Chapter 158: Why Can a Middle-Aged Man Guard the Royal City with Such Short Stature?

"Don't teach my Xiao Ji bad habits." Liu Zhuren scrubbed his hands and returned, just in time to hear the Circulating Nurse chatting with Ji Xiang. While disinfecting his hands and putting on his gown, he said, "Tomorrow I'm taking Xiao Ji out for a Flying Knife; how is that not better than being a Head Nurse?"

"Just you lot, tired like dogs, with the life to earn it but not the life to spend it." The Circulating Nurse didn't even think before retorting to Liu Zhuren's words.

"We in Urology have lofty aspirations; how can Orthopedics compare to us?" Liu Zhuren put on his gown, crossing the ties behind his back with both hands.

"Can't you put it on yourself!"

"I'm used to it. It's been like this since I first learned surgery; if no one ties my gown, I don't know how to perform surgery." Liu Zhuren chatted idly with the Circulating Nurse with a grin.

"How do you in Urology have lofty aspirations?" The Circulating Nurse tied the strings of the sterile gown and took the opportunity to squat down and smooth out the hem of Liu Zhuren's gown, making it flatter and more comfortable.

"The Poet Saint Du Fu said it back in the Tang Dynasty; this is officially stamped and certified."

"What?"

"Middle-aged men are extremely short and small, how can they guard the royal city."

"..."

Ji Xiang finished laying out the drapes, just in time to hear this sentence from Liu Zhuren.

Tsk tsk, what a cultured old rascal.

Liu Zhuren was just spouting nonsense, which didn't affect his focus or concentration in the slightest.

Seeing Ji Xiang finish laying the drapes and stand directly in the assistant's position, Liu Zhuren didn't say much else and stood in the surgeon's position to begin the operation.

The Patient was already under general anesthesia. Liu Zhuren made a 1.5cm incision below the rib margin at the posterior axillary line into the Retroperitoneal Cavity.

After stopping the bleeding at the incision, he extended his finger through the incision to push aside the peritoneum, inserted a balloon, and injected about 800mL of air.

"Speaking of technological progress, it really is fast. When I first learned surgery, it was all total Kidney Resection, just opening up with a big incision. You'd reach your hand in, grab the Renal Pedicle, and clamp it directly; the surgery was simple as hell." After injecting the air, Liu Zhuren placed his hands in the sterile field and began to chat.

There was a wait here, as Ji Xiang knew.

"Look at you lot, how many kidneys have you 'harvested' in your lives." The Circulating Nurse said with disdain, "Aren't you afraid that in your next life, you won't have a single kidney left?"

"It's a matter of curing illnesses and saving lives; how can you call that harvesting kidneys." Liu Zhuren said, "You wouldn't understand the matter of technological progress."

"As if you understand it."

The few of them chatted indifferently, while Ji Xiang carefully observed the differences between the operating room equipment and the System Operating Room.

The difference was huge; the System Operating Room should be the upper limit of the current era, both in hardware and software.

After a 5-minute pause, Liu Zhuren shut his mouth and began the surgery again, switching freely between the two states.

Liu Zhuren expanded the Retroperitoneal space, released the air, withdrew the balloon, and inserted a Trocar at an appropriate position based on the location of the Tumor.

By this point in the surgery, Liu Zhuren gradually became serious.

He was like a martial arts master about to engage in a duel against a lifelong enemy, gradually adjusting his state.

Liu Zhuren used a Number 7 Suture to secure the posterior axillary line Trocar, then inflated CO2 gas to maintain the pressure at 12-14mmHg.

Observing the space under the laparoscope, he dissected the Renal Artery and Renal Vein along the surface of the Psoas Major Muscle outside the perirenal fat capsule. Then, he dissected the Perirenal Fat, getting as close to the Kidney Tumor site as possible.

Up to this point, everything was no different from previous surgeries.

But when Liu Zhuren continued the dissection, he immediately discovered the difference.

