godfather of surgery

Chapter 1446 The Battle for Talent

Chapter 1446 The Battle for Talent

Yang Ping hadn't experienced this kind of casual conversation in the operating room in a long time, so he listened with great interest.

He leaned against a stool in the corner of the operating room, a position that wouldn't obstruct the nurses' busy movements while still allowing him to have a clear view of the entire operating room.

Director He Xiangjun's lecture on "how to win over a single PhD at the research institute" left the nurses stunned. Several young nurses blushed, but couldn't help but listen intently. The scrub nurse was so engrossed in listening that she almost missed handing over the instruments. Dr. He had to call out "drainage tube" three times before she snapped out of it, causing those around her to suppress their laughter.

As Yang Ping watched this scene, the corners of his mouth unconsciously turned up.

An older nurse chuckled and said, "Director He, are you here today to provide marriage counseling? Why don't you just switch careers and go work at a matchmaking agency? I guarantee your business will be booming."

"I'd love to, but unfortunately no one invites me," Director He said seriously. "My biggest flaw is that I'm too enthusiastic and can't stand seeing young people single. Think about it, how pitiful it is for someone to be all alone, coming home to no one to talk to. Besides, it's always better for two people to work together than for one to fight alone. Look at Xia Shu, since he married Cai Qiaojun, he's completely different. He performs surgeries better, he can talk again, and even his hair is neater than before."

Upon hearing his name called, Xia Shu looked helpless: "Director He, could you please stop using me as a negative example?"

“How did I use you as a negative example? I’m a positive example! A benchmark! A role model!” Director He said emphatically. “Look at you. When you first came to Sanbo, you were as dull as a wooden post, and you couldn’t even speak properly. And now? You can answer questions right away! This is all thanks to Cai Qiaojun.”

Xia Shu shook his head and stopped talking, but the barely suppressed smile on his lips betrayed his true feelings.

Watching this scene, Yang Ping suddenly realized that this is what a hospital should be like. It's not just about cold, impersonal surgeries and serious academic discussions; it also includes these warm, vibrant, and down-to-earth people and events.

Everyone was quite sensible and didn't keep harping on the topic, because Professor Yang rarely comes, and the department heads have many questions to ask, so we couldn't delay their important business.

The atmosphere quickly returned to professional topics.

Director He Xiangjun was the first to seize the opportunity. He took two steps forward and stood in front of Yang Ping, his tone urgent: "Professor Yang, I have a few surgeries that I need your help to oversee. When would be a convenient time for you?"

He spoke bluntly, but everyone present understood his underlying meaning: the cardiac surgery department shouldn't get all the good things.

Director He knew perfectly well that the cardiac surgery department had been developing at an incredible pace in recent years, so fast that it was the envy of many. After Li Zehui came from Cleveland, he brought with him the most cutting-edge international technology. Coupled with Xia Shu, the workaholic deputy director, the two worked together seamlessly, propelling Sanbo's cardiac surgery department to the world's top level. Now, Sanbo's cardiac surgery department sits at the same table as Anzhen and Fuwai departments.

And what about general thoracic surgery?

The general thoracic surgery department also benefited, developing alongside the department and gaining some reputation. But Director He knew how much of this "benefits" and "reputation" was genuine. Thoracic surgery, after all, isn't as sophisticated as cardiac surgery. Even the most difficult surgeries, such as those involving large mediastinal tumors invading the heart, often have to be performed by cardiac surgeons. They're world-class when it comes to heart surgery; you can't deny their expertise.

Therefore, Director He has been looking for a breakthrough.

He found it.

Central lung cancer invades the carina and adjacent major blood vessels, so he chose to perform carina resection and reconstruction, along with pulmonary artery or superior vena cava replacement. He was determined to find a way out of this.

While vascular surgery hasn't yet become an independent department, he still has a chance. Once it does, he'll likely only be able to achieve success in lung cancer and lung transplantation. But the path of lung transplantation is far from easy. There are only a handful of centers nationwide capable of performing lung transplants, each with decades of experience. For him to surpass them is no easy feat.

So Director He was really anxious.

"Professor Yang, I have a few cases that I really need your help with." Director He repeated, his voice earnest. "One of them is a case of central lung cancer. The tumor has already invaded the carina and the main pulmonary artery. I plan to perform carina resection and reconstruction plus pulmonary artery replacement, but I'm not confident about this plan and would like to ask you to review it."

Before Yang Ping could speak, Xia Shu spoke first.

"Professor Yang, about that coronary artery bypass graft case we're working on?" Xia Shu looked up from the operating table, his tone carrying a hint of "I also have important business to attend to." He knew Director He was there to recruit him, but he couldn't just let him go like that. He had been working on that "six exceptional" coronary artery bypass graft patient for several days, revising the plan several times, each with its flaws. He just wanted to wait for Professor Yang to have some free time to consult him properly.

