Perfect Surgeon 128
Perfect Surgeon chapter 128

Episode 127.

127.

Liver transplantation opened the way for transplantation without waiting for organs from the brain dead.

While waiting for a brain-dead organ donor, his condition worsened and he could lose his chance, but there was no concern for living liver transplantation.

The biggest advantage was that the liver to be transplanted was of excellent quality because it did not undergo the process of brain death.

Among them, the two-to-one liver transplant was a method in which the right and left lobes of the liver were obtained from two donors, respectively, and transplanted into the patient.

It was a surgical method developed to reduce the burden on the donor as much as possible.

What Hyun-jun was trying to do now was to deliver the liver cell function to the patient while maintaining it in the best state.

Standing between the patient’s crotch, Hyunjun moved his hand while looking at the 3D stereoscopic screen.

The bile duct was not yet fluorescent because the required time had not passed since the ICG was injected.

“I am going to have a gallbladder removed. Please raise the right 15 degrees.”

The operating table was tilted and the patient’s posture was changed.

When the gallbladder was sufficiently exposed on the screen connected to the camera due to the change of posture, Hyunjun pushed the gallbladder up to the right side of the patient through the lateral trocar.

In time, Ronnie’s advice adequately aided Hyun-jun.

[It is not the feeling of pushing up the gallbladder, but the feeling that the liver does not cover the triangle of Calot to secure space.]

‘OK.’

According to Hyun-jun’s delicate movements, the space needed for the operation was secured in an instant.

I could feel slight fluctuations from the steps in the fast paced process.

After checking the Calot triangle and common bile duct, Hyun-Jun opened the curtain using CUSA (Cavitron Ultrasonic Surgical Aspirator, an equipment that crushes the liver parenchyma using ultrasonic vibrations and suctions and removes the crushed tissue).

The CUSA that Hyunjun is using now has an electric cauterizer integrated into it.

“The gallbladder duct, dissection of the gallbladder artery.”

While checking the tissue with his eyes, Hyeon-jun slowly but quickly peeled off the funnel area of ​​the gallbladder.

Hyun-jun, who gave the first signal to Song Seon-hee, located on the patient’s left armpit, opened his mouth.

“Song, please suck the fat.”

“Yeah!”

Song Seon-hee answered vigorously.

In the second year, the two of them were working as housekeepers and assistants, but she did not tremble at all.

Hyun-jun was more reliable than any of the surgeons she assisted.

‘Who would think of this person as a second-year resident?’

Nursing team leader Lee Do-kyung stuck out his tongue in his calmness. He was worried that he was only embarrassed by himself.

After she had stopped worrying about unnecessary things, she concentrated and assisted Hyun-jun, who started the work.

As the operation progressed, Hyun-jun was entering a state of hyper-focus.

It had long since disappeared from his mind that the surgery was now being broadcast live on ILTS.

Rather, Team Leader Lee Do-kyung peeked at the screen showing the conference hall.

The conference hall, which was initially empty, was gradually filling up as the operation began.

“Team leader, Professor Joo, please check the operation progress every 30 minutes. How far have you gone now?”

“Yeah. It is now in the mobilization phase.”

“Yeah.”

Mobilization.

The fluidization of the liver during the surgical procedure was the next step in cholecystectomy. It meant that Professor Joo had already completed the cholecystectomy that Hyun-jun is doing now.

‘You’re fast too.’

The liver resection site differed between the left and right lobes, but since it was the same operation, the operation speed was compared openly.

However, there was nothing good about one being faster.

After all, both livers had to be prepared before the transplant could be performed.

In other words, the key to determining the overall operation time was Hyeon-jun’s operation speed.

‘Let’s increase the speed a little more.’

Hyeon-jun, who had been careful because it was the first time, moved his hand while concentrating on the screen again. His hands got faster and faster.

“fan retractor.”

“Yeah.”

After cholecystectomy, Hyun-jun entered the stage of mobilization like Professor Joo.

He lifted the liver up using a fan retractor and continued dissection from the right triangle ligament to the right adrenal gland.

“Ultrasonic shears.”

Hyun-jun, who incised three ligaments in order, confirmed the inferior vena cava.

“Umm.”

While watching the operation from the side, team leader Lee Do-kyung suddenly realized that Hyun-jun’s operation resembled Professor Joo Kwang-wook.

‘The face and personality don’t look alike, but… … .’

Hyun-jun pointed out as soon as the hand delivering the device slowed slightly.

“manager.”

“Yeah?”

“Concentrate.”

“Yeah!”

In the operating room, the surgeon was the captain and king.

Regardless of the age, the operation could proceed properly only if everyone followed the surgeon’s instructions.

Team leader Lee Do-kyung, who sticks out his tongue inside the mask, felt as secure as when assisting Professor Joo Kwang-wook.

‘… … They also have a bit of a personality.’

Hyeon-jun, who captured the atmosphere of the operating room, dissected and ligated the interstitial vein, then dissected the upper part of the inferior vena cava to confirm the inlet of the right hepatic vein.

[The small hepatic vein is ligated.]

‘5mm or more?’

[The lower right hepatic vein greater than 5 mm is not ligated, but is ligated immediately before liver resection.]

Hyunjun nodded his head.

This is because first ligation can cause liver congestion and damage to the graft.

‘OK.’

The liver, which is composed of more than 300 billion cells, is the largest organ in the body.

About one-third of the blood in the human body is stored, and almost one-third of the blood that purifies in the body passes through the liver each time.

The surgery was that difficult.

