Great Doctor Ling Ran Chapter 223
223 Alternate Vascular Channel
The operating theater slowly became calm again.
Ling Ran felt very excited, yet he still looked calm while he pulled the blood vessels together and sutured them. In his mind, he imagined the structure of the vascular network while he built it with his hands.
He felt as if he was building a city all by himself.
There was no standard guide that showed how the vascular network surrounding the Achilles tendon should look like, as there were not many modern medical types of research on it. This was unlike what people imagined, that modern medicine had come to a full understanding of the human body. When it came to the community in the field of clinical medicine, most of the information obtained by surgeons was jumbled-up.
For instance, were there three or four perforating arteries in the posterior tibial artery showed in the MRI scan? Dissection showed that some people had three perforating arteries while some had four. Why would this happen? What was the rule behind this? It was not clear. Where was their exact location and was there any regular pattern to the number? The answer was not clear. Did the arteries have any other function, and what was the relationship between the arteries and human tissue in the feet as well as legs? The answer was not clear either.
If Academician Zhu Tongyi's plan was successful, a research article would be written about it, and through this method, they could use clinical medicine to give a description of the vascular network surrounding the Achilles tendon and explain its importance.
If it failed, there would not be a need to talk about it.
Ji Tianlu who participated in designing the plan was very worried. He linked the blood vessels together before he passed them to Ling Ran. When he saw Ling Ran connecting the broken vessels step by step, he could not help but smile.
The plan required the vascular network to be maintained at a particular standard, but at the same time, the surgeon had to aim to shorten surgery time. This required the chief surgeon to operate at high speed, but also be highly accurate.
Before this, Ji Tianlu went out of his way to look around for surgeons. Those who could meet their requirements were practically all very famous, but it was not a surprise, because their surgery, which required a fast working pace, sharp judgment, and high accuracy, could not be performed by the surgeons from the local hospitals who claimed themselves to be the best. The plan needed the best doctors from the top hospitals.
In the current era, a young doctor would start climbing up their skill tree since their early twenties, but they would only have the courage to claim themselves as brilliant when they were in their forties, and only then would they have a specialty and could be the chief surgeons in more important surgeries.
Among the doctors who were around forty years old, those who worked at a fast pace, had sharp judgment, and high accuracy, were normally quite famous.
It was quite similar in hospitals overseas. In fact, their doctors were even better than the local doctors. Their hospital ecosystem was totally market-oriented. No one would force a doctor to learn basic skills or pursue advanced studies. The excellent doctors who were famous usually practiced their skills on their own after they went back home from the pub, or were talented genii.
Ji Tianlu was able to meet talented surgeons in internationally well-known hospitals using the opportunity provided by international meetings. However, when he faced successful surgeons, Academician Zhu Tongyi's plan was not able to draw their attention.
International-level surgeons or surgeons specializing in the field of sports medicine performed surgeries everywhere around the world throughout the year. They did not have any psychological problems if they had to come to China, but due to their packed schedules doctors and the amount of money they usually earned, they were not really interested in participating in guided surgery.
They would not come even if they were paid.
In fact, even with Liu Weichen paying for a normally scheduled surgery, he might be scheduled to receive surgery a few weeks later, and he did not want that. His high requirements were something that the high-ranked surgeons simply could not accept.
This was similar to when Wang Haiyang worked as a freelance surgeon in Yiyuan County Hospital, the first thing he asked was the patient's wishes. If the patient had an unusual demand, such as complete recovery of the finger after the finger replantation surgery, Wang Haiyang would probably walk away without a single word.
The surgeon did not even need to think about the limitations of the current medical world, he only needed to care if he could fulfill the patient's demands. If he could not fulfill those demands and forced himself to perform the surgery, the surgery itself would be meaningless.
Initially, Ji Tianlu was ready to persuade Academician Zhu Tongyi to amend the plan.
They also prepared plans B and C, but the value of plan A was still the highest.
Ji Tianlu stared at Ling Ran's operation, and he suddenly felt a little envious. Although medical research was the most important part in the development of medicine, in reality, regardless of whether it was the results of medical research or the discoveries in clinical medicine, all of this was nothing if the implementer could not bring the results and discoveries to fruition.
An extremely skilled surgeon was always much more blessed compared to a normal medical researcher.
"If this part is connected, a vascular channel will be completed." Ling Ran's voice interrupted Ji Tianlu's thoughts.
"You're done?" Ji Tianlu was slightly surprised.
"This first among the two vascular channels. I just need to suture another part" Ling Ran still stuck very closely to the microscope, and he looked at it while he operated on Liu Weichen. He asked for a pair of forceps in a monotonous voice before he clamped down on the sutured blood vessels in a stable but gentle grip.
The blood vessels in a human's body were extremely fragile. The only blood vessels that could be played around at a surgeon's will were probably the arteries that were near to the heart. In a cow, that would be the part used to make beef aorta.
However, practicing vascular clamping always posed as a problem in hand and foot surgery.
The first requirement was to clamp down on the blood vessel with a stable hand because it was a must to not damage the blood vessels.The surgeon needed to judge the strength needed to clamp the blood vessels when they faced blood vessels that were of different lengths in different people, and they could only rely on their gut feelings, just like what Ling Ran did earlier.
