Chapter 3175: 2970 Overly Cautious

Facing Zheng Ren's relaxed smile, everyone's tension eased somewhat.

The surgery began; after opening the chest, Zheng Ren dissected around the lung hilum, cut open the mediastinal pleura, and performed blunt dissection toward the lung side, exposing the pulmonary vessels.

Then Lin Yuan and Gu Xiao Ran retracted the upper and lower lobes posteriorly, exposing the anterior edge of the pulmonary hilum. They first isolated the superficial pulmonary vein, then ligated and cut the upper lobe vein and middle lobe vein.

Doctor Charles stood silently to the side watching the surgery, his pupils gradually constricting.

The standard pneumonectomy procedure was textbook-perfect. After 15 minutes, the right pulmonary artery and vein were exposed, and ligation began.

Doctor could see that Zheng Ren wasn't deliberately seeking speed, but was proceeding step by step. The surgery was exceptionally smooth; not only the surgeon and first assistant, but also the second and third assistants understood the process well, their coordination reaching an astonishing level.

What does the surgeon most hope for?

What is most desired is a clean surgical field; not only does bleeding obscure the view, but using a retractor to pull aside other tissues to expose the field is also crucial.

When Zheng Ren performed blunt dissection on the right lung side to expose the pulmonary vessels, second assistant Lin Yuan and third assistant Gu Xiao Ran had already pulled open the tissues that needed to be retracted, making the surgical field exposure quite sufficient.

During the surgical practice, Doctor Charles didn't notice the assistants' role; at that time he focused all his attention on the 3D-printed lung tissue graft; and on Zheng Ren's microsurgical skills.

But today, facing the real patient, watching the surgery from start to finish, Doctor Charles thought the two youngsters' performance was perfect.

Surgery isn't a one-person job; today the second and third assistants perfectly illustrated that.

"Liver function, ALT..."

"Blood gas analysis..."

At the 15-minute mark, Lao He began reporting the lab results. Liver and kidney function, blood gas analysis—several key indicators were reported clearly.

"Next time." Zheng Ren replied briefly; to others it sounded nonsensical, but Lao He nodded, indicating he understood.

The assistant beside Doctor Charles translated behind him, and the doctor began pondering these numbers.

Now looking at liver function, total bilirubin is 89 mmol/L, four times the upper limit of normal. However, according to the medical record, this young patient's preoperative total bilirubin was already high, possibly related to multiple prior hepatic interventional embolization procedures.

Kidney function was fine, blood gas analysis was fairly ideal, ECMO operation was smooth. Doctor Charles smiled; Doctor Zheng was truly cautious, having preoperatively limited the low-molecular-weight heparin dosage and continuously monitoring intraoperatively.

Although doctors should be meticulous, Doctor Zheng was overly cautious today.

After receiving the first lab report, Zheng Ren ligated and cut the first branch of the pulmonary artery, namely the anterior segment artery.

Immediately, the right pulmonary artery trunk was fully exposed, and a thick suture line was placed for occlusion.

"Zheng, you're being too cautious." Doctor Charles could no longer hold back and began communicating with Zheng Ren.

Here we need to wait, normally about 10 minutes. But the patient is already on ECMO, so even if the resection causes blood pressure to drop, it wouldn't be a major problem as long as we maintain fluid administration.

"Doctor, because the patient's liver function is poor, I must be careful." Zheng Ren explained to Doctor Charles why he still cautiously monitored blood pressure even with ECMO assistance.

In the operating room, Zheng Ren's voice mingled with the song 'Good Luck Come'; the people standing on the platform, including Su Yun, remained still, as if waiting for something.

"Beep beep beep---" the monitor alarm sounded, and the displayed arterial pressure kept dropping.

Doctor Charles didn't think it necessary; as long as we maintain fluids, could we really stop the surgery just because blocking the right pulmonary artery caused blood pressure to drop?

That's basically impossible, so saying Zheng's waiting is meaningless.

But then Su Yun made a gesture without hesitation, and the person standing beside him, Gu Xiao Ran, pulled the sterile drape upward, preserving the sterile field and exposing the left groin.

What is this for? Doctor Charles stared.

The ICU doctor who had been ready immediately came from the operating area and pushed over a strange-looking machine. Xie Yiren handed him a puncture kit; after hand disinfection, he began the procedure.

The machine—a patchwork of countless repairs—looked shabby and worn. The monitor alarm's blaring in the ears made people feel irritable; even the song 'Good Luck Come' seemed less pleasant, and everyone grew impatient.

Doctor Charles didn't comment on the machine; he narrowed his eyes to closely watch the ICU doctor's operation.

The femoral vein was punctured and catheterized to establish a circulatory pathway; the ICU doctor then started the machine and connected the tubing.

Adsorb bilirubin, plasma exchange! Doctor Charles quickly realized the machine's purpose. With blood pressure dropping, should we do hepatic dialysis? This seems excessive.

Indeed, hypotension can impair kidney and liver function, but kidney injury is usually considered more severe. Intraoperative dialysis… seems unnecessary.

Could it be that Doctor Zheng, after practicing surgery for too long, has lost himself? Doctor Charles speculated. But out of respect for the surgeon, he didn't voice his doubts about Zheng Ren.

After establishing the hepatic dialysis access, Zheng Ren immediately released the occlusion and continued the surgery; despite the alarm from arterial blood pressure monitoring, he once again began an orderly procedure.

Lin Yuan retracted the lower lobe forward; Zheng Ren and Su Yun began ligating and cutting the pulmonary ligament.

Then they pushed aside the mediastinal pleura, freed the inferior pulmonary vein, placed a suture, ligated and sutured it, then cut it.

Gu Xiao Ran pulled the upper lobe downward, dissected free the right main bronchus below the azygos arch, cut it 0.5 to 0.8 cm from the tracheal carina, and sutured it.

No one spoke; the silent surgical process was accompanied by a shrill alarm, making even the well-coordinated teamwork seem less clear, and they became irritable.

Is this okay? Doctor Charles turned his gaze more to the monitor, watching the blood pressure change, feeling some worry. He feared that a drop in the patient's blood pressure would directly cause cardiac arrest, leading to surgical failure.

Although the blood pressure was still within tolerable limits, not giving fluids would be indefensible.

"Give heparin 82 U/kg, prostaglandin E1 860 U/kg, Perferdex solution antegrade infusion, infusion pressure 52 cmH2O, temperature 4°C." Zheng Ren said solemnly.

"Zheng, do we need to give fluids?"

After holding back for several minutes, Doctor Charles could no longer restrain himself when Zheng Ren was preparing to give the infusion before lung transplantation, and he began to whisper a suggestion.