Chapter 73: After All, Big Brother Knows A Lot!
“Xiao Lu, do you know the fundamental reason why I don’t continue to teach you spleen preservation surgery?” Chen Song’s gaze flickered slightly before he changed the subject, his tone quite conflicted.
Chen Song of course knew that Lu Cheng’s learning efficiency was good, but Chen Song also knew that there were some surgeries Lu Cheng couldn’t learn.
If in the past, Lu Cheng had really thought Chen Song was ‘lazy’ or had the idea of ‘a student’s success leading to the master’s downfall’.
But now, Lu Cheng’s spleen preservation surgery had reached the specialized level, and he could no longer add skill points to advance it, so Lu Cheng naturally understood the fundamental reason.
“I know, Teacher Chen, just a moment, I’ll find my notebook for you.” Lu Cheng deftly pulled out his notebook and, as if recounting a familiar story, flipped it to a specific page.
【 Main trunk; splenic artery, celiac trunk → peripancreatic four segments → splenic hilum 】
【 First-level branches: splenic lobar arteries, 2-7 branches at the splenic hilum （ upper/middle/lower lobes ）】
【 Second-level branches: splenic segmental arteries, supplying independent splenic segments （ wedge-shaped areas ）】
【 Third-level branches: terminal arterial branches, trabecular arteries → central arteries → penicillary arterioles 】
【 Variant branches: splenic polar arteries, aberrant pancreatic/gastric branches, direct perforators not passing through the splenic hilum 】
To persuade someone to study medicine is to invite divine retribution!
Splenectomy is very simple, belonging to a common secondary surgical procedure in general surgery, but the difficulty of performing spleen preservation surgery is hundreds or even thousands of times greater than splenectomy.
To perform a good splenectomy, one must first be thoroughly familiar with the anatomy of the first, second, and third-level branches of the splenic artery, and be agile and effective in spleen preservation and hemostasis.
The spleen is an organ, and splenic injury can occur at any location.
The diameter of the splenic artery is not large, and the diameter of the secondary branches is even smaller. When performing spleen preservation or partial splenectomy, a slight mistake can lead to cutting into other splenic lobes and segments.
If the incision and hemostasis techniques are not precise, then attempting very complex spleen preservation surgery would be like a eunuch getting married.
“The core critical point is still to practice the basic skills of hemostasis. For example, if you cannot complete 80 precise electrocoagulation hemostasis operations within one minute, with a hemostasis error tolerance of less than 4 times.”
“And the diameter of this hemostasis point cannot exceed 1mm.”
“If bleeding from the wound seeps across the entire resection surface, then as the chief surgeon, you will have completely lost the opportunity to perform spleen preservation surgery and can only refer the patient for a splenectomy.”
“This step is too big a leap. With your current ability, you can only complete 40 precision hemostasis operations within one minute at most, and this is without requiring depth manipulation, just simulating hemostasis on the surface…”
“In reality, our organs are three-dimensional; they cannot be laid out flat for you.”
“Therefore, you still need to practice basic hemostasis skills for a long time, not only practicing planar hemostasis but also curved surface hemostasis and depth hemostasis, and you must improve your efficiency,” Chen Song instructed specifically, and then continued.
“Generally speaking, for mature surgeons to specialize in the surgical procedures of a subspecialty, it still takes over ten years of diligent and serious study after graduating with a doctorate before they can barely master most of the procedures in that subspecialty.”
“This also requires talent. This investment of time is not a waste of youth, but a genuine, solid dedication of a large amount of effort to learning and practicing.”
“Although they are both called surgical procedures, a single word difference can lead to vast differences.”
Chen Song explained to Lu Cheng the past learning experiences of many deputy chief physicians at Xiangya Second Hospital.
Lu Cheng nodded: “Thank you, Teacher Chen. I will collect some practice modules for basic hemostasis skills, then practice techniques and methods, and I will report my progress to you anytime, Teacher Chen…”
As Lu Cheng was speaking, there was a knock on the door: “Doctor Lu! The patient outside is here again, saying they still want to have surgery here.”
Judging by the tone, it was Tian Duoduo from the Nursing Department.
