Chapter 287: Synchronized Caution

Ji Xiang dissected the peritoneal reflection of the bladder dome, opened the bladder, and used a small retractor to pull it open, exposing the fistula.

Lu Gang stood behind, staring at the surgical field without blinking.

Liu Zhuren stood on the opposite side, honestly acting as an assistant; Lu Gang found this very hard to understand. Usually, Liu Zhuren was not like this; although he didn't hold the surgery himself and was relatively hands-off, he was definitely not the type of director who was easy to talk to or lacked principles.

Even if he was being hands-off or trusting, it shouldn't be like this; Lu Gang felt conflicted.

After opening the abdomen and seeing the fistula, Ji Xiang asked for a standard Urinary Catheter; Lu Gang's view was restricted, so he turned around to move a footstool and placed it on the ground.

With the added height of the footstool, Lu Gang could just see the surgical field over Ji Xiang's shoulder.

He saw Ji Xiang insert a standard Urinary Catheter from the fistula into the vagina, while Zhao Zhe waited below to guide the Urinary Catheter out of the vagina.

Seeing this, Lu Gang still did not understand what use the ping-pong ball had.

After placing the Urinary Catheter, Ji Xiang punched a hole in the top of the sterilized ping-pong ball and handed it to Zhao Zhe.

Zhao Zhe used a traction thread to firmly tie it to the top of the Urinary Catheter.

After finishing all this, Zhao Zhe looked up at Ji Xiang.

"Brother Zhao, let's begin." Ji Xiang nodded to signal.

"Alright." Zhao Zhe pulled back on the Urinary Catheter and the top traction thread.

Zhao Zhe used his right hand to push the ping-pong ball upward, and the ping-pong ball easily followed the fistula inside.

This is...

Lu Gang was inexplicably confused.

Ji Xiang tightened the traction thread at the top of the ping-pong ball inside the fistula, lifting the anterior wall of the vagina to fully expose the fistula.

The previous surgery failed mainly because the fistula was poorly exposed due to the many folds in the inner wall of the bladder.

This was the same as when Wu Zong used a Zebra Guidewire to find the Ureter orifice in the bladder.

But this time, with the ping-pong ball as support, the force pressed against the soft wall, and the fistula was exposed quite perfectly.

Lu Gang was stunned.

With the surgery only at this stage, he knew it would definitely be completed, and it could definitely be completed.

It would be the same if he were doing it himself; the subsequent surgery had no difficulty at all.

It was just that Lu Gang was a bit dazed; so this is how you use a ping-pong ball for surgery!

Ji Xiang fully exposed the fistula, then trimmed the scar tissue at the edges of the fistula and performed appropriate separation between the bladder and vaginal walls.

"Catgut." Ji Xiang reached out his hand, "2-0."

Tang Yan nimbly threaded the needle, the thin catgut hit the mark in one go, and she immediately placed the Needle Holder into Ji Xiang's palm.

Ji Xiang used the 2-0 catgut to perform a longitudinal Interrupted suture of the full thickness of the vaginal wall, then used a No. 4 silk thread to perform a transverse Interrupted mattress suture on the muscular layer of the bladder wall.

Lu Gang quickly noticed a detail: the suture Ji Xiang used did not penetrate the full thickness.

The suture does not penetrate the full thickness; the needle and thread pass between the seromuscular layer and the mucosal layer, causing the tissue at the wound edges to invert, keeping the outer surface smooth, ensuring good apposition, and reducing adhesions; this is commonly used for anastomoses of the gastrointestinal tract and bladder.

After suturing, the serosal layers are tightly apposed, which is conducive to wound adhesion and healing.

It sounds very simple, but Lu Gang had never seen anyone who could do it as quickly and well as Ji Xiang.

And he knew very well that, not to mention the "flying immortal" ping-pong ball, he could not achieve the perfection Ji Xiang did in the suturing step alone.

Could it be that so many long-established Experts and professors at the Second Affiliated Hospital were not even as good as a Standardized Training Student?

Gradually, a haze of disappointment shrouded Lu Gang's heart.

Finally, Ji Xiang used 3-0 catgut to perform an Interrupted suture of the bladder mucosa, then pulled the traction thread left outside the vagina to remove the ping-pong ball from inside the vagina.

