Chapter 676: [(676)] Liver Chapter 676: [(676)] Liver Due to the time constraints, there was no opportunity for students to ask questions or discuss cases in the ward. Like in General Surgery Department Two, the attending physician made rounds without discussion and rushed off to the operating room to perform surgery. On this point, surgeons are far more hard-working than internists.
The half-hour shadowing session for Xie Wanying, a medical student who was in this department for her first day of learning, was a mere glimpse into the practice. She couldn’t fully recognize the faces of many patients and had no idea what was going on. Any tasks her teacher might assign her would have to wait until the afternoon; there was no point in rushing. In contrast, it seemed like being left alone in the ward at General Surgery Department Two was actually a good thing for her.
Descending to the operating room, Xie Wanying was quite familiar with the environment there. This time, however, she was following a surgery in the Hepatobiliary Surgery Department, not one from General Surgery Department Two. Remembering Senior Kang’s words, she focused on learning from the teacher wherever she went, and made sure not to be distracted by her ‘ex.’ Without encountering Teacher Tan and his team, she stood directly in the operating room of Hepatobiliary Surgery to observe.
This morning’s surgery was a laparoscopic procedure for a patient with primary liver cancer.
All surgical departments now tend to perform minimally invasive surgery. The laparoscopic approach for liver cancer has become much more prevalent, but the threshold for performing these surgeries is much higher than for laparoscopic gastrointestinal surgery. This particular surgery had been the subject of a lengthy discussion at a meeting the previous night.
Xie Wanying had not participated in that evening’s group meeting and was not clear on the details, so she could only stand in the operating room and observe.
The chief surgeon was Senior Tao, whom she had heard about before.
The first assistant was Dr. He.
The mirror assistant was not Dr. Qiu, as Dr. Qiu had gone to help with another surgery. It was another resident named Gong Xiangbin, who was a year older than Dr. Qiu, shorter and plumper, and not as handsome as Dr. Qiu, but a gentle and steady doctor.
Then there was Song Xueling, who was called over to try her hand; she donned the surgical gown and stood behind the first assistant and chief surgeon as if on standby, uncertain of what operation she would be allowed to perform when the time came.
As they were graduates and she was not, just an intern, it only made sense for her teachers to ask her to just watch. Xie Wanying watched with intense concentration. Having gained quite a bit of experience as a mirror assistant with Teacher Tan, it was her first time in the Hepatobiliary Surgery Department watching a laparoscopic liver surgery. She naturally started by closely observing Dr. Gong’s operation.
Dr. Gong’s hands seemed motionless, and it was only by looking closely, as if through a magnifying glass, that one could detect their subtle movements. The liver, unlike the gastrointestinal tract, is a solid organ anchored in one area. The surgeries performed around the liver are basically conducted within this region and require a great deal of stability and precision. The gastrointestinal tract is a hollow organ with many twists and turns, requiring more dexterity.
The mirror assistant was already very cautious; needless to say, the first assistant and chief surgeon were even more so, like mine clearance soldiers as Dr. He had described, inching forward little by little, daring not to make any large movements.
After all, the liver is densely packed with blood vessels. When removing a tumor and cutting into the liver, any slight deviation in the place of incision could easily strike one of the various blood vessels within the liver, causing blood to bubble up from the entire liver surface.
In the event of substantial bleeding from a solid organ, during open surgery, surgeons would be in a hurry to use their hands to press directly on the liver surface to stop the bleeding. In laparoscopic surgery, however, the surgeons’ hands cannot reach inside, so they have to press with a hemostatic sponge. If the bleeding cannot be controlled and the bleeding point cannot be found, they must convert to open surgery. From this, it is clear that difficulty in stopping bleeding is a major drawback of laparoscopic liver surgery, severely limiting the use of laparoscopy for liver tumors that cannot be large, cancer locations that must not involve the portal vein, and requiring a higher level of liver function in patients.