Chapter 123: Chapter 121: Crisis! The Challenge of Iatrogenic Biliary Tract Injury
Dean Tang also placed great importance on this matter.
Lately, Dean Tang had been championing the project to establish a national research center for laparoscopic diagnosis and treatment techniques.
And the cornerstone of this project was Wu Ting’s research on Daytime Laparoscopic Cholecystectomy.
The Hepatobiliary Surgery Department had been working overtime to perform Wu Ting’s new surgical technique in order to advance the research project and quickly build up a team.
After all, according to the current plan, once the research center was officially established, the corresponding publicity and promotional campaigns would have to follow.
Once they opened their doors, a massive number of patients would flood in.
Jiuhua Hospital, Saint An Hospital, and Haijin Port Hospital were all household names nationwide. With such a dream team, patients wouldn’t just come from within the province, but would be drawn by their reputation from surrounding provinces and cities as well.
One can only imagine how immense the pressure would be. Therefore, they had to build a team large enough to handle such a high volume of surgeries.
Relying solely on the Emergency Surgery Department was unrealistic. The Emergency Department needed to contribute some of its personnel, but it also had to reserve enough capacity to treat other patients.
Thus, the Hepatobiliary Surgery Department naturally became the target for incorporation and expansion.
For the Hepatobiliary Surgery Department, joining this research center was also an excellent opportunity.
Even Director Cai Qi’s name was listed on the project, so of course, the department’s doctors had to follow suit. The department offered its full support, from top to bottom!
It was under this very atmosphere and pressure that the Hepatobiliary Surgery Department, in addition to its senior attending surgeons, also attempted to train junior attending surgeons to perform the surgical technique.
The goal was to cultivate new lead surgeons as quickly as possible.
However, haste makes waste. Dong Feiyue’s recent medical accident sounded an alarm bell for the hospital, for the Hepatobiliary Surgery Department, and for the rapid first-phase development of the Emergency Department’s research center.
Wherever you have people, you have politics.
At City First Hospital, besides Dean Sun, the head of the hospital, there was also a Vice Dean, Dean Liu.
Dean Liu and Dean Tang were direct competitors in a zero-sum game.
This time, Dean Tang had ridden the wave of the Emergency Department’s repeated brilliant performances, gaining immense prestige and putting huge pressure on Dean Liu.
And now, just as Dean Tang was directing the Emergency Surgery and Hepatobiliary Surgery departments to break new ground, the Dong Feiyue incident occurred.
This type of iatrogenic bile duct injury was a classic complication, and one that all hospitals took very seriously.
Dean Liu also showed up uninvited to a provisional meeting he and Dean Tang called with Huo Yun and Cai Qi.
The main objectives were twofold: first, to create an emergency response plan for the Dong Feiyue incident, and second, to develop a protocol for handling such occurrences in the future.
As the representative of the department involved, Cai Qi was the first to report on the patient’s condition and analyze the cause:
"I bear unshirkable responsibility for this incidence of iatrogenic bile duct injury. Of course, there are both subjective and objective reasons for what happened."
"Objectively speaking, cholecystectomy is inherently a procedure with potential complications. The incidence rate of iatrogenic bile duct injury is approximately 0.1% to 0.5%."
"Generally, iatrogenic bile duct injuries occur mainly for the following reasons: First, a lack of clarity in the anatomy of the triangle of Calot, leading to the cystic duct being transected before the common bile duct and common hepatic duct are clearly identified."
"Second, an overemphasis on the ’daytime surgery’ concept led to the assumption that using the new surgical technique combined with National Medicine treatment would prevent all complications. This caused us to overlook the potential for bile duct injury that exists even in traditional procedures..."
"Third, the surgical field was not clearly exposed. The abdomen was not relaxed, preventing direct visual operation. Furthermore, the patient was obese and had severe adhesions in the triangle of Calot."
"These factors combined led to this accident."
"Of course, as for the human factor, we allowed a junior attending physician to lead the surgery prematurely. We did this because the new surgical technique was theoretically safer and less difficult. However, their lack of experience ultimately led to this outcome."