A part of this gut feeling was from experience, while the other part was from theoretical knowledge. For example, blood vessels appeared all the same under the naked eye, but if someone had arteriosclerosis, it was clear that greater strength will be needed to clamp down on his blood vessels. In fact, the surgeon would even need to put forth a lot of strength to clamp down on the blood vessel. Otherwise, the needle might not be able to penetrate the blood vessel.
In conclusion, when a normal doctor performed surgery, he had to be very careful, and he had to try multiple times. Only doctors who were of a certain skill level would dare to operate on the blood vessel right when they grabbed it.
Their great skill might be backed by the accumulation of experiences gained from hundreds or even thousands of surgeries.
Ling Ran repeated the previous operation and carefully sutured two small blood vessels together.
After he finished this step, Ling Ran set aside the instrument and stood up.
"Huh?" Ji Tianlu was stunned.
"I'm resting for a while. Please check on the vascular channel first," Ling Ran casually said.
Ji Tianlu had not worked as the first assistant for quite some time, and he was baffled by how naturally Ling Ran acted when he ordered people around. When he looked down to check on the blood vessels, he suddenly came up with a thought. 'Don't I need to rest as well?'
Ling Ran removed his scrub and gloves while he massaged his neck. Then, he turned around and went out to wash his hands again.
Surgery gloves were not durable goods, and there would usually be some changes in the physical properties of the gloves after a surgeon performed surgery with them on for more than three hours. In layman terms, it would not stick tightly to the hands, and it would run the risks of being damaged. Research showed that when heart surgeries were performed up to the third hour, the perforation rate of the gloves was at 30%. And when heart surgeries were performed up to the fifth hour, the perforation rate of the gloves went up to 65%.
Besides, the number of bacteria on the surgeon's hands would also increase nonstop as time went on.
Therefore, some hospitals suggested surgeons and their assistants to change their gloves after four hours of surgery. In the world of academia, some even suggested a change of gloves after one and a half hours.
Ling Ran did not pay attention to this kind of information in the past. In other words, he did not know about this at all. It was only because he had more free time recently that he had time to read more research papers. It was only then that he noticed this information.
When he thought about the total length for today's surgery, Ling Ran decided to change his gloves now. He could also take the time to rest a little.
Although it felt good to suture the blood vessels, he did indeed use up a lot of his stamina and concentration.
Ji Tianlu checked every blood vessel carefully.
First assistants were meant to check and cover up the holes left behind by the chief surgeon. In other words, a first assistant who was qualified to check and cover up the holes left by the chief surgeon was a first assistant that was highly valued, so Ji Tianlu should feel happy.
But Ji Tianlu was not happy at all. However, he did feel a degree of admiration towards Ling Ran.
It was already very tiring to check the blood vessels, how tiring would it be to suture the vessels?
He worked on joints in the past. He actually did not have much experience in suturing blood vessels. As he checked the blood vessels, he slowly realized the complexity of the surgery.
The vascular channel built by Ling Ran was not a simple loop. Instead, he built the vascular channel after he considered the probability of not suturing some blood vessels perfectly. Although the probability for that was very low, if there was only one loop and a complication happened in one of the breakpoints among the many breakpoints formed by the sutures, the entire vascular channel formed would be meaningless. This just meant that the difficulty of the surgery had just been increased to that of a finger replantation surgery.
Ling Ran, who had performed many finger replantations, knew the limitations of a vascular channel clearly. Therefore, the vascular channel he built was more like an interchange system. It was useless to merely build backup blood vessels because it could be damaging at the systemic level. For example, any falls, crashes, or sprains during the recovery period would cause damage to the backup system.
Therefore, a crisscrossing and interchangeable vascular channel was the main point in Ling Ran's design.
This made the suture become more difficult, but it also provided a safety net that the plan did not offer.
When Ling Ran came back, Ji Tianlu's neck ached from the check. He said, "There's no problem on the suture of the blood vessels. I think the safety level of this vascular channel is quite sufficient."
What he meant was that they did not have to do the alternate vascular channel.
Ling Ran neither agreed nor disagreed. He put on his scrubs again and changed into a pair of new gloves before he said, "Let go the clamp and let me take a look."
Both of them sat back in front of the microscope. Ling Ran slowly released the clamp that held the posterior tibial artery.
Blood flowed through smoothly. No blood oozed out from the blood vessels.
"Is there no problem?" Lu Wenbin was quite nervous.
A mission prompt appeared in front of Ling Ran:
[Rise into Prominence: 75% completion rate.]
A completion rate of 75% meant that Liu Weichen's Achilles tendon functionality could recover to around 75%. As an invasive surgery, this recovery ratio was considered quite good. Moreover, the recovery rate could be even higher if postoperative rehabilitation and training were carried out properly.
However, an Achilles tendon that recovered by 75% would not be enough for Liu Weichen to participate in world-class competitions.
It could only be said that while the current surgery was not bad, Ling Ran had not performed a miracle yet.
"Let's build another alternate vascular channel." Ling Ran no longer hesitated.