There was a low chance the interventional procedure could truly save the woman from pain and misery.
Zheng Ren had made some mental calculations and realized his estimation from a few days ago had been too optimistic. The success rate of the surgery was less than 20%.
He did not like the numbers.
Once he arrived at the emergency wards, Zheng Ren gave out some instructions before quickly heading for the on-call room; there, he laid on the bed and entered the System.
The air in the System was cool and refreshing.
The water in the lake rippled with life.
The fox statue was on its four limbs before the thatched cottage, its eyes gleaming in the light. Zheng Ren felt its gaze follow him wherever he went.
He tried to communicate with the little fox, to no avail.
The System had always been distant and that was not about to change today.
Zheng Ren shrugged. He bought some training time and entered the System's operating room.
Adenomyosis was considered a non-deadly disorder, but in Zheng Ren's eyes, it was comparable to cancer. Both were debilitating diseases that deserved his full attention.
It was especially so when those infirmed were getting younger and younger, affecting women who had yet to have children.
He could spare some time to experiment in the System in hopes of finding an alternative to a hysterectomy.
The training room rose from the ground, a simulation mannequin lying ready on the operating table. Zheng Ren did not rush to the surgery but looked through the patient's presurgical tests and scans.
The scans showed that this case of adenomyosis was confined to the cervix.
With that in mind, Zheng Ren could visualize the path of least resistance to the target site.
It was a path to victory; he was sure of it.
The surgery began.
The System conjured up a string of simulation mannequins with focal adenomyosis at the cervix.
From the System's behavior, Zheng Ren postulated that interventional surgery was not suitable for the diffuse variant of the disorder.
Being in the System's space did not mean Zheng Ren could make just any procedure work.
The cause of adenomyosis was unknown to this day. The general consensus was that the thinning submucosal layer of the uterus triggered endometrial tissue proliferation in the myometrium.
Zheng Ren performed artery superselection and studied the contrast image for any signs of abnormality.
Tissue proliferation would often be accompanied by angiogenesis.
During superselection, contrast agent was administered to color the blood vessels. They appear black against the bright background.
Zheng Ren successfully located the vessels supplying blood to lesions in the uterus.
The subsequent steps were simple. He proceeded with injection of the embolic agent, then follow-up imaging to confirm that the vessel was completely blocked. It was a successful surgery, in Zheng Ren's opinion.
However, the System disagreed. The completion bar was at only 60%!
Barely a pass.
The whole procedure had taken less than 20 minutes.
Barring any life-threatening emergencies, this would have been a straightforward surgery that Zheng Ren could perform with his eyes closed.
Su Yun had implied something similar during the emergency surgery to address the pelvic fracture hemorrhage.
However, Zheng Ren was worried about complications as that patient was not in a stable condition.
Now, he was sure he had made the right choice. What was he missing?
The 60% kept haunting him.
Where was the problem?
Zheng Ren took a break from the surgery and went to sit beside the lake, ruminating on the task at hand.
Just like the TIPS surgery, it was best to sharpen one's axe before chopping wood.
At this stage, he was stuck at 60% completion for surgical treatment of focal adenomyosis.
What would he do next?
Zheng Ren took a trip down memory lane, revisiting books and journals he had read.
Many of them were largely to do with general surgery, especially the liver. There was little that contributed to adenomyosis.
He spent a long time thinking, his mind calm and collected.
Department Chief Qian was handling patient communication and that would need at least half an hour to an hour. This was not a life-or-death surgery like the TIPS surgery had been.
Adenomyosis… problem… surgery…
A question popped into his mind. Could it be the imaging?
Zheng Ren's method of imaging had always been superselective. He would only begin it at the third or fourth branch of artery.
Many doctors did not like this method because superselection was time-consuming and meant prolonged exposure to radiation.
However, it allowed the surgeon to be more accurate.
Why was the surgery still incomplete? Perhaps there was more than one site with adenomyosis.
There were possibly cl.u.s.ters of cells spread across the myometrium that had yet to grow into a pronounced mass.
Like seeds of grass, some cl.u.s.ters were still dormant. The procedure only addressed the fully-grown weeds, not the seeds deep within the soil.
Right!
Zheng Ren smacked his t.h.i.g.h in realization.
The pain was a jolt to his senses.
He regretted his action and swore to keep his excitement at bay in the future.
His precise imaging method could be the cause of the incomplete surgery.
Zheng Ren chuckled as he called forth the operating room again.
This time, he did not overdo superselection.
Once the guide catheter was in the uterine artery, Zheng Ren began imaging.
As expected, a complex network of vessels appeared onscreen.
The more condensed network indicated the initial embolization site while the less concentrated networks were potential problem areas.
Zheng Ren would try to embolize the remaining vascular networks.
The vessels feeding into the adenomyoma were larger than the capillary network that Zheng Ren had treated during the prostate interventional surgery. This would be an easy task.
One by one, Zheng Ren delivered the embolic agent into the feeder arteries. The progress bar at the top right corner of his vision ticked towards 100%.
60%... 65%... 70%...
