The Returning Doctor Wanted to Live Quietly - Chapter 376



Only Noblemtl

Episode 376. Decided to Live Quietly (8)

Ball tip syringe.

The so-called ball tip syringe.

It wasn’t a typical syringe, as its name suggests.

So there were no needles to dig into the blood vessels.

Instead, what is attached to the end is a round, circular iron ball.

It was a syringe that enabled washing without tissue damage.

Jinhyuk, grab the pancreas right now.

The opposite side that Jang Hyuk-jun restrained.

So, I started cleaning the inside of the bile duct in the pancreas.

A possible blood clot.

Glassy tissue.

Even to pieces.

This was a cleaning procedure done because a foreign body may have entered during the frozen section examination.

Right after.

“Please give me 5-0 prolene (suture).”

Jang Hyuk-jun changed his surgical tools.

Forceps.

And the needle holder.

He moves his hands as if he is afraid of receiving it.

Pull to the left.

Back to the right.

And then back to the left.

It was the so-called continuous suture.

And the hand movements were neat.

Proper tension.

Invisible dead space (empty space).

Up to the margins where the ends of the sutured tissue are slightly raised.

The basics were good too.

The level of proficiency was also excellent.

Because all of this has been trained.

One of the missing puzzles that Korean doctors had at that time.

In other words, it was possible because the surgical experience was supplemented.

* * *

Back to the situation before the frozen section examination.

Unclip and check the patient’s condition.

“It’s better than I thought.”

“What are you going to do now?”

“We should do it the right way.”

“Do you want to do further testing?”

“Yes, of course. Just in case.”

But I was notified as positive.

To also examine other areas within the common bile duct.

The proverb that says you should test a stone bridge before crossing it was very fitting.

Of course, this is something you can’t do if you don’t have confidence in your abilities.

Jinhyuk looked at the pancreas and asked.

“Shall we do some work on the stand?”

“Let’s go safely?”

“yes.”

“Then let’s go right away.”

“Please give me a needle holder and forceps.”

“Here it is.”

“Let’s go.”

The voices mix for a moment.

Jinhyuk, who had even received the suture, moved his hands.

We plan to resect and examine the common bile duct that has penetrated deep into the pancreatic tissue again.

First, pull the surrounding tissue.

Begin to place the tissue with sutures.

Two on the left.

Two more on the right.

And the three above.

Four more below.

Like tying the joints of a marionette doll with string.

The surrounding tissue is secured with sutures, of course, with just the right amount of tension.

Then Jang Hyuk-jun stepped forward.

“I think this is enough.”

“How much will it cost?”

“First, we need to secure as much insulation as possible. Just go 3cm.”

“Let’s do that.”

A short question and answer.

At the end, Jang Hyuk-jun started to make a fuss.

* * *

That moment.

A deep, muffled noise was erupting from the observation room.

A condition in which the tumor penetrates deep into the pancreatic parenchyma.

Pancreatic fluid may leak after surgery.

Another complication could arise.

But.

“Too blunt… … .”

The Korean doctors, who obviously knew this, showed no hesitation in their hand movements.

Digging in.

Digging in again.

And moderation.

so.

“Ugh… … .”

“Heh heh… … .”

“Big, big.”

A flood of unnecessary reactions are pouring in.

How I feel when I see my wife who just got behind the wheel.

It was more terrifying and thrilling to see it from a distance.

But the surgeries continue despite them.

Frozen section examination was also performed again.

hereto.

“Ha… … I don’t think I hit the pancreas that hard.”

“Still, my flesh is shaking.”

“Should I give you some attention?”

“Are you trying to interrupt the performance?”

“That’s not it, but… … .”

“Just watch.”

“Hmm.”

Once again opinions were divided.

Let’s just believe and watch.

The one who is half in doubt with a half-hearted expression.

And the distrustful side.

During the outpatient treatment.

Or between surgeries.

If Jinhyuk had seen the judgment of the doctors who rushed over during their free time, he would have laughed.

If you were that worried, you could have just pushed yourself to schedule it like Korean doctors do.

But then he refused, saying that other people would make the same request.

It was just a lot of talking.

While the observation room was so noisy.

The operating room was making rapid progress.

