CHAPTER 159: 159 COMBINED SURGERY

Whether it was a femoral artery thrombectomy or an endarterectomy, both were considered highly dangerous major surgeries. After all, it involved operating directly on blood vessels, especially a major artery like the femoral artery.

There were also two viable methods in thrombectomy: one was direct extraction by incision, and the other involved using a balloon catheter to remove the thrombus. Like an appendectomy, there was conventional open surgery and minimally invasive procedures like laparoscopy.

You couldn’t simply say which surgery had a better effect, because it involved evaluation of many aspects, such as the patient’s physical condition, surgical costs, and subsequent necessary procedures.

Grandpa Cao also had diabetic foot. The balloon thrombectomy needed to be performed in the DSA operating room, and he also required an endarterectomy.

Plaques had already been found on the blood vessel walls. If left untreated, they might detach and become new emboli in the future. Moreover, addressing the diabetic foot as well would make things quite troublesome.

So, after consultation and seeking the opinion of the patient’s family, there was no need for other departments to intervene in this surgery; it was directly handled by two general surgeons from the Emergency Department.

This procedure, being a major and combined operation, also held certain teaching significance. Therefore, the operating room allocated was a teaching operating room. The two chief surgeons were Shi Lei and Liu Banxia, with Liang Xiaolin and the observing Qing Kewa as assistants.

"Boss, I don’t really have much to do, so why am I so nervous?" Liu Banxia said while scrubbing in.

"What the hell are you nervous about? Have you reviewed the relevant surgical knowledge?" Shi Lei asked.

"I did review, but this is my first time witnessing such a surgery. It would be perfect if you could explain some key technical points, Boss," Liu Banxia said.

"As if I have nothing better to do. Just watch," Shi Lei shot him a glare.

He knew this guy was just talking nonsense. It would be a miracle if he hadn’t prepared for such a major surgery. Quietly, who knew how much surgical knowledge he’d actually mastered? It wouldn’t be surprising if he surpassed him in a few years.

"Dr. Liu, my life is in your hands," Grandpa Cao said upon entering the operating room, before Liu Banxia could speak.

"Don’t worry, Grandpa Cao. I’ve even brought my senior brother in. Your current vitals are quite good. Just take a short nap, and then it’ll be time for recovery," Liu Banxia said with a smile.

"But one thing: no more of those health supplements. If you’re really bored, go chat at Uncle Jiang’s shop."

"I won’t, I won’t touch them anymore. I’m scared of dying; I want to live a few more years," Grandpa Cao said.

"Alright, leave it to us. You just focus on sleeping. Don’t forget, you’re treating us to hotpot after you’re discharged," Liu Banxia said.

"Absolutely, I must treat you," Grandpa Cao said.

The preoperative communication was quite harmonious, which had become Liu Banxia’s habit. Even though this was a procedure under general anesthesia, he didn’t want the patient to be overly nervous.

"Who will be first assistant?" Shi Lei asked after Grandpa Cao was under general anesthesia.

"Doctor Liang, you’re up," Liu Banxia waved his hand.

"Oh, me?" Liang Xiaolin said curiously.

"It’s somewhat in your line of work anyway. When you officially return to Cardiothoracic Surgery, you’ll be dealing with these vessels a lot," Liu Banxia said casually.

In his view, this was very normal. However, it was a different story for the onlookers in the observation gallery. How much was he indulging her? To let Liang Xiaolin be first assistant in such a major operation?

Many people knew Liu Banxia well. He’d never encountered surgery at this level before. Being first assistant would have been an incredibly rare learning opportunity for him.

But what happened? He’d given the opportunity directly to Liang Xiaolin. Even Qing Kewa, who had only been learning from him for a day, was allowed to observe on site.

They were envious, but there was nothing they could do.

Hadn’t Liu Banxia just said it? Shi Lei was his senior brother. The operating room wasn’t a place one could just wander into. With an understanding between senior and junior brothers, it was a simple matter.

"I’ll do the main procedure; you handle the suturing. That should save some time," Shi Lei said.

Liu Banxia nodded and led Qing Kewa to the edge of the operating table.

It would be a lie to say he wasn’t itching to do this surgery himself. He was only this generous because of the intensive training he could get in the Dream Space.

Shi Lei began to operate.

The most fundamental step was still exposure. For a thrombectomy, exposing the blood vessel was paramount. Otherwise, why would that casual remark from Zhang Yun have struck such a chord with Liu Banxia?

The fundamentals of surgery are truly crucial, just like driving a car. You must first know how to drive before you can attempt advanced maneuvers like drifting.

If you can’t even drive, trying to show off will only lead to flipping the car or stalling the engine.

This was surgery, where the slightest misstep could endanger the patient’s life. If a major problem occurred, the consequences would be dire.

Shi Lei’s movements weren’t particularly fast, but they were absolutely precise and efficient, not a single wasted motion, not one unnecessary cut. This was a testament to his skill and accumulated experience.

