Chapter 2394: 2312 Can't Be Done

Jinling to Feng County is not far, not near—several hundred kilometers; even if it's an early morning drive with no traffic, Director Xia arrived at Zhongxin Yiyuan Hospital just before noon.

Director Xia ate a quick burger in the car, and upon arrival, surrounded by the patient's family, he glanced at the patient's scans and the patient himself.

As expected, the patient was already in late-stage cancer, the disease had penetrated deep.

He again explained the condition to the family: the risk of surgical failure was high, and even if successful, it could only prolong life by about one year.

This is the key point—if the family harbors hope of a cure, Director Xia would turn and leave without a word.

The family stated their attitude: they only wanted the elderly father to receive the highest level of medical care within their means; after that, life and death are fate, and they understood this.

In that case, let's proceed with the surgery.

Li Zhu ren listened, his mouth twitching; he thought, the best medical care is right before you, yet you don't cherish it.

But this already has nothing to do with him—Zheng Lao Ban's several TIPS surgeries are already done; he should be eating now, then take the high-speed train and plane back to Di Du.

Brushing past Zheng Lao Ban is truly regrettable, whether for the patient or himself, this is fate.

Sending the patient onto the operating table, Li Zhu ren accompanied Director Xia of Jinling Tumor Hospital, chatting as they went up.

Upon learning that Director Xia planned to perform this surgery laparoscopically, Li Zhu ren was shocked.

No wonder they dared to take on this surgery—this Director Xia truly has real skill.

Anesthesia, scrubbing, donning gowns and going up.

Establishing pneumoperitoneum, but after Director Xia fiddled with the laparoscopic forceps a couple of times, he just stood there frozen.

Li Zhu ren saw clearly: the intra-abdominal adhesions were severe, fundamentally unsuitable for laparoscopic surgery.

There was no operating field—what laparoscopy! (Note)

Then let's convert to open laparotomy—can't just abandon surgery because laparoscopy won't work.

Director Xia felt no embarrassment; the situation lay before him, forcing a tough approach would only bring trouble upon himself.

He made a midline abdominal incision about 20 cm long, cutting layer by layer into the abdomen.

Re-examining the liver surface, small intestine, and pelvic cavity revealed no metastatic nodules; the gallbladder measured about 8×3 cm, the common bile duct diameter about 0.6 cm, and he performed retrograde cholecystectomy.

The surgery proceeded routinely; laparoscopy showed nothing, but the open procedure proved Director Xia's skill was quite high.

Li Zhu ren's inner unease eased slightly.

Director Xia opened the gastrocolic ligament along the colonic margin, opened the lateral peritoneum of the duodenum, lifted the duodenum for a combined examination. Exploration found a tumor at the pancreatic uncinate process, diameter 4 cm, hard texture, indistinct borders, moderate mobility.

As the surgery progressed, Director Xia's face grew increasingly solemn.

Looking at the scans is one thing; truly opening up and seeing is another.

The current surgery's difficulty absolutely exceeds anything he's done before; the patient's intra-abdominal adhesions are heavy, making smooth removal extremely difficult.

Having reached this point, Director Xia strove not to think about the possibility of surgical failure.

Continuing to dissect the pancreatic head and the posterior duodenum, he explored the inferior vena cava—unaffected. He explored the root of the transverse colon mesentery—no shrinkage or invasion.

But when dissecting the superior mesenteric vein, Director Xia was stunned.

He opened the retroperitoneum at the root of the transverse colon mesentery, followed the direction of the superior mesenteric vein to locate the vessel.

Then he skillfully separated the tributary veins draining into the superior mesenteric vein, clamped and suspended them, and proceeded upward along that vessel to dissect the main trunk of the superior mesenteric vein.

The naked eye could see the tumor closely related to the superior mesenteric vein, and the bifurcation downstream of the superior mesenteric vein where it converges was involved.

All……involved……

Gazing at the tumor mass adhered to the superior mesenteric vein, Director Xia drew a deep breath, then prepared to begin dissection.

Of course, he knew in his heart that such adhesions would be extremely difficult to dissect cleanly; at this moment he began to regret—why had he been possessed last night, rushing over to change knives and take on this surgery?

Damn it!

Director Xia cautiously probed the dissection; subconsciously he realized he'd made a wrong choice. His body secreted large amounts of adrenaline and dopamine, the parasympathetic nervous system was suppressed, the sympathetic nervous system excited, directly entering a stress state.

Sweat glands poured out sweat; the sterile cap was soaked through within 2′22″.

Director Xia turned his head, but this wasn't his own hospital—there was no tacit understanding. No one grasped the intent behind each of his movements; he felt his action was foolish.

"Wipe sweat." Director Xia said helplessly in a low voice.

The circulating nurse took a piece of gauze, wiped his sweat, then softly asked, "Director Xia, shall I tie a gauze strip for you?"

"Okay." Director Xia used this opportunity to ease his already tense sympathetic nerves.

He recalled the tumor and superior mesenteric vein stuck together in the operative area, feeling helpless.

Truly possessed—why did I rush to drag Zheng Lao Ban into this? The result? Zheng Lao Ban escaped unscathed, while I'm the one being roasted over the fire.

Damn it!

Director Xia has a good temper, rarely swears. But the complex situation made him irritable—perhaps the parasympathetic nervous system's dormancy and sympathetic excitation's side effect.

A gauze strip was tied over the sterile cap on his head; Director Xia focused and continued the surgery.

Hope to get it done,

Hope the adhesion between tumor and superior mesenteric vein isn't as tight as it appears.

Hope…

Director Xia's heart holds too many hopes.

However, after 3′12″, all hopes were shattered.

The tumor clung tightly to the superior mesenteric vein; surgery could not proceed.

"Do you have a vascular surgery department?" Director Xia asked in a low voice.

"Um…" Li Zhu ren hesitated; he felt a strange pleasure that shouldn't have arisen.

But he suppressed that emotion; the patient can't leave the table, and he must also bear the blame. Although this blame was self‑inflicted by the family, avoiding it is still better.

"Director Xia, we do have a vascular surgery department, but its technical level is average." Li Zhu ren spoke frankly.

Director Xia halted the surgery, helplessly gazing at the operative field. Organs and bloodstains under the shadowless lamp were glaring; his hands and feet felt numb, and he pondered how to explain to the family.

The operating room was deathly silent; Li Zhu ren glanced sideways at the electronic timer, he waited three minutes, seeing Director Xia still silent, he quietly suggested, "Director Xia, Zheng Lao Ban from Di Du hasn't left yet—do you want to…?"

……

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Note 1: This Shou Bing is taken from a real Shou Bing at a top-tier tertiary Hospital in the country, laparoscopic conversion to open. Not all preoperative assessments can correctly determine the Shou Bing method; this point is mentioned separately.