Chapter 313: Let Me Treat You To Dinner (Part 1 of 4)
After the separation of the hepatoduodenal ligament, Zheng Ren moved on to the lesser omentum and separated the adhesion between the hepatic flexure and the right lobe of the liver (lobus hepatis dexter).
He then pushed down the transverse mesocolon and cut open the retroperitoneum behind the duodenum to perform a blunt dissection.
His skill at blunt dissection had been initially developed when he was training at appendectomy. It was his best trait.
By his own estimations, that one skill alone could probably reach a Master level.
However, it was so common that most people did not appreciate its art. Zheng Ren glanced at Yang Lei and was a little disappointed when he saw that the latter had not noticed it.
It seemed like he had to point out the gist of the surgery from time to time for the man to understand it.
After finishing blunt dissection on the retroperitoneum, he moved the second and third portion of the duodenum towards him until the head of the pancreas (caput pancreatis) and the duodenum were closer to the surface of the surgical field. Then, he temporarily put gauze soaked in warm saline behind them.
Under normal circumstances, he would use the duodenum as an anchor point while performing the sphincteroplasty of the sphincter of Oddi.
However, the patient had undergone a side-to-side choledochoduodenostomy. He did not need to do this anymore.
Zheng Ren prepared to cut open the duodenum.
He used mosquito forceps to clamp it on both sides and cut open the middle region. Clamping was done between one to two mm, followed by an atraumatic needle and suture to patch up the duodenal mucosa and common bile-duct mucosa at 2.0 to 2.5 cm.
This step was performed with extra care to prevent the occurrence of duodenal fistula.
After making an incision on the sphincter muscle, he cut off the traction suture on both ends to check for any bleeding.
Then, he examined the opening of the pancreatic duct.
The opening of the duct was below the incision Zheng Ren had made on the duodenum. Directly on its right, there was leakage of pancreatic fluid.
He inserted a thin catheter into the duct to check for any signs of narrowing or obstruction.
It was important to make sure both layers were in line during a double-layer suture of the duodenum incision to prevent duodenal flexure and stenosis.
Zheng Ren did not suture directly on the incision as usual, choosing a vertical suture instead to avoid the risk of said complications.
[Hmm? This is a unique suture.]
It did not miss the keen eyes of a Xinglin Garden viewer.
After several broadcasts, loyal viewers firmly believed the host surgeon was above any mistake and began considering the benefits of the suture.
There were few comments on the bullet screen.
The viewers pondered and learned.
After suturing of the incision on the duodenum, Zheng Ren carefully retrieved the greater omentum to enforce coverage before positioning the abdominal drainage tube between the subhepatic region and the lesser omentum.
The peritoneal cavity was washed clean with warm saline and he checked for any active bleeding before administering three local antibiotics. He did not close up right away, though.
“B-scan ultrasound, sterile covers, 50 mL injector,” he said.
Su Yun hesitated. “Do you really plan to do it right now?”
“Don’t worry.”
Su Yun did not persist. Soon after, the circulating nurse pushed over a B-scan ultrasound, wrapping the probe and connecting wire in sterile covers. Zheng Ren then began performing a scan directly on the liver.
Without obstruction from the skin and tissues, the image was crystal clear!
The 50 mL injector was inserted into the liver abscess cavity and sucked out yellowish-green pus under the guidance of the B-scan.
After almost 125 mL of pus was aspirated, resistance against the injector began to increase.
“Two vials of Cefoperazone, dissolve and rinse,” Zheng Ren ordered.
After rinsing off with warm saline, the circulating nurse opened two doses of Cefoperazone and Tazobactam. Zheng Ren solubilized them and inserted them into the abscess cavity.
Finally, the surgery was complete. Zheng Ren carefully checked all the regions he had worked on for any bleeding or unattended foci of infection.
“Closing.”
Xie Yiren changed into a pair of new gloves and passed him the clean tools she had prepared earlier.
The pace of the entire surgery was alternating wildly. Zheng Ren had been very slow and cautious when scraping off the abscesses and performing the sphincterotomy.
When closing the abdominal cavity, he had such speed that his movements seemed to leave afterimages.
He was sure that Su Yun would be able to follow his pace.
[My goodness, the only step I understood so far is this closure. How is it so fast?]
[You’re just too weak, kid.]
[This is almost light speed. The surgeon was extremely slow when scraping off abscesses. Is this their way of adjusting their speed to the procedure?]
Not all the doctors had been able to understand the surgery.
However, every one of them knew the abdominal closure procedure.
The surgeon was operating at full speed, with his first assistant following closely. Together, they took less than three minutes to close the abdomen.
This speed… They were just too skillful, like rockets blasting off and leaving everyone else behind.
After the last suture, the patient began showing signs of agitation and the livestream stopped broadcasting.
The viewers were not willing to leave just yet, however; they treated it like a forum with everyone chatting against the empty video background.
Now, they could say anything they wanted with no issue.
Since abdominal infections were very common, this surgery had great reference value, especially in abscess removal, B-scan ultrasound positioning for catheter insertion and pus drainage, and rinsing the area with antibiotics.
The surgeon only had one goal—to treat and improve the patient’s sepsis as much as possible.
With the source of the problem dealt with, the rest depended on the microbiological culture and antibiotics administration.
The surgery had been near-perfect. Many doctors were still hung up about it an hour later, staying behind to chat and share their thoughts.
By sharing their experiences, they could also improve their skill sets.
If only they could record some audiovisual material, many doctors thought greedily.
Those remained distant dreams, however. They were already incredibly lucky that someone had been confident enough to broadcast their surgery live.
There were few who dared to do such a thing. Who could guarantee that their surgery would not go wrong?
Only someone truly gifted would dare broadcast their surgery live.
The doctors in the live surgery broadcasting room did not disperse for a long time, expressing their admiration of the surgeon, who was not aware of them.
The patient had already woken up by the time Zheng Ren finished his last suture.
Both Chu Yanran and Chu Yanzhi were greatly skilled at anesthesia, living up to their status as researchers in Intensive Care Medicine.
Zheng Ren left the operating table and took off his sterile surgical gown, stretching his neck.
“Are you feeling discomfort?” Xie Yiren asked nervously.
Zheng Ren laughed. “No, I’m just relaxing.”
“Oh.”
She began cleaning the surgical tools, washing them and sending them for sterilization.
“Zheng Ren, you’re not on shift tonight, right? Let me treat you to dinner,” she said with her back to him.
A sudden gush of warm blood rushed from his heart, almost erupting from his closed fontanelle.
“You don’t have to pay tonight, there’s a dinner invitation.” Zheng Ren was a little disappointed. Although it would be more lively with all of them present, how nice it would be if he could have dinner alone with Xie Yiren.
It seemed ages since they had gone out for crayfish and met the Chu sisters.
“Oh, okay,” Xie Yiren answered.