Chapter 62: Edematous Gallbladder
Intraoperative exploration revealed that there were no abnormal changes in the stomach and small intestine. The liver was normal in size and smooth with no irregularities or nodules commonly seen in cirrhosis.
However, the gallbladder was congested and visibly edematous, and it was slightly larger than half an adult man’s fist.
The swollen gallbladder looked like an inflated balloon. From its appearance alone, any iatrogenic perforation would blow this surgery sky-high.
[Wow, how many gallstones have accumulated in this gallbladder?]
[It isn’t necessarily caused by gallstones. It could be parasites, too.]
[Why do I have a feeling that the gallbladder will rupture at the slightest disturbance, causing bile to flow into the peritoneal cavity and contaminating the operative site? Damn it, I can’t watch anymore. I’ll probably have a nightmare about a never-ending surgery.]
Despite their claim, the anonymous doctor stayed. In fact, none of the viewers left the broadcast room, and more latecomers continued to come into the livestream to observe the surgery performed by the demon, who had become a legend in Xinglin Garden.
With the tip of his scalpel, Zheng Ren made a small incision 0.5 centimeters away from the liver edge. After that, he began his signature move—blunt dissection.
Most of the viewers were experienced surgeons with hundreds of surgeries under their belt, or they would not dare to even comment on the livestream.
However, none of them could reach Zheng Ren’s level of skill at blunt dissection.
After repeated observation of his 49+1 appendectomies, some of them tried to perform a larger range of blunt dissections, but their results had been disappointing and in some cases nearly caused iatrogenic intestinal perforations.
During this period, a new discussion post appeared in Xinglin Garden for those who attempted the host surgeon’s technique after watching the live broadcast.
Some of them initially thought that their skills were inferior, but after reading through the post, it seemed everyone was on the same level.
It was likely due to their own perspectives and that the host surgeon had actually performed many surgeries to achieve such expertise in his manipulation.
There was pin-drop silence in the live broadcast room as Zheng Ren bluntly dissected tissue with a pair of hemostatic forceps and his fingers.
Zheng Ren’s movements induced slight tremors in many viewers’ fingers.
Like a butcher skillfully and effortlessly dismembering an ox, it was obvious that they could only observe this master at work without no hope at imitating his actions.
The edematous gallbladder, half the size of an adult man’s fist, had extremely high surface tension. Even a simple open cholecystectomy would require one to proceed with the utmost vigilance, let alone blunt dissection, as a split-second distraction could rupture the gallbladder.
Even so, the host surgeon seemingly manipulated the instruments without a second thought. The medium curved forceps reached under the incised serous layer of the gallbladder surface and bluntly separated the tissue at a quick pace.
That speed… He must have a death wish.
However, no one would comment that on the livestream.
This was due to the humiliation of every one of the host surgeon’s previous critics. To preserve their mortification, many nosy parkers had screenshotted their comments as evidence for the discussion forums.
A few seconds later, the tissue had been bluntly dissected up to the gallbladder neck. The host surgeon then began lysing the messy adhesions caused by inflammation in the Calot triangle.
His finger movements were proficient and slow, but every step was seemingly done without forethought, which frightened the doctors watching the livestream.
The surgeon was walking a tightrope! Generally, professors in Class Three Grade A Hospitals… Why Class Three Grade A Hospitals? Why was he suspected to be a professor? Any hospital below the rank of Class Three Grade A would not dare perform this type of surgery because of the high risk of medical error.
Even in a Class Three Grade A Hospital, ordinary attending surgeons and chief residents would never handle such a troublesome operation.
Only those of lead professor rank and above would possess the confidence to perform such a difficult surgery.
Even so, they would still tackle the situation with extreme care rather than simply using forceps to bluntly dissect tissue without hesitation like this surgeon.
Upon inspection, the host surgeon’s movements were not fast but very precise. Then, like a painting, the anatomical structures of the Calot triangle gradually appeared in front of everyone.
This brat must have dissected a few cadavers. No! A few were definitely inadequate; he must have dissected at least dozens of cadavers.