After 2 hours and 12 minutes, the surgery was finally complete.
100%!
A grim smile was on his face when he saw the time.
He had turned a minor procedure into a major one.
Despite the laborious process, Zheng Ren was glad to thoroughly complete treatment of adenomyosis.
Only he could achieve such precision and accuracy.
A Grandmaster rank in interventional surgery was no joke.
Chapter 319 - Unimportant Matters
Zheng Ren exited the System.
The success in the System's operating room had given him great satisfaction.
Although the procedure was not for all forms of the disorder, he was content with it being effective for focal adenomyosis.
His phone rang.
"Chief Qian, hello.
"Alright, we will begin preparations.
"Please bring the family to the emergency ward, I will brief them on the procedure."
The conversation ended.
Zheng Ren left the on-call room and saw Su Yun in the office playing a mobile game, thumbs tapping away furiously at the screen. He was probably gaming and texting at the same time.
"Su Yun, the family has agreed to the surgery. Go ahead and prep," Zheng Ren ordered.
Su Yun made a noise of acknowledgment. He pocketed his phone, a smug grin on his face.
Zheng Ren shook his head. This manwhore; he could smell the pheromones from meters away.
Professor Rudolph was listening intently to Chang Yue's explanation of the
local medical scene and did not notice Zheng Ren's arrival.
Sitting at one of the computers, Zheng Ren typed out the consent form.
As this was a rare disorder and the patient was suffering multiple fractures, the informed consent doc.u.ment had to be tailor-made.
Zheng Ren carefully listed down each possible complication. His typing was agonizingly slow.
A moment later, the patient's family was gathered in the room. Zheng Ren vaguely remembered the young man.
He asked the man to take a seat with a gentle smile to soothe the nerves.
The man had received a non-stop barrage of bad news that would have made anyone else crumble.
Zheng Ren began his explanation of the procedure. Rather than recite the doc.u.ment he had just made, he spoke about adenomyosis.
The most important detail to convey to the family was not the potential complications but the special circ.u.mstances surrounding the patient. There was no way to determine if the adenomyosis was focal or diffuse.
If surgery found that it was diffuse adenomyosis, they would abandon this course of treatment.
Communication went on smoothly.
The young man had brought the patient to many hospitals, including larger hospitals in Imperial and Sorcery Capital, in hopes for treatment.
He had some basic understanding of the disorder. Between the multiple hospital trips, he had decided that he would accept hysterectomy were there no alternatives.
His choice was clear; between the potential for generating a new life and protecting an existing one, he would choose the latter. It was the patient who could not give up the idea of biological children. She was adamant about bearing a child before going for surgery.
The man had even thought of how to console her after the hysterectomy.
Needless to say, he was shocked when Zheng Ren bring up the possibility of alternative treatment.
Professor Rudolph Wagner turned and said, "Zheng, did I hear you mention adenomyosis?"
"Yes, professor," Zheng Ren confirmed.
"My lord, do you have a sure-fire way to treat focal adenomyosis?" the professor exclaimed, gesticulating wildly.
"It would only work for focal adenomyosis. A hysterectomy remains the only solution for diffuse adenomyosis."
"Staying back was the best decision I made. You surprise me every week," Professor Rudolph Wagner said dramatically.
"I don't think this counts as a surprise, professor. Focal adenomyosis has always been treatable."
"But no surgeon can guarantee success. Zheng, I hear the confidence in your tone and I believe you."
Zheng Ren waved dismissively. He was still in the midst of informing the family.
The young man stared at the foreigner whom Dr. Zheng had called the professor. Was he the expert on this case?
"Professor, sir, do you understand Mandarin?"
"Yes, but I'm a bit slow and I can't understand dialects," the professor replied.
"What is your expertise?" The young man stood and approached the professor, hope sparkling in his eyes.
He had visited hospitals more equipped than Sea City General Hospital and received negative responses from them all, filling with him justifiable doubt. Zheng Ren's suggested procedure was a last ditch effort in his eyes.
"Interventional surgery," the professor said.
The answer prompted the young man to bow before the professor. "Can I request that you operate on my fiancee?"
Professor Rudolph Wagner was taken aback by the man's gesture. His head swiveled to Zheng Ren and back again.
The man noticed the odd expression on the professor's face. Perhaps he had said something wrong.
There was an odd tension in the air.
"Zheng, did I misinterpret your words earlier?" Professor Rudolph Wagner asked quizzically.
"What words?"
"When you said you could treat focal adenomyosis through interventional surgery with confidence."
"No," Zheng Ren said.
"Then, why is this young man asking me to perform the surgery? I will likely have only half your confidence," Professor Rudolph Wagner said in confusion.
The young man was at a loss. He looked between the professor and Zheng Ren but could not decipher the relationship between the two men.
Zheng Ren smiled. He did not blame the poor fellow.
"Young man, I'm from Heidelberg University in Germany. The purpose of my visit is to invite Zheng to Heidelberg for a collaboration, to research new methods and build a new research lab. I believe only Zheng alone can perform this procedure," Professor Rudolph Wagner clarified.
