Chapter 68: Chapter 68: A Major Challenge for the Department: A Super-Elderly Appendicitis Patient
Before officially performing an umbilical port laparoscopic appendectomy, Wu Ting planned to go through a transitional period and find a suitable patient.
Before attempting the new procedure, Wu Ting planned to perform several conventional laparoscopic appendectomies first. He also invited Luo Ming and Cheng Feng to be part of his initial team.
After all, he had been working with Luo Ming and Cheng Feng the most lately. Cheng Feng, in particular, had both talent and a good disposition.
Wu Ting had already studied the five-year plan Director Huo had previously given him. As long as he could assemble a research group and produce significant results, he would receive support in the form of funding, equipment, research projects, and personnel.
This way, he wouldn’t have to use the surgical division of the Emergency Department’s single permanent position. He could make use of the research group’s ’outstanding talent acquisition’ program.
Through the talent acquisition program, not only could Cheng Feng stay, but he would also receive better compensation and more opportunities for future development.
With the Scar-Hiding Laparoscopic Appendectomy (Purple), Wu Ting was full of confidence.
When he heard Wu Ting invite him to assist with a laparoscopic appendectomy, Cheng Feng was thrilled.
"Brother Ting, thank you so much."
Cheng Feng had great aptitude; he just lacked opportunities. Wu Ting was confident he could train him to become an important asset in the future.
As for Luo Ming, he was already experienced with appendectomies and had held the camera for laparoscopic surgeries before. He would be Wu Ting’s primary camera assistant!
Luo Ming was naturally thrilled and felt fortunate to be able to join Wu Ting’s research group.
According to Director Huo’s plan, Wu Ting’s research group was entitled to 3% of the project’s profits. As long as their surgical volume went up, this would be a very substantial income.
With the backing of Wu Ting’s state-of-the-art technique and the motivation of generous financial returns, the team’s future was naturally limitless!
As Wu Ting was leading Luo Ming and Cheng Feng through a routine laparoscopic appendectomy, a very unusual patient arrived in the Emergency Department.
The patient, Zhang Ying, was an 89-year-old woman diagnosed with acute appendicitis. She also had concurrent conditions of coronary heart disease and hypertension.
The attending physician who first saw her was Song Qi, who immediately went to find Deputy Director Jiang Ming.
With the increasingly severe trend of an aging population, the incidence of acute appendicitis—the most common acute abdominal emergency—is also rising annually among very elderly patients over 80.
Over the years, City First Hospital had admitted some of these very elderly patients with acute appendicitis, but in the past, many of them were ultimately transferred to a higher-level hospital.
Therefore, Song Qi’s intention was clear: he wanted to transfer the patient.
In the conference room, Song Qi reported on the patient’s condition.
"Director Jiang, the patient is 89 years old and has concurrent coronary heart disease and hypertension. Her organ function is in marked decline, and her overall physiological condition has seriously deteriorated to a decompensated state. The initial clinical symptoms of her acute appendicitis were not obvious, and by the time it was discovered, her condition had already progressed rapidly. Perforation could easily occur, leading to diffuse peritonitis... The situation is highly pessimistic..."
"I recommend we notify the family as soon as possible and transfer her to a higher-level hospital."
Song Qi had a conservative approach and was well aware of the limits of his own medical skills.
Hearing Song Qi’s suggestion, Jiang Ming frowned. He was still a young man, full of ambition.
"Under normal circumstances, a transfer would be fine. But right now, our department is pushing forward with the appendectomy research project. If we transfer patients the moment things get tricky, it’ll be a huge blow to the department’s morale."
"The goal of our current project is to surpass the top provincial standards, and even pioneer a signature Surgical Technique for our department. If we can’t even handle a single case of a very elderly appendicitis patient, how can we find the motivation to continue our research?"
"Alright, since we can’t come up with a good solution ourselves at the moment, go get Director Huo. Also, contact Director Zheng from General Surgery to join us for a consultation."
