The Surgeon’s Studio

Chapter 303: Stent-in-stent (Part 3 of 4)

In the live surgery broadcasting room, the video feed froze. Viewers waited for a few seconds, checked their Internet connections and, puzzlingly, found no issues with the latter.

[Why aren’t they moving?]

[The surgery isn’t complete yet. It can’t possibly be finished after the puncture alone.]

[I wanted to see if the surgeon would apply a unique method to connect the hepatic and portal veins.]

A few bullet comments passed by, confirming that it was not a connection problem. The confusion only deepened.

Were there any other surgical methods they were unaware of? Was it going to be like the previous emergency surgery broadcast, where two surgeries were aired at the same time?

[No, the oxygen saturation in the patient’s blood is declining!]

It did not take long before the issue was spotted.

Due to lag, changes to blood oxygen saturation due to aspiration were only just being broadcast, but no physician observing could miss them.

Before any of them had the time to process the shock, though, the operative field of the live surgery broadcast began to move again.

However, it was different from before, shaking tremendously like a documentary filmed with a hand-held camera.

It was nausea-inducing.

Those more prone to motion sickness were more heavily affected.

What had happened?

Through the operative field, the 10 mm stent graft was moving forward rapidly, advancing to the portal vein through the guide wire to find the mark left behind by the angiographic needle.

[Damn… I can’t watch this anymore. What’s going on?]

[Did the patient vomit blood again?]

[Very likely! Aspiration could have happened. Still, is the surgeon continuing the surgery under such circumstances?]

The viewers quickly guessed what had transpired.

However, the horror of the situation was too much to bear; most remained in denial.

It was almost over, but the patient had abruptly vomited so much blood… Was the surgery still going on?

Even though the surgeon persisted, many watching doctors had given up hope.

It was already extremely difficult to insert a stent in a stationary patient, let alone one in this state.

In the operating room, the patient’s blood oxygen saturation was rapidly falling.

Chief Xia held the aspirator in her hand, stunned. Ten seconds? Would he be able to do it? It would still be manageable if the patient was deprived of oxygen for three to five minutes.

However, under such circumstances, it was better to fix it as early as possible.

Zheng Ren was asking for ten seconds…

As Chief Xia looked on, Zheng Ren and Su Yun had their eyes fixed on the screen. Zheng Ren was at full speed inserting the stent graft along the guide wire towards the puncture site between the portal and the hepatic veins.

Su Yun was trying his best to keep the guide wire in place, adjusting for the patient’s movements to buy more time for Zheng Ren.

When unable to judge the scale of movement, Su Yun pushed the guide wire further in despite the damage within the blood vessel. It was better than withdrawing the wire and having to restart the entire surgery from the beginning.

After the 10 mm stent graft was in place, it was dilated and deployed against the vessel walls of the portal and hepatic veins.

The surgery was complete!

“Chief Xia, commence suction.” Zheng Ren was not relieved yet. Aspiration could be life-threatening.

At his cue, she inserted the aspirator into the patient’s nasal cavity.

At the same time, she compressed its outlet periodically and removed blood clots from the patient’s nasal cavity, oral cavity and airway with every pump.

It had only been a short while and the patient was not in a good condition, so the matter had not been sucked too deep into the airway.

In less than three minutes, all the dark red blood clots were removed.

The patient’s blood oxygen saturation began to rise.

“Zheng Ren, is it done?” Chief Xia asked with uncertainty.

“We’ve completed the first part,” he answered. He had no intention of packing up and leaving the operating table yet.

Su Yun was still holding the guide wire in the patient.

The first part? Chief Xia did not understand.

What was going on?

After another two minutes, the patient was visibly calmer with no signs of agitation. Oxygen saturation of the blood returned to 98%.

“You guys can leave,” Zheng Ren said.

Without hesitation, Chu Yanran and Xie Yiren left the operating room with their lead aprons.

He sounded like a department chief giving orders. Chief Xia was startled for a moment before following the other two out.

“8 mm stent graft,” Zheng Ren ordered.

Su Yun passed him the finer stent and he began inserting it along the guide wire.

[Damn… the surgeon’s technique is incredible!]

[How did they manage to insert that? I really admire that, it’s amazing.]

[I’m speechless. This surgeon managed to pull off an emergency TIPS surgery. Too bad we can’t download the whole process, it’s the perfect operation.]

Xinglin Garden was flooded with praise from doctors.

However…

The surgery was not over yet!

Another stent graft was inserted through the guide wire.

[What kind of operation is this? Anyone care to explain?]

[Yeah, wasn’t the stent graft successfully deployed? What is this stent for?]

[Could the surgeon be so busy that they forgot about the previously inserted stent?]

Their wild speculations did not seem likely, as they were not general or interventional surgeons.

This was because specialists from both those departments had turned off the bullet screen to avoid the comments from blocking their view of the surgery.

Double-stenting, also known as stent-in-stent, was a modified method recently developed by general and interventional surgeons to help with post-operative symptoms of hepatic encephalopathy.

If they began grafting with a smaller stent, the encephalopathy would be kept under control but the tract formed between the veins would be too narrow to reduce portal pressure.

With two stents, the tract would be narrowed as well, minimizing bleeding after surgery. Removal of the second stent could be decided later depending on the degree of hepatic encephalopathy to treat pressure buildup in the portal vein.

This was the most appropriate measure.

Of course, there was also a huge obstacle.

Stent-in-stent required both stents to overlap accurately, leaving no room for error.

Any unevenness would disrupt the stability of the inner stent and risk it being dislodged by blood flow.

The consequences of that… would be very serious.

Zheng Ren had chosen to do this without hesitating.

The System’s monitor at the right upper corner of his vision had reported that the patient was showing symptoms of hepatic encephalopathy. Mild though they were, they would worsen with time and could be life-threatening.

The doctors watching the broadcast stared at their phone screens silently and unblinkingly.

Stent-in-stent; this surgeon was truly ambitious!

Did they not know when to stop? Completing the TIPS surgery under emergency conditions was hard enough; yet, this doctor was already looking at the patient’s postoperative hepatic encephalopathy complications?

How confident was the world’s top surgeon?