Surgery Godfather

Chapter 2223: Chapter 1451: With Him by My Side, the Surgery Is Already Half Successful

The next morning at eight, Yang Ping arrived at the Operating Room.

Xia Shu was already inside, looking at the film with the light on the wall, and turned around when he heard the noise.

"Professor, you came really early."

"How’s the situation?"

The patient had already been brought into the Operating Room, prepared for anesthesia.

Xia Shu pointed at several marks on the film saying, "I checked again, the calcified plaques of the right internal mammary artery are mainly concentrated at the proximal end, the distal two centimeters are clean, and the anastomosis can be set at the distal end."

Yang Ping nodded, took the film from Xia Shu’s hand, and looked again, one by one. This was his habit for many years: no matter how thoroughly the pre-operative preparations, he must personally review all the imaging data before going on stage. It wasn’t a matter of distrust in the team, but there is no "almost" on the Operating Table, only "certain" and "uncertain."

"I’ve seen the great saphenous vein angiography," Yang Ping flipped to the next one, "The great saphenous vein in the right lower limb is completely unobstructed, with a diameter of three to four millimeters, no varicosities, can be used, but there is a segment of tortuosity in the left lower limb, so we abandon it."

"I’ll have Dr. He retrieve it," Xia Shu said.

Yang Ping clipped the films back in order to the viewing lamp, his eyes landed on the last vascular angiography. It was the heart’s coronary artery tree, like a withered old tree, the branches covered with plaques and calcification, with only a few weak collateral branches still barely maintaining blood supply.

"This heart, it’s a miracle it lasted until today," Yang Ping said softly.

Xia Shu didn’t respond; he knew Yang Ping wasn’t expressing sentiment but conducting an assessment: assessing how much reserve this heart still had, assessing how much the blood pressure could drop during anesthesia induction at its limit, assessing if it could withstand extracorporeal circulation if it must be used.

Anesthesiologist Old Zhou pushed the door open, holding a freshly printed lab report: "Professor Yang, the platelet function re-evaluation results are back, suppression rate has dropped to forty-eight percent."

"Still high!" Yang Ping took the report, "But better than yesterday, using tirofiban to reverse during surgery, combined with platelet transfusion, should be controllable."

Old Zhou nodded, turned around to make preparations. He was an old anesthesiologist at Sanbo Hospital, needing few words.

Yang Ping, Xia Shu, and Li Zehui walked together to the scrub sink and began scrubbing their hands. Yang Ping felt the cold iodine spread from his fingertips to his forearms as he scrubbed, mentally rehearsing the surgery procedure: opening the chest, retrieving bridging blood vessels, exploration, anastomosing... each step breaking down into more detailed actions, each action corresponding to possible surprises and response strategies.

This was his unique skill, each surgery rehearsed in his mind at least three times: first in ideal condition, second with common surprises, third with extreme conditions. After three rehearsals, he could be sure on stage.

"Director Xia, the patient’s blood pressure is fluctuating," the anesthetist nurse reported.

Xia Shu donned his Surgical Gown, put on gloves, and quickly walked to the Operating Table, the assistant having already completed the disinfection draping.

The patient was a 67-year-old male, thin, pale, with an old scar in the center of his sternum from a bypass surgery ten years ago. Xia Shu glanced at the monitor: heart rate eighty-two, blood pressure one hundred and five over sixty-two, blood oxygen saturation ninety-four percent.

"Induction completed?" he asked the anesthesiologist.

"Just completed, blood pressure dropped fifteen millimeters of mercury, now stabilized."

Xia Shu turned his head to look at Yang Ping, who nodded.

"Let’s start," Xia Shu said.

Xia Shu was the Chief Surgeon, Li Zehui acted as Assistant, and Yang Ping observed from the side, ready to help when needed.

The electric knife cut through the skin, following the old scar, layer by layer downward. Subcutaneous Tissue, Muscle, fascia... Xia Shu’s actions were not fast, but each step was precise and unerring. The scar tissue adhesion was more severe than imagined, and he patiently alternated with scissors and electric knife for separation, occasionally pausing for the Assistant to suction away ooze.

"Sternum saw,"

Xia Shu took the sternum saw and sawed in the middle of the sternum. This was one of the most dangerous moments of the entire surgery; the calcified aorta lay just behind the sternum, and if sawed too deep, it might directly rupture the aortic wall.

He slowed down, letting the saw blade penetrate downward bit by bit. Li Zehui gently pushed aside the mediastinum tissue to expose a clearer view.

"Stop!" Xia Shu suddenly said.

The saw blade stopped less than a centimeter from the aortic wall; he put down the sternum saw, switched to the periosteal elevator, and slowly separated the remaining tissue behind the sternum. This maneuver was much slower than sawing through directly, but much safer.

"All right, continue!"

The sternum was fully split, retractors opening the chest cavity. The Heart was exposed in view, covered with a thin layer of fat, dark in color, weakly beating. Xia Shu’s gaze first fell on the aorta; it was a segment of gray-white, rock-hard blood vessel, its surface rough and uneven, even a gentle touch revealed its disturbing brittleness.

"More calcified than on the film," Li Zehui whispered beside him.

"That’s why it’s called an ’exceptional’ case," Xia Shu didn’t lift his head.

"I’ll start freeing the right internal mammary artery," Li Zehui said.

His actions were gentle and precise, like embroidery as he detached the internal mammary artery from the chest wall, preserving it intact along with the surrounding fat pad and accompanying vein.

Xia Shu focused on examining the Coronary Arteries, gently fingering the heart’s surface, feeling the vessels’ course and hardness. The location of the left main was almost completely occluded, leaving only a hair-thin slit. The mid-section of the left anterior descending had a relatively normal vessel, about eight millimeters long, barely enough for an anastomosis. The obtuse marginal branch, posterior descending branch, posterior left ventricular branch... he touched each in turn, constructing a vascular map in his mind.

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