Chen Song stretched lazily upon hearing this and asked indistinctly, “What’s going on?”
“Oh, Teacher Chen, a patient came in earlier with a flexor tendon rupture in zone A3 of the lower limb. The patient said that if I can’t guarantee the surgical outcome, what kind of doctor am I, and what kind of surgery am I doing.”
Lu Cheng then chuckled lightly: “He also said that doctors like me are the dregs of the hospital, shirking responsibility and pushing all the blame onto the common people themselves.”
“So, I told him to seek out someone better…” Lu Cheng replied calmly.
Chen Song immediately felt a sense of boredom. He thought it was a surgery that he himself would have to perform as the chief surgeon.
Waving his hand: “Then go deal with your own matters…”
Lu Cheng stood up and tidied his white coat in front of a mirror.
Because on September 2nd, Lu Cheng had been complained about by an unknown patient for his untidy attire. The Medical Affairs Department had called specifically, ordering Lu Cheng to maintain a proper appearance from then on, though they didn’t criticize him.
But a lesson learned is a lesson learned. Lu Cheng didn’t want to waste complaint resources on such minor matters.
Lu Cheng walked out of the door and immediately saw the young man with a tattooed arm, sitting in a wheelchair, now looking full of apologies. Upon seeing Lu Cheng, he extended his hand to shake it: “Big brother, I’m really sorry.”
“Your big brother here is a rough person, not very educated, and my mouth is indeed a bit foul, I don’t speak well, I offended you a lot before.” The young strong man, who had some unknown tattoo, was now smiling obsequiously.
“There’s no offense, but the surgery is still the surgery I mentioned, the situation is still the same situation, and the risks are still the same risks.”
“Tendon suturing carries a risk of rupture, a risk of a second surgery, and a risk of poor functional healing postoperatively.” Lu Cheng didn’t feel there was anything wrong with what the young strong man said. For a lower limb flexor tendon rupture in zone A3, which is a rupture at the musculotendinous junction of the gastrocnemius-soleus muscle, the preferred treatment is the Pulvertaft weave technique!
This suturing technique, even Master Tong Yuan’an hasn’t fully mastered it. Most of his surgical procedures are prepared for high-end hand surgery procedures such as finger replantation and tendon transposition, unlike Lu Cheng’s eclectic approach.
In the past, Tong Yuan’an used fascia embedding reinforcement combined with the modified Tang technique, and the postoperative results were acceptable.
But Lu Cheng, being ‘idle,’ and in pursuit of better treatment efficiency for patients, ‘practiced’ the Pulvertaft weave technique to try on patients.
After all, it is the primary recommended treatment method, and the effect is truly remarkable.
Moreover, the Pulvertaft weave technique has better therapeutic effects than the modified Tang technique with fascia embedding reinforcement. On average, it yields about 0.2 more skill points.
Therefore, for tendon ruptures in this area, Tong Yuan’an no longer performs them routinely in orthopedics and refers them to Lu Cheng.
After the young man had a go at Lu Cheng and then tried to seek treatment elsewhere… the outcome was predictable.
Even if he went to the Zhou People’s Hospital, they could only ‘make do.’ And this big brother demands ‘guaranteed results,’ so he definitely wouldn’t find a rash youngster in the county.
The young strong man smiled with a ‘relaxed’ expression, his fleshy face creasing into a smile: “Risks are risks! Who asked Doctor Lu to mention these risks?”
“Doctor Lu, I’ll sign, I’ll pay, I want the surgery, I won’t run away anymore.”
“If the surgical outcome isn’t good, I’ll just consider it my bad luck.”
The main reason the young strong man had a temper was that he had a bit of a network of contacts.
After inquiring through his contacts, he realized, ‘Good heavens,’ the person he called a troublemaker was actually an ‘expert’!
Even when Lu Cheng’s patients went to Jishi City for work and then had follow-up examinations at the Zhou People’s Hospital, many doctors there knew Lu Cheng’s name…
“Aren’t you going to the Zhou People’s Hospital anymore?” Lu Cheng asked again to confirm.
Patients have the right to informed consent and the right to refuse treatment, and also the right to be referred to a higher-level hospital for further treatment.
After all, Big Brother is knowledgeable.
