However, no matter who did the surgery, they could only reduce the bleeding from 5 liters to 2-3 liters.
Professor Tian had never seen a volume lower than that.
Was there a better doctor in Sea City compared to Imperial Capital?
Impossible, it was definitely impossible.
Professor Tian's mind was wondering about all these things even as his hands continued working.
After performing the same surgery so many times, he could do it with his eyes closed. At the very least, he would not need to repeatedly recall the topographic anatomy during his first surgery.
He used the nerve dissector to search for the nerve roots from both sides of the dural sac for protection.
After that, Professor Tian started to dissect the tumor, dura mater, and lateral nerve roots. He then removed the tumor together with the surrounding vertebral arch, superior and inferior articular processes.
This particular step was the reason they performed the lumbar artery embolization prior to the vertebral resection surgery.
Life-threatening hemorrhage would occur without the embolizations.
What did life-threatening hemorrhage mean?
Bleeding of unnoticeable, tiny blood vessels that would drown the surgical field in red, making it impossible to find the ruptured vessel, let alone be able to continue with the vertebral resection surgery.
It was good that there was no life-threatening hemorrhage.
Not only there was no life-threatening hemorrhage, there was no bleeding at all!
Of course, to say that there was no bleeding at all would be an exaggeration.
Nonetheless, the uncovered aspirator Dr. Zhou was holding was able to suction the blood cleanly, providing great exposure of the surgical field. The exposure was so clear that Professor Tian was a little fl.u.s.tered.
This was not something in vertebral resection surgery that he was familiar with…
Did he do something wrong?
He stopped and retraced the entire surgical procedure. There was nothing wrong!
He stared at the surgical field, and the anatomical structures were so clear that it was as if they could have been reference pictures in textbooks.
What the hell was going on?
Who knew that surgery this successful would be a problem.
Professor Tian was quite worried. He had never seen a surgical in such a condition since he had first started doing vertebral resection surgery.
If he was in Imperial Capital, he would have asked a few of his colleagues or even his mentor to observe the surgery and check for mistakes.
But this was Sea City.
He had no choice but to continue.
The exposure and resection of the lumbar transverse process were carried out smoothly. There was still very little bleeding. Usually, it would take 30 minutes to reach this step and the bleeding volume would be around 500 mL.
This was from Professor Tian's experience.
However, in this freaking surgery, it only took him 15 minutes with 30 to 50 mL of blood loss to complete this step.
After that, Professor Tian began to expose the anterolateral vertebra. The vertebra that was invaded by the tumor was moderately enlarged, but the tumor boundary was very distinctive. It could be removed by gently peeling the surrounding tissues.
Normally, there would be around 200 to 300 mL of bleeding during this step and time of…
Oddly, the surgery was still smooth sailing, with only 10 percent of the usual blood loss. Judging from Dr. Zhou's aspirator, it would be safe to say that there was 20 to 30 mL of blood loss.
After Professor Tian dissected from the diseased vertebra all the way until the anterior longitudinal ligament and let Dr. Zhou retract the surrounding tissues with the Hohman retractor, the vertebra's anterolateral pathway could be seen.
The surgery was…far too successful. It went so smoothly that it made people anxious and fearful.
Was this a vertebral resection surgery?
How could the patient bleed so little? How could the surgery be this successful?
… Freaking hell!
Chapter 354 - The Truth
Professor Tian closed his eyes to make sure that he was not dreaming.
These things would only happen in dreams so had he thought wrongly?
Dr. Zhou was happily suctioning the blood.
He thought that Professor Tian's skills had improved significantly. All the vertebral resection surgeries he had participated in would induce massive blood loss. They would have gone through 5 units of red blood cells at this stage of surgery.
Yet, today's surgery was so clean.
Usually, suction was crucial in this step. Before the surgery, Dr. Zhou was very nervous about it because If he screwed up the suction, the professor would skin him alive.
To his surprise, the surgery today turned out to be so successful!
The weather was good and he was in a good mood, Professor Tian's skills were great!
Out of a sudden, the surgery was halted abruptly. Dr. Zhou and the scrub nurse were a little confused. She asked, "Professor Tian, are you feeling okay?"
Professor Tian was retracing the entire surgery from the very beginning, replaying all the scenes in his mind. He completely ignored the scrub nurse's concern.
Dr. Zhou and the scrub nurse were stunned.
The surgery was very successful. Why was Professor Tian closing his eyes repeatedly? Was he gathering energy to break another record?
If so, they let him be as the patient was not bleeding much. Right then… Dr. Zhou noticed that only 40 minutes had passed since the surgery started.
Under usual circ.u.mstances, it would take at least 2 hours.
Most of the time would be spent on searching for the sources of bleeding.
A few minutes later, Professor Tian opened his eyes slowly.
"Rongeur," he said softly.
The scrub nurse placed a rongeur into his hand.
Professor Tian calmly suppressed his emotions and used the sharp-edged tip to remove the tumor tissues on the vertebra. He kept the posterior part of the vertebra as a landmark to avoid damaging the spinal cord or nerve roots.
