Capítulo 29: 29 - First Open Surgery
Lui Jing retold the incident to technician Wu. It was the first time Li Yun assisted as second assistant in the general surgery department.
A middle aged woman was scheduled for a simple laparoscopic cholecystectomy in the morning. Doctor Chun was in charge of the operation. Doctor Chun was a senior attending due to his seniority, but he mainly did paperwork. Every once in a while, he would take simple cases, such as that particular day.
It was the woman's first surgery, and her history was uncomplicated.
"Can everyone see here?" asked Doctor Chun showing a group of residents the ultrasound screen. "From the ultrasound, you can see that the wall thickness is around 3mm, the size is around 8mm, and the common bile duct diameter is 4mm. This shows that the patient is a perfect candidate for an elective laparoscopic cholecystectomy."
Doctor Chun sounded like he knew what he was saying, but the report was already written by a sonographer.
"Doctor Chun, I recommend an open cholecystectomy," Li Yun suggested.
Doctor Chun stared sharply at Li Yun. Attending surgeons hated to be contradicted by residents.
"Student Li, how did you come up with that conclusion?" asked Doctor Chun. "An open surgery is unnecessary and creates an added risk for the patient."
"There's a high chance that there is a low CVS. If an experienced surgeon was handling the case, it would be fine. But for someone of your caliber, I would recommend an open cholecystectomy," Li Yun said without much reservation.
The comment infuriated Doctor Chun, but he held back.
In over 95% of the cases, it was better to perform laparoscopic cholecystectomy. If there were complications, conversion to open cholecystectomy wasn't too late.
Doctor Chun placed Li Yun as the second assistant, hoping to get an opportunity to scold him.
The operation began with a simple incision. Doctor Chun narrated his actions to the group of residents, and once in a while asked Li Yun random questions.
"If you're wondering what a CVS is, I will explain it as the laparoscope is placed," Doctor Chun had his first assistant move the laparoscope deeper into the small incision. The camera view moved closer to the location of the gallbladder. "Critical view of safety is a method to identify the bile duct and cystic artery and duct."
Once the camera was in place, Doctor Chun moved his trocar.
"This right here is the bile duct. You want to avoid injuring this during surgery."
"Are you sure about that?" Li Yun asked as he raised his brow. Did this guy even know that the patient had a bacteria infection recently, and the topography had changed?
At Li Yun's questioning, Doctor Chun paused. He re-examined the screen. It was different from what he was told. He thought it was a simple operation, but he could barely tell the bile duct and cystic artery apart.
He hesitated.
"The cursed brat!" Doctor Chun thought. He was livid; not knowing how to proceed.
There was a good chance he could damage the bile duct and cause major complications afterward. They could convert it from a laparoscopic cholecystectomy to an open cholecystectomy, but Doctor Chun wasn't too experienced with open cholecystectomy.
Since the early nineties, there had been a major shift from open surgery to laparoscopic surgery. For a doctor who was more interested in hospital politics than surgical skill, he had not done an open surgery in years.
"Dr. Li, since you have suggested this, why don't you give it a try as I supervise?" Doctor Chun requested. He was hoping to pin any errors on him.
Li Yun had used Zuowang on a lot of open cholecystectomy, but he wasn't confident to perform it. If Doctor Gao was supervising, he would at least feel more confident, not the egomaniac Doctor Chun and his resident in the room.
Li Yun took a deep breath. It was better that he performed the operation on the patient. Luckily the nurse had a lot of experience and assisted him throughout the process.
Everyone in the room was surprised. Li Yun was much better than anyone had anticipated.
The event not only pissed Doctor Chun, but the senior radiologist who made the report, Doctor Shang.
"Do you think he intentionally pissed them off?" asked Technician Wu.
Lui Jing thought about it. He didn't know Li Yun too well, but he did have an uncanny ability to read people.
"So you're saying he intentionally pissed them off to perform surgery?" asked Lui Jing.
If Lui Jing attempted to do something like that, he wasn't sure what the outcome would be. Why wasn't Li Yun afraid of getting fired? How was he so sure that Doctor Chun would place him as second assistant?
"You're new, so you may not know about Dr. Chun, but he's known to harass residents during surgery all the time," said Technician Wu. "It's bad practice, but management mostly ignores it since they think it's just part training."
Pimping in medical schools and residency were common. However, there was a line that many attending crossed over. Once the line was crossed, it was considered harassment.
"Oh, wow," Lui Jing was half convinced that it was planned.
"Not only that, Dr. Shang also started recommending Li Yun as assistant in interventional surgery. It surprised everyone that Li Yun agreed. Not a lot of doctors want to be constantly exposed to radiation. Afterward, Dr. Mu from vascular surgery also requested Li Yun's assistance."
"Gee," Lui Jing was halfway into joining Li Yun's fanclub.
During the next few weeks, Li Yun was able to perform more surgery. Although he was not the main surgeon, he had enough involvement to gain experiences and action points.
Li Yun already knew enough to perform cholecystectomy and appendectomy in his sleep, but to actually perform it on a person felt different. Performing in person made him recognize that every living person was unique. It was these crucial points that separate great surgeons from an average surgeon.
For every general surgery Li Yun had performed, he had performed twice as many interventional surgeries. Interventional surgery was more common as it was less invasive, but most doctors would reconsider due to the risks. Li Yun would be lying if he said he wasn't concerned about radiation exposure.
Orthopedic surgeons and surgeons who regularly worked with radiation have higher risks of cancer. Albeit, if they followed proper protocol, the risks would be minimized. Some people couldn't think in the long term, and only wanted to get things done fast and easily. They didn't think about the long term consequences.
Following protocols were also important for the patient's recovery. When Li Yun watched the surgeries, he could easily see so many errors. It didn't matter that he pissed off the surgeons, he would rather see an operation that benefited the patients.
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