In China, the number of cadavers, also known as silent mentors, was so limited that some medical institutions only had one cadaver per class for studying anatomy.
Few medical institutions had the luxury of providing a cadaver for a group of eight, let alone the mythical four-man team, for dissection.
For example, in a town of strategic importance in the northern frontier, whether it was just an ordinary school or medical institution, countless Kwantung Army[1] corpses from decades ago were still preserved for dissection purposes. That was exactly why the doctors from that medical institution did not know what a silent mentor was.
The Kwantung Army corpses were simply unworthy of that title—silent mentors—even though they had been immersed in formalin for decades.
As the number of cadavers was scarce, many doctors actually made up their minds to apply for part-time jobs in the forensics department.
Naturally, such special privileges were provided only to motivated doctors working in tier-three or four cities[2] due to a lack of licensed forensic pathologists.
The host surgeon in the livestream had definitely dissected a large number of cadavers. This assumption emerged in every viewer’s mind at the same time and was proven during the gradual exposure of the Calot triangle.
The cystic duct and cystic artery were clearly visible. The host surgeon then began to ligate, resect and retrogradely remove the gallbladder.
The removal was just the beginning.
[He is very good at laparoscopic surgery, but I didn’t expect him to achieve such a high standard in open cholecystectomy too.]
A dazed doctor expressed his thoughts in Xinglin Garden.
An expert would understand the difficulty behind this surgery. From the cholecystectomy alone, everyone firmly believed that the host surgeon would complete this surgery beautifully.
How much could they learn from this surgery? Well, it would depend on their individual talents.
[Are you stupid? How can he perform laparoscopic surgery if he can’t do an open surgery well?]
[Not exactly. Nowadays, many junior attending surgeons start their practice in laparoscopic surgery. Hey, both of you have inadvertently exposed your age group.]
[The gallbladder had been resected. I’ve a feeling that there will be at least three to five gallstones of over three centimeters in it.]
The anatomical structures could be seen very clearly. After the gallbladder had been resected, the common bile and hepatic ducts were exposed in the operative field, and any surgeon could easily identify them.
Even so, Zheng Ren wanted to minimize risks of medical error and requested a 5-milliliter syringe so that he could confirm the common bile duct by bile aspiration.
After traction was applied to stretch the duct, an aspirator with a suction tube was then gently placed on Zheng Ren’s palm.
The aspirator was plunged into the common bile duct as soon as it was incised.
It was done without a moment’s hesitation. The huge amount of bile that had accumulated in the duct was aspirated before it was forcefully ejected by high intraductal pressure.
This detail attracted the attention of the doctors of Xinglin Garden.
Generally, the area around the common bile duct would be protected to a certain extent as bile leakage was inevitable.
However, the host surgeon had not taken any safety precautions at all. The incision on the common bile duct was the same size as that of the aspirator, preventing any bile leakage.
Everything was done perfectly. It appeared extremely simple and easy, but only those who had performed similar surgeries would understand the difficulty behind it.
[I suddenly feel sad. A few years ago, I performed an incision and drainage of an acute obstructive suppurative cholangitis. Bile leakage occurred during the surgery and resulted in postoperative infection. Initially, it was just a bacterial infection but it was further complicated by a fungal infection. The patient recovered only after one month of aggressive treatment.]
[The feeling is mutual. The host surgeon’s manipulation is indeed stable. That incision had been made about the same size as the aspirator. Is it possible to master such a superb hand- and eyesight-based judgment through sheer practice?]
[That’s talent, so curb your enthusiasm.]
[1] The Kwantung Army was formed in 1906 as a security force for the Kwantung Leased Territory and South Manchurian Railway Zone after the Russo-Japanese War and was expanded into an army group during the Interwar period to support Japanese interests in China, Manchuria, and Mongolia.
[2] The Chinese city tier system (Chinese: 中国城市等级制) is a hierarchical classification of Chinese cities. Cities in different tiers reflect differences in consumer behavior, income level, population size, consumer sophistication, infrastructure, talent pool, and business opportunity.