Chapter 30: 30 – First Open Surgery

Lui Jing retold the incident to technician Wu. It was the first time Li Yun assisted as second assistant in the general surgery department.

At the time, a middle aged woman was scheduled for a simple laparoscopic cholecystectomy in the morning. Doctor Chun, a senior attending, was in charge of the operation. He mainly worked in the administrative building with supervisory duties over the financial administrators, but every once in a while, he would take on simple cases. It was the woman's first surgery, and her history was uncomplicated.

"Can everyone see here?" asked Doctor Chun showing a group of residents the ultrasound screen while they waited for the anesthesia to kick in. "From the ultrasound, you can see that the wall thickness is around 3mm, the size is around 8mm, and the common bile duct diameter is 4mm. This shows that the patient is a perfect candidate for an elective laparoscopic cholecystectomy."

The senior nurse and anesthesiologist standing nearby both rolled their eyes. Doctor Chun sounded like he knew what he was saying, but the report was already written by a sonographer.

"Doctor Chun, I recommend an open cholecystectomy," Li Yun suggested.

His sudden comment prompted everyone to turn their heads in his direction. "Is this kid crazy?" They all thought.

Doctor Chun stared sharply at Li Yun. Almost every single attending surgeon hated to be contradicted by residents, especially someone who valued face like Doctor Chun.

"Student Li, how did you come up with that conclusion?" asked Doctor Chun, with his voice turning nasally to suppress his rising anger. "An open surgery is unnecessary and creates an added risk for the patient."

"There's a high chance that there is a low CVS. If an experienced surgeon was handling the case, it would be fine. But for someone of your caliber, I recommend an open cholecystectomy," Li Yun said without much reservation.

The comment infuriated Doctor Chun, but he continued to hold back; he had to display his superior patience as the senior attending. In over 95% of the cases, it was better to perform laparoscopic cholecystectomy. If there were complications, conversion to open cholecystectomy wasn't too late.

"If Student Li is confident, why don't you chip in as the second assistant?" Doctor Chun asked in a condescending tone. It was unheard of for a first-year resident to work as a second assistant, but Doctor Chun wanted to see Li Yun embarrass himself in front of everyone.

Li Yun scrubbed in quickly and Doctor Chun began the operation with a simple incision. Doctor Chun narrated his actions to the group of residents.

"If you're wondering what a CVS is, I will explain it as the laparoscope is placed," Doctor Chun had his first assistant move the laparoscope deeper into the small incision. The camera view moved closer to the location of the gallbladder. "Critical view of safety is a method to identify the bile duct and cystic artery and duct."

Once the first camera was held in place by the first assistant, Doctor Chun moved the second trocar with a camera.

"This right here is the bile duct," said Doctor Chun pointing. "You want to avoid injuring this during surgery."

"Are you sure about that?" Li Yun asked as he raised his brow. Did this guy even know that the patient had a bacteria infection recently, and the topography had changed?

At Li Yun's questioning, Doctor Chun paused. He re-examined the screen. It was different from the report and what he was told by the senior radiologist Doctor Shang. He thought it was a simple operation, but he could barely tell the bile duct and cystic artery apart.

"The cursed brat!" Doctor Chun thought as his hands froze in place, he didn't know how to proceed. His face above his mask was visibly red and he wanted a veil to shield himself. He shook himself to snap out of his depressed state and quickly formulated a plan.

If the surgery continued, there was a good chance of damaging the bile duct and causing major complications afterward. Doctor Chun could convert the surgery from a laparoscopic to an open cholecystectomy, but he wasn't too experienced with open cholecystectomy. Since the early nineties, there had been a major shift from open surgery to laparoscopic surgery. For a doctor who was more interested in hospital politics than surgical skill, he had not done an open surgery in years.

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Doctor Chun finally looked to Li Yun, and a smile slowly crept from underneath his mask. "Dr. Li, since you have suggested this, why don't you give it a try as I supervise?" He was hoping to pin any errors on him.

Li Yun took a deep breath. He had used Zuowang on a lot of open cholecystectomies, but he wasn't confident to perform it. If Doctor Gao was supervising, he would at least feel more confident, not the egomaniac Doctor Chun and his resident in the room.

After a brief moment, Li Yun nodded. It was better that he performed the operation on the patient. Luckily, the senior nurse appeared unfazed, meaning she had a lot of experience. He turned to look at him, and a slight nod from her reassured him that she was would assist him throughout the process.

As Li Yun continued with the operation, everyone in the room was surprised. Li Yun was much better than anyone had anticipated. In the end, Li Yun performed without any mistakes and even stitched up at the end.

The event not only pissed Doctor Chun, but the senior radiologist who made the report, Doctor Shang.

"Do you think he intentionally pissed them off?" asked Technician Wu after hearing the story.

Lui Jing thought about it. He didn't know Li Yun too well, but he did have an uncanny ability to read people.

"So you're saying he intentionally pissed them off to perform surgery?" asked Lui Jing.

If Lui Jing attempted to do something like that, he wasn't sure what the outcome would be. Why wasn't Li Yun afraid of getting fired? How was he so sure that Doctor Chun would place him as second assistant?

"You're new, so you may not know about Dr. Chun, but he's known to harass residents during surgery all the time," said Technician Wu. "It's bad practice, but management mostly ignores it since they think it's just part training."

Pimping in medical schools and residency were common. However, there was a line that many attending crossed over. Once the line was crossed, it was considered harassment.

"Oh, wow," Lui Jing was half-convinced that it was planned.

"Not only that, Dr. Shang also started recommending Li Yun as an assistant in interventional surgery," Technician Wu had heard all the gossips from the radiology department. "It surprised everyone that Li Yun agreed. Not a lot of doctors want to be constantly exposed to radiation. Afterward, doctors from the vascular surgical department also requested Li Yun's assistance since they were short of qualified surgeons."

"Gee," Lui Jing was halfway into joining Li Yun's fanclub.

During the next few weeks, Li Yun was able to perform more surgery. Although he was not the main surgeon, he had enough involvement to gain experiences and action points.

Li Yun already knew enough to perform cholecystectomy and appendectomy in his sleep, but to actually perform it on a person felt different. Performing in-person made him recognize that every living person was unique. It was these crucial points that separate great surgeons from the average surgeons.

For every general surgery Li Yun had performed, he had performed twice as many interventional surgeries. Interventional surgery was more common as it was less invasive, but most doctors would reconsider due to the risks. Orthopedic surgeons and surgeons who regularly worked with radiation have higher risks of cancer. Li Yun would be lying if he said he wasn't concerned about radiation exposure. Albeit, if they followed proper protocol, the risks would be minimized.

Li Yun didn't think he was a stickler for rules and protocols, but they were important for his own safety. People who regularly broke protocol didn't think about the long-term consequences, and only wanted to get things done fast and easily. Following protocols were also important for the patient's recovery.

Whenever Li Yun watched other perform surgeries, he bluntly pointed out their errors. It didn't matter that he pissed off the surgeons or if the others called him a Nian, he would rather see an operation that benefited the patients. As many surgeons didn't want to be criticized by their own students, they made Li Yun perform surgery with them, giving him more opportunities to harvest action points.

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