Surgery Godfather-Chapter 360 - 0341: Surgery in Theory

Chapter 360: Chapter 0341: Surgery in Theory

Takahashi’s speech received a burst of enthusiastic applause, and the few brilliantly drawn illustrations were also constantly praised.

“Dr. Takahashi, with your procedure, after the rectum is reconstructed, the sequence of muscle control and nerve reflexes is opposite to that of the natural anal sphincter. Normally, the anal sphincter is contracted and tightly closed, relaxing and opening only when defecating. Whereas, the pectoralis minor muscle that you use for grafting is normally in a relaxed state, only contracting when exerted.” a graduate student questioned.

Those able to ask questions are the ones who usually study diligently. Otherwise, their heads would be filled with confusion, leaving them unable to ask any questions at all.

“You lack a basic understanding of reconstructive surgery-” Takahashi began, then immediately realized his tone was off and glanced at Yang Ping. There was no surprise on Yang Ping’s face.

After confirming that Yang Ping hadn’t noticed his slip in tone, Takahashi paused and continued in a softer voice, “After the surgery, we will use biofeedback stimulation to coordinate the contraction of the transplanted muscle. In other words, we will train the muscle to remain contracted and tightly closed most of the time, only relaxing and opening when necessary.”

“Defecation doesn’t only involve the opening of the anus, but also the rhythmic contractions and peristalsis of the rectum, propelling feces downward until they are excreted. This patient has both her rectum and sigmoid colon damaged. How do you plan to solve this issue?” A Ph.D. student asked an even sharper question.

In academic debates, ad hominem arguments are not recognized. It is obvious that those who usually delve deep into research, do not have the cunning and sophistication of socialites.

“This problem does not exist. The entire intestine has peristalsis. Although the descending colon doesn’t have as strong a propulsive force as the lower part of the rectum, according to the principle of anatomical and functional adaptability in the human body, as the use of the reconstructed anus increases, the propulsive force of the descending colon will gradually increase to adapt to its role.”

“You mentioned earlier that the graft for the sphincter is taken from the pectoralis minor muscle but you did not say anything regarding the material for urethral reconstruction. I am interested to know which material you plan to use for urethral reconstruction? The anterior or posterior wall of the bladder?” An associate chief physician from Urological Surgery asked.

Having performed urethral reconstruction himself, he naturally showed interest in this matter. Yu Shuilian had nearly the entire length of urethra missing. How to find enough material to cover such a length? If the bladder wall mucosa was used for reconstruction, it might not be enough.

“The colonic mucosa can be used for urethral reconstruction. This material is abundant and imposes no limitation on the length of the urethra. This method comes from Magic City Sixth Hospital, and I have improved it.”

Even though urethral reconstruction is a field of Urological Surgery, Takahashi, being a trauma surgeon, is on par with any expert urologist in the world.

The questions asked varied, ranging from newly graduated research students to high-ranking professionals within the field. Takahashi utilized his broad and profound knowledge to perfect each question.

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Takahashi is known for his aggressive style in international academic conferences. Once, in a trauma surgery conference in North America, he single-handedly took on several Americans, leaving them speechless.

Today, he got a bit carried away in his enthusiasm, almost going off track. Luckily, he realized it in time to prevent severe consequences.

Of course, these were “serious consequences” as per Takahashi’s thoughts.

The conflicting feelings of stress and confidence were intertwined. Due to Yang Ping sitting in the audience, he was nervous. The student within him constantly observed Yang Ping’s expression, fearing any bad performance from himself.

On the other side, standing in front of the audience, he was accustomed to eloquence, brimming with confidence, and often getting carried away in excitement.

When it was Song Zimo’s turn, the surgery diagram he presented was even more stunning than Takahashi’s. Possibly under the influence of Professor Zhang and the guidance of Yang Ping, his diagram had a strong three-dimensional effect; its visual effects surely outperformed those of Takahashi’s two-dimensional figures.

Takahashi’s surgical plan was extremely comprehensive. Many parts overlapped with Song Zimo’s plan. Hence, Song Zimo quickly went over the similar parts, focusing mainly on the portions that Takahashi had not covered.

“The patient’s ovaries, fallopian tubes, and uterus have already been preserved. I can’t focus solely on urethral and anal reconstruction, but should consider reconstructing the vagina as well, to solve the problems associated with the cyclic breakdown and associated bleeding of the endometrium in female patients.”

“The patient has already given birth, under such unusual circumstances, retaining the uterus serves no purpose, why not remove the uterus? By doing so, there will be no need to reconstruct the vagina, which will reduce complications.” A newly-appointed Ph.D. in orthopedic trauma, proposed a more simplified method.

We can remove it, why reconstruct? It’s superfluous! The logic of the questioner was clear.

“Uterus removal does not only make pregnancy impossible but may also cause the ovarian function to decline and result in estrogen secretion disorder, metabolic abnormality in blood lipids, and other endocrinal abnormalities, which might affect mental and psychological conditions. It doesn’t rule out the possibility of causing depression.”

“A little extra trouble for us can ensure a lifetime of comfort for our patient.”

Song Zimo’s thinking was contrary. Since it could be reconstructed, why remove it?

