NOVPUBChapter 1006 -1008: New Ideas (Extra 10 for Qingyan Xiaoguan)
Chapter 1006 -1008: New Ideas (Extra 10 for Qingyan Xiaoguan)
After Chen Cang was ready, Ford and his team arrived in the operating room.
Several doctors and assistants were present as well, but they stood in the distance, looking at the operating table without speaking.
Ford surveyed the operating room and suddenly locked eyes with Chen Cang, and he was momentarily stunned.
What did that look mean?
It seemed a bit like… encouragement?
Ford was a bit puzzled. It seemed similar to when he first entered the hospital and his mentor had looked at him with satisfaction, saying, “Study hard!”
At this moment, Ford’s nurses brought in the surgical instruments, apparently… ready to take over the surgery at any moment.
Though the Whipple procedure is a relatively effective treatment for tumors such as pancreatic cancer, its efficacy still can’t be considered fully satisfactory.
Especially for cancer of the head of the pancreas, which has the worst prognosis!
The prognosis for other types of cancer was slightly better, but the overall resection rate was only 30%, with both the surgical mortality rate and the five-year survival rate after resection around only 10%.
Thus, the procedure demanded high precision and meticulousness at every stage.
Likewise, this was where Ford and his team’s confidence lay—they had ample clinical experience and strategies to cope!
Even in the field of digestive tract reconstruction, there had been significant advancements.
Ford watched Chen Cang, seeing his calm demeanor with not even a hint of ripple, which piqued his curiosity even more.
This young man didn’t seem nervous at all; did he not understand the difficulty of the Whipple procedure?
Perhaps… ignorance is bliss!
Ford believed that during the surgery he would be able to point out many of Chen Cang’s shortcomings and mistakes, even planning to write a paper on it to be published in an American medical journal.
The surgery was about to begin!
The anesthesiologist, who was the head of the anesthesia department, had already been sufficiently communicated with—it would be an open surgery.
The choice was continuous epidural anesthesia, which would last longer, have milder reactions, relax the abdominal muscles well, and facilitate exposure.
Seeing this, Ford almost couldn’t help but laugh: were you really planning to perform an open Whipple procedure?
At Mayo Clinic, these surgeries were almost all done laparoscopically now!
Ford suddenly felt as though he was experiencing a downgrade…
“Dr. Chen, are you going to perform open surgery?” Ford still couldn’t help but ask.
Chen Cang didn’t turn around, but said to a nurse beside him, “Scalpel!”
When Ford saw this, his face reddened for a moment.
Chen Cang had already discussed this with the anesthesiologist; choosing to perform open exploration was a necessary step to decide whether resection was possible!
Because the elder was at a very early stage, with not too much metastasis, Chen Cang’s initial plan was to preserve some tissue and resect some.
This was also the surgical approach he had been researching and exploring recently.
If they were to perform a traditional Whipple procedure, given the old man’s physical condition and long-term diabetes, Chen Cang was certain that the survival period wouldn’t be long.
Even a perfect pancreatectomy would be useless!
This was an inherent flaw of the surgery itself.
That’s exactly why Chen Cang had fought for the chance to perform the surgery—because he knew if Ford did it, a total resection would be inevitable. The only difference from a layman’s procedure would be in the digestive tract reconstruction, where Ford could arguably perform a bit better.
That was where the gap between Ford and Chen Cang lay.
As Chen Cang’s skills in pancreatoduodenectomy reached perfection, combined with those nearly perfect biliary-intestinal anastomoses… impeccable gastrointestinal sutures, and so on, Chen Cang had come to realize a certain truth.
That was the inherent imperfection of the surgery itself.
The deeper he delved into his research, the more the imperfection of surgery became apparent to Chen Cang.
There is no such thing as a perfect surgery; it’s merely the tallest dwarf, the best of the bad options. Only when absolutely necessary, he could perform the surgery better, and the relative chance of complications would be a bit lower.
Therefore, Chen Cang didn’t pay any attention to Ford. What he needed to do next was to perform one good surgery.
Taking the scalpel, Chen Cang made an incision beside the right upper abdomen of the elderly patient.
The incision was small, but its position was ideal for extending upwards and downwards, fully exposing the entire digestive tract.
Once the abdominal cavity was exposed, Chen Cang began his examination.
The gallbladder was of normal size, which was good; the cancer of the pancreatic head hadn’t caused any pathological changes in the gallbladder by compressing the bile duct.
When Chen Cang touched the head of the pancreas with both hands, he clearly felt a burst of information.
“Pancreatic head cancer: very early stage, recommended excision!”
After feeling the tumor in the head of the pancreas, Chen Cang’s next step was to open the duodenum to inspect and confirm the development of the pancreatic head cancer.
This procedure was risky, as it could easily lead to the spread of the tumor or the introduction of intestinal bacteria into the abdominal cavity and should generally be avoided unless particularly necessary.
Sun Guangyu watched Chen Cang anxiously, not daring to take a deep breath.
Although they had discussed the surgical plan, he was still a bit nervous.
Ford was equally astounded!
Chen Cang was dancing on the head of a needle!
After finally getting a clear view of the internal structure, he breathed a sigh of relief.
What had to be decided next was whether to proceed with the excision and if it could be done radically.
He had to examine whether the tumor itself had spread beyond the glandular tissue and invaded important blood vessels such as the portal vein, the superior mesenteric artery and vein, the abdominal aorta, the inferior vena cava, and others.
At this moment, Chen Cang directly opened the posterior peritoneum on the outer side of the duodenum and flipped the duodenum and the head of the pancreas inward!
Afterward, he carefully probed the back of the head of the pancreas and the abdominal sides of the aorta and inferior vena cava with his left index finger.
Being able to insert a finger into this space indicated that the tumor was still confined to the pancreas without metastasis.
Fortunately, there was no metastasis!
This process required a three-step check, but Chen Cang took more than a dozen steps, taking into account all that he could think of.
This… could never be achieved with a laparoscopic surgery.
Minutely and precisely.
Time ticked away, with Chen Cang inspecting very carefully.
At last, the examination was completed!
Chen Cang looked into the abdominal cavity, and the four-dimensional model began to simulate continuously. After two minutes, Chen Cang started to move!
Next, he had to fully separate the organs to be excised.
But at this critical juncture, Chen Cang suddenly did not separate the stomach but began to mobilize the biliary tract!
Following… with the hemostatic forceps ready, he made the first cut in a Y-shape below the common bile duct and at the pancreatic location.
Then he executed a clever separation, and at that moment, the pancreas suddenly became mobilized!
This baffling maneuver left everyone watching speechless!
At this time, the head of the pancreas was not to be touched, and surgeries on the duodenum, stomach body, or even the biliary tract all needed to be properly ligated before excision to prevent the spread of tumor cells.
Yet now, Chen Cang had separated the biliary tract from the pancreas, freeing the bile duct!
This move left Ford, standing behind, dumbfounded!
What was happening?
Chen Cang took a deep breath; he had been extremely cautious with that last move, fearing adverse consequences. His eyes, already sharp, were now intently focused!
He was completely absorbed in the process!
What he aimed to do was not to excise the bile duct but to cleverly achieve an excision effect through separation.
So far, the effect was good!
At least, the difficulty of the bile-enteric anastomosis later on would be reduced.