Take tissue samples.

Then place it back in the formalin solution.

Simple freezing process.

Even the process of sending it to the pathology lab was completed smoothly.

There is no rest even while waiting for the test results.

Remove the sutures installed for placement.

It was sutured again.

* * *

Two positive reactions.

Fortunately, it wasn’t malicious.

However, it is a situation where moderation is necessary because it can develop into malignancy at any time.

This time, Jinhyeok and Jang Hyeokjun’s hands were directed towards the duodenum and mesentery.

A structure as complex as its name.

A peritoneal fold extending from the hilum to the upper part of the duodenum.

Again to the left is the hepatic plexus.

A hole in the wall to the right.

Anterior and posterior are the hepatic artery and portal vein.

And it was where the bile duct passed.

The tissue is then pulled upward to expose the portal vein and hepatic artery.

Jang Hyuk-jun took a breath.

“The context is too messy.”

“Shall I kick it out and go?”

“What do you think the side effects will be when I take it off?”

“hmm…….”

“It’s positive, but… … .”

“Yes, it is positive.”

“But it can still develop.”

“Hmm.”

Those who hesitate for a moment.

If it was malignant, the lymph nodes around the vein would have to be removed en bloc.

But the patient is positive.

However, looking at the patient’s lifestyle, it was unclear at what time the disease might develop into malignancy again.

So the doctor’s judgment was important.

Jang Hyuk-jun, who had been thinking for a while, made a decision.

“Moderation is minimal.”

“Okay. Okay.”

A tetralogy.

A tetralogy.

The work progressed in silence for a while.

Simplifying the vascular structure of the portal vein.

It was just preliminary work, but it was going very difficult.

Leave what needs to be left behind.

If something has to be removed, it will be removed.

Something I wouldn’t have done if I hadn’t thought about the patient.

It was like claiming to be a high-difficulty surgeon.

After a while like that.

The intrahepatic artery was fully revealed.

Without any time to enjoy it, additional peeling work continued.

But soon.

“uh?”

An organization larger than expected comes into view.

Lymph nodes located beneath the hepatic artery.

It was enlarged, unlike other lymph nodes.

It was also brightly lit.

Right now.

“Additional frozen section testing will be included.”

Jang Hyuk-jun played with his hands.

* * *

This is already the third frozen section examination.

The observation room was as quiet as a mouse.

Now there was no one to doubt his abilities.

Of course, it would be normal if you tidied everything up and went in.

Korean doctors who took the difficult path.

Even the doctors who were half in doubt all had faces of approval.

That’s a choice for the patient.

And the high-difficulty approach.

No, it was an approach that was usually not possible without confidence.

Notification arrived shortly thereafter.

Fortunately, it was positive again.

but.

“This time, you’re being restrained.”

“Eliminate any possible risks… … .”

“Save what needs to be saved.”

“So you’re saying that what needs to be killed will be killed.”

They each said a word to each other.

He didn’t say much.

A situation that is completely recognized as a surgical procedure.

Amilon and Nakamura, who had entered the observation room late, could not help but bite their lips at that sight.

What kind of skill is this?

To be honest, I invited you because I knew you could do it to some extent.

I never dreamed it would be like that.

No, honestly, to this extent… … .

‘They say you can become an associate professor at most… … .’

In Germany, where surgery is performed slowly, it is only possible after accumulating years of experience.

Even if you become a fellow, they treat you like a slave.

The power of the Korean medical community is truly amazing.

While they were talking like that.

Jang Hyuk-jun and Jin Hyeok were removing the plexus of nerves (a complex collection of nerve fibers formed by the complex anastomoses of nerve roots or peripheral nerves) around the enlarged lymph nodes.

As if pulling it out by the roots.

It is literally like cutting down trees and roots.

At this, Dr. Amilon raised his voice as if he had something to find fault with.

“It seems like you are exfoliating the periarterial plexus excessively.”

“… … .”

“If you do that, the risk of developing a pseudoaneurysm increases. I think it’s too much.”

As he kept raising his voice, the gazes of the onlookers changed strangely.

One of them turned his head towards Amilon.

“Why can a pseudoaneurysm develop?”