"My position is clear: our department absolutely must handle this surgery!"
"Besides, don’t you think that treating such an elderly appendectomy patient would make for an excellent case study? It would be great material for getting our department featured on the ’Path to Health’ program."
"Understood."
Song Qi felt a wave of emotion. Since Wu Ting’s arrival, Jiang Ming had become increasingly assertive. ’This new generation of young people really is full of drive!’
Soon enough, Director Huo and Director Zheng arrived at the conference room.
After assessing Zhang Ying’s condition, Jiang Ming turned to Director Zheng.
"Director Zheng, do you have a good solution?"
Looking at the patient’s various physiological metrics, Director Zheng’s expression grew troubled:
"A traditional open appendectomy is out of the question; the trauma would be too severe. However, a laparoscopic appendectomy also presents significant difficulties and uncertainties."
"Laparoscopic appendectomies require establishing and maintaining a CO2 pneumoperitoneum pressure of 13 to 15 mmHg to ensure adequate exposure of the surgical field and to facilitate the procedure."
"As you all know, pneumoperitoneum affects the body’s physiological functions. It can cause an increased heart rate, elevated blood pressure, decreased cardiac output, increased airway pressure, and a drop in SpO2..."
"Given that the patient has diminished physiological function on top of her hypertension and coronary heart disease, the surgical risks are simply too high."
Director Zheng reflected on his surgical career and shook his head:
"I don’t think a conventional laparoscopic appendectomy is feasible. I wouldn’t recommend it."
"Not unless we can devise an entirely new, modified approach that solves the pneumoperitoneum issue."
After Director Zheng finished, Huo Yun also mulled it over and sighed:
"That’s a difficult proposition, Director Zheng. Without inducing pneumoperitoneum, the abdominal cavity is too cramped. There’s simply not enough exposure of the surgical field, and it’s very difficult to maneuver. What’s more, without enough space, we can’t make accurate judgments, and we risk causing an incisional infection."
"With a patient this old, we can’t accept any significant, obvious risks. If we truly can’t find a solution, it’s better not to operate at all."
Huo Yun offered his opinion. The patient’s situation was so unusual that, for the moment, even his vast experience left him at a loss.
"If it really comes to it, why not contact the provincial experts? We could hold an inter-hospital consultation?"
Jiang Ming suggested his idea.
"There’s a risk with the timing. For a patient this old, the condition progresses differently than in a normal person. It’s too aggressive, and there are too many uncertainties. An inter-hospital consultation takes a long time to arrange, and even then, there’s no guarantee the provincial experts can propose a treatment plan immediately."
"If we miss the optimal treatment window because we were organizing a consultation, we won’t be able to answer to the family."
Song Qi voiced his concerns from the side. Seeing that all the directors were stumped, he stuck to his original suggestion:
"Why don’t we just notify the family right away and transfer the patient to a higher-level hospital? If we can’t come up with a perfect solution in the end, we’ll just be wasting her time."
Zheng Duqing frowned. It was a true dilemma. But the option of simply transferring her to a higher-level hospital felt disheartening and a bit like admitting defeat.
Suddenly, a young figure came to Zheng Duqing’s mind.
"Oh? Why isn’t Dr. Wu here? During the recent exchange at the Military Hospital, Dr. Wu demonstrated a profound mastery of appendectomies."
"Dr. Wu is in surgery with Luo Ming and Cheng Feng, performing a laparoscopic appendectomy. It’ll be a while before they’re out."
"In that case, let’s wait for Wu Ting to get out of surgery and have him take a look. Let’s see if he has any ideas."
Jiang Ming didn’t have high expectations for Wu Ting in this case, but he had to admit that Wu Ting’s past performance demonstrated a wide-ranging knowledge of cutting-edge techniques, both domestic and international, and a knack for applying them flexibly.
"I’ll contact Yasui right now and have him wait outside the OR. He can bring Wu Ting over the moment he’s finished."
