has to perform the surgery under such circ.u.mstances.]
[I think it can be accomplished within ten attempts. We invited a professor from Imperial Capital who succeeded on the tenth try.]
[That's just luck. A few years back, we also invited a famous professor from Sorcery Capital to perform TIPS surgery, but he failed even after thirty attempts. I think the patient's liver was perforated from all the punctures but the portal and hepatic veins remained out of reach.]
The viewers' experiences soon fully conveyed the difficulty of the operation to all present.
Many of the doctors were dismayed from the descriptions of TIPS alone.
What kind of surgery was this? It was more like an attempt on the doctor's own life.
The procedure required quite a bit of luck. Multiple punctures would seriously injure the liver and increase the risk of hepatic encephalopathy after surgery.
Either reason was enough for the doctor to give up.
If they refused to get involved, the life and death of the patient would not be on their hands.
If they did, and the patient died or suffered from serious hepatic encephalopathy, there was a high chance of a medical dispute after.
This… this surgeon was truly brave.
Chapter 301 - Just a Bit More (Part 1 of 4)
Zheng Ren was in the operating room, his full concentration on the surgery.
He finally understood and realized a novel method of positioning. However, he could not put his theory into practice as the patient in front of him had not done the necessary tests.
His skill had improved by leaps and bounds, even if it did not benefit the surgery right now.
In the System's operating room, he had managed to reduce the number of attempts at punctures and intubation between the hepatic vein and portal vein branch to below ten.
He could already complete one TIPS surgery within two hours., even refining the prevention of hepatic encephalopathy.
The research and learning process had been highly beneficial to Zheng Ren.
Although he had exhausted all of his acc.u.mulated surgery time and experience points, it had been worth it.
An emergency surgery was no longer an issue, let alone a normal one.
When the angiographic needle superimposed at the anticipated location, Zheng Ren growled, "Prepare to puncture."
Su Yun acknowledged the order, holding the guide wire steadily.
Right now, stability was more important than speed.
Zheng Ren confirmed the point of egress and made a few final adjustments before pressing down the angiographic needle.
As expected, he failed.
Zheng Ren was not disappointed, though; this puncture had been a calibrative one and failure was its intention.
It made an impression on the venogram and functioned as a landmark.
Zheng Ren focused on the venogram, the three-dimensional image of the patient's hepatic vein and portal vein already taking shape in his mind.
"Move 1.5 cm upwards and 15 degrees to the
right," he said as he inserted the guide wire.
Su Yun was startled. Under normal circ.u.mstances, Zheng Ren would not be fulfilling that role. What did that order mean? 15 degrees to the right?
After some consideration, Su Yun quickly understood.
The hepatic vein was very thick and would cause the guide wire to drift inside.
Zheng Ren confidently maneuvered the guide wire inside, using the vascular wall as an anchor. It was not of much help, but it was better than moving blindly in an empty space.
This was where surgical skill would come into play. Su Yun knew that one could only develop such skill through experience.
He reminded himself to angle his hand at 15 degrees to the right with the guide wire.
It was fortunate that he had a high IQ, he thought disdainfully. Were someone else to partner with Zheng Ren, they would not have been able to catch up. The man was fortunate enough to have met him.
Zheng Ren was also aware of this, but had not had the time to communicate what he had just recently learned in the System.
[Hah, that's the first time!]
In Xinglin Garden, there was a scoreboard being tallied in the bullet comments.
After so many live surgery broadcasts, loyal viewers had the impression that the surgeon would never fail.
Few of them were gloating, however; most were cheerfully keeping track of how many punctures the surgeon would need to complete the surgery.
[The puncture site was quite far from its target.]
[It's a little off. I'm not sure what the surgeon intended. If they were trying their luck, the odds don't seem to be in their favor.]
[I don't believe that the surgeon would make a puncture blindly. Remember when the embolization that led to the necrotizing intestine was used to mark a source of bleeding? I was panicking back then but the surgeon did it anyway.]
Soon, the surgeon began the second puncture under the comments.
The shadow of the angiographic needle shot down like black lightning.
The images of the portal and hepatic veins overlapped each other. Once the needle was in, the whole superimposed angiography was difficult to differentiate.
[Did it work?]
[I don't know, but the puncture site is great. I have a feeling it was successful this time.]
[We'll know when we see what the surgeon does next.]
It was as if the doctors in Xinglin Garden were in the operating room, performing the surgery themselves. They all had their hearts at their throats.
A few began suggesting that the surgeon had purposely punctured too far during their first attempt, but others disagreed. However, after the second puncture, the idea that these were blind guesses was no longer of any consideration.
Although it failed, success seemed more and more likely with the next puncture!
It was a confidence brought on by the dozens of live surgery broadcasts before.
In the operating room, Zheng Ren shook his head and stared hard at the image before saying, "Retreat 0.3 cm and 10 degrees to the right."
He was like the captain of a small boat in a rocky sea, facing down roaring waves and barking orders without fear.
His crew carried out his orders with determination, keeping faith that their boat would conquer the waves and reach shore safely under the guidance of their captain.
The guide wire withdrew slightly, its movement so tiny it was invisible to all but the most acute of senses.
The distance of 0.3 cm… was extremely difficult to measure.
Su Yun could feel the changes in the wire. He tilted it to the right by 10 degrees and secured it as much as he could after Zheng Ren withdrew it by 0.3 cm..
Zheng Ren checked it again. He was full of confidence.
It was completely different from the System's operating room! Zheng Ren clearly felt this discrepancy after only two real-life punctures.
After the System's mission rewards, he had already acc.u.mulated +6 luck points.
Although he still had no idea what they were for, Zheng Ren could clearly sense how the surgery before him diverged from the one he had had in the System's operating room.
The second puncture had been a tentative attempt at making another landmark to confirm the portal vein's location between the first two points.
This was the technique Zheng Ren had managed to work out.
However, the second puncture had almost successfully entered the branch of the portal vein, penetrating it just by a little. It suddenly dawned on Zheng Ren that he could have made it if he had an extra luck point!
He had never been more sure that at this moment!
If he did not succeed this time, he would get it with the next puncture!
With Su Yun securing the guide wire, he started the next puncture.
His finger was latched firmly on the button.
At that moment, the patient began vomiting vigorously.
As his body moved, the puncture site shook intensely. Under such circ.u.mstances, the god of luck did not favor Zheng Ren and the third puncture failed.
There was utter silence in the live surgery broadcasting room.
Most of them had expected success at the puncture.
[Too bad…]
After a while, a comment flew by slowly.
[No worries, it was just an accident. The next one will definitely be the one!]
[The next puncture site will probably have to be pinpointed, and that's quite reliant on luck.]
[... I suddenly feel a deep despair, like I've just opened up McBurney's point but the appendix was missing.]
[... that's the plot of a horror movie. Please don't talk about not finding the appendix at Mcburney's point. I performed an appendectomy several days ago for three whole hours and finally found the appendix near the splenic fossa.]
[Sending empathy.]
[Sending empathy +1.]
[...]
Chapter 302 - Success and Failure Separated by a Hair’s Breadth (Part 2 of 4)
The viewers digressed further and further, like it was a self-defense mechanism against anxiety.
In the operating room, upon encountering an accident, a surgeon would either take out their anger on their equipment or remain silent.
In the live surgery broadcasting room, they did not throw their tools and lash out at their assistants as they were not the ones operating. It was more relaxing to observe than to perform.
The host surgeon had failed at another attempt, but the viewers could not blame it on the surgeon and thus resorted to telling jokes for fun.
In the operating console room, Professor Rudolf Wagner stared at the images with piercing eyes.
He found it hard to believe that this was Zheng Ren's first TIPS surgery.
The man was so proficient! Were it not for the patient's sudden hematemesis, the third puncture would have succeeded.
Zheng Ren's talents were so exceptional they were borderline enviable, Professor Rudolf Wagner thought.
Su Yun felt sorry, but was not surprised.
He had already overlooked the fact that Zheng Ren's first TIPS surgery had been exceedingly skilled.
Something that happened so often would lose its novelty. Were Su Yun to be surprised every single time, his jaw would have fallen off by now.
He was numb to it, subconsciously expecting such performance.
Perhaps it was the same frustration that others once felt when they looked at him.
"Emergency surgeries are all like this, just be patient," Su Yun comforted him calmly.
"Sure." Zheng Ren nodded, nonchalantly pushing aside the mote of regret in his heart before adjusting and repositioning the guide wire to prepare for another puncture.
He observed the venogram carefully and noticed that the wire was not very far from the location, possibly not having moved much at all.
Maybe Su Yun's hand had followed the motion of the patient vomiting. There was no other explanation.
Such a perfect assistant. At least to Zheng R
en, Su Yun was indeed flawless.
"Move forward 0.5 cm, 25 degrees to the right… 23 degrees," Zheng Ren estimated.
Soon, the guide wire was back in position.
The experience he had gained from surgery on the simulation mannequin in the System's operating room had been tempered on the anvil of reality, and it felt transcendental.
This had to be it. Although Zheng Ren had failed again, he was never more confident.
He did not comfort the patient or tell the patient to stop moving.
This was not the emergency treatment room. The patient was not throwing a tantrum.
The rupture of the gastric varices resulted in a large amount of blood acc.u.mulated in one's stomach. It was an involuntary biological response, uncontrollable by the individual.
Like a burp or a fever, no one could decide if it came or went.
He had to use this short window of recovery between the patient's intermittent vomiting to operate quickly.
The patient had rapid, shallow breathing, but no signs of agitation.
Zheng Ren pushed the button.
From imaging, the dark shadow of the angiographic needle advanced through the hepatic portal and reached the branch of the portal vein.
Su Yun barely managed to suppress his shout. "It went in!"
"Hold it." Zheng Ren was not in a hurry. He was stable and determined like a ballast, keeping their boat afloat to conquer the raging waves and reach the shore of victory.
"Yes," Su Yun responded.
A successful puncture was just one of the key steps. Any mistakes after this would cause the surgery to fail, requiring the whole process to be repeated.
Everything had to be carried out cautiously, as if walking on thin ice.
[Damn… success on the fourth attempt! Awesome!]
[The third puncture could've been the one.]
[This surgeon has once again exceeded my expectations. From what I remember, our hospital has performed over dozens of TIPS surgeries and their average duration exceeds 4 hours with about 20 puncture attempts.]
Xinglin Garden was joyous. Even the physicians who had expected failure were relieved.
They did not want the surgery to fail, no matter if it was overseas or not.
There were not many bullet comments left. Although the most crucial step was done, the subsequent procedure was also very important—deployment of the stent graft.
The Surgeon's Studio c1-799 Page 144
