Chapter 1013: Chapter 1013: Liu Banxia’s Surgical Teaching
(Thanks to Zilian Shijiu Shouyue for encouraging with the virtual ticket)
"Teacher Liu, is the preparation almost done, should we head over now?"
Xu Yino approached Liu Banxia’s side.
Liu Banxia rubbed his face, "Let’s go, directly to the operating room, swiftly finish the work, and then we can have a good rest for the afternoon."
Xu Yino was somewhat surprised because she unexpectedly felt Liu Banxia’s nervousness. This was rarely seen before; even during the surgery for the child the day before yesterday, he hadn’t shown it so evidently.
When he arrived at the operating room, the patient was already waiting there, and the observation room in the operating room was filled with people.
"Xu Yino, let’s get ready." Liu Banxia said.
Xu Yino nodded, and once again verified information with the patient, as is necessary in the procedure. After the verification was complete, Liu Banxia nodded to Wang Lei, indicating that anesthesia could start.
"I’ll say a few words before the surgery." Liu Banxia stated.
"With the development of medicine, the equipment has become more advanced. For many of us doctors, there are more choices during operations."
"This is something that makes us surgeons happy, but also brings some headaches. Which type of surgery should be chosen for the patient has become a new problem."
"Because we have too many surgical options available, we instead don’t know which to choose. If it were up to me, the surgery that causes the least harm to the patient and that you’re proficient at is the one to recommend."
"The reason I chose the NOSES technique for this patient is to reduce an incision for specimen extraction, which is very beneficial to the patient."
"NOSES surgery has its basic techniques, all available in fundamental materials, so I won’t introduce them one by one. There’s one thing I want to emphasize, and that’s the basic principle of this surgery. Xu Yino, start with the puncture and exploration."
Listening seriously, Xu Yino hastened to operate, more or less doing the procedure as explained.
"The fundamental purpose of our surgery is to help the patient relieve their ailment." Liu Banxia continued.
"I believe whether it’s minimally invasive or not isn’t important; what’s vital is this point. If we haven’t achieved the basic goal, what’s the significance of this surgery?"
"Once the basic goal is achieved, we employ minimally invasive techniques to enhance it further. Relative to this operation, we are adding another flower on the minimally invasive foundation."
"During the operation, we must be particularly careful not to overlook the ’sterile and tumor-free’ requirements of NOSES surgery."
"Otherwise, it would be a disaster, a disaster you led that threatens the patient’s life. This can’t be brushed off as mere negligence; it reflects a disregard for crucial requirements, only seeing the new technique."
"This is why multiple indicators are required for the NOSES surgery to ensure patients eligible for this type of surgery."
"These are fundamental theoretical knowledge, and I’ll emphasize during the upcoming surgery. Actually, today’s operation is relatively simple; the preliminary work is laparoscopy, followed by specimen extraction later."
"Teacher Liu has finished exploration; no adhesion seen among abdominal organs, no apparent cell metastasis, no ascites. Rectal cancer resection under laparoscopy and specimen extraction via natural orifice is feasible." Xu Yino reported.
"OK, let’s start directly; you handle the preliminary separation." Liu Banxia instructed.
Though Xu Yino felt some stage fright, she didn’t dare delay. She knew too many people were focusing on this surgery today; a mistake can’t be made at Liu Banxia’s expense.
"Routine laparoscopic rectal cancer resection is actually simple; the difficulty lies in the mid to late stage, the challenge being the process of specimen extraction." Liu Banxia continued.
"We return to the issue I mentioned earlier; the essence of this surgery is ’sterile and tumor-free.’ Even if cumbersome, we must exhaustively protect while extracting specimens."
"For some initial patients, we have many choices. Just like with our current patient, whose tumor isn’t large, making specimen extraction straightforward."
"However, when performing NOSES surgery on certain patients and the specimen is large, during extraction, overpressure might cause specimen rupture, causing fluid reflux into the abdominal cavity."
"Even with protective tubes and sleeves, this can occur during operation. What if it happens? I believe we shouldn’t tackle this problem when it arises."
"We should provide preemptive protection; my idea involves this. First, place the hard tube, then insert the sleeve from the puncture area, and be cautious while loading the specimen."
"To avert specimen reflux into the abdominal cavity during extraction, we can use a simple method: extend the sleeve a bit longer, granting ample space for fluid flow."
"Maybe the extended sleeve might go unused, but when the specimen truly ruptures, we’ll find even that bit we reserved is pretty charming."
"Even if ligated robustly, oversight may happen; while operating on patients, comprehensive protection is needed regardless of patients’ awareness."
"I’ve also viewed some NOSES surgery videos; some colleagues noticing small tumors, don’t use sleeves and directly deliver specimens via hard tubes, which I find unacceptable."
"Because during delivery, friction might dislodge cancer cells, causing new pollution. I deem combined methods for specimen protection more favorable."
Listeners nodded consistently; although that step hadn’t been reached yet, what Liu Banxia expounded were key issues integrating his comprehension of NOSES surgery.
As he said, surgery aims to alleviate patients’ condition distress.
If trivial issues arise during specimen extraction, not only does it fail to help the patient, but it leads to abdominal cavity contamination—which isn’t minor.
Of course, the patient lying on the operating table is unaware. Even if tumor recurs later, they’d presume incomplete cancer cell removal from their body.
However, in actuality, it might be related to errors during surgery.
Those without conscience wouldn’t care about these; anyway, the surgery’s completed. Even if recurrence occurs much later, nothing traces back.
Yet, as conscientious doctors, we must fundamentally prevent such scenarios.
Liu Banxia understands this point thoroughly; the crucial part is the ’sterile and tumor-free’ principle during surgery. If these aren’t considered beforehand, if you only know to do NOSES, are you qualified?
Through Liu Banxia’s explanations, people discerned his choice of this technique wasn’t for show; it was researched, with a certain comprehension of this surgery.
"Xu Yino’s separation is decent; over such a long period, she’s done related separation work often." Liu Banxia added.
"There’s no need to delve into these separation points; they’re basic knowledge. Steady, accurate, decisive, swift—achieve these four points, and it’ll be fine, a very easy matter."
"Although Xu Yino didn’t specify the tumor’s actual situation earlier, it isn’t her negligence; they had comprehensive discussions preoperatively, ensuring clarity on tumor location and size."
"Exploration isn’t merely for recognizing known facts, it’s purely validation. Critically, it’s for detecting situations overlooked during equipment checks."
"Alright, the separation’s almost done. I’ll take over the next phase. Li Hao on the tube, Huang Bo First Assist, Liu Yiqing Second Assist, prepare for detachment."
Following Liu Banxia’s words, those observing the surgery started feeling tense.
The next phase is the pivotal point of surgery; previous was merely preparation.
"Shuwen, indeed, this lad is adept at surgical explanation. How long was his preparation?" Chen Zhenxing asked.
"Twenty minutes, I informed him impromptu this morning." Zhou Shuwen responded.
"Only prepared for this short duration?" Chen Zhenxing scarcely believed it.
"Yes, it actually indicates he devoted considerable effort to this surgery. Moreover, he’ll give a surprise in this surgery." Zhou Shuwen stated.
"What surprise? Isn’t it a routine NOSES surgery, could he have new tricks up his sleeve?" Chen Zhenxing queried.
"You’ll know upon seeing; whether tricks are present rests on his judgment post-detachment and specimen extraction." Zhou Shuwen chuckled.
"But I think it’ll be enlightening for many here. This lad, sporadically, doesn’t settle down. Just from today’s talk, I reckon some colleagues might be displeased."
"What if they’re displeased? Isn’t Banxia right? Specimen extraction should be well contemplated beforehand." Chen Zhenxing pronounced.
"Surgery is meant to help patients, not to display anyone’s skills. A good surgery solely bases itself on the patient’s prognosis as the standard."
Zhou Shuwen smiled, abstaining from further comment. Since Liu Banxia took over, the pace slightly quickened.
Even if speed isn’t pursued, ensuring surgical quality while being swift would undoubtedly be better.
Liu Banxia’s operations were decisive; after clipping, the intestines were straightaway placed into protective sleeves, cautiously dragged through the anus.
Up till now, the demonstration effect of this surgery was remarkable.
However, many were surprised Liu Banxia seemed to lack intent to use a bowel anastomosis device.
