Chapter 491: Choledochoscope

Ling Ran stood at the chief surgeon’s position by the operating table. Zhang Anmin was at the first assistant’s position, Ma Yanlin stood at the second assistant’s position. All of them were fully immersed in their tasks.

The patient on the operating table was covered with green drapings. His face and hands were not visible. Only his abdomen was exposed, specifically for access to his liver.

Zhang Anmin gasped for breath and watched as Ling Ran broke off a small piece of liver.

He had actually performed quite a number of liver surgeries. If he did not include the time where he had been a second assistant, ever since becoming a senior resident doctor, he had performed eighty to one hundred of hepatectomy surgeries as the first assistant.

It could be said that he was very excited during the first few hepatectomies he performed. But after performing twenty to thirty cases, that fire quickly simmered down.

Today, however, Zhang Anmin felt the excitement he had not felt for a long time.

Perhaps it was because of the fact that he now had hoped to become the chief surgeon for hepatectomies reignited in him.

“Done. Endotherm knife,” Ling Ran extended his hand, lowered his head, and instantly dealt with a few small vessels that were oozing blood.

“Needle-holder,” Ling Ran continued to ask for equipment and worked on the liver. His hands danced to music only he could hear.

Zhang Anmin stared greedily.

Unlike Lu Wenbin and the others, who had just come into contact with hepatectomy and just followed Ling Ran in whatever he did, Zhang Anmin had stayed in the Department of Hepatobiliary and Pancreatic Surgery for a long time. He had worked with nearly ten young and old attending physicians, but none of them were nearly as good as Ling Ran.

Zhang Anmin could care less about wondering about the reason. He just wanted to learn a little more.

Being a doctor was a profession where its members seldom took the initiative to work overtime. Doctors complained about working overtime every day. But if the hospital did not ask doctors to work overtime, it was not because of the doctors’ complaints, it was because they only had a few patients. 90% of the doctors would run away if that was the case. If Yun Hua Hospital had become a hospital like this, perhaps only Doctor Zhou would be the only left.

Of course, the doctors truly complained a lot about night shifts.

“Okay. We’ll check again to see whether there is any bleeding,” After Ling Ran finished, he began to check the patient’s abdominal cavity.

Zhang Anmin also quickly checked the situation. He was the first assistant, and it was his job to do these auxiliary tasks.

“Doctor Zhang, perform abdominal closure.” After Ling Ran finished checking and confirming that there were no problems, he transferred the work to Zhang Anmin.

“Okay,” Zhang Anmin hurriedly replied. He then put his hands up and sent Ling Ran away.

Lu Wenbin did not have any intention to stay. He smiled and said, “I’ll go and have a look at the kitchen. Doctor Zhang, after you are finished here, just go to Operating Theater 3. If you are early, you might be able to still be the first assistant.”

Zhang Anmin’s face burned, and he said, “I don’t mean to snatch the position of the first assistant.”

“Oh, I’m not saying that you’re snatching it…” Lu Wenbin paused before he smiled instantly and said, “You’ll know after you go to Operating Theater 3 to have a look. If you want to be the first assistant, the others won’t be particularly concerned. Our group takes turns. We don’t snatch stuff or whatever.”

Zhang Anmin laughed a couple of times and thanked him again. He thought, ‘You are all able to take turns because you have a lot of resources. Now that I’ve joined you, I’ll be serving as the first assistant for half of your hepatectomies. By that time, I’ll see whether you want to snatch those chances or not.’

*Shick.*

The airtight access door was closed.

“Phew…”

“Phew!”

Zhang Anmin and Su Jiafu sighed together before he looked at each other and smiled.

“Doctor Ling’s presence is pretty heavy.” Zhang Anmin was a little embarrassed as he voiced his thoughts. He considered what he said his explanation for his sigh just now.

Su Jiafu laughed, wiggled his butt comfortably, and said, “I don’t care how strong his presence was, I just want to have a good sleep. How long will this take us?”

Surgeons were often urged to hurry up by the anesthetist and the circulating doctors.

Zhang Anmin smiled and said, “Abdominal closure can be done in a few minutes. However, I want to learn more about it. You should take your time and sit for a while.”

“Okay,” Su Jiafu and Zhang Anmin were considered acquaintances, but they did not speak to each other much. The two were not in the mood to chat either.

Zhang Anmin let the circulating nurses pull down the shadowless lamp and changed the angle himself so that he could observe the surgical field.

After checking the surgical field with his naked eye for a while, Zhang Anmin was still somewhat dissatisfied, and he asked the nurse to pass him a choledochoscope. He then carefully observed the stones in the patients’ intrahepatic bile duct.

The core problem of hepatectomy for hepatolithiasis was that the rate of stone fragments was high. It also meant that the stones in the intrahepatic bile duct were difficult to clean.

It had been reported that the residual stone rate of hepatolithiasis was as high as 31.3%. This meant that after removing part of the liver, there were still about 30% gallstones remaining in the liver.