The young man was stunned. When did Sea City have such talent?
Were they pulling his leg?
"If you agree to the terms, sign this. Preparations in the operating room are almost done," Zheng Ren said, tapping the paperwork in his hand.
The surprise remained on the young man's face.
"Relax. If I can't complete the procedure, we still have this German professor here, right?" Zheng Ren said with a smile. It did not matter whose skill was greater as long as it worked to reassure the family.
The young man's eyes glimmered with sincere gratitude. He gave both Professor Rudolph and Zheng Ren a bow of respect before signing the doc.u.ments.
Zheng Ren received the paperwork and nudged the professor. Together, they departed for the operating room.
"Zheng, do your people not know you have the hands of God? Unbelievable," the professor remarked.
"Recognition is not important to me. As a doctor, my focus is solely on treating patients. That's all," Zheng Ren said, smiling.
Chapter 320 - A Northeastern Slang
On the operating table, the patient's lower body was held in place by a plaster cast, her breathing assisted by a ventilator.
"Why did it take so long? I thought the family was rather compliant." Su Yun was already at the operating table, all set and ready to go.
"The guy spotted the professor and requested he perform the surgery," Zheng Ren replied as he scrubbed his hands.
Su Yun's eyes widened before bursting into laughter.
He entered the operating theater in a sterile surgical gown, but as he was closing the lead door, his phone rang loudly from the inside the control room.
Zheng Ren halted. "Have a look."
Chu Yanran checked the number. "Emergency department," she called out.
It was one of Zheng Ren's fears: having one ongoing surgery while another emergency case required his attention. It was manageable with the added manpower, but still not ideal.
He made his decision. "Su Yun, go check on the emergency."
"Can you handle the surgery alone?" Su Yun asked while taking off his gloves, despite his faith in Zheng Ren.
"Yes."
"Zheng, I can step in as your assistant," Professor Rudolph Wagner interjected abruptly. "This pretty old lass's1 condition shouldn't be too complex."
"..."
"..."
"..."
Zheng Ren and Su Yun were momentarily baffled.
Old lass? Pretty old lass?
The foreign accent and the Northeastern slang was an odd combination coming from the professor's mouth.
Su Yun held back his laughter as he removed his surgical gown, leaving for the emergency department while pulling on his white coat.
He wanted to ask about the choice of slang but prioritized emergency cases over gossip.
It could be anything from acute appendicitis to a major emergency. It was best to bring his A-game.
Although Old Chief Physician Pan was available, Su Yun did not want to trouble the old man unless it was critical.
In the operating room, Zheng Ren's brows furrowed. "Who taught you that?"
Professor Rudolph Wagner was amused by the question. His words had stunned the young doctors.
"Chang taught me. She said 'old lass' was equivalent to 'little miss' in this district," the professor said.
Chu Yanran pursed her l
ips to hide her laughter but her shaking shoulders betrayed her.
This joker, Chang Yue, was toying with the foreign professor.
The age gap between the professor and the patient was not wide enough to warrant the title.
"Scrub in." Zheng Ren swept the issue under the carpet. He would speak to Chang Yue later to convince the professor to leave. Although the man's presence had brought an international flair to their department, it was getting on Zheng Ren's nerves.
Professor Rudolph Wagner happily went to put on a lead apron and scrub in.
Zheng Ren began artery cannulation, placed the introducer sheath and inserted the guide wire.
When the professor was done at the sink, Zheng Ren said sternly, "Professor, be quick. I'm switching on radiation."
The professor was taken aback. He struggled to find the words as he said, "Zheng… Boss Zheng, it's too soon to turn on the equipment. The radiation is bad for you. The X-rays may be directed but scientific—"
"The guide wire is already in position. If all you want to do is talk, please stay in the control room," Zheng Ren said, interrupting the professor's lecture.
He had gone off to scrub in and this man had already reached the target site? Professor Rudolph Wagner was filled with disbelief but he quickened his pace to keep up.
Chu Yanzhi laced up his sterile surgical gown and sent him back inside. The lead door shut tight. Without waiting for the professor, Zheng Ren commenced imaging.
[Another international surgery… Can we request some neurosurgery?]
[Neurosurgery would be a good topic to livestream. It'll definitely benefit us, broaden our horizons.]
[Quiet down. The surgeon is treating an adenomyosis patient. I'm not familiar with this disorder and am looking it up on Moudu1.]
[You're a doctor but you need to search for a disorder on Moudu? Embarrassing.]
[Adenomyosis is a complex disorder that's hard to cure, according to Moudu.]
Routine banter picked up as the livestream started on Xinglin Garden.
By the time Professor Rudolph was done and ready to assist, Zheng Ren was already analyzing the imaging display.
"Boss Zheng, you didn't perform superselection before imaging. Isn't that too reckless?" the professor commented.
Zheng Ren had once thought Su Yun's snide remarks unbearable, but Professor Rudolph Wagner's incessant commentary was far worse. He found himself wanting Su Yun back if only to remove the professor from the operating room.
The Surgeon's Studio c1-799 Page 152