After finishing the analysis, Cai Qi felt conflicted and ambivalent.
"Deans, Director Huo, from my personal perspective, I definitely want to vigorously promote the Daytime Laparoscopic Cholecystectomy. I also want to quickly build a fully-staffed team of lead surgeons and, through the improvements in the surgical technique, promote junior attendings ahead of schedule."
"But the objective facts tell me... perhaps we cannot afford to be so blindly aggressive."
"Dr. Wu’s new surgical technique is not the problem. However, we must be selective about who performs it as the lead surgeon. It should be limited to senior attending physicians and above—doctors with enough experience to handle any potential issues."
"Director Huo, Dean Tang, I am truly sorry. Our department has dragged everyone down."
"After this incident, I have to correct our course. I’m taking all junior physicians in our department off lead surgeon duties for this procedure. We will maintain the standard of having only senior attending physicians and above perform the new surgical technique."
"We cannot allow the rate of iatrogenic bile duct injuries to rise for the sake of blindly expanding the daytime surgery program. That would be a great disservice to both the patients and us surgeons."
"Of course, because the number of senior physicians is limited, our department can now only provide thirty percent of the lead surgeons originally planned for the research center for laparoscopic diagnosis and treatment!"
After speaking, Cai Qi lowered their head, their spirits low.
Huo Yun wanted to say something, but faced with Cai Qi’s well-reasoned analysis, he, as a fellow department director, also felt that this was the responsible course of action.
Tang Long frowned. If they really followed Cai Qi’s proposal and only allowed senior attending physicians to lead the surgery, it would be extremely difficult to complete the first phase of the research center’s development using only City First Hospital’s own staff.
After all, the project had such a high profile, uniting three of the nation’s top hospitals. If they didn’t have the capacity to launch properly and handle the large influx of patients drawn by their reputation, it would be a devastating blow to the research center’s establishment and initial survival.
"Then we only have two paths to choose from. Either we recruit a sufficient number of senior attending physicians in a short amount of time."
"The second option is to see if we can improve and optimize the current protocol. Can we upgrade the technique so that junior attending physicians can perform the new surgical technique while avoiding iatrogenic bile duct injuries?"
Dean Tang felt as if a bucket of cold water had been poured over his head.
After listening to the reports and analyses from Huo Yun and Cai Qi, Dean Liu summarized:
"First, ensuring the safety of both patients and surgeons is paramount. Therefore, it is necessary for us to promptly issue a policy stating that physicians below the senior attending level are not permitted to act as lead surgeon for the Daytime Laparoscopic Cholecystectomy."
"Second, given our hospital’s current staffing and overall planning, it’s impossible to recruit so many senior attending physicians in such a short time for a project that isn’t even mature or fully implemented. That option is out. Besides, the hospital has already allocated a significant amount of funding and resources to the Emergency Department for this research center. We can’t continue to divert resources from other departments for this project."
"That leaves only one option: the Emergency Department and the Hepatobiliary Surgery Department must find a way to modify and improve the surgical technique to solve this problem of iatrogenic bile duct injuries with junior doctors. I am also aware that further refining and optimizing the surgical technique in such a short time is a nearly impossible task."
Dean Liu continued to add:
"According to Dean Tang’s current plan, the inauguration and promotional campaign for the research center is just two weeks away. Invitations have already been sent to television stations, relevant media outlets, leaders from the Health Bureau, and experts in the field. Professor Ma, Professor Shen, and Professor Jin from the three partner institutions will also be in attendance... The matter is urgent. We cannot let a project of such milestone significance for City First Hospital end up as a laughingstock."
Dean Liu’s expression was grim:
"So, this is no laughing matter. If you can’t solve it in time... even if you manage to get through the inauguration ceremony, how will you operate afterward? How will you handle the massive influx of patients drawn by the hype? And after admitting them, how will you face a drastically increased rate of iatrogenic bile duct injuries?"
Listening to Dean Liu’s sharp line of questioning,
Dean Tang fell silent, his gaze shifting to Huo Yun and Cai Qi.
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