CHAPTER 72: 072 HAVING A BLAST MAKING MONEY

After a brief rest, Liu Banxia and Shi Lei freshened up by washing their faces. This was especially true for Liu Banxia, who had performed four appendectomies that morning. Even though he worked quickly, the exertion was immense.

He felt that if he hadn’t focused on building his endurance, he would have probably needed a glucose drip to replenish his energy after finishing all the surgeries.

"You two have certainly benefited greatly this time. Doctor Liu, don’t forget our agreement," Xu Chengjun said with a smile.

"Chief Director Xu, rest assured. As long as I have time, this is a small matter. It’s Dr. Shi’s skills that are really remarkable. He’s almost like a first assistant handpicked by our Director Zhou," Liu Banxia replied.

"I would like to invite Dr. Shi more often, but he’s too busy. And usually, we do not have many major surgeries here. Most patients are referred directly to Binhai City," Xu Chengjun said with a wry smile.

His words confirmed Shi Lei’s earlier assessment; it seemed their main interest truly was the small-incision appendectomy.

However, Liu Banxia didn’t mind. He felt a sense of gratitude towards Xu Chengjun. After all, Xu Chengjun let him practice and kept increasing his pay; it was a good deal.

As they scrubbed in for the surgery, it seemed there were even more doctors observing this time. Cholecystectomy, or gallbladder removal, is also a common general surgery procedure, and its incidence has been particularly high in recent years.

This time, Liu Banxia was unequivocally the first assistant. Xu Chengjun, on the other hand, wished Liu Banxia would quickly move on to the anal fistula surgery, which would free up another spot in the OR.

The incision chosen was a 7-centimeter subcostal incision under the right rib margin. After incising the skin, an electrosurgical knife was used to sequentially dissect the subcutaneous tissue and the anterior rectus sheath. The rectus abdominis muscle was bluntly separated, and then the posterior rectus sheath and parietal peritoneum were incised to enter the abdominal cavity.

The hallmark of Shi Lei’s surgical technique was its stability. Liu Banxia had assisted him many times, and watching him operate always instilled confidence. It was a feeling as if the outcome was already known from the start.

Cholecystectomy is also a routine surgery; it was just that Liu Banxia hadn’t personally experienced many cases. Not everyone comes through the emergency department; many patients go to the outpatient clinic.

"Exploration," Shi Lei commanded.

"No obvious ascites or exudate in the abdominal cavity. The gallbladder shows widespread adhesions to surrounding tissues, with a purulent coating and high surface tension visible on its surface," Liu Banxia quickly reported.

"Precautions?" Shi Lei prompted, his hands never ceasing their work.

"During the operation, accurate identification of the cystic duct, common bile duct, common hepatic duct, and cystic artery is crucial to prevent accidental injury. The cystic duct stump should not be left too long, to avoid the formation of a residual gallbladder stump syndrome, which can lead to bile stasis, infection, and become a recurrent source of problems," Liu Banxia recited while assisting.

"However, it also cannot be too short, as that could cause stenosis of the common bile duct. Depending on the patient’s condition, a length of 0.3 to 0.5 centimeters from the common bile duct should be chosen."

"Hmm... This patient’s gallbladder is tightly adhered to the gallbladder bed. Forcible dissection would damage the liver. I propose we incise the gallbladder, remove the contents, and then strip out the mucosal layer, proceeding up to the cystic duct," Shi Lei stated.

The two of them had a practiced synergy, a familiar routine. However, to onlookers like Xu Chengjun and the others, it appeared entirely different.

They also spoke during their own surgeries, but it often affected their focus to some degree. But these two? There was no impact on their performance whatsoever. Moreover, with Liu Banxia assisting, Shi Lei’s surgical pace seemed significantly faster than usual.

This clearly indicated that the previous first assistants assigned to Shi Lei lacked both skill and synergy with him.

In fact, they had all felt this way during the second appendectomy earlier that morning. That particular operation had been the quickest of the four performed that morning.

This was the difference in skill. The same operation, employing the same surgical techniques, yet the disparity was so stark. True skill is revealed in the subtleties; the slightest advantage in each step, when accumulated, can make a world of difference, even before the entire surgery is complete.

Shi Lei clamped and divided the cystic duct, then placed the removed gallbladder onto the tray and glanced at Liu Banxia. Liu Banxia understood instantly; the subsequent steps were his responsibility. He first double-ligated the cystic duct stump with silk thread. After ensuring complete hemostasis of the gallbladder bed, he oversewed it with interrupted sutures.

After irrigating the abdominal cavity with saline solution, Liu Banxia carefully inspected the area again, confirming there was no active bleeding. He then inserted a drainage tube into the abdominal cavity, positioning it superior to the foramen of Winslow (also known as the epiploic foramen) for drainage.

Many open abdominal surgeries actually require the placement of a drainage tube. Fortunately, the four appendectomies this morning were relatively straightforward. Although the appendices were inflamed, there was no significant exudate, so drainage tubes were unnecessary; the abdominal cavities were clean.

After the count of surgical instruments and supplies was confirmed correct, it was time for Liu Banxia’s signature task: abdominal closure.

Although the observers had already witnessed Liu Banxia’s ’flying needle’ suturing technique, watching him work was still a captivating sight.

BING! Cholecystectomy completed. Received 300 Experience Points, 300 Cholecystectomy Skill Proficiency Points, 100 Diagnostics Skill Proficiency Points, and 150 Suturing Skill Proficiency Points.

Congratulations to the Host for advancing to Level 21 (25,545/27,621 EXP). Received 1 Attribute Point and 5 Glory Points.

"Impressive, truly impressive. Despite the severe adhesions, the entire surgery only took 47 minutes. That’s simply remarkable," Xu Chengjun exclaimed.

"Chief Director Xu, you’re too kind. It’s mainly because we’ve handled so many similar cases at Second Hospital. Our patient volume is larger than yours here, so we’ve naturally become more proficient through practice," Shi Lei replied.

"Actually, if the opportunity arises, you could consider sending some of your general surgeons who need more experience to our Second Hospital for training. This kid here," Shi Lei gestured towards Liu Banxia, "used to be quite a handful. Once he finally got his act together, his potential was truly unlocked."

"Hehe, Dr. Shi, I’ll take that as a compliment," Liu Banxia replied, chuckling.

Today’s efforts were definitely not in vain; the rewards were substantial. Even if he only acted as first assistant for the upcoming anal fistula surgery, today was already incredibly fulfilling.

This time, he could finally pay off his entire loan at once! No more monthly worries about repayments or how to budget the remaining cash. From now on, when he bought savory Chinese crepes, he could afford to add four eggs at once!

Anal fistula seton ligation surgery; this was Shi Lei’s specialty. Even though he had been in general surgery for many years, his skills in this area hadn’t dulled in the slightest.

This time, Liu Banxia’s gains were slightly less: only 150 Experience Points and 180 Anal Fistula Seton Ligation Skill Proficiency Points.

He had already reached Level 2 proficiency in this procedure. If it had been a complex anal fistula, he might have been able to grind out more experience points.

They declined Chief Director Xu’s dinner invitation and also his offer to drive them directly back to Binhai City. Taking the high-speed rail was faster and more comfortable.

After performing so many surgeries in a row, both of them needed a good rest once they returned. But Liu Banxia’s mind was elsewhere. He kept pulling out his phone to check the extra 16,000 yuan that had appeared in his account. Who could possibly be in the mood to rest?