Numerous blood vessels were passing through, so if bleeding occurred, blood was constantly flowing and it was difficult to find the bleeding point.

This was the reason why Hyun-Jun is wrestling with thin veins that a normal person would not be able to distinguish.

“tape.”

With sophisticated laparoscopic instrumentation, a suspending tape was inserted between the right hepatic vein and the middle vein.

It was truly a movement that brought admiration.

Coex conference hall at the same time.

“Oh my… … Such precise movements with a laparoscopy… … .”

A British doctor who was mesmerized by the screen of surgery Hyun-jun was performing expressed his surprise over and over again.

“fantastic. I cannot see this alone.”

Most of the doctors were still watching the robotic surgery in Room A, and even if they were in Room B, they tended to focus on Professor Joo’s screen.

However, more and more doctors were watching Hyun-jun’s operation from all over the world.

The doctor pulled out his cell phone and texted Dr. Chase at the same hospital who was watching robotic surgery in Room A.

A reply message came right away.

-what’s the matter? Come to Room B now?

-How about robotic surgery?

– Huiyu, that’s great. He’s doing a sophisticated liver resection with robotic surgery. Also Korean doctors. how about that

– It’s amazing. It has gone beyond what we know of laparoscopic surgery.

-Yes? Is that enough? What stage are you at now?

-Uh, both donor surgeries went into mobilization. Oh, Dr. Joo is a cholangiostomy.

-to? already? It’s very fast. Wait, I’ll go there now.

Professor Joo Gwang-wook looked at the screen and explained the next step to the attendees.

It was a feature of live demonstrations.

“Next is cholangioplasty. As you can see on the screen, the bile duct is differentiated from the surrounding structures and is fluorescing. This allows for faster and more accurate surgery. Then we will proceed.”

Near-Infrared Fluorescence Light Guided Surgery, a surgical method developed by Hyunjun, for short, NIRFGS was explained in English by the chairperson of the society.

The two chairpersons were in charge of explaining the surgical procedure and discussing it at the same time next to the screen.

“This week’s surgical technique by the professor’s team seems to show that laparoscopic liver transplantation has no limits.”

“The amazing surgical skills and the new technology called NIRFGS are added, so the surgery time will be shorter than before.”

“It will be less burdensome for the patient.”

“It is a surgical technique for patients that is convenient in many ways.”

The camera attached to the NIRF 3D glasses showed the screen that Professor Joo Kwang-wook could see as it was in the conference room.

As he explained, Professor Joo Kwang-wook was rapidly exfoliating the bile ducts that glowed beautifully with fluorescence.

“Unbelievable!”

“Wow!”

Cheers erupted in the conference hall like a concert hall. Since there were not many people, the sound was also great.

The seemingly cool doctors cheered on Professor Joo Kwang-wook’s team’s surgery.

To those who didn’t know, it looked like a national competition rather than the president of a medical society.

Unlike robotic surgery, NIRF surgery was a method that could be used in their hospital right away.

That fact made them particularly excited.

“I want to use it in our hospital surgery as soon as possible!”

“Look at that speed. How could you be that fast?”

“Are Korean doctors wizards? … .”

The cheers from Room B in the conference hall seemed to have reached Room A as well.

The doctors began to fill the empty room B one by one.

‘It’s comfortable too.’

Professor Kwang-Woo Joo removed the bile duct while checking the running of the common bile duct, on bile duct, and right bile duct.

As the wavelength of near-infrared rays could be seen through the film attached to the 3D glasses, the fluorescence surrounding the bile duct was clearly distinguished from the surrounding structures.

Naturally, the speed was inevitably faster than when dissecting the bile duct in general.

The problem was the movement.

He couldn’t keep concentrating and the pace slowed down by beats.

“This teacher. Concentrate.”

“… … Yeah!”

“More than anything else, for now, just focus on the patient’s well-being. That’s all in the operating room.”

Lee Dong-shin nodded his head without saying a word.

Prof. Joo, who took his eyes off the screen for a moment, looked at Hyun-jun’s surgery screen, who developed this amazing surgical technique.

‘Is the guards peeling off?’

Hyun-jun’s surgery was proceeding at a speed not significantly different from his own.

‘Who, if you are careless about this, it will be reversed.’

After becoming a transplant surgeon, Professor Joo, who is known as the owner of unparalleled surgical skills in liver transplant surgery, whistled inwardly at the speed of Hyeon-jun’s operation.

At that age, he was a doctor who knew nothing.

After a really long time, his excitement was activated, and he smiled slightly and concentrated on the operation again.

On the other hand, Hyeon-jun’s face, who had a Glissonian incision on the door in the operating room next door, was not as good as Professor Joo thought.

The commonly used method to block blood flow to the liver was the Glissonian approach.

In laparoscopy, the angle of the instrument was limited, so it was not easy to dissociate the hepatic region.

Rather than dissecting the hepatic artery, portal vein, and bile duct separately, the Glysonian incision method was easier to perform with less bleeding.

However, Hyun-jun chose an intermediate method to get a more perfect liver transplant.

By the way.

‘Strange… … .’

Hyeonjun’s hand, which was moving quickly, stopped.

As the focus of his eyes was blurred, his senses were abnormal.

Of course, Song Seon-hee and the staff also looked at Hyun-joon with puzzled eyes.

‘Ronnie!’

[Analyzing. My heart is beating faster.]

Even if it wasn’t Ronnie’s words, the heartbeat reached her ears.

‘What’s wrong?’

Perfect Surgeon chapter 128

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