Chapter 164 - Guess Ill hold the mirrors (1/2)
On the next day, Zhang Fan was the primary surgeon, Zhao Quanping was the primary surgical assistant, and Zhao Jun was the secondary surgical assistant. Li Jingjin, a professor from Dee University Affiliated Hospital, was also in the operating room on standby. Even Li Jingjin didn't have much confidence in being able to perform such a difficult liver cancer tumor removal surgery. Although he was here as an invited expert consultant, he also didn't have much confidence that Zhang Fan would be able to successfully accomplish the surgery. However, he didn't say it out loud. He decided to just watch and see how things went! Professor Chang came to watch the surgery as well. Although they were both expert professors of tumor surgery, the two professors didn't have a good relationship with each other. Since they were on the same level of expertise and also from the same area, this meant that they would often have to compete with each other for the few jobs there were for their tumor surgery expertise. It would be no mistake to say that those in the same medical field would often hate each other.
Well, neither of them felt too awkward from just standing near to each other. The two of them stood on opposite sides of the operating room. Although neither professor talked to the other, neither of them believed that Zhang Fan could succeed at this surgery. For such a young doctor to perform such a highly difficult and technical surgery seemed like such a joke to them.
Both professors were only here as consultants. As long as they didn't personally participate in the surgery, they wouldn't have any responsibility. They were both here only to watch the show, so they didn't care if there was an incident. Chasu City Hospital was insisting on having the surgery performed, so Li Jingjin didn't say anything!
The surgery began. Zhang Fan chose to begin with a standard incision. For this type of surgery, the incision would need to be large rather than small. Although smaller incisions might seem like they would to less damage to the body, the vision would be unclear, which would cause even more damage to the internal organs in the end. The electrotome easily sliced through the skin and stopped the bleeding in a flash!
Zhang Fan entered the abdomen and began determining the size and area of the tumor. He needed to understand if the tumor had truly invaded the porta hepatis and the major blood vessels. This tumor truly wasn't small. Its leaves had spread through a significant portion of the liver. Li Jingjin and Professor Chang also saw how large the liver was while standing by the sides. They simultaneously shook their heads. This tumor was too large. It was likely that it had already invaded the major blood vessels! One slight misstep would cause hepatic failure!
Zhang Fan gently searched with his hand. The tumor tissue had grown swiftly and aggressively. It had damaged a large amount of the liver tissue and structure. On the surface, there was a light membrane that would easily break. This patient's tumor had already invaded the major blood vessels. Moving it even slightly too much would likely result in major bleeding and collapse of the blood vessels.
Zhang Fan slowly separated the hepatorenal ligament and cut the deltoid ligament. This surgery was far more difficult than typical hepatobiliary surgeries. Any movement that was slightly too much would instantly result in major bleeding. This was why Zhang Fan had to be extremely careful with every single movement! ”Wrap in gauze,” Zhang Fan stated simply. Zhao Jun immediately wrapped the liver in gauze and held it with both hands. Zhang Fan separated the coronary ligament for the final ligament. Now, all the ligaments securing the liver in place had been separated. The secondary surgical assistant would need to remain in a bent over position and ensure that the liver didn't move.
Zhao Jun was bending his back for this. He was a director already, yet he was acting as a surgical assistant for a resident doctor and doing what a resident doctor would normally do instead. However, Zhao Jun had zero complaints about this. This was teamwork. This was what being a doctor was about. This was the trait of working at a place where skills reigned supreme. Only those with the best skills would get to lead.
The surgical knife slowly slid past the liver capsule. Hemostatic forceps slowly entered the liver tissue as it was separated at the margo anterior hepatis. The forceps could only enter slowly. The timing would be quite critical. The surgeon absolutely had to be extremely accurate and be highly familiar with anatomy. Otherwise, if even a single blood vessel was missed, it would be incredibly difficult to stop the bleeding.
Vena cava, short hepatic vein, and so on all had ligation performed. The liver had a double blood supply system that was especially complex. It wouldn't be possible to perform ligation on all veins leading to other liver lobes, as the liber lobes would die of oxygen starvation by the end of the surgery. After Zhang Fan confirmed that all the ligation was complete, he gently let go of the hemostatic forceps. The left and right liver lobes were already going pale, but now they recovered some color. This meant that the blood was flowing between the two liver lobes.
The middle liver lobe was located in far too critical a position. The hilum of the liver was close to the inferior vena cava. Three liver veins passed through the middle liver lobe. There would be far too much bleeding if surgery was performed here because of the abundant blood supply and complex tissue structure, which exponentially increased the surgery's difficulty.
It would be critical to determine which veins and arteries required ligation as well as which veins and arteries would be kept open to provide blood flow. It would truly be impossible to differentiate these without a minimum of a decade of experience with liver surgery. That was just how difficult surgery was. It would be far too difficult without a teacher. This was why a tumor in the middle of the liver would be especially difficult to remove. Without a large number of patients to help a surgeon gain experience, it would be impossible to gain the necessary skill level. A surgeon would need both an excellent teacher and a large number of patients.
As Zhang Fan finished ligation, stopped the bleeding, and the left and right liver lobes recovered their color, both Li Jingjin and Professor Chang felt that this was far too inconceivable. Zhang Fan was clearly so young, yet his skills were already so well practiced. Both professors were experts who instantly knew that this young doctor was quite amazing just by watching him.
Time slowly passed. Four hours had now passed since the start of the surgery. All of this time had been used to prepare for the tumor's removal. Now was the final step. Zhang Fan used a hot salt water bag to cover the liver and then began cutting out the cancerous tissue. Cancer grew too quickly, so the outside cancer cells had yet to mature. The internal cancer cells had already died due to lacking nutrition. A human body's normal nutritional level would never be able to satisfy cancer cell growth. Invasion, penetration, planting, and so on. Cancer cells had far too many ways to spread. It was truly scary.
Zhang Fan completely removed the five-centimeter cancerous tissue. He applied pressure to the wounded and bleeding tissue, then injected chemotherapeutic drugs through the omental vein in order to kill any cancer cells that entered the bloodstream. Finally, he covered the liver with the free greater omentum flap and performed ligation and fixation.
The surgery had been a success. Zhang Fan had cleaned out the area around the cancer tissue quite cleanly. The moment that he surgically removed the cancerous liver tissue and placed it in the tissue disk, Li Jingjin exclaimed, ”Such precise liver tumor removal! Amazing! I've learned so much!”
Professor Chang had secretly left already when he saw Zhang Fan successfully removing all of the cancer tissue without major bleeding occurring and with the patient's vitals stable. Professor Chang didn't even have the face to request his consultation fee or plane ticket fee! He made up his mind to never come to Chasu City again! This seemed too ridiculous to him. Even a random resident doctor was capable of performing such a surgery?
Nobody cared about the fact that Professor Chang had left. The Chasu City Hospital directors were still waiting outside the operating room on standby. They ignored him as he left. He had received his comeuppance far too quickly!
The surgery continued. Zhang Fan inserted drainage tubes while the medical equipment nurse counted the gauze. After the gauze was counted, it was time to close the abdomen. The surgery finally finished after more than six hours. Zhang Fan started giving medical advice. ”After the surgery, the patient is forbidden from eating for three days. He needs blood transfusions and protein along with low-flow oxygen.”