He Xiangjun immediately chimed in, his tone carrying the composure of an "elder brother": "Let's complete the pre-operative examinations for coronary artery bypass grafting first. Elderly patients shouldn't rush."

This statement was perfectly worded, making it seem like the speaker had considered everything thoroughly, while subtly implying that "your patients aren't ready yet, so what's the rush?"

Xia Shu understood the implication in those words, but he was no longer the taciturn man he once was. He said calmly, "I've been hospitalized for many days, and the pre-operative examinations have been very thorough. I'm just waiting to consult Professor Yang about the surgical plan."

"Oh! I have surgery tomorrow, so time is a bit tight," Director He said again.

"Surgery tomorrow? That means you're quite confident. Our case is too complicated, so we don't dare schedule surgery for now." Xia Shu said with a smile, her tone gentle, but the meaning was clear: your patients are simple, so you dare to schedule surgery; our patients are complicated, so we have to be cautious.

Director He was furious.

How can you be so blind? Your cardiac surgery department is already so outstanding, can't you give some opportunities and time to your sister departments?

Director He, you should also consider the order of arrival. Professor Yang has been spending a lot of time in the lab lately and rarely comes out. We also have many questions to ask him.

Neither of them spoke a word, but they both understood what the other was thinking.

The atmosphere in the operating room became subtle. Several nurses exchanged glances, smiles playing on their lips.

"Alright, I'm off today. Nothing much to do. Ask me any questions you have, don't rush me."

Yang Ping finally spoke.

He noticed their fussing and pulling; they clearly wanted to ask a few questions, afraid he'd only sit for a short while before leaving, or perhaps stay in the operating room for an extended period. He understood this mentality all too well. He himself had been like that before, encountering a difficult problem and wanting to consult an expert, only to find that the expert was extremely busy, while he waited for days or even weeks without getting an opportunity. He had experienced that kind of anxiety.

So today he simply made it clear: I'm off today, I have plenty of time, you don't need to rush, take your time.

Upon hearing this, both Director He and Xia Shu breathed a sigh of relief.

"Director He, you go first!" Xia Shu promptly gave up his seat. Since Professor Yang had time, there was no need for everyone to fight over it. They were all from the same department, and it would be unseemly to argue back and forth.

Director He was taken aback, not expecting Xia Shu to offer up so readily: "Then... I won't stand on ceremony?"

"Of course, of course! You go first!" Xia Shu nodded, indicating that Director He should go first, and then added, "I'll take this time to tidy up the film again so that Professor Yang can see it more clearly later."

This was a polite way of putting it, giving Director He face while also making it seem like the speaker was being thorough.

Director He didn't stand on ceremony.

The gap between general thoracic surgery and cardiac surgery is currently enormous. Cardiac surgery is already world-class, while general thoracic surgery is still striving to become one of the top in the country. He must catch up, and the only way to do so is to perform surgeries that others cannot and solve problems that others cannot solve. To achieve this, he needs Professor Yang's guidance.

Director He knew that Professor Yang no longer spent most of his time in clinical practice as he used to. Previously, he could occasionally bump into Professor Yang in his office or operating room and seize the opportunity to ask him a few questions. Now, Professor Yang spent most of his time in the laboratory, which was under closed management and not just anyone could enter. He couldn't possibly bring his films to the laboratory to find Professor Yang, and even if he did, he might not be able to get in.

Therefore, he must seize this opportunity today.

Thinking about all this, Director He suddenly felt a pang of emotion.

He misses the old days and regrets it!

I regret not cherishing the great opportunities I had before. Back then, I always thought that since he and Professor Yang worked at the same hospital, they would see each other all the time, there was plenty of time and opportunities, so why worry about the immediate future? And what happened? Taking it slow, taking it slow, and then it was gone.

Sometimes, you really can't procrastinate. You might intend to put things off for a day or two, but you end up putting them off for a week or two; a week or two, and then a month or two; a month or two, and then a year or two. Looking back, several years have already passed, and those opportunities have long since slipped through your fingers.

Procrastination is a really bad habit that can harm people.

Director He hated himself for not being like Gao Yuan. Gao Yuan was a man who acted immediately, without any procrastination or ambiguity.

And what about myself? I'm still saying "take it slow," "wait a few days," "it's still a long way off."

Director He took a deep breath, clearing his mind of these distracting thoughts. The past is past, and regret is useless. The important thing is to seize the present, to seize this opportunity today.

He walked to the computer in the corner of the operating room and pulled up the medical records he wanted Professor Yang to review.

"Professor Yang, what do you think of this case..." Director He began his inquiry.

Yang Ping took the mouse from Director He and started looking through the video data on the screen himself.

This was a thin-slice CT scan; the images were sliced ​​very finely, and each layer was clearly visible. Yang Ping flipped through the pages one by one, his brow furrowing slightly.

The location of the tumor is indeed tricky.

