Great Doctor Ling Ran Chapter 646


648 Walnut Cake Like Blood Vessels


"Take note of the bleeding." Ling Ran handled the situation very gently. He lightly dabbed at the patient's liver. 

For a patient in his seventies, even if proven healthy from his physical examination, his liver still appeared to be brittle and stiff after he was cut open. The aging of internal organs was similar to the aging of skin as they both changed according to time.

Young people's skin would stay red and supple, and their livers were also pink and supple. But when they were old, no matter how many make-up products and how many pieces of SKII facial treatment masks they had used, their skin could never retain their youth, and this was the same for their livers. 

Ling Ran needed to be very careful to avoid causing secondary damage to the liver. 

Both Xu Wen and Zhang Anmin widened their eyes and observed the exposed liver while they tried to find the possible bleeding point.

"No."

"No."

Two of them answered one after another. 

"Hmm," Ling Ran answered. He did not immediately end the check-up. If anything, he seemed to grow even more diligent.

Medicine has always been complicated when it came to the minute details.

For example, as they were looking for the bleeding point, it did not mean things would end if they could not find it, and it also did not mean that they could just end the examination by looking for it from one or two sites. They needed to check until there were really no bleeding points, and only then could they call it an end. 

But the problem was that the liver was inside the abdominal cavity, and they could not simply flip it around. This was possibly even more stress-inducing than the actual operation. 

"No bleeding. Let us proceed." Ling Ran raised his head and looked at the watch. It had been forty-eight minutes, but what should be done must never be skipped.

Just now, if they did not check for bleeding points or had just done a simple check, they could probably save about two minutes, but they would also need to consider whether the risk was worth it.

From the moment the surgeon stepped on the operating table, he would need to keep making multiple choices. However, the more complicated an operation was, the harder it would be for him to make those choices. That was why there were multiple guidelines, different evidence-based medicine, and different types of tree analysis… 

This actually looked like Go. Every chess move would affect the subsequent development, but it depended on the chess player to see how great the impact was and which step was counted. On the other hand, to solve these difficult calculations, several strategies were invented, like the avalanche joseki and cursed katana. 

Selecting a strategy, arranging the time, and making a basic judgment would basically be enough to make a doctor excellent, but if they were to truly consider everything else, that doctor would remain a true amateur.


To become a doctor who was equivalent to a professional Go player, there were more techniques that he needed to master.

Ling Ran used Perfect Level Barehanded Bleeding Control when it came to judging the bleeding point and predicting where the bleeding was.

Every time when he took up the endotherm knife, his Perfect Level Hemostasis by Heat would play a role. It stopped the bleeding of the liver, while it did not burn the liver. His judgment on the distance alone was enough for the amateurs to call him their master. 

His Master Level Simple Interrupted Suture Technique was ready to be used as a backup at any moment, while during the most important step in hepatectomy, which was predicting the spot for incision, the suture time and strength would inevitably affect the prognosis of this surgery.

At the same time, Master Level Hepatectomy and Perfect Level Lymphadenectomy also provided the basic guarantee for the surgery.

Skills including Regional Abdominal Anatomical Dissection Experience, MRI Scan Analysis, X-ray Scan Analysis, and cardiopulmonary resuscitation were the techniques that increased the safety of the surgery. 

At that moment, even the high-ranking doctors in the visitation room could only see Ling Ran that handled the surgery systematically, but they did not completely understand the difficulty of this surgery.

As usual, Ling Ran performed the surgery according to the established operation. After separating different ligaments, Ling Ran still used different colors of bands to hang the vessels to show the right hepatic arteries on the right front, and another to show the arteries on the back of the right hepatic lobe…

At this time, if there was a miniature human standing at the front of the right lobe of the liver, there would be a piece of soft and crisp floor made of flesh under his feet. If he stepped hard on it, it might bleed. On the top of his head was a network of flesh pipes being hung with colorful bands. They trembled and fluttered, and they might bleed. Above them were huge eyes that passed by… 

The surgery was extremely smooth.

The operating theater and visitation room were filled with peaceful smiles.

Everyone felt that the situation was stable. Only Xu Wen vaguely noticed the difficulties in the surgery, so he silently thought, 'It's really as people say, "The best fighter wins no glorious honor." The surgery today…'

"The blood pressure is increasing." The anesthetist suddenly shouted. His voice was slightly sharp, like the alarm of a machine.

*Beep beep beep beep.*

Right after he spoke, the alarm rang. 

At that moment, a hint of nervousness mixed with some degrees of an expression that said, "Why am I so unlucky?" will be found on the anesthetist's face. 

However, no one looked at the anesthetist.

Everyone focused on Ling Ran.

The chief surgeon was the final decision maker in the surgery.

Ling Ran's mind also stopped instantly.

In the next second, Ling Ran threw away the instrument on his hand and gave clear instructions, "Don't move, everyone stop working."

Right after he finished speaking, a blood fountain appeared in the abdominal cavity.

The blood fountain was not very high, and it slowly rose from the liver like an artesian spring.

Xu Wen and Zhang Anmin broke out in cold sweat.

'Damn it, was there a torn blood vessel?'