Inserting an adult No. 18 balloon Urinary Catheter through the urethra, Ji Xiang used a Syringe to inject 15ml of Saline into the balloon.

The mucosal layer of the bladder incision was sutured continuously with 2-0 catgut, and the outer layer was sutured with No. 6 silk thread using Interrupted mattress sutures, with the sutures still not penetrating the mucosa.

Ji Xiang's hands were very steady; high-difficulty operations were displayed in his hands like flowing clouds and water, as if there were no difficulty at all.

After the suturing was finished, Ji Xiang injected methylene blue solution into the bladder through the Urinary Catheter.

Lu Gang's eyes were wide open; he knew this step was the only standard to verify the surgery just performed.

If there was no leakage, it would be proof by fact that the suturing was sound.

In the last surgery, after Liu Zhuren finished suturing and injected the methylene blue, there was always seepage; in the end, it really couldn't be sutured anymore, and although the amount of seepage wasn't much, he could only comfort himself and hope it would heal on its own.

Regrettably, the fistula did not heal...

Then what about this time?

Ji Xiang waited for 5 minutes after injecting the methylene blue.

Generally, when a surgery is finished and everyone is waiting for some kind of examination, the atmosphere in the operating room is very relaxed, with everyone chatting and laughing.

But this Patient was a case involving a Medical Dispute, and the surgery was a second or third attempt; it looked like it had been sutured very firmly, but who knew how it would actually turn out.

The atmosphere in the operating room was oppressive, and no one spoke.

Especially Bai Chuzhang, who stood directly behind Zhao Zhe, watching without blinking.

Time ticked away, second by second.

No seepage.

No seepage!

No seepage!!

"Brother Zhao, is it okay?"

"It's okay."

"Prepare to close."

"Wait a moment!" Bai Chuzhang and Liu Zhuren said in unison.

"Hm?" Ji Xiang was confused, "What's wrong?"

"Wait a little longer." The two said in unison once again.

Outside the Jiguan Lou there were still hundreds of Family Members, and both old hands showed extreme caution.

"..." Ji Xiang expressed his helplessness.

The two were overly cautious; presumably, Liu Zhuren was once bitten by a snake and is now afraid of well ropes for ten years, and Bai Chuzhang had to face the hundred or so Family Members downstairs after getting off the stage, so he had to confirm it repeatedly.

After waiting another ten minutes, wiping it once more with clean Gauze, and repeatedly confirming there was no methylene blue seepage, Bai Chuzhang let out a long sigh and turned to leave.

Liu Zhuren looked up at Ji Xiang, "Xiao Ji, well done."

Ji Xiang smiled, placed the balloon Urinary Catheter, and then began to close the abdomen layer by layer.

"Xiao Ji, this method is the first time I've heard of it." Liu Zhuren was relaxed now, saying happily and joyfully, "You don't even know, during the last surgery, I thought of countless ways to push it up, even tried using my fingers and such, and almost got pricked by a needle; I never expected a ping-pong ball would solve such an old problem."

Ji Xiang smiled and said nothing.

Liu Zhuren also knew that at this moment, whatever Ji Xiang said would be wrong, but having witnessed a surgery that solved the problem with a ping-pong ball like a celestial being descending from the sky, he felt a little excited while relieved.

Wu Zong chuckled and walked from behind Liu Zhuren to Lu Gang's side.

"Lu Zhuren, look, I told you the surgery could be pulled off."

Lu Gang was a bit dazed, staring at the surgical field without moving, as if he hadn't even heard Wu Zong's slight sarcasm.

It wasn't until Ji Xiang turned around and almost knocked Lu Gang over that he finally snapped out of it.

"Sorry, Lu Zhuren." Ji Xiang apologized.

Lu Gang's expression was hidden beneath his mask, and he just stood blankly in the corner, like a student being punished to stand.

Ji Xiang's surgery was done cleanly, unlike some Doctors whose surgical fields are a mess, making it impossible for others to even understand.

Clean, simple; others could see at a glance what Ji Xiang was going to do next.

Lu Gang truly hadn't expected a ping-pong ball to have such great utility.

(End of this chapter)