The central lung cancer in the upper lobe of the right lung wasn't particularly large, but its location was extremely insidious. Like a greedy octopus, it grew out of the main bronchus, spreading towards both the carina and the main pulmonary artery. The carina is where the trachea branches into the left and right main bronchi, essentially a "traffic hub" of the respiratory tract. Once invaded, a simple lobectomy is insufficient; carina resection and reconstruction are necessary. The main pulmonary artery, on the other hand, is the primary blood vessel supplying blood from the right ventricle to the lungs. If invaded, its removal requires replacement with an artificial blood vessel.

Either of these procedures alone would be a highly complex thoracic surgery, let alone when they are combined.

What's more troublesome is that there are also adhesions between the tumor and the superior vena cava. Although there are no clear signs of invasion, the location is too close, so close that the vein wall could be damaged at any time during the separation process. Once the superior vena cava ruptures, the bleeding will be extremely profuse and hemostasis will be extremely difficult.

Yang Ping flipped through a few more pages, his gaze settling on the images in the lattice windows.

"How are the lymph nodes?" he asked.

Director He was prepared. He took out a folded piece of paper from his pocket, unfolded it, and handed it to Yang Ping: "Preoperative staging was done with EBUS. There was one positive lymph node in each of the 2R and 4R areas. There were no clear signs of metastasis in the other lymph nodes. PET-CT showed that the SUV values ​​of these two lymph nodes were not high, one was 4.2 and the other was 3.8. They should still be N2 stage, but not N3."

Yang Ping nodded. Stage N2 means ipsilateral mediastinal lymph node metastasis. Although it's not early stage, it's not entirely without surgical options. The key is whether these two positive lymph nodes can be completely removed.

"And the other side?" Yang Ping asked again.

"Random multi-point punctures were performed on the contralateral lymph nodes, and all results were negative."

"That's good." Yang Ping put down the paper in his hand. "This case can be done, but there are a few key points you need to pay attention to."

Director He immediately took out his notebook. He knew that every word Professor Yang said could be invaluable experience, and he had to write it down word for word.

“First, the method of carina reconstruction.” Yang Ping pointed to the image of the carina on the screen. “With such a large resection area, a simple end-to-end anastomosis is definitely not enough; the tension would be too great. I suggest you perform a left main bronchus-trachea end-to-side anastomosis, and then anastomose the right main bronchus to the side wall of the left main bronchus, forming a ‘side-end-side’ structure. This way, there is no tension at the anastomosis, and the blood supply is also better.”

Director He took notes quickly, nodding as he typed.

"Second, pulmonary artery replacement," Yang Ping continued. "What materials do you plan to use?"

“I originally planned to use Gore-Tex artificial blood vessels,” Director He said.

“Gore-Tex can be used, but I suggest you apply a layer of bio-adhesive to the vessel wall before anastomosis,” Yang Ping said. “You will definitely need postoperative anticoagulation for this surgery. Although the pulmonary artery pressure is lower than that of the aorta, the risk of anastomotic bleeding is still very high. Bio-adhesive can help seal the anastomosis and reduce postoperative bleeding.”

Director He nodded repeatedly; he really hadn't thought of that detail.

“Third, and most importantly,” Yang Ping turned around and looked into Director He’s eyes, “the biggest risk in your case during surgery is not bleeding or anastomotic leakage, but airway management.”

"What do you mean?" Director He was taken aback.

“Think about it,” Yang Ping explained, “After carina resection and reconstruction, the anastomosis between the trachea and the main bronchus is there. Your surgical approach involves a median sternal incision and a right anterolateral sternal incision. Postoperatively, the patient’s cough reflex will be greatly affected. If sputum cannot be expelled and accumulates near the anastomosis, it can cause atelectasis or pneumonia in mild cases, and anastomotic dehiscence in severe cases.” Yang Ping paused, “Therefore, in your case, postoperative bronchoscopic suctioning must be frequent, at least twice a day, and cannot be interrupted for the first three days.”

Director He wrote down every single word he said.

Yang Ping then pointed to another image on the screen and said, “There’s another detail: although the superior vena cava is not clearly invaded, you must be careful during the dissection process. I suggest you first put a occlusion band on the proximal and distal ends of the superior vena cava. If it ruptures during the operation, immediately stop the bleeding and then repair it. Don’t wait until there’s a large rupture before you scramble to fix it.”

"Understood!" Director He wrote this down as well.

Yang Ping checked the time; he had been talking for almost ten minutes without realizing it. He handed the mouse back to Director He and leaned back in his chair: "That's all. Go back and think about it some more. This surgery can be done, but we can't rush it. Preoperative preparation must be thorough, intraoperative procedures must be meticulous, and postoperative management must be in place. All three aspects are indispensable."

Director He was overjoyed, putting the notebook back in his pocket and repeatedly thanking Professor Yang: "Thank you, Professor Yang! I will go back and redo the plan according to your instructions, and I will ask you to review it when it is finished."

"Go ahead," Yang Ping waved his hand.