In a liver surgery, the scariest part was the rupture of blood vessels. And it will usually occur in liver surgeries, no matter much they hoped for the contrary. 

In a second, Zhang Anmin raised his hands. He made to block the blood vessels.

"Don't move first." Ling Ran's voice was heard again, and he stopped Zhang Anmin's movement.

Chief Surgeon Ling Ran also did not start working immediately.

Therefore, a chief surgeon, two assistants, a scrub nurse, and an anesthetist who just stood up in a tense manner and looked at the patient's injury while he laid in the middle of the operating table. They watched the blood flowing out… 

Ling Ran looked downward without blinking his eyes.

This scenario had never appeared when he was using the Virtual Human.

Ling Ran did not perform a complete surgery on the Virtual Human, and he also did not know there would be a time like this. In other words, even if he used the Virtual Human to perform a complete surgery, since the anesthetist beside him was different, he would probably obtain different results.

Countless thoughts popped up in Ling Ran's mind.

'Why? Why would the blood pressure increase?' This was the first thought that appeared in Ling Ran's mind.

However, Ling Ran did not keep thinking in this direction. There were many reasons for intraoperative hypertension. Pain, hypoxemia, hypercapnia, low body temperature, or excessive blood volume were also a possible factor. However, this time was not a good time to ponder about the reason of increased blood pressure. The key to the problem was the need to control the bleeding in time.

As long as the reason of high blood pressure did not clash with bleeding control, then, the problem of blood pressure could be left for the anesthetist to handle.

Subsequently, more problems appeared in Ling Ran's mind.

'Why would the blood vessel rupture?'

Ling Ran seized onto this question. He stared at the bleeding point below him, thought for a while, and slowly said, "Zhang Anmin, aspiration first, starting from the borders. Don't touch any tissue."

"Phew."

"Phew."

Sighs of relief were heard from both the upper and lower floors at the same time.

The past five to six seconds was pure torture for everyone in the room. Many of them thought that Ling Ran was scared or that he was stunned.

Doctors actually encountered or heard about this kind of situation often. 

Not every surgeon could handle the stress from the rupturing of blood vessels and the flowing of blood.

Ling Ran rarely had such an experience, and the system did not even provide him with similar skills.

However, during the one year he spent in the Emergency Department, the pressure Ling Ran had to face while he had to make swift decisions was never rare. 

While he listened to the familiar aspiration sounds, Ling Ran used his fingers and pointed at the bleeding point. He said, "The blood vessels here are probably brittle and have been eroded by the cancer cells. They're pressed down by other tissues. Now that the pressure is gone, the blood spilled out."

"The blood vessels are… brittle?" Xu Wen could not help but mumble. This concept was slightly shocking for a doctor who worked in the field of hepatobiliary disease.

The doctors in the room only just realized why Ling Ran kept insisting that they did not move just now. 

If the blood vessels were brittle, then when they pressed down on it, the blood vessel pieces would flow into the blood vessels, and it would easily cause thrombus in other body parts.

Ling Ran looked at the surging blood, but he did not immediately block it. Instead, he said steadily, "It's okay for the blood vessels to be brittle. If we suture them nicely, they can still be used. It's just that the difficulty of the suture is higher, so we need to take note of the postoperative medication. Anesthetist, how long do you need to lower the blood pressure?"

"It'll be effective in a second… that… too much bleeding…" The anesthetist was dizzy. 'This patient's body is so bad that it's like soybean curd residue… It's no wonder then why the doctors from other hospitals are not willing to perform the surgery for him.' 

Ling Ran did not know about anesthesia, and he also did not want to give instructions.

"Okay," he said. Then, he looked at the bleeding wound and said, "The first part of the surgery is very smooth, so having slight bleeding occur now does not matter. Alright, it's exposed. Forceps."

The scrub nurse quickly passed the forceps to Ling Ran.

Ling Ran quickly clamped a blood vessel piece that was exposed in the blood.

"Scissors."

"Done." Ling Ran put the cut piece into a small transparent bowl before he threw aside the scissors. He asked for a needle holder before he started to suture the blood vessel on the spot.

As the blood pressure was reduced, the blood flow also slowed down, so the bleeding was stopped very quickly.

"29 ounces." The anesthetist reported a number.

Ling Ran smiled. "More than what I expected, but it's alright." 

"It's all thanks to your decision-making skills during the critical moment, Doctor Ling." Xu Wen sighed in relief, and he took the chance to butter up to Ling Ran.

Zhang Anmin imitated his senior's tone and said, "If someone else operated on him, he will definitely die in this kind of accident."

After she waited for them to finish buttering up to Ling Ran, the scrub nurse asked, "Does this cut tissue need to be sent for examination?"

"No need," Ling Ran said. 

After he finished talking, Feng Zhixiang's voice could be heard from the interphone in the visitation room. "Ling Ran, if the blood vessel piece is useless, can you let us take a look?" 

"Everyone is quite curious. Yes, academically curious." Zhu Tongyi added. 

Ling Ran then nodded and said, "Send someone here to collect it."

After he finished speaking, Ling Ran continued to perform the surgery. 

Everyone in the visitation room looked at the high-resolution screen in front of them, and they felt curious as well as passionate.