If it were subdivided, the rate of gallstones in the left lobe was 17.3%, and the rate in the right lobe was 54% percent.

The reason why the right liver was about three times that of the left lobe was that doctors usually performed left hepatectomy, thus removing a large number of residual stones from the left lobe, and they left behind a large number of gallstones in the right lobe.

Of course, this was the average percentage. In the hands of the experts, the residual stone rate of left lobe going down to less than 10% was something basic for them.

And the rate in which they were able to reduce the gallstones in this sort of surgery was usually the main point that allowed the surgeons to boast about themselves.

Zhang Anmin also intended to verify just how good Ling Ran’s surgery was through this method.

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He took out the choledochoscope and followed the tunnel just now to observe silently.

There was no gallstone.

There was no gallstone…

There was no gallstone!

Zhang Anmin was shocked the more as he observed.

When he was an assistant, he had to be responsible for a lot of work, so he could not keep an eye on the moves Ling Ran made. That was why he took the opportunity to make a quick replay of what happened just now while he performed the abdominal closure.

However, even if Zhang Anmin’s gallbladder was swollen, he would never think that he could see such a bile duct.

The patient could even pretend to have a normal person’s bile duct.

*Shick.*

The door of the operating theater door was opened again.

Three attending physicians from the Department of Hepatobiliary and Pancreatic Surgery came in together. They first looked to their left before they looked at the right. When they were sure that Ling Ran was not there, they laughed. “Old Zhang, we were just looking through the door and thought, ‘What are you doing here alone?’ What’s this? Abdominal closure?”

“The resident doctors from Ling Ran’s treatment group already went back, and you’re here doing abdominal closure?”

“It’s just abdominal closure. There’s nothing to be embarrassed about it.”

The three attending physicians’ qualifications were slightly higher than Zhang Anmin’s. They had either started performing hepatectomy, or they were trying to get experience in performing hepatectomy. When they heard that Zhang Anmin was Ling Ran’s first assistant, they rushed to the operating theater to have a look.

Yun Hua Hospital’s Department of Hepatobiliary and Pancreatic Surgery was inferior to the Emergency Department, and much more inferior to the elite department—the Hand Surgery Department. It was just a small department in the General Surgery Department.

A small department meant fewer people, fewer resources, and fewer patients. It was very easy for them to end up in a situation where they only had just enough work for everyone

They were already in a situation where Director He Yuanzheng could not even schedule his hepatectomies fully. The associate chief physicians who were positioned higher than Zhang Anmin could not even have their fill in surgeries. Hence, those attending physicians who were under the associate chief physicians had even lower chances of performing hepatectomies.

While other attending physicians waited for their turns obediently, Zhang Anmin wanted to get out of that cycle. Naturally, this action was not very accepted by the others.

Zhang Anmin himself knew about that. He chuckled a couple of times and continued to look at the screen. He operated the choledochoscope without a sound.

Like other endoscopes, a choledochoscope transmitted images from the camera at the top of the choledochoscope to the screen on the operating table.

The three attending physicians of the Department of Hepatobiliary and Pancreatic Surgery only glanced at it and knew it was a choledochoscope.

A senior attending physician who stood in the middle laughed and joked. “What’s wrong? Did you just realize that there’s no gall stone in the biliary tract after you cut off his liver?”

The person next to him immediately followed.

“If there’re no gallstones, this will be medical negligence.”

“It’s okay. We’ll put in some ourselves. Don’t say that I’m not teaching you anything.”

Zhang Anmin silently moved the choledochoscope for around ten seconds before pointing at a small point on the screen. He said, “Here, this is the stone in the bile duct.”

The three attending physicians were stunned for a while before they burst out laughing.

“If this is the reason behind performing hepatectomy, I would have died laughing.”

“I can’t. I really can’t. My stomach is already hurting from laughing so much.”

“They cut out the liver just because of these small gallstones? Did they send the tissues to the Pathology Department? This is medical malpractice.”

Zhang Anmin looked at the three of them indifferently.

He could actually understand them completely. If he had not been there when Ling Ran performed the surgery, he would not believe that the residual stones could be cleaned up so tidily.

However, the fact remained that having only 2% residual stones in the liver, which was something only elites could do, was something that was not difficult for Ling Ran to do.

“Those are the residual stones after the surgery,” Zhang Anmin said.

The others were still laughing. “These are the gallstones in total? What’s the point of having this surgery?”

“Excuse me, do you mind putting up the patient’s CT scan.” Once Zhang Anmin finished talking, Su Jiafu the anesthetist quickly put up the CT scan on the computer in front of him.

The smiles on the attending physicians’ faces gradually disappeared.

“Is it from the same person?”

“Look, the biliary tract is the same.”

“It’s so clean. Is he scared of gallstones or something?”

Zhang Anmin looked at them with the shadow of a smile on his face.

Although he had the same expression a few minutes ago, at this moment, Zhang Anmin felt that his smile should be extremely mysterious.