Liu Banxia could also perform what he was doing now. However, Liu Banxia had acquired his proficiency through intensive training in the Dream Space, whereas Shi Lei had mastered it through years of real-world practice.

"Why did you place the tourniquet just now?" Shi Lei asked.

"Doctor Liang, please answer," Liu Banxia prompted.

"It was to control blood flow and prevent the thrombus from migrating distally," Liang Xiaolin hastily explained.

Shi Lei nodded, made a longitudinal incision distal to the embolism, and then loosened the tourniquet. Under the pressure of the blood flow, a segment of the thrombus emerged from the incision.

Shi Lei’s expression remained serious. He picked up the forceps, clamped the thrombus, and carefully extracted the 9.5-centimeter-long segment. After observing unobstructed distal blood flow, he reapplied the tourniquet.

This indicated complete removal of the thrombus with no residual fragments.

However, his work wasn’t over yet; there was still the endarterectomy to perform, a procedure significantly more challenging than the thrombectomy. It required extreme precision.

Shi Lei introduced the endarterectomy dissector and meticulously began to separate the plaque.

As Shi Lei removed the plaque fragments one by one, Liu Banxia mentally noted the amount of force Shi Lei applied during each step.

"Six fragments in total. Considering the patient’s age, we’ll use a patch for the arteriotomy closure to prevent postoperative stenosis," Shi Lei said after the dissection was complete.

"You guys need to speed up. The patient’s vital signs are showing a downward trend," the anesthesiologist, Wang Lei, reminded them.

It was a simple statement, yet it cast a pall over the operating room.

This was an unexpected development. Normally, the patient should have been able to tolerate the entire operation. This decline was likely due to the stress of the surgery on the patient’s cardiopulmonary function.

"Banxia, your suturing needs to be quick," Shi Lei said as he sutured the blood vessel.

Liu Banxia nodded. "Don’t worry, I’ll be as fast as I can. My only concern is whether there’ll be enough time to debride the foot wound."

"Let’s finish suturing the vessel and restore blood flow. Then we’ll assess the patient’s condition. We can’t force it," Shi Lei said.

Once the suturing was complete, Shi Lei removed the tourniquet and carefully inspected the anastomotic site. Seeing no signs of leakage, he finally breathed a sigh of relief.

"The patient’s vital signs are currently stable," Wang Lei reported.

"Alright."

Liu Banxia picked up a needle and thread.

For the current Liu Banxia, this was indeed routine. He could have even sutured the femoral artery earlier without issue, as it was quite a large vessel.

During the previous small-incision appendectomy, people had only seen his small incision, not his suturing. This time, many first-time observers were truly stunned.

Today, Liu Banxia was going all out, racing against time. Grandpa Cao’s foot ulcer had to be debrided. Any further delay risked infection spreading to the periosteum, leading to periostitis.

"Current surgical time: 53 minutes," Wang Lei announced after Liu Banxia tied off and cut the thread.

"Brother Wang, can he hold on for about another forty minutes?" Liu Banxia asked.

Wang Lei thought for a moment, then nodded. "The faster, the better. Preferably within thirty minutes."

Liu Banxia wasted no more time and immediately began debriding the ulcer on Grandpa Cao’s foot.

Many of the observers started to worry. Had Liu Banxia been too ambitious? Could such a wound be debrided in thirty minutes?

Grandpa Cao was quite fortunate. The initial lesion had ulcerated due to whatever he had stuck on his foot. It was fortunate it had been discovered in time. Otherwise, a few more days, and not just his foot but his very life might have been lost.

When it came to debridement, having faced necrotizing fasciitis and severe burns, Liu Banxia’s skills were now considerable. His estimate of forty minutes had been conservative.

He hadn’t known the extent of contamination in the sinus tract or how much tissue beneath the foot was involved.

To onlookers, Liu Banxia’s movements during debridement seemed large. But the results told a different story.

His movements only appeared large; it was an illusion created by his speed. The difficulty of debriding this ulcer was far less than dealing with necrotizing fasciitis or burns. Besides, Grandpa Cao’s actual condition wasn’t as dire as it had initially appeared.

Debriding all three ulcers took 25 minutes. One of the ulcers involved an infected tendon, and Liu Banxia excised that portion of the tendon.

This would undoubtedly have some impact on Grandpa Cao’s future mobility, but his life had been saved.

DING!

Daily Task Completed (20/20)

Acquired: 300 Experience Points, 5 Glory Points.

Congratulations! Host level increased to Level 32 (53,087/55,902). Acquired: 1 Attribute Point, 5 Glory Points.

Combined Surgery Task completed.

Acquired: 200 Experience Points, Suturing Skill Proficiency +100, Dressing Change Skill Proficiency +100, Diagnostic Skill Proficiency +100.

Surgery Rating: Perfect. Acquired: 500 Experience Points, Suturing Skill Proficiency +500, Dressing Change Skill Proficiency +500.

Looking at the system rewards, Liu Banxia was a bit stunned. Why so little? Was it because he had only performed basic tasks?