Chapter 29: Professor Tong’s Approval
In the summer, the rain arrived in haste, with curtains of rain and a rainbow simultaneously hanging in the clear blue sky.
His parents had already left. Lu Cheng still closed the door to the training room tightly, then looked up and asked, “Teacher Tong, can you see the operating table from this angle?”
“The training room at home is quite small, and I only bought one camera, so it’s not easy to control the field of vision you see,” Lu Cheng said obsequiously towards the camera, his expression slightly flattering.
Professor Tong Yuan’an from Xiangya Hospital was the ‘examiner’ Professor Chen Song had invited for Lu Cheng. After Chen Song sent Professor Tong Yuan’an the video of Lu Cheng practicing the modified Tang method, he waited a few days before finding a free moment during his lunch break.
Professor Tong Yuan’an’s voice was deep and resonant. “This direction is fine, don’t move it anymore.”
“Doctor Lu, I can completely understand your desire to learn more specialized hand surgery techniques, but there are many tendon suturing techniques that can be learned, and the modified Tang method is considered one of the more difficult ones for beginners in terms of requirements and practice difficulty.”
“Even experienced hand surgeons need to practice continuously for several weeks to become proficient.”
“If your technique for the modified Tang method is not proficient and your operation is somewhat stiff, it might not be as good as other types of tendon suturing techniques.”
“In fact, it’s not very cost-effective for you.”
Tendon suturing is, after all, a relatively simple surgery in hand surgery, and tendon injuries are minor conditions. In Professor Tong Yuan’an’s view, for a hospital like Lu Cheng’s, which hasn’t developed hand surgery, learning the modified Kessler method to a certain degree of proficiency would be enough to get by.
Just like individual skill development, the overall technical learning in a region is a gradual process; don’t try to achieve too much too quickly.
Therefore, Professor Tong Yuan’an was always advising Lu Cheng not to waste time. If the opportunity arose, he could consider practicing flap transplantation techniques.
“Thank you for your guidance, Teacher Tong, but I’ve already come this far, and it’s difficult to give up halfway. Otherwise, all the time invested so far would be wasted.”
Lu Cheng then proceeded to show Professor Tong his training path: “Professor Tong, this is the ‘three-needle bidirectional puncture method’ I practiced on a silicone pad.”
“According to the precise data I previously researched, the starting point, ending point, and puncture angle of the three needles vary.”
“First needle: enter 8mm from the transection end at a 60° angle to the longitudinal axis of the tendon, exiting equidistantly on the opposite side.”
As Lu Cheng verbally explained to Professor Tong, he picked up the silicone pad and began to operate. The 7-0 Vicryl suture he held was almost invisible.
“Teacher Tong, can you see my entry and exit points? Shall I demonstrate again with a normal-sized needle for you?” Lu Cheng asked.
Professor Tong Yuan’an had a bushy beard, and the muscles on his arms bulged. He gently shook his head. “Continue.”
“If you truly wish to learn more specialized hand surgery suturing techniques and are willing to invest the time, I, representing hand surgery, will certainly welcome Doctor Lu.”
Upon hearing from his friend Chen Song at the Second Hospital that a young man from the emergency department, only thirty years old, was attempting the modified Tang method, Professor Tong Yuan’an’s first reaction was, “What is this?”
Is medicine also about ‘pre-consuming’ and causing trouble…
After Chen Song sent him the video of Lu Cheng’s operation, Professor Tong Yuan’an realized that Lu Cheng’s ‘pre-consumption’ actually had some substance.
Although his basic skills in suturing were ‘ordinary’ and many areas were not handled with sufficient proficiency or precision, to the point where they offered no pleasant surprises, his mastery of the technique was very proficient.
Lu Cheng then continued his demonstration: “Second needle: 5mm from the transection end on the same side, entering at a reverse 45° angle to form the first ‘Y’-shaped intersection; the third needle is a mirror image on the opposite side, completing the first set of core anchor points.”
“Teacher Tong, the overall time taken and needle spacing error should both be within acceptable limits, right?”
Professor Tong Yuan’an replied, “More or less. This is just for simple tendon suturing, so you don’t need to be overly strict.”
“If this were our clinical group, the standard for mastering the technique would be a needle spacing error of ≤0.2mm measured under 20x magnification ）, and a total time for three needles of <90 seconds. Your operating speed meets this, but your precision does not."
“But it doesn’t matter. For simple tendon suturing, an error within 2mm doesn’t have a significant impact, unlike nerve or blood vessel anastomosis…”
“Try performing another operation with chicken tendon, and then use a tensiometer to verify the approximate tensile strength…”
Lu Cheng responded, quickly grabbing a fresh chicken leg and proceeding to trim the tendon vertically under the microscope, leaving about 1mm of the paratenon.
Professor Tong Yuan’an said, “Let me see the cross-section of the tendon you trimmed? It wasn’t clear in the video. Is there any beveled cutting?”
“If there is beveled cutting during your practice, it’s not suitable for practicing the technique.”
Learning and imparting medical techniques are very private matters, which is why clinical teaching is necessary.
Such video teaching is not detailed enough.
Especially since Professor Tong Yuan’an mentioned that the error needs to be within 0.2mm; how can a camera discern such a fine distance?
Lu Cheng paused slightly, then examined it himself. “Teacher Tong, it meets the requirements.”
“Then begin the first bundle of sutures…” Professor Tong Yuan’an instructed.
The core of the modified Tang method is the three-bundle, six-strand core suture.
Lu Cheng began to operate, very carefully estimating the distance before—
He could only rely on feel, entering at 10mm from the transection end → exiting obliquely at 5mm on the same side → entering obliquely at 5mm on the opposite side → exiting at 10mm （ forming a “W” trajectory ）…
Next, Lu Cheng added a bundle parallel to the first bundle at 1.5mm on each side, standardly penetrating the middle layer of the tendon’s thickness.
When all three threads were pulled simultaneously, the gap between the transected ends instantly tightened, with a gap of less than 0.1mm, barely visible to the naked eye…
“Measure the tensile strength,” Professor Tong Yuan’an instructed.
Lu Cheng pulled it with a tensiometer, and the force finally settled at about 40N, after which Lu Cheng dared not pull any harder.
“Okay, next time you can use pig trotter tendon and increase the load to 80N. If you can complete the three-bundle suture within a 5mm x 5mm surgical field, you’ll be able to handle this surgery confidently.”
“In actual patient tendon suturing, the field of vision is extremely narrow. Your current skill is quite good, indicating you are diligent and motivated…”
“Your hospital doesn’t have a hand surgery department, which is why you went to the emergency department, right?” Professor Tong Yuan’an asked.
Professor Tong Yuan’an had naturally assumed Lu Cheng was a Master’s student in hand surgery, or at least undergoing standardized training in hand surgery.
During the multi-person video call, Chen Song also explained, “Professor Tong, it’s true that Long County People’s Hospital does not have a hand surgery specialty department, and Doctor Lu was indeed an orthopedic doctor before.”
Professor Tong Yuan’an smiled and encouraged him, “Everyone starts from nothing. I see you’re young, Little Lu, but your accumulated skills and learning efficiency are truly excellent.”
“At your age, to have achieved such proficiency and basic skills in suturing, you have the potential to develop your local hand surgery department in the future…”
Lu Cheng sincerely expressed his gratitude, “Thank you, Teacher Tong…”