This surgery was executed so perfectly that it was almost textbook-worthy.
However, Professor Tian was aware that this was not because of his extraordinary skills, but because of the fact that the surgical field was extremely clean.
He resected the tumor on the vertebra carefully to protect the healthy tissues from implantation metastasis.
He then gently separated the adhesions and used the dissector to push the posterior part of the vertebra forward until it collapsed. The purpose of this was to remove the tumor completely without the risk of damaging the spinal cord.
There were no signs of tumor infiltration in the adjacent vertebral disc. However, Professor Tian also resected the bone right up to the cartilaginous endplate and removed everything between the superior and inferior endplates to provide a secured bone graft bed.
This procedure would normally induce around 1 liter of blood loss but…there was only 100 to 150 mL of blood up to this stage.
Professor Tian was keeping track mentally but already felt numb to the situation.
This was such a freaky surgery!
Other than his skills, was the patient just extremely lucky? What other possible reasons could there be?
The interventional doctor?
Impossible! No matter how great the interventional doctor was, no one could accomplish this.
Professor Tian numbly continued the surgery according to protocol.
He harvested the bone graft from the posterior iliac crest according to the length of the bone defect between the vertebrae.
Right then, the condition of surgery was back to what the professor conceived as "normal".
There was a lot of bleeding from the posterior iliac crest harvest.
He was relieved.
Dr. Zhou was stunned as everything was a breeze prior to
this. He scrambled with the aspirator for suction and tried to stop the bleeding with dry gauze.
The surgery took a sharp turn.
After the bleeding had stopped, Professor Tian continued.
Usually, the bone graft would be slightly longer than the actual bone defect by 2 to 3 mm. After the harvest, the ends would be refined by cutting it with an electric bone saw and tying them together using non-absorbable nylon sutures.
The bone graft would then be inserted from the dural sac anterolaterally into the bone defect. After that, it could be filled with bone ch.i.p.s to promote reossification.
Shape-memory alloy, bone cement, one step after another.
The surgery was finished in 2 hours and 12 minutes.
Including the blood loss after the posterior iliac crest bone grafting, the total amount of blood produced was less than 500 mL. The surgery was an unbelievable success.
The patient was sent back to the ward after recovering from the anesthesia. Dr. Zhou was smiling brightly.
The surgery was so successful that they did not touch any of the 20 units of frozen red blood cells prepared prior to surgery. He felt a little awkward not having to do any transfusion and gave 2 units to the patient as safety.
After all, there was still 500 mL of blood loss.
"Professor Tian, your skills are becoming far more advanced!" Dr. Zhou raised his thumb and complimented him.
Professor Tian kept going through the surgery while resting, trying to find out what had made it so successful.
He knew that his skills were definitely out of the equation.
This meant that it was due to the interventional doctor. Even though he found it difficult to believe, it was the truth.
Professor Tian had officially become Detective Tian.
"Little Zhou, where's the interventional department? Bring me there, I want to take a look," Professor Tian said.
"We don't have an interventional department. Currently, all interventional surgeries are being carried out by the emergency ward chief resident," Dr. Zhou replied.
"Only one doctor?" Professor Tian started to doubt his speculations.
"Yeah, his assistant was transferred from the ICU. Oh, I also saw a foreigner helping him with the surgery yesterday, and he said that he's from Heidelberg University."
Oh, there was an external specialist present.
Professor Tian was relieved when he finally found the "truth".
At least he knew his brain was not faulty.
"The professor did the lumbar artery embolization?" Professor Tian asked.
"No, the foreigner might not have been a professor. I'm not sure about his status but he has a Chinese name called Lil Fugui."
The conversation took a new turn. Lil Fugui?
"It is funny to hear him speak Northeastern Mandarin." Dr. Zhou could not resist his chuckle when he thought of Professor Rudolf Wagner.
"Chief Zheng from the emergency department performed the surgery while Li Fugui assisted him," Dr. Zhou said.
What nonsense was this!
Professor Tian could not figure out what had really happened. All of this was beyond his comprehension.
"Let's go." Professor Tian glanced at his phone. He still had some time before flying back to Imperial Capital because the surgery was cut short.
Both of them checked on the patient once more before heading to the emergency wing.
On their way there, Professor Tian asked about the interventional surgery under the Sea City General Hospital's emergency department.
What was the doctor's level at pelvic fracture embolizations and gynecological embolizations?
It should not have been to the point of making his own surgery such a success.
Weird.
Dr. Zhou and a doubtful Professor Tian reached the emergency ward.
"Lil Fugui, there are two surgeries tomorrow. You can come earlier to send the patient to the operating room." Zheng Ren's voice could be heard.
"Yes, boss. What surgery are they?" Professor Rudolf asked in a Northeastern accent.
"Secondary TIPS surgery to retrieve the shunt and another TIPS surgery."
"Uhm, I won't act rashly. Don't worry, boss."
Professor Tian was stunned when he heard the Northeastern accent...
He walked into the office and saw Professor Rudolf Wagner standing beside a young doctor, talking in a very respectful manner.
This… This guy looked familiar.
F*ck!