Why aim for sixty out of a hundred, when you can aim for ninety?.

Discussions among academically excellent students naturally marginalize average students. This is an inevitable reality.

The discussion placed Song Zimo and Takahashi as the main characters, even Xu Zhiliang from the triage group felt immense pressure.

If you consider clinical experience as the card power and personal intelligence as the card technique, this discussion is like playing cards.

When the power of the cards is evenly matched, technique can sway the outcome. But when the balance of power is skewed, no amount of technique can affect the result.

While Takahashi’s cards were the best and Song Zimo’s strategy was superior, Xu Zhiliang did not excel in either area. His card playing skills were inferior to Song Zimo’s, and his hand was weak compared to Takahashi’s.

But he wasn’t downcast; on the contrary, he was fired up. Delighted to be part of this formidable team, he appreciated Yang Ping for not disregarding his inherent deficiencies and granting him this precious opportunity.

Director Gao Yuan of the Sports Medicine Center was extremely busy. Having completed his work, he hastily left for the comprehensive orthopedics meeting. Case discussions, preoperative discussions, and mini lectures – he would always participate whenever he could.

By the time Director Gao arrived, the meeting room was already packed. The center table was of rounded rectangular shape. Around it, people were standing three deep with a one-meter gap. Even the doorway was crowded.

Wondering how to get in, Director Gao paid no heed to his reservations and was determined to force his way in. He turned his body sideways and pushed inwards with a considerable force. An intern, eyes fixed firmly on the screen and with ears pricked up, couldn’t help but feel irritated by the constant pushing and shoving.

Irritated and infuriated, the intern, without a backward glance, harshly bumped into the direction of the pressure, causing Director Gao to stagger backwards, almost falling.

“Stop pushing! It’s already crammed full. Should have come earlier,” the intern muttered under his breath, eyes fixated still on the screen.

Director Gao managed to regain balance, wiped the sweat off his forehead and looked around. Everyone was engrossed in the presentation, paying him no heed.

Old Gao didn’t bother arguing with the intern. The meeting room had two doors, so if he couldn’t get in through this one, he would try the other side. However, it was no better. It was packed and airless.

With no other choice, Old Gao got a chair from a nurse and placed it near the doorway. He stood atop the chair after cushioning it with a piece of paper, and now, finally, he could see inside.

Luckily, everyone was maintaining discipline; except for the speaker, no one was talking, not even whispering. He could listen with absolute clarity. Song Zimo was speaking at the moment.

Yang Ping hadn’t spoken yet. He would speak last, and Director Gao was glad that he had not arrived late.

Takahashi felt a touch of shame upon hearing Song Zimo’s proposal for YD reconstruction. He hadn’t considered the patient’s condition as comprehensively.

Indeed, Song Zimo being Dr. Yang’s assistant, had contemplated the patient’s surgery deeper than he had.

As for Xu Zhiliang, his surgical plan was unlikely to surpass Takahashi’s. When Xu Zhiliang came up on stage, Zhang Lin felt a shudder run through him instinctively.

As soon as Xu Zhiliang began to speak, Zhang Lin grew anxious. However, Old Xu wasn’t stuttering as he discussed the case: “The surgery plan has been thoroughly decided upon. I have an immature suggestion. When the patient loses her lower body, she also loses her sexual identity. Considering her mental state, can we reconstruct the shape of the vagina? It is more acceptable than an abrupt cavity look. Besides, the natural anatomy of the female vagina can protect the urinary opening, potentially reducing the chances of urinary infection.”

The suggestion Xu Zhiliang had given was not essential, even something most doctors wouldn’t consider, but he did — and bravely so.

A round of discussions ensued, featuring questions from the surrounding audience and debates among the orthopedic team. Finally, it was time for Yang Ping to speak.

Everyone had been awaiting this moment eagerly, especially Old Gao, who had been standing until his legs were numb.

The minute Yang Ping stepped on the stage, dozens of cellphones discreetly aimed at him. Better to record him than rely on memory.

A dozen or so pictures circulated, one after another. Just looking at these images was enough to grasp the contents of the meeting. To someone oblivious, these might have looked like old black-and-white photos of the human body, but these images had an extraordinary depth.

By utilizing the technique of split-screen storytelling from comics, the surgical steps were distinctly elaborated upon. The key steps even received a close-up shot.

After summarizing everyone’s proposals, he added his own thoughts: “To reconstruct bowel function, apart from reconstituting the sphincter, it is also necessary to transplant bladder mucosa. Part of this mucosa should be relocated to the inner surface of the descending colon. Since pressure receptors exist inside the bladder mucosa, these could be used to reconstruct bowel sensations and establish autonomous bowel control.”

To transplant bladder mucosa inevitably meant connecting nerve endings. However, the dissection of lesser-known, minuscule nerves is almost impracticable. Otherwise, many surgeons would have done so.

If nerve connections are not considered during mucosal transplantation, then the pressure receptors cannot transmit signals to the brain and spinal cord centers. Therefore, their existence would become insignificant.

If unknown nerve connections could be found and then utilized in biofeedback training, regaining bowel sensation would be entirely possible.