Chapter 312: Problematic Operation (Part 4 of 4)
Zheng Ren reached out and an uncovered aspirator was placed in his hand.
In the surgical field, blueish-green pus was visibly leaking out from the ileocecal fossa.
He hesitated before putting the aspirator on the patient’s thigh. “Pa.s.s me a sc.r.a.per.”
“Yes.” Xie Yiren blinked and pa.s.sed him the tool before picking up some sterile gauze.
Zheng Ren did not drain the pus by suction. Instead, he sc.r.a.ped at it and wiped it off on the gauze in Xie Yiren’s hand.
It was a sample for subsequent microbiological culture. Xie Yiren had understood his intentions without a word.
Even though the greenish pus in the ileocecal fossa seemed to be caused by infection by Pseudomonas aeruginosa, they could not confirm it until they performed a test.
After collecting the sample, Zheng Ren began draining the rest of the pus with the aspirator.
Xie Yiren carefully put the contaminated tools aside and organized the sterile tools for closure later.
Everything was in order.
[Wow, it’s green!]
[It’s blueish-green. From the color of the pus, we already know the infection is extremely bad. Even after surgery, there’s no guarantee that a combination of Tienam and vancomycin can actually control the infection.]
[The surgeon took a sample. This surgery seriously has no flaws.]
After Zheng Ren cleaned up the pus, he continued to examine the surrounding connective tissues and edematous adhesions.
The patient’s gallbladder had been removed 24 years ago. Zheng Ren carefully searched for the biliary duct and separated it from the pancreas.
This was the most difficult step. He could feel Su Yun paying full attention to keep up with his thought process for each step, but Yang Lei seemed bewildered.
Zheng Ren felt slightly sorry since no one had control over their natural talent.
The pancreas was slightly swollen, but it was nothing serious. The patient would be put on somatostatin for some time to prevent uncontrolled acute pancreat.i.tis.
“Yang Lei, remember to tell Chief Xia to administer somatostatin post-op, normal dose for three to five days,” he said, getting the man to note down the key reminder.
Yang Lei acknowledged the order.
Zheng Ren continued to separate the hepatoduodenal ligament and explore the duodenum, soon finding the ileocecal fossa he had drained the pus from earlier.
Its wall was covered in abscesses.
Xie Yiren’s view was obstructed from her angle, so Zheng Ren extended his hand and, in a rare display, said out loud, “Small sc.r.a.per.”
Before he could finish his sentence, a handy sc.r.a.per was placed in his hand.
Surprised, he turned to look at Xie Yiren, who was smiling at him.
[The sight of abscesses is giving me a headache. When I previously encountered something similar, the patient suffered a fever for twelve days post-surgery.]
[Yeah, this surgeon isn’t planning to sc.r.a.pe off those abscesses, right?]
[He better not… the abscesses are heavily attached to the intestinal tract so it’s not advisable to puncture the intestine. Edema in the intestine makes the patient even more vulnerable.]
[Mortals, don’t try to predict the surgeon’s next step with your simple minds.]
[I can sense that the surgeon is going to sc.r.a.pe off the abscesses… He’s moving, he’s really moving! He’s sc.r.a.ping them!]
Zheng Ren used the sc.r.a.per to remove the surface layer of the abscesses, then asked for a mosquito clamp, searched for an area with more deeply-rooted abscesses and began separating them from the intestinal wall.
Su Yun held the surgical hook tightly and carefully, his breathing becoming shallower.
He was afraid to move for fear that the slightest movement would make Zheng Ren falter, leading to the rupturing of the swollen intestinal walls.
If that happened, in addition to leakage of intestinal contents, the edema would not subside even after they st.i.tched the intestines back together. It could worsen to a point where the patient would require a second laparotomy.
What Zheng Ren was doing was incredibly bold given his skill. After all, he had done many surgeries involving similar separation techniques in the System’s operating room.
Nevertheless, he was still very cautious. He patiently sought out small gaps and inserted the mosquito clamp to separate them.
This surgery was progressing at a painfully slow pace, at complete odds with the lightning speed with which he had performed the laparotomy.
In both the operating and live broadcasting rooms, viewers held their breath anxiously.
Five minutes…
Ten minutes…
Fifteen minutes…
At the 22nd minute, Zheng Ren retrieved the mosquito clamp and small sc.r.a.per from the patient’s peritoneal cavity. There was an irregularly shaped, 20 cm² wide abscess on the clamp.
[My goodness, this is the best operation I’ve ever seen.]
[This looks like a microsurgery. It’s hard to believe this surgeon did it with their naked eyes.]
[Bullsh*t; the difficulty of this operation doesn’t depend on one’s surgical view, it all lies with both hands. Its execution was so meticulous that the intestines remained uninjured while the abscesses were completely removed.]
Across Zheng Ren, his first a.s.sistant, Su Yun let out a long sigh.
“There’s a problem in your operation,” he said.
“Yes, I know,” Zheng Ren replied, “but this patient has sepsis. This would reduce the risk of infection and increase the chances of survival post surgery.”
“You’re that confident?” Su Yun’s words did not come with context, but Zheng Ren understood that he was referring to the great risk taken in sc.r.a.ping off the abscesses.
Perhaps, from another’s viewpoint, it had been extremely risky. However, he did not feel the same way; all it had taken was a little extra effort.
It was worth it if the patient healed faster after surgery.
After removing the abscesses in the ileocecal fossa, Zheng Ren completely separated the duodenum. Then, he reached out again and the surgical blade was put into his hand.
At the same time, Su Yun also opened his palm.
An uncovered sterile aspirator was pa.s.sed to him.
When the common bile duct was incised, Su Yun inserted the aspirator.
Rotten food debris, pus-like fluid and digestive juices were sucked into its tube.
Su Yun shook his hand slightly and tried his best not to leave anything behind.
The common bile duct was so full that the uncovered aspirator was obstructed after only 20 seconds.
Its hissing began to fade.
Zheng Ren covered the area with wet gauze once Su Yun removed the aspirator.
Xie Yiren had already prepared warm saline. Su Yun put the aspirator into a bucket of it and repeatedly rinsed the tubing; after clearing the obstruction, he continued to remove the contents of the bile duct.
This whole process was repeated five times before the bile duct was finally cleared.
[Does this mean the surgery is halfway done?]
[Probably. The next step should be sphincteroplasty of the sphincter of Oddi. The rest should be easier after removing the abscesses and obstruction of the bile duct.]
[This surgery is so intricate. However, how will the patient avoid postoperative infection?]
[That’ll be dealt with by the ICU. Had they had not done this surgery, they would not have been able to control infection anyway with so much rubbish inside the body.]
[I read the diagnosis before surgery and saw that the patient has sepsis. The patient received this surgery quite late; hopefully the surgeon’s skill can pull her back from the gates of h.e.l.l.]
After suction was complete, Zheng Ren was relieved. He had been more worried about the bile duct having serious edema or containing a huge foreign body. Those would require him to expand his surgical methods and cut open the bile duct for extraction.
Luckily, that had not been the case.