It suddenly dawned on Professor Tian that this person was Professor Rudolf Wagner whom he had met twice at Heidelberg University!
Chapter 355 - A Tough Pill To Swallow
"Professor Rudolf Wagner?" Professor Tian asked softly, straightening his back subconsciously as he lowered his stance like he was still studying at Heidelberg University back then.
"Uhm, who the hell are you? Where'd you come from?" Professor Rudolf turned aside and asked in a mixed Bavarian accent when he heard someone called out his name.
Professor Tian was speechless. It truly was none other than Professor Rudolf Wagner!
Professor Tian was stunned. Who was he? Even if he answered, Professor Rudolf might not know who he was.
He was a renowned professor in Imperial Capital now, but he was just an ordinary postgraduate researcher at Heidelberg University a few years ago.
He was not the top student that the entire school would be aware of.
Would Professor Rudolf Wagner recognize him? The obvious answer was that it was not possible.
However…
What was Professor Rudolf Wagner, the world's top interventional doctor, doing in Sea City? Most importantly, why was he speaking in a Northeastern accent?
Was this a sign of cosmopolitanism?
Professor Tian stood rigidly at the office door in utter silence like he used to do when he was a postgraduate.
"Brother Zhou, what happened?"
Zheng Ren greeted Dr. Zhou smilingly when he saw him standing panicked at the door.
"I… I brought Professor Tian…to look around," Dr. Zhou stuttered. He could sense the strange atmosphere.
Especially when Professor Tian had asked about Professor Rudolf Wagner after they arrived. He recalled Professor Tian telling him yesterday that Professor Rudolf from Heidelberg University was a pioneer in interventional surgery.
He stole a glance at Professor Tian and saw him standing in an upright posture even straighter how he used to do it back when he was still studying and doing ward rounds in Imperial Capital.
Stern and meticulous, with a German's stoic stance.
"Come in, Brother Zhou," Zheng Ren greeted enthusiastically.
Dr. Zhou moved forward a little, but Professor Tian was blocking the entrance. He could not just push him aside and walk in, could he?
Zheng Ren was too focused on the patient's condition and just noticed that something was not right. He then looked around in confusion.
What was going on?
"Professor Rudolf Wagner, I didn't expect to see you here." Professor Tian regained his senses and carefully took two steps forward as he extended his hand.
Professor Rudolf was not keen to have this stranger interrupt his discussion on the patient's condition with Zheng Ren.
Zheng Ren had mentioned something rather interesting. No one in the field had thought of using liver DW-MRI as a preoperative assessment for TIPS surgery.
It was brilliant.
Zheng Ren had just started talking about it and Professor Rudolf Wagner's mind was already filled with the idea of a novel surgical and differential diagnostic method.
The person who dared to interrupt him had to be a devil!
Professor Rudolf Wagner totally ignored the enthusiastic yet cautious handshake that Professor Tian offered.
The idea of whether this person would be embarrassed was not within the professor's consideration.
The professor's arrogance could be clearly seen.
His attitude toward Zheng Ren wa
s purely incidental, simply a beautiful accident.
His compliance was largely due to Zheng Ren's extraordinary surgical skills and not because of his good temperament.
Professor Tian did not feel embarrassed as this was exactly what he had expected.
After all, he studied at Heidelberg University and knew about the characters of German professors.
In fact, he had gotten used to it after spending a few years there.
"I'm Tian…" Before Professor Tian had the chance to finish introducing himself, Professor Rudolf Wagner interrupted him rudely.
"I don't care who you are. If you want to see me, please go and make an appointment with my assistant. My God, I'm very busy!" Professor Rudolf Wagner said frustratedly, the submissiveness he had when he spoke to Zheng Ren just now disappearing entirely.
"Lil Fugui, be nice." Zheng Ren frowned.
"Yes, boss." Professor Rudolf Wagner said ever so kindly as if he was a totally different person before this, smiling kindly. "Why do you want to see me? We're really damn busy right now. Please speak quickly if you need anything."
"..." The tone of the scene kept changing, Professor Rudolf Wagner's role kept interchanging between the artistic, arrogant German professor and a Northeastern Chinese.
The professor was speaking in a typical accent that was rarely heard even by people from Northeastern China so naturally, Professor Tian had a hard time accepting it.
"Professor Tian, right? Have a seat." Zheng Ren stood up and shook hands with Professor Tian. He then said with a laugh, "Brother Zhou, please take a seat too. Did the surgery go well?"
When Professor Tian heard Zheng Ren ask about the surgery, he finally remembered why he came to the interventional department.
"The surgery was very successful. There was very little bleeding, hence why Professor Tian wanted to come to visit and ask about the interventional surgery," said Dr. Zhou.
"Oh, as usual, lumbar artery embolization was done. I also performed embolizations on a portion of the spinal tumor," Zheng Ren said. "Did the bleeding exceed 500 mL?"
"That's the approximate volume." Dr. Zhou was surprised by Zheng Ren's estimation.
"Uhm, Professor Tian's really good," Zheng Ren said calmly.
The Surgeon's Studio c1-799 Page 168
