Healing Doctor

Chapter 158 How could a man with such short stature defend the royal city?

"Don't corrupt my little Ji." Director Liu returned from washing his hands and overheard the circulating nurse and Ji Xiang chatting. He was washing his hands and getting dressed at the same time. "Tomorrow I'm taking little Ji to do scalpel surgery. Isn't that better than being the head nurse?"

"You lot are working like dogs, earning money but not having the life to spend it." The circulating nurse retorted to Director Liu's words without hesitation.

"Our urology department has lofty aspirations; how can the orthopedics department compare to us?" Director Liu said as he put on his clothes, crossing his arms and handing the straps behind his back.

"Can't you dress yourself?"

"I'm used to it. I've been like this since I first started learning surgery. I can't perform surgery without someone tying my surgical gown for me," Director Liu said with a grin, chatting idly with the circulating nurse.

"Why are you urologists setting such high goals?" The circulating nurse tied the straps of the sterile gown and squatted down to help Director Liu pull the bottom corner of the gown to make it smoother and more comfortable.

"The poet Du Fu said this during the Tang Dynasty, so it's officially certified."

"What?"

"The middle-aged man is extremely short; how can he defend the royal city?"

"..."

Just as Ji Xiang finished laying out the forms, he overheard Director Liu say those words.

Tsk tsk, what a cultured old rogue.

Director Liu was just talking nonsense, which did not affect his attention or concentration at all.

Seeing that Ji Xiang had finished laying out the sheets and stood directly in the assistant's position, Director Liu didn't say anything more and stood in the surgeon's position to begin the surgery.

The patient was under general anesthesia. Dr. Liu made a 1.5cm incision below the costal margin along the posterior axillary line to the retroperitoneal space.

After stopping the bleeding at the incision site, he inserted his fingers through the incision to push open the peritoneum, placed an air bag, and injected about 800 mL of air.

"Speaking of technological advancements, they've really progressed fast. When I first learned surgery, it was all about removing the kidneys, just a big incision. You just stick your hand in, grab the kidney pedicle, and clamp it. The surgery was incredibly simple." After injecting air, Director Liu placed his hands in the sterile area and began chatting casually.

Ji Xiang knows we'll have to wait a while.

"Tell me, how many kidneys have you eaten in your lifetime?" the circulating nurse said disdainfully. "Aren't you afraid that you won't have a single kidney in your next life?"

"Treatment and saving lives, that's not something you can call 'kidney-cutting'," Director Liu said. "You wouldn't understand about technological advancements anyway."

"As if you know it."

The group chatted casually while Ji Xiang carefully observed the differences between the equipment and the operating system in the operating room.

The difference is significant; a system operating room represents the pinnacle of what's possible in this era, both in terms of hardware and software.

After pausing for 5 minutes, Director Liu shut up and resumed the surgery, switching seamlessly between the two states.

Director Liu expanded the retroperitoneal space, deflated the balloon, and inserted a cannula at an appropriate location based on the tumor's location.

As the surgery progressed, Director Liu gradually became more serious.

He was like a chivalrous knight-errant facing a lifelong adversary, gradually adjusting his state of mind.

Director Liu used a No. 7 suture to fix the axillary suture cannula, and then filled it with CO2 gas to maintain the pressure at 12-14 mmHg.

Under laparoscopic guidance, the renal artery and vein were dissected along the renal fat capsule on the surface of the psoas major muscle. Then, the perirenal fat was dissected, as close as possible to the renal tumor site.

Once you get to this point, everything is no different from any other surgery.

However, as Director Liu continued to wander around, he immediately noticed the difference.

The closer the tissue is to the tumor, the easier it is to dissect it. Due to the embolization, the tumor and the surrounding tissue within 1 cm have already experienced ischemia and necrosis, and after the initial edema period, it separates from the surrounding tissue with blood supply.

So that's how it is!

Director Liu's guess was confirmed.

Although it's an endoscopic surgery and you can't touch the kidney tissue to check for changes, Dr. Liu has performed similar surgeries for many years and can feel the local changes even with long forceps.

He clamped the renal pedicle artery with a vascular clamp to control the blood supply to the renal pedicle.

After securing the kidneys with forceps, inject approximately 100 ml of ice-cold saline solution through a suction device to lower the local temperature and protect the kidneys.

By gradually separating the tissues close to the tumor, the surrounding tissues become easier to dissect, much like a layered cake.

Previously, I was very nervous during the countdown period for the surgery, fearing that delays would prevent the surgery from being completed smoothly.

After all, if the renal artery is clamped and closed, and the tumor cannot be removed and the blood supply can be reopened during the countdown, the next closure will waste at least 10 minutes just for hemostasis.

That would complicate a simple surgery, drastically increasing its difficulty.

However, tumor removal after interventional surgery is completely different, with the difficulty of the surgery decreasing dramatically.

Soon, Director Liu experienced another benefit.

During the countdown, you can simply move and cut along the necrotic areas, because the embolized tumor artery is the place where the tumor artery supplies blood, as there is no blood supply to the occluded tumor artery.

This is fucking ridiculous!

Director Liu became happier and happier as he did it.

"Specimen bag," Director Liu said in a low voice.

"Director Liu, has it been cut off?" The anesthesiologist was still calling out the time every minute to remind the surgeon. He hadn't expected it to be so fast!

"Yes." Director Liu nodded happily.

The anesthesiologist had just finished recording the anesthesia and hadn't even had a chance to look at the screen yet.

Looking up and carefully observing, I noticed the anesthesiologist's mask had moved slightly.

"Director Liu, why do I feel that this surgery is different from the ones I've done before?" the anesthesiologist asked, puzzled.

"Didn't I say that the patient's blood vessels supplying the tumor were first embolized, and the tumor tissue and surrounding tissues underwent a certain degree of necrosis?" Director Liu put the tumor and adipose tissue into a specimen bag and pulled it out.

"The necrotic tissue and the surrounding normal kidney tissue are so clearly distinct, so clearly distinct!" Director Liu couldn't help but exclaim in admiration.

"Two zeros are absorbable lines."

"Wow, Director Liu, you've really researched new surgical techniques!" the anesthesiologist exclaimed in surprise.

Doctors of Director Liu's age rarely encounter new things; they have plenty of experience and knowledge. Why would he want to make things difficult for himself?

Besides, mature technology is also a responsible approach to patients; most senior department heads and professors think this way.

The anesthesiologist was surprised to learn from the patient's medical record that the patient had undergone an interventional procedure a few days prior, as he did not understand the purpose of such a procedure.

However, judging from the surgical procedure, the significance of doing it this way is immense, as it drastically reduces the difficulty of the surgery.

The scrub nurse handed two absorbable sutures with needles to Director Liu.

After stitching in a figure-eight pattern, Director Liu carefully added two more stitches.

After loosening the vascular clamp and restoring blood supply to the renal pedicle, Director Liu and Ji Xiang observed the wound for any active bleeding.

There was no active bleeding; the wound was covered with hemostatic gauze, and a silicone drainage tube was placed around the kidney.

The surgery was over before the circulating nurse and scrub nurse had finished counting the instruments.

"Finished! Call it a day!" Liu Zhuyi said confidently.

(End of this chapter)