“Wouldn’t it damage the arterial lining?”

“okay?”

“Yes. When you remove the nerve plexus, you can’t help but touch it… … .”

“Does it look like you’re touching it now?”

“yes?”

Amilon, who asked a question belatedly, looked at the monitor installed on the left side of the observation room.

A monitor with high magnification, unlike the large monitor installed in the center.

His pupils shook slightly.

It is a structure that clearly cannot help but touch the arterial sheath.

When using an electric cautery device, damage to blood vessels is unavoidable.

Mechanically.

Just be careful.

And yet quickly.

The plexus was removed without any damage to the arterial sheath.

This time, it was not Jang Hyuk-jun, but Lee Jin-hyeok, who came in as an assistant.

“No… … . How can it be like that… … . without even using a vascular elastic band to pull it out?”

When Amilon stuttered,

Someone said.

“Yeah. I didn’t even put a rubber band on it to temporarily compress the blood vessel.”

“… … .”

“I just did it because I thought that excessive traction could put a strain on the blood vessels. So just shut up and watch.”

As the harsh words came out, Amilon took two steps back.

* * *

The surgery is gaining speed.

Transection of the right hepatic artery.

Ligation.

Traction of surrounding connective tissue including lymph nodes.

Everything happened quickly.

“Should I pull a little more?”

“That would be great.”

“Just a moment.”

“That’s enough.”

This time, Jinhyeok started putting a vascular rubber band on Jang Hyeokjun to help him.

Until a little while ago, they said they just pushed for surgery because it could cause blood vessel damage.

Because this time there was no reason to do so.

So, the context was like this: a rubber band was put on the blood vessel and pulled to the right.

Again, the proper hepatic artery was traction to the left.

At this, Jang Hyuk-jun waved his hand.

The connective tissue around the hepatic artery and portal vein is peeled off in the longitudinal direction.

The problem is.

“uh…….”

The bile duct is attached to the left portal vein.

It was a state of complete adhesion.

Jang Hyuk-jun, who had been silent for a moment, rolled his eyes.

He himself took over as the surgeon in Jinhyeok’s place.

They said they could discuss it right away, but he was the one who had to carry it.

Isn’t that the role of the surgeon?

“… … .”

But I quickly dismissed that thought.

Where did Liu Bei establish the Shu kingdom because he was good at fighting?

As for the copycat, there’s Zhuge Liang.

Again, the generals include Zhao Yun, Guan Yu, and even Zhang Fei.

He was a mat seller who became a king by using people well.

so.

“What should we do?”

I asked coolly.

Jinhyuk’s answer was quick.

“First of all, I knew that my inflammation levels were high before I went into surgery.”

“That’s true.”

“Do not forcefully remove the adhered area.”

“Should we just ignore it?”

“Yes, because the goal is reconstruction after bile duct resection anyway.”

“Okay, then. Give me the Bulldog clamps.”

“Please give me some too.”

The clamp ends are striped.

The handle grip is a strangely shaped spring-loaded clamp.

Each one moved around, carrying one of the surgical tools that could avoid damaging blood vessels or tissue.

One bulldog clamp on top.

Place two more below again.

Then the blood flow is blocked.

Keep moving your hands without stopping.

Right portal vein blood flow blockage.

Ugandan glass.

Transection of the superior mesenteric membrane.

Transection of the deltoid ligament.

Hepatorenal resection.

In addition to that.

“The area between the liver and the adrenal glands is favorable, so we expose it starting from the inferior vena cava.”

We will proceed with additional work.

Add a handful of lies.

So much so that you can’t see your hands.

Cut.

Ligation.

Suture.

Cut again.

Between the exposed inferior vena cava.

So, we quickly work on the single veins that exist in more than 10 places.

Sometimes with a metal clip.

Sometimes with continuous sutures.

Sometimes with Tonsil forceps.

Looking at them like that, this time it was Dr. Nakamura who blushed.

“Who is Dr. Jang… … No, more than that, Dr. Lee, who assists Dr. Jang… … .”

This is absolutely ridiculous.

Jang Hyuk-jun’s skills are also great, but Lee Jin-hyeok, who assists him, is also a monster.

I was starting to feel ashamed of having bickered with them.