The closer he got to the Tumor, the easier it was to dissect the tissue. Because of the Embolization, the Tumor and the tissue within 1cm of it had already developed ischemic necrosis, and after the initial edema period ended, it appeared layered against the surrounding tissue with blood supply.

So that's how it is!

Liu Zhuren confirmed his guess.

Although it was a laparoscopic surgery and he couldn't use his hands to feel the changes in the Kidney tissue, Liu Zhuren had performed similar surgeries for many years and could feel the local changes using long forceps.

He clamped and severed the Renal Pedicle artery to control the blood supply to the renal pedicle.

After the clamping was secure, he injected about 100ml of ice-cold Physiological Saline through the Suction Device to locally lower the temperature to protect the Kidney.

Separating step by step near the Tumor, the tissue around the Tumor was like a thousand-layer cake, and the dissection became simple.

In the past, during this countdown period, the surgery was very tense, for fear that a delay would prevent the surgery from being completed smoothly.

After all, with the Renal Artery clamped and closed, if the Tumor could not be removed during the countdown and the blood supply had to be reopened, it would waste at least 10 minutes just on stopping the bleeding the next time it was closed.

In that case, a simple surgery would be complicated, and the difficulty would rise sharply.

But the Tumor resection after performing Interventional Surgery was completely different; the difficulty of the surgery dropped in a straight line.

Soon, Liu Zhuren experienced another benefit.

During the countdown, he just needed to dissect and cut along the parts that had already become necrotic, because where the embolized tumor artery was, the area without blood supply was where the tumor artery had been supplying blood.

This is amazing!

The more Liu Zhuren did, the happier he became.

"Specimen Bag." Liu Zhuren said in a low voice.

"Liu Zhuren, you've cut it off?" The Anesthesiologist was still announcing the time every minute to remind the surgeon. He hadn't expected it to be this fast!

"Mm." Liu Zhuren nodded very happily.

The Anesthesiologist had just finished the anesthesia record and hadn't had time to look at the screen.

He looked up, scrutinized it carefully, and the Anesthesiologist's mask moved.

"Liu Zhuren, why do I feel like this is different from previous surgeries?" The Anesthesiologist asked in confusion.

"Didn't I say, the Patient had the Tumor's blood supply vessels embolized first, so the Tumor tissue and the surrounding tissue have a certain degree of necrosis." Liu Zhuren put the Tumor and fatty tissue into the Specimen Bag and pulled it out.

"The necrotic tissue and the surrounding normal Kidney tissue are truly clearly layered, clearly layered indeed." Liu Zhuren couldn't help but praise.

"2-0 Absorbable Suture."

"Damn, Liu Zhuren, you really are researching a New Surgical Technique!" The Anesthesiologist said in surprise.

Doctors of Liu Zhuren's age rarely come into contact with new things; their old foundation is thick enough, so why make things difficult for themselves?

Besides, mature technology is also being responsible to the Patient; the vast majority of old directors and professors think this way.

Originally, seeing the description in the Medical Record that the Patient had undergone Interventional Surgery a few days ago, the Anesthesiologist was very surprised; he didn't know what the point of doing that was.

But looking at the surgical process, the significance of doing this was simply too great; the difficulty of the surgery had dropped in a straight line.

The Instrument Nurse handed two 2-0 Absorbable Sutures with needles to Liu Zhuren.

For the figure-eight Suturing, Liu Zhuren cautiously added two more stitches.

Releasing the vascular clamp to restore blood supply to the Renal Pedicle, Liu Zhuren and Ji Xiang observed the wound surface together for any active bleeding.

There was no active bleeding; Hemostatic Gauze was used to cover the wound surface, and a Silicone Drainage Tube was placed around the Kidney.

Before the Circulating Nurse and Instrument Nurse had even finished counting the instruments, the surgery had already ended.

"Done! Let's pack up!" Liu Zhuren said, full of high spirits.

(End of this chapter)