Challenge (6)
“A major accident almost occurred.”
“I thought my heart was dropping.”
Everyone in the surgical observation room breathed a sigh of relief.
Just before the tray containing the liver fell, Ki-Seok Choi flew forward and caught the tray.
The surgery almost failed due to a non-medical mistake.
‘I didn’t like it from the first time I came here.’
Paul furrowed his brows.
If the trey had been dropped, Smith could have been hit without that strategy…
Jeeeeee.
The door opened and the staff left the rosette.
It moves to the next rosette where the beneficiary is.
Currently, the observation room is dedicated to transplant surgery, so observers can inspect both rosettes without having to move.
“Amazing. Isn’t he Smith after all?”
The man sitting next to him stared at Paul.
This is Bud, Paul and Smith’s medical school classmate.
“It’s a natural result. I wouldn’t have played this game without thinking.”
“So, that’s amazing of your guts. I have one question.”
“….”
“What kind of friend is the friend standing second?”
“Kiseok Choi. A fresh-faced new resident from Korea.”
“That friend is the new resident?”
Bud opened his mouth in disbelief.
“A new resident has joined Meijou’s first laparoscopic living liver transplant surgery, or rather the first in the United States?”
“that’s right.”
“Does Smith have two hearts?”
“I know.”
Paul shrugged.
I was delighted to hear that Choi Ki-seok was the second player, but my thoughts changed completely after I started watching.
He controlled his vision like a ghost throughout the surgery.
Originally, laparoscopic surgery was difficult because the surgical field of view was narrow and limited.
However, Choi Ki-seok moved the camera port to provide the surgeon with the best view.
It was truly an unbelievable performance.
“Hey. I heard the second is a new resident?”
“A new resident has vision like that?”
As people around the two overheard the conversation, rumors about Choi Ki-seok spread rapidly.
“What do you think? Smith is still growing, don’t you think?”
Laparoscopic surgery is performed using special tools rather than regular surgical tools.
If we compare it to eating, it is like eating with chopsticks that are several times longer than regular chopsticks.
Nevertheless, Smith showed excellent skills comparable to that of general surgery.
“Honestly, I thought Smith would be under you for the rest of his life, but isn’t it really scary what’s going on in the world?”
“Cut the bullshit.”
“Hmm. I apologize if I offended you.”
While the two were talking, the staff came into the rosette.
The second chapter of laparoscopic living liver transplant surgery has arrived.
‘No matter how much you do, it won’t be easy.’
Paul’s eyes were fixed on Smith on the monitor.
The donor’s liver was successfully removed, but the remaining process will be difficult.
Liver transplantation is several times more difficult than extraction.
Moreover, Paul had a secret weapon prepared for today. If that weapon and the difficulty of the surgery were combined, Smith would have no choice but to collapse.
‘bouncer. ‘Please don’t be embarrassed.’
The surgery resumed amidst Paul’s grim smile.
* * *
After completing the donor liver extraction, the staff came out to the operating room.
“I will change into my gown and re-sterilize before going in.”
Smith nodded at Choi Ki-seok’s words.
Choi Ki-seok threw himself on the floor and caught the tray. It was polluted and needed redevelopment.
“Todd. You take the tray and go into the rosette first.”
“All right.”
The two men left and Smith and Jose stood facing each other.
There was a breathtaking tension.
The staff around them were too busy watching the two people and not being able to approach them.
“S-sorry.”
Jose lowered his head and spoke with difficulty.
But at that very moment.
Sigh!
The sound of a car being kicked spread throughout the operating room.
Smith slapped Jose’s cheek with his hand.
“You crazy bastard. Is it okay if you say you’re sorry? Your mistake almost killed two people. Do you think people’s lives are a joke?”
“no.”
“Why did I make such a stupid mistake? If Mr. Choi hadn’t received the tray, this surgery would have been over.”
“I feel so relieved that the surgery is over. I will never do this again.”
Jose pursed his lips.
“At Rosette, even the slightest carelessness cannot be tolerated. For any reason! Jose, your general surgery intern evaluation is unconditionally the lowest, so I know that.”
“…All right.”
“Call the ward, give another assist, and you’re gone.”
Smith hit Jose on the shoulder and walked away.
“Ha…what a fool.”
Jose lamented and placed his hand on his forehead.
My cheeks were swollen, but it didn’t hurt at all.
I just kept repeating the stupid mistakes I made over and over again in my head.
“Jose. Are you okay?”
Choi Ki-seok, who had changed his gown, approached him.
“No. Not at all.”
“Don’t be too hard on yourself if you make a mistake. I’ve made similar mistakes.”
“Thank you for your words, but it still doesn’t comfort me.”
A bitter smile appeared on Jose’s lips.
Ki-seok Choi frowned as he gave Jose the eyes of Hippocrates.
Taxes are caught by invisible hands.
Surprisingly, this debuff lