If the stent removal resulted in a hemorrhage, it was not worth the risk.
Before this surgery, he was strongly against the idea of Zheng Ren removing the stent.
However… Chief Zheng from the emergency department finished the surgery while he was in a daze?
Chapter 365 - Don’t Be Too Surprised
Director Zhang shuddered. He was not supposed to blank out.
Was the surgery done by Professor Rudolf Wagner?
That had to be the only reasonable explanation.
He lifted his head to see the professor applying pressure to stop the bleeding while Chief Zheng casually chatted with Chief Xia in the operating console room.
What…
He approached Zheng Ren and asked with a forced smile, "Chief Zheng, how did you perform the surgery? I didn't quite understand it. Can you explain it to me please?"
Not that he failed to understand what was going on; he had just missed the entire surgery.
Zheng Ren was unaware of that, but could he elaborate at Director Zhang's request?
However, the key to the stent removal post TIPS was in the coordination between Professor Rudolf Wagner and himself during the operation. This was something that was not displayed in the films, so it was difficult for him to explain in words.
"There's nothing much to talk about the surgery. The only notable point is the stent removal technique," Zheng Ren explained. "Just need to avoid a secondary hemorrhage and injuring the hepatic tissue."
Zheng Ren spoke as he pointed at the scans.
"..." Director Zhang was at a loss for words.
'Who doesn't know about this? You don't say!' He thought.
Nonetheless, Director Zhang was also from the same field. He knew that it was not Chief Zheng's intention to withhold information, but he had no idea how to describe it.
He felt a sense of deep regret. He made an unforgivable mistake blanking out and missing the whole surgery.
Director Zhang gathered himself to focus on the next TIPS surgery.
If he had doubts before, it was safe to say that Zheng Ren had his full attention now. If Zheng Ren was as good as he thought, he would satisfy him with ample surgeries!
Professor Rudolf Wagner on the other hand…
Director Zhang dared not touch him.
How could they afford the world's top professor? His surgical fee would cost at least 10,000 US dollars per procedure.
If the patients in Secondary Hospital were that rich, they could visit any hospital in the country. Why would they stay behind to die?
After 15 minutes, Professor Rudolf Wagner applied a pressure bandage on the patient and transferred the patient to the gurney with Zheng Ren's help. The patient was then sent back to the ward by the gastroenterologist.
The patient raised his hand as he left the operating room, saying, "Thank you, Dr. Zheng."
"You're welcome," Zheng Ren smiled.
This was the satisfaction of performing surgeries.
There was nothing more important to ensure that everyone is safe and sound.
After that, the patient with decompensated cirrhosis and refractory ascites was sent into the operating room.
Zheng Ren took her scans and put them up on the film viewer to check them once more before the surgery.
The professor was heavily built; he could transfer the patient easily by himself. Zheng Ren stood still, with his left arm crossed and his cheek resting on his right hand while he studied the scans.
He had spent a lot of time researching with Professor Rudolf Wagner the day before, improving the surgical method that he invented to a great extent.
He was very confident in today's surgery. This was just a routine inspection.
"Boss, what did you and the professor research?" Su Yun came to Zheng Ren all of a sudden and asked.
"Here, the T2-weighted images with two identical gradient lobes applied on either side of the slice selection gradient for the 180° RF pulse allow us to identify the route of entry," Zheng Ren said, pointing at the DW-MRI scans with his right hand.
The things he mentioned were so technical, even a clinical physician could not understand him.
Other than those specializing in neurology, not many people could read DW-MRI scans.
Not to mention that Zheng Ren was explaining the concept of the random movement of molecules (the brownian motion) and the effect of spin-echo used in magnetic resonance diffusion-weighted (MRDW) imaging.
Even if it sounded alien to others, Su Yun was still a brilliant scholar.
He thought for a moment and understood what Zheng Ren was trying to say. Without Zheng Ren's idea, Su Yun would never think of using DR-MRI to locate the puncture site.
There was nothing much left to say after the revelation.
"Interesting, how did you come up with the idea?" Su Yun's focus had always been different.
"I was wondering that we shouldn't just depend on luck all the time. The recent advancement in TIPS surgery was to create a tunnel in the portal vein branch to mark the location and proceed to label the puncture site in the hepatic vein," Zheng Ren said, "I think that's quite troublesome. We can just skip those procedures with these supplementary tests."
"It makes sense, but you need to put your theory into practice."
"We should be seeing results soon," Zheng Ren said confidently. "Don't be too surprised."
"Tsk!" Su Yun exclaimed in disdain.
Even Su Yun was entranced when he turned around to watch Professor Rudolf Wagner carry out all forms of preoperative preparation.
His boss, Zheng Ren must have had strong mental strength to have the world's top professor assist him.
Su Yun estimated that the TIPS surgery would be done within an hour.
Even when they had to overcome so many unexpected obstacles during the emergency TIPS surgery, it did not take them too long. It would be a joke if Zheng Ren needed two hours to complete an elective TIPS surgery.
Su Yun also guessed that Zheng Ren would be puncturing about three times.
This was what a world-class surgeon could deliver.
There were only a handful of surgeons who could perform the TIPS procedure. Excluding failed surgeries, it would take an average of 15 to 20 punctures before the surgeon could successfully carry out the procedure.
Three times. This was his judgement based on his estimation of Zheng Ren's skill.
Surprised? There was no such thing.
"Boss, prepare for surgery," Professor Rudolf Wagner said.
Su Yun left immediately. One should avoid being exposed to radiation as much as possible. It was not the time to be competitive.
Zheng Ren and Professor Rudolf started the surgery after the lead door closed.
Su Yun stood in front of the leaded glass and observed attentively. Director Zhang was shocked when he found out that the surgeon was Chief Zheng, Zheng Ren, and not Professor Rudolf Wagner, the world's top interventional physician in Baidu Baike.
Su Yun took out his phone and started the stopwatch when the surgery began.
He was perplexed by Zheng Ren's confidence.
Su Yun reckoned that the surgery would take at least 40 minutes. Why would he be surprised?
Never!
Soon, the radiation was switched on. Everything went smoothly. Chief Xia was unable to gauge the situation, but Su Yun knew that Zheng Ren was operating with a speed that was on an entirely new level with the help of Professor Rudolf.
Was he not good enough?
Su Yun refused to admit that.
However, the reality was proving him wrong.
'Bast*rd!' Su Yun swore internally.
The puncture needle went in. Su Yun held his breath while he stared at the image on the screen.
It was not moving too fast, but it was extremely stable. It was so steady that it gave a sense of security to those who understood the surgery.
This was not an easy procedure.
It reached a point and stopped. The position seem
ed odd, maybe Zheng Ren planned to use this location to adjust the puncture needle.
Click.
Su Yun heard Zheng Ren pull the trigger on the puncture needle.
On the imaging screen, the puncture needle shot out and came to a halt shortly after.
Chapter 366 - Everything Seemed So Surreal
It was difficult to judge from the imaging if the puncture needle had entered the portal vein branch in the liver.
However, Su Yun had a hunch that Zheng Ren had nailed it in his first attempt by working seamlessly with Professor Rudolf Wagner.
Zheng Ren's subsequent insertion of the stent graft along the guide wire proved that Su Yun's speculation was accurate.
Was it successful?
It looked rather strange. If TIPS surgery was this easy, it should not be coined as the crown jewel of interventional surgery.
The stent was in place, opening the vessel, and blood flow was restored.
Su Yun sighed internally. Even though he addressed Zheng Ren as his boss, he had never stopped trying to catch up with him.
Why did it feel like the more he chased after him, the distance between them grew further apart?
If Su Yun had not seen it with his own eyes, he would not believe that Zheng Ren conquered TIPS surgery so effortlessly.
He looked down and checked the time: 15 minutes and 26 seconds.
Su Yun quietly turned his phone off.
Split time? There was no point in noting the time. Why should he give him the chance to boast about this in the future?
Director Zhang stared intensely at the giant LED screen that was showing the ongoing operation and dared not blink.
Nevertheless…he was still at a loss when the TIPS surgery was completed.
When he was young, he studied under Professor Xu Ke at China Medical University.
Director Zhang witnessed first-hand Professor Xu Ke's research and attempt at TIPS surgery.
TIPS surgery was like nailing jelly to the wall.
Until today, Director Zhang could still remember Professor Xu Ke's isolation gown under the lead apron, drenched in sweat, and the smile on his face during his first successful surgery.
When he returned to Sea City, he was held back by trepidation whenever he wanted to establish TIPS surgery in the Secondary Hospital due to the difficulty of the method.
Had TIPS surgery evolved into a simple surgery?
Impossible.
Director Zhang rubbed his eyes in disbelief.
Everything…
…seemed so surreal.
In the operating room, Zheng Ren and Professor Rudolf Wagner were placing the second removable stent.
The surgery was almost finished, but the elapsed time was less than 30 minutes.
Was this really a TIPS surgery?
Impossible!
"Old Xia… are they performing a TIPS surgery?" Director Zhang asked softly.
"You're the one involved in interventional surgery. Why are you asking me?" Chief Xia frowned, "Have you lost touch with clinical work? How can you let your operations drop so low!"
Director Zhang seemed unfazed by Chief Xia's mockery. They were old friends, this was just normal banter.
Moreover, Director Zhang did not think that he neglected his work.
TIPS surgery was his dream. He was determined to have at least one successful case before his retirement
He even took a trip to Shenyang recently to reconnect with his old contacts. If there was a need for TIPS surgery, he could invite one of the professors over to perform it.
Who knew that Sea City General Hospital had been secretly doing TIPS surgery with highly skilled surgeons!
He personally witnessed the young doctor from Sea City General Hospital perform all of the surgeries. Judging from the situation, the professor was not much help.
He must invite Chief Zheng to perform surgery at Secondary Hospital! The thought crossed Director Zhang's mind when he saw the second stent set in place.
How did he do it? Director Zhang was still perplexed, even though he had been observing the surgery the entire time.
"Chief Xia, I'm done. The surgery went well." Zheng Ren removed his sterile gloves and entered the operating console room to inform Chief Xia.
"So much faster than the first surgery," Chief Xia said.
"Yeah, I went back and summed up my past experiences. Also, this surgery is elective, it's normal to take a shorter time," Zheng Ren said nonchalantly and turned around to change.
"Lil Fugui, help me transfer the patient afterward," Zheng Ren told Professor Rudolf on his way to the changing room.
"Sure thing. I have your back, no worries," the professor answered directly.
Director Zhang was stunned again.
He had stopped speaking in the Northeastern accent that he was once so familiar with.
Hearing a German professor speaking with that accent, he thought he went back in time.
"The surgery's not too bad, right?" Chief Xia said with a laugh.
Even though Chief Xia did not perform the surgery, she was the one who invited the chief resident of Sea City General Hospital to operate the first TIPS surgery. In her opinion, she totally had bragging rights.
"Yes, more than okay. It was excellent," Director Zhang shook his head and said, "Old Xia, you discovered a treasure."
"What do you mean? That's because I have an eye for talent." Chief Xia rolled her eyes at Director Zhang.
"Yeah, yeah. You have great eyes." Suddenly Director Zhang realized something in the middle of talking. He tugged Chief Xia's lab coat sleeve and hinted with his eyes.
Hmm? Chief Xia was confused. Why did he need to speak to her in private? What was there to say when the surgery was finished?
Even though Chief Xia had questions, she still followed Director Zhang out of the console room.
In the corner of the corridor, Director Zhang looked around to see that there was nobody around before saying softly, "Old Xia, the chief resident's surgery is really amazing."
"You don't say."
"However, the better he is, the more troubled I am," Director Zhang said, "How much do I need to pay when I invite Chief Zheng for surgery?"
The situation in the Northeastern region differed from the South. In Sorcery Capital, a small facial suture would cost 3,000 to 5,000 yuan. In the Northeast, they only charged a couple of yuan for the processing fee.
The huge disparity in the fees was the major causing factor of brain drain. Physicians with adequate skills were all set to work in the South.
The surgical fee was so low, he was certain it would cover Zheng Ren's expenses.
The patient's family members would have to come up with cash.
Before this, he thought that Zheng Ren was a TIPS surgery amateur that mostly relied on luck.
1,000 to 2,000 yuan should have sufficed.
Now, he knew that he was highly skilled in this surgery with a world's top professor as his assistant.
He even told the German professor to help him move the patient after surgery.
If Director Zhang was the one who invited the German professor for surgery, he would have worshipped him like a God. No one in their right mind would tell him to move the patient.
The unexpected situation had spiraled out of his control.
He wanted to hear Chief Xia's opinion on the appropriate amount for Zheng Ren's payment.
"Payment?" Chief Xia frowned. She had no prior experience on fly-in jobs. Internal medicine rarely invited professors to consult, compared to general surgery.
"Yeah, how much do you think I should pay Chief Zheng?" While speaking, it dawned on Director Zhang that he made another mistake.
"Right, if Chief Zheng's going to Secondary Hospital to perform surgery, he wouldn't bring Professor Rudolf Wagner along, would he?"
To have a German professor as an assistant…
God, Director Zhang had never dreamt of something like this.
Chapter 367 - Pro Bono
"Why don't we ask him?" Department Chief Xia said with much thought. Before Director Zhang could speak, Department Chief Xia hollered down the corridor, "Chief Resident Zheng, could you come over for a bit?"
"Hold on a minute," Zheng Ren's voice sounded from the changing room.
"Ah! So hasty. What if Chief Zheng asks for a high price?" Director Zhang asked.
Director Zhang's worry was not baseless. There would be no negotiations once Zheng Ren quoted a price.
The Secondary Hospital could take it or leave it.
If the quoted amount was more than 5,000 yuan… A patient who could fork out that much cash would have gone to Provincial Capital, Imperial Capital, or Sorcery Capital for the TIPS surgery.
Director Zhang sighed.
"What's the matter, Chief Xia?" Zheng Ren walked toward them in his white coat.
"Old Zhang wants you to perform a TIPS procedure in the Secondary Hospital. How much would you charge?"
"Charge?" Zheng Ren was confused. He had not thought of that aspect.
He was not given a single penny in the past. How would he know what to charge?
Money was of little importance to a man like Zheng Ren.
He was used to his current lifestyle and more money would change little. Furthermore, an additional 10,000 yuan in his bank account would mean nothing to Xie Yiren's parents.
"We have to give you a consultation fee for your services, or else the scarcity of the skill is not reflected. It is also a respect to the medical personnel," Director Zhang said carefully. "But, the financial status of patients who visit the Secondary Hospital…"
Director Zhang subconsciously addressed Zheng Ren with deference.
"It won't be an issue," Zheng Ren said with a grin. "The money's not an issue, but the communication to the patient and family has to be done right. TIPS is a risky procedure."
Here laid the problem: oftentimes when people said it was not an issue, it meant otherwise. Director Zhang mulled over his options.
As a man part of the hospital bureaucracy for more than a decade, Director Zhang would not take Zheng Ren for his word.
With a dour face, Director Zhang offered the highest amount he deemed appropriate. "Chief Zheng, how about 5,000 yuan per surgery? Would that be alright?"
The Surgeon's Studio c1-799 Page 173
