Chapter 92: He’s Faster, That’s All
The light reflected off the cold scalpel, radiating a bloodthirsty aura. Without hesitating further, Zheng Ren cut through the abdomen.
Instead of a standard incision, he chose to make a twenty-five-centimeter incision superior and lateral to the left rectus abdominis muscle.
This was completely different from his usual manner of surgery. Xie Yiren was momentarily stunned and grabbed a self-retaining retractor while staring attentively at his movements.
Chu Yanran, who was sitting beside the ventilator, fixed her gaze closely on the readings on the ventilator and various monitors while constantly spinning a pen in her right hand.
Standing opposite Zheng Ren, Chu Yanzhi asked, “Chief Zheng, do I scrub up and a.s.sist you?”
“No, the surgery will be over by the time you finish scrubbing up,” answered Zheng Ren coldly without looking at her. After asking for a pair of medium-sized curved forceps and an aspirator with a suction tube, he plunged the aspirator into the peritoneal cavity as soon as the peritoneum was opened.
The dark red blood was quickly aspirated. A few seconds later, Zheng Ren instructed, “Chu Yanzhi, tell the circulating nurse to hurry up.”
Chu Yanzhi nodded and ran out of the room like a scalded cat.
In Xinglin Garden, there were not many viewers in the live broadcast room.
It was morning now, the busiest time of day where every doctor was occupied with ward rounds, disease reports, surgery and so on.
Thus, “only” more than a thousand viewers were online at the moment.
[That’s a severe hemorrhage. I can at least diagnose a splenic rupture in this case.]
[Blood pressure has dropped to only 60…]
[I hate emergency surgery the most, especially this type of rescue. Every time I’m done, my body will feel so sore that I need to rest for at least two days.]
Watching the turbulent flow of dark red blood in the suction tube naturally made every doctor in the live broadcast room feel the same way the commenter did.
The tension and suffocation of a rescue operation had subconsciously seeped into the viewers’ hearts.
Only a few comments floated past the screen and most of them were from the same talkative viewer.
This sort of doctor preferred to calm his nerves through conversation.
After aspirating for approximately ten seconds, the amount of dark red blood was considerably diminised. Without waiting for complete aspiration of blood, Zheng Ren directly opened the peritoneum and inserted his left hand into the peritoneal cavity.
Xie Yiren immediately put a kidney dish beside Zheng Ren.
He extracted several large blood clots and threw them into the kidney dish.
“Rubber drainage tube,” said Zheng Ren to Xie Yiren; it was a rare request.
Xie Yiren acknowledged the instruction and handed the pre-prepared rubber drainage tube to Zheng Ren, taking the kidney dish away at the same time.
That near-perfect coordination was simply amazing.
Zheng Ren started searching for something in the peritoneal cavity.
[Wow, is he going to occlude the porta hepatis? Is the liver ruptured as well?]
[Sure looks like it. The host surgeon must be anxious to stop the bleeding as soon as possible, but I think it’s better to expose the surgical field first. His manipulation is simply too risky.]
[Based on what I’ve seen these past few days, I’m waiting for the above commenter to get humiliated.]
In the live broadcast room, they watched as Zheng Ren inserted the latex drainage tube after a brief moment of discussion.
If the surgical site was adequately exposed, he should have been able to see the pa.s.sage of latex tube through the hepatoduodenal ligament that was extended between the omentum and porta hepatis, but he was currently manipulating the instrument without any direct view of the surgical field at all.
Subsequently, Zheng Ren quickly performed a peritoneal protection and used a retractor to open the peritoneal cavity.
There was a clear four-centimeter wound with irregular, jagged edges on the spleen, and blood oozed out of it like a river overflowing a dam.
The patient’s hypotension was the reason behind his slow flow rate.
However, everyone in the operating theater and live broadcast room knew that death was imminent if the hemorrhage continued for another ten minutes.
Zheng Ren instructed in a deep voice, “Appendix retractor.”
He used the retractor to pull the incision edge to Xie Yiren’s side and adjusted its position before pa.s.sing the tool to her. That way, she could help him expand the operative view to its maximum.
Then, he extended his hand again and a pair of dissecting forceps was gently placed on his palm.
The gastrosplenic ligament was clamped with the dissecting forceps before being ligated and incised. After that, he quickly ligated the short gastric arteries to avoid damage to the gastric wall.
[His movements are so f*cking fast…]
[The host surgeon’s understanding of the anatomical structures has reached a very high level. Why do I have a feeling that they know where the short gastric arteries are without even searching for them?]
[You’ll know after repeated executions. Young man, more surgeries and thinking are the keys to success.]
As the comments pa.s.sed, the splenic artery was separated and exposed in the operative field. After ligating it using a 3# suture thread, Zheng Ren noticed a significant reduction in spleen size.
Subsequently, the spleen was removed from the splenic fossa. The splenophrenic ligament and splenocolic ligament were transected, and the vascular pedicle was treated using double ligation and transfixation with nonabsorbable suture ligatures.
These were accomplished in less than five minutes.
[That’s very fast. I think I know why the host surgeon occluded the porta hepatis in the first place.]
[He is confident that occluding the hepatic hilum can minimize hemorrhaging as much as possible. If I’m not mistaken, the occlusion can go up to ten minutes, max.]
[Fifteen minutes, but we usually release it every ten minutes to prevent ischemic liver injury.]
The doctors in the live broadcast room understood the host surgeon’s methods. Despite their astonishment at the removal of spleen in only five minutes, the surgery itself was not difficult. It only showed that the host surgeon had a deep understanding of local anatomy, no more.
Yes, that was basically it.
Apart from blind manipulation to occlude the porta hepatis, everything else was plain and simple, but how many surgeons in this world could finish it so quickly?
Everyone understood the principle behind it, which was why there were relatively few comments thus far. They were eagerly waiting to see what the host surgeon was going to do with the ruptured liver.
Liver surgery was ten times more difficult than a splenectomy.
After simple ligation of the vascular pedicle on the diaphragmatic surface using a 2# suture thread, Zheng Ren began extending the surgical incision to the right.
There was no bleeding from the subcutaneous tissue: a typical manifestation of hemorrhagic shock. This was due to peripheral vasoconstriction, which was a compensatory mechanism to maintain vital organ perfusion.
Despite the absence of bleeding, Zheng Ren remained vigilant and quickly performed blunt dissection, trying his best not to cause any further damage to the surrounding tissue.
A large sterile gauze was used to protect the peritoneum before he repositioned the appendix retractor and let Xie Yiren pull on it.
At this moment, Chu Yanzhi and the circulating nurse finally returned.
“Transfuse the blood!” Zheng Ren ordered while exploring the peritoneal cavity.
Resuscitation was of utmost importance and courtesy was absolutely unnecessary in this instant.
The circulating nurse and Chu Yanzhi each took a bag of fresh frozen red blood cells and hung them on the infusion stand.
Warm blood had to be used, so they had been trying to use their body temperature to thaw the bags on their way back to the operating theater.
After an ident.i.ty check between the patient and his blood components, the circulating nurse placed a bag of fresh frozen red blood cells into the pressurized infusion device before putting another bag into her embrace.
“Give me a bag,” said Chu Yanran, who was attentively watching the data on the ventilator and various monitors.
Without wasting any time, they divided up the blood bags and constantly changed positions to warm the frozen blood as much as they could.
The blood bag in the pressurized infusion device soon depleted and was quickly replaced with another.
Seeing the dark red fluid entering the patient’s vein via the central venous line relieved everyone’s anxiety to a certain extent.