Chapter 348 236: Bleeding
"?"
Wang Zhengchu was stunned for a moment.
He quickly recovered and said, "You can do it? How confident are you? What gives you the right to say something like that?"
Jiang He said, "Director, I have the practical skills. Professor Yang Xu can vouch for me. I'm very familiar with the retroperitoneal approach. Besides, if you go talk to the family about a C-section now, not only is it unlikely the fetus will survive, but the mother will also most likely die from intraoperative diffuse bleeding and septic shock. That being the case, why not let me try?"
"She's twenty-eight weeks pregnant! Can't you see how compressed the inferior vena cava and portal venous system are? If you go in through the retroperitoneum, the field of view is extremely narrow. If your hand shakes even once and the venous plexus ruptures, blood will completely flood your vision in ten seconds!"
"Then I'll just make sure it doesn't rupture."
"?"
Wang Zhengchu couldn't take it anymore. He cursed, "Damn it, you actually make a weird amount of sense."
Jiang He: "Mm."
Wang Zhengchu asked Yang Xu, "Old Yang, can your student not take a hint?"
"Ahem..." Yang Xu coughed again. "Old Wang, let him do it. Trust him. If anything happens, I'll take responsibility."
Wang Zhengchu: "?"
He said angrily, "I'm the one who called you here! If something happens to him, you take the fall. If something happens to you, I take the fall. So aren't you just saying I'm the one taking responsibility in the end?"
Yang Xu: "Ahem... Just trust Jiang He."
Wang Zhengchu turned his head to look at the light box, then glanced at the time.
'Damn it, we can't delay any longer!'
The pregnant woman's vital signs were all sliding toward the edge of a cliff. Any more delays and they'd lose the chance to operate at all!
"Damn it all, go change and scrub in!"
Wang Zhengchu strode toward the door.
"Notify the OR to prep for a retroperitoneal exploration. Get the director of anesthesiology in here personally. And have the blood bank send over another four units of red blood cells and four hundred milliliters of frozen plasma!"
...
「Fifteen minutes later.」
Operating Room 1 of City First Hospital.
The shadowless lamp lit up.
The pregnant woman had been placed in a special left lateral decubitus position.
Her back was elevated to maximally expose the right flank and lumbar region, while also relieving the uterus's pressure on the inferior vena cava.
The director of anesthesiology stared intently at the monitor. "Director Wang, blood pressure is 85/55, heart rate is 130, and the fetal heart rate is fluctuating around 160. The patient is on the verge of the compensatory stage of shock. You don't have much time. I've used a general anesthetic combination with the least impact on the fetus, but it won't last long."
Wang Zhengchu: "Understood."
Jiang He moved to the patient's dorsal side.
Wang Zhengchu stood on the opposite side, serving as the first assistant.
"Jiang He," Wang Zhengchu began in a low voice, "I'm left-handed. Since you're the lead surgeon, our positioning and instrument passing will be the reverse of usual. You'll have to adjust accordingly."
"No problem." Jiang He put on his sterile gloves and held out his hand. "Number 10 blade."
The scrub nurse immediately slapped the scalpel into Jiang He's palm.
With a slight drop of his wrist, the blade sliced through the skin.
Wang Zhengchu immediately applied pressure with gauze for hemostasis while following up with an electrosurgical knife to cauterize.
"Retractor. Blunt dissection of the muscle layer."
Wang Zhengchu took the retractor in his left hand, inserted it into the incision, and pulled firmly to both sides.
Although this was the first time they had worked together, Wang Zhengchu was surprised to find Jiang He's movements were remarkably smooth.
It was as if they had cooperated in a past life...
"SZZT—"
Fat and muscle were peeled back layer by layer.
Two minutes later, the renal fascia (Gerota's fascia) was exposed.
"Scissors."
Jiang He took the scissors and picked open the fascia.
He inserted his fingers into the retroperitoneal space.
And began the blunt dissection.
This was the first major hurdle of the entire surgery.
The retroperitoneal space was already narrow to begin with.
Now, it was compressed by the massive uterus in front, leaving almost no room to work.
When he inserted his fingers, all he could feel was the congested and swollen venous plexus.
Wang Zhengchu stared intently into the depths of the incision, ready to deal with any potential arterial spurting.
"Push the kidney and colon ventrally."
Jiang He gave the order.
Wang Zhengchu immediately used a large retractor padded with gauze to press the right kidney and ascending colon anteriorly and inferiorly.
The field of view suddenly opened up.
Or rather, it was relatively open.
A mass appeared in the field of view.
The surrounding tissue had been soaked black by leaking pancreatic fluid and was matted together in adhesions.
The situation was even worse than it had appeared on the scans.
The second assistant at his side said grimly, "Director Wang, this is impossible. The pressure in the inferior vena cava is so high during pregnancy. If it tears, the patient will be gone in seconds."
Wang Zhengchu frowned and nodded.
Under these circumstances, even he wouldn't dare to make a cut lightly.
'In this situation, what's the best emergency measure?'
Wang Zhengchu thought of a plan that might just work.
He was about to tell Jiang He, but he saw Jiang He hold out his hand and say:
"Long forceps, ultrasonic scalpel."
As the top surgeon of City First Hospital, Wang Zhengchu instantly understood Jiang He's intention.
He couldn't help but speak up. "You're going to dissect directly? There are no layers here. If you cut off the mark..."
"Quiet."
Jiang He interrupted him.
'This is the most annoying thing about working with someone for the first time. Too many opinions.'
'An assistant with too many opinions is the worst.'
'If my professor were the first assistant, he wouldn't be running his mouth so much.'
'Wang Zhengchu still needs some training.'
Jiang He: "Listen to me. Keep the retro-duodenal space taut."
At the operating table, the lead surgeon has absolute authority.
Wang Zhengchu's medical professionalism was still high.
He stopped questioning and, putting force into his left hand, adjusted the angle of the retractor!
Jiang He held the long forceps in his left hand and lifted the adhered tissue.
The high-frequency vibrations of the ultrasonic scalpel.
And then...
No bleeding!
Wang Zhengchu's pupils contracted slightly.
He immediately followed with the aspirator, suctioning away the fluid.
The view became a fraction clearer.
The forceps continued to pull, and the ultrasonic scalpel continued to dissect.
Throughout the whole process, Jiang He's hands were terrifyingly steady.
...He was nothing short of a surgical machine.
Wang Zhengchu gradually realized this, and then, he was gradually rendered speechless.
'This is a new surgical technique!'
'Why does Jiang He's mastery of this new technique give me the feeling... that I'm watching a leading authority in medicine?'
"BEEP! BEEP! BEEP! BEEP!—"
The monitor suddenly blared an alarm.
The director of anesthesiology shouted, "Fetal heart rate has dropped to 90! Blood pressure is down to 70/40! The patient's abdominal pressure is too high, the uterus is contracting, compressing the return flow in the inferior vena cava!"
Wang Zhengchu said urgently, "Jiang He, the fetus is hypoxic and the mother is in shock! We have to decompress immediately! Aspirate the cyst!"
"If we aspirate now and the cystic fluid leaks into the retroperitoneum, the infection will spread rapidly. Even if we save her, she'll die post-op from severe sepsis."
"That's still better than dying on the table! Didn't you see her vitals!"
"Push one of phenylephrine, increase the transfusion speed, and give me three minutes."
"Three minutes?"
Wang Zhengchu didn't understand.
'What could possibly be done in three minutes?'
Jiang He put down the ultrasonic scalpel and switched to a pair of dissecting forceps.
He abandoned cauterizing and cutting.
And switched to blunt dissection.
The dissecting forceps spread open the adhesions.
'So fast! Jiang He's movements were so damn fast!'
The portal vein was dissected free.
The superior mesenteric vein was exposed.
The safe space on the anterior wall of the inferior vena cava was forcibly opened.
Wang Zhengchu didn't even dare to blink, his aspirator tightly following Jiang He, afraid of missing even the smallest bleed.
Two minutes and forty-five seconds.
Jiang He dropped the dissecting forceps.
The adhesions between the cyst and the surrounding major blood vessels were released.
He said calmly, "Large syringe. Puncture and aspirate."
Wang Zhengchu: "Got it!"
He finally realized something: Don't question, don't waste time with nonsense, don't waste Jiang He's time. That was the most important thing he needed to do!
The syringe pierced the cyst.
The turbid cystic fluid was rapidly drawn out.
The heavy pressure on the inferior vena cava vanished, and cardiac return was instantly restored.
The director of anesthesiology announced, "Blood pressure is rising! 95/60! Fetal heart rate is back up, 140!"
Wang Zhengchu looked up at Jiang He, trying to say something.
Just then, a sudden complication arose!
Because of the rapid decompression of the cyst, the surrounding tissues retracted.
An arterial branch below the head of the pancreas, pulled by the retracting tissue, suddenly ruptured!
"SPURT—"
Bright red blood shot out, splattering onto Wang Zhengchu's goggles.
Bleeding!
A major hemorrhage!
Wang Zhengchu turned the aspirator to maximum, trying to suction away the pooling blood.
But the blood was flowing too fast.
The moment he cleared a spot, it was immediately filled again.
"I can't find the bleeder! There's too much blood!"
Wang Zhengchu's heart sank completely.
'It's over.'
Just as he was about to desperately pack the area with gauze for compression...
Jiang He plunged his left hand directly into the sea of blood, applying pressure in the blind field.
This was Jiang He's signature move.
—The blind suture!
"Needle holder, 3-0 Prolene."
The scrub nurse froze for a second before quickly handing over the needle holder.
Wang Zhengchu stared at Jiang He in disbelief. "You're going to do a blind suture?"
Jiang He paid him no mind.
'If Wang Xiaoqing were here, she would tell him: "Don't ask questions. Just watch and learn. That's all you need to do."'
In fact, after Jiang He had shown off his blind suture technique in the advanced class, Professor Wang Xiaoqing had secretly tried it herself later.
Well... she couldn't do it nearly as fast as Jiang He. Not even close. It was a total headache.
Now, Jiang He was practically re-enacting that same scene.
He took the needle holder.
The needle point went in.
Puncture, tie the knot.
It was as smooth as flowing water, executed in a single, fluid motion.
When Jiang He released his left hand and removed the needle holder,
the bleeding had stopped.
Wang Zhengchu stared blankly at the stump of the vessel.
A blind suture ligation, single-handed.
'Is that even humanly possible?'
"Irrigate the field," Jiang He reminded him.
Wang Zhengchu snapped back to his senses, quickly rinsing away the residual blood with saline and suctioning it clean with the aspirator.
The field was clear once again.
He took a deep breath and asked, "You... how did you do that?"
Jiang He replied faintly, "Lots of practice."
He'd left out the first two words that should have preceded "lots of practice," which was already a show of respect for Director Wang.
Wang Zhengchu was dazed. For the first time, he, who had always been extremely confident in his medical skills, had been crushed by a younger man.
Next came the excision of the lesion and debridement of necrotic tissue.
Without the threat of a major hemorrhage, Jiang He's movements were even more deft and effortless.
Wang Zhengchu, on the other hand, had become obedient, cooperating quietly without another word.
「A few hours later.」
"Debridement complete. Placing two double-lumen drainage tubes."
Jiang He began the final closing procedures.
Because it was a retroperitoneal approach, there was no need to open the abdominal cavity, thus avoiding the cardiopulmonary failure that could be caused by excessive incisional tension.
Jiang He sutured the muscle and fascia layer by layer, finally tying the last knot on the skin.
The suture was cut.
He took half a step back and placed the needle holder on the tray.
"Surgery's over."
He looked back.
On the monitor, the mother's heart rate and blood pressure were stable, as was the fetal heart monitor.
The director of anesthesiology peered over the screen, looking at Jiang He as if he were a monster.
And Wang Zhengchu, who had been standing all night, only now realized he was completely soaked in a cold sweat.
He watched Jiang He take off his sterile gown.
He worked his throat, wanting to ask something, but found that only silence came.
'What should I say? I can't just praise him, can I?'
'I've never praised anyone in my life, and Jiang He is so young.'
'Damn it, it's a little embarrassing. I can't bring myself to say it...'
SPLASH.
Only now did Jiang He let out a long sigh in his heart.
'Was it risky? Of course, it was.'
'In 2008, without a 3D laparoscope, performing blunt dissection and a single-handed blind suture in the minefield of the retroperitoneum was no different from walking a tightrope over a cliff.'
'Even ten years from now, the number of surgeons who would dare to take on this kind of procedure could be counted on one hand.'
'But, a good thing I was here!'
Jiang He dried his hands and pushed open the doors to the operating room.
The storm had stopped by then.
There were many people outside the door.
Besides the patient's family, Yang Xu and Su Zhi were also there.
It seemed Su Zhi had been comforting the patient's family, while Yang Xu had been waiting for Jiang He.
The family member, the husband who had broken down, shot his head up at the sound of the door opening.
He saw the doctor.
He scrambled over, his lips trembling so violently he couldn't even speak a single word.
Jiang He, bathed in the morning light,
spoke the eight words that were, to the family, the most beautiful in the world:
"The surgery was a success, mother and baby are safe."