Chapter 319: 313 Please Have a Meal (1/4)

The hepatoduodenal ligament had already been dissected, Zheng Ren began to free the lesser sac opening, separating the colonic hepatic flexure from adhesions of the right liver lobe.

Then Zheng Ren pushed down the transverse colonic mesentery, cut open the lateral posterior peritoneum of the duodenum, and performed blunt dissection.

Zheng Ren's blunt dissection Shou Bing skill was honed during his initial training in appendectomy; it could be said to be his signature technique.

He estimated that, as a single technique, he had at least reached the level of a master.

But others, seeing it often, had grown accustomed and didn't think it was that impressive. Zheng Ren glanced at Yang Lei, seeing he hadn't noticed this, feeling some regret.

Looks like when he has free time, we should tell him this, so he can understand the key points of the surgery.

After Zheng Ren completed blunt dissection of the posterior peritoneum, he then mobilized the second and third segments of the duodenum forward, until the duodenum and pancreatic head could be lifted to the superficial operating field, with a temporary warm saline gauze pad placed behind the duodenum and pancreatic head.

During a normal Oddi sphincteroplasty, one needs to locate the duodenal landmark.

But this patient had already undergone a choledochoduodenal side-to-side anastomosis, so this point does not need to be done again.

Zheng Ren began preparing to incise the duodenum.

Using mosquito-style Blood Vessel forceps to clamp both sides, cutting between the clamps, each clamp 1~2mm, then immediately suturing the duodenal mucosa and bile duct mucosa with 3-0 non-traumatic suture thread, achieving a distance of 2.0~2.5cm.

This step, Zheng Ren did very carefully, to avoid postoperative duodenal fistula.

After sphincterotomy, traction was applied to the sutures on both cut edges to check for bleeding.

Then the pancreatic duct opening was examined.

The pancreatic duct opening was located inferior-medial to where Zheng Ren had incised the duodenum, at the 3 o'clock direction, with pancreatic juice seen flowing out.

A fine catheter was placed into the pancreatic duct to check for obstruction or stenosis.

The duodenal incision was closed in two layers; during suturing, careful alignment was required to prevent duodenal lumen stenosis or fistula.

Zheng Ren did not simply suture the incision as usual, but instead used a transverse-longitudinal suturing approach at this site, trying to avoid duodenal lumen stenosis and fistula.

【Huh? This suturing method is quite special.】

In Xinglin Yuan, someone soon noticed this.

After countless rounds of practice, viewers of the surgery live broadcast subconsciously believed the surgeon would not make a mistake, and began to appreciate the benefits of this suturing.

The bullet comments were not many, and few people shouted '666'.

Everyone was savoring and learning.

After suturing the duodenal incision, Zheng Ren carefully pulled over the greater omentum, used it to cover and reinforce, placed abdominal cavity drainage at the hepatic inferior area and lesser sac opening.

The peritoneal cavity was irrigated with warm saline, no active bleeding was seen, locally three antibiotics were used, and Zheng Ren did not directly close the peritoneal cavity.

"Ultrasound machine, sterile sheath, 50ml syringe." Zheng Ren said.

"Are you really going to do this now?" Su Yun hesitated a bit.

"It's fine." Zheng Ren said.

Su Yun did not persist further; soon the circulating nurse brought the mobile ultrasound machine from the Operating Room. The sterile sheath covered the ultrasound probe and its cable, and Zheng Ren began performing ultrasound-guided liver ultrasound.

Without skin or subcutaneous tissue interference, the view was incredibly clear!

The 50ml syringe needle entered the liver abscess under ultrasound guidance, and tube after tube of yellow-green pus was aspirated.

After aspirating about 125ml of pus, resistance in the syringe began to increase.

"Two vials of cefoperazone, dissolve, irrigate." Zheng Ren said.

Then warm saline irrigation was performed, and the circulating nurse opened two vials of cefoperazone sulbactam, which after dissolution were injected by Zheng Ren into the liver abscess.

This time the surgery was finally finished; Zheng Ren carefully examined the operated area again, seeing no bleeding and no untreated inflammatory foci.

"Close the abdomen." Zheng Ren said.

Xie Yiren immediately changed into a pair of gloves, and began handing Zheng Ren the reserved clean instruments.

The whole operation had fast and slow parts; when dissecting the pus membrane and performing sphincteroplasty, Zheng Ren moved very slowly and carefully.

When closing the abdomen, the movement was almost as fast as taking off, so fast it almost left an afterimage.

Su Yun could keep up with his own hand speed; a real person indeed believes this.

【Wow, the only abdominal closure steps I can understand, how did you do it so fast?!】

【That's because you're too weak, kid.】

【It's literally light-speed abdomen closure; while the surgeon was dissecting the pus membrane, that was slow. This is exactly the idea of being fast when needed and slow when needed, right?】

Surgery is not something every doctor can understand.

But the steps of closing the abdomen are understood by everyone.

The surgeon's hand speed at full blast, an assistant can completely keep up; two people closing the abdomen took absolutely no more than three minutes.

This speed… is simply too proficient, worthy of being called rocket speed.

With the final suture tied, the patient became restless, and the Surgery Livestream Room closed.

The doctors watching the surgery still lingered reluctantly, staying here, treating this place as a chat room, facing the empty background, they began to chat aimlessly.

At this moment, things like casually driving a car are not a problem.

Because abdominal cavity infections are frequently encountered, the reference value of this surgery is very high, especially the dissection of the pus membrane and the intraoperative ultrasound localization, direct puncture aspiration of pus, followed by antibiotic irrigation.

The surgeon's goal is only one—to try to let the patient's septicemia improve.

Once the source problem is solved, the rest depends on the results of bacterial culture and antibiotic application.

The surgery was almost perfect; many doctors remained in the surgery live broadcast for over an hour after it ended, reluctant to leave, chatting here, sharing their feelings, viewing others' feelings.

Mutual reference, Enhancement of Technique level.

If audiovisual materials could be retained, how great that would be; many doctors thought of wanting to have both.

These are all wishes; if someone could confidently livestream surgery, that would already be an extremely fortunate thing.

Those who dare to do this are truly few; who can guarantee the surgery will absolutely have no problems?

Only someone as heaven-defying as the surgeon would do a livestream.

In the surgery live broadcast room, doctors sighed for a long time; even if the surgeon didn't know, they shouted '666' many times before gradually dispersing.

Zheng Ren finished suturing the last stitch, the patient had already woken up.

Whether it's Chu Yanran or Chu Yan zhi, the anesthesia standard is very high, no wonder they are graduate students in critical care medicine.

Zheng Ren stepped down, tore off the sterile surgical gown, twisted his neck.

「Uncomfortable? 」 Xie Yiren somewhat Tension.

Zheng Ren laughed, "Nothing, just moving around a bit."

「Oh. 」

Xie Yiren began to tidy up the Surgical Instruments, clean them, prepare to send for sterilization.

「Zheng Ren, you're off duty today Evening, let me treat you to a meal. 」 Xie Yiren said with her back to Zheng Ren.

Zheng Ren felt a surge of hot blood rush to his heart, almost spurted out from the already closed fontanelle.

「No need to treat guests tonight Evening, there's a dinner gathering. 」 Zheng Ren felt somewhat regretful, although saying everyone going together would be livelier, but if he could have a meal with Xie Yiren, how nice would that be?

It's been so long, it seems only when she first arrived did the two go out for a bite of crayfish and encounter the Chu Family Sisters.

「Oh, okay then. 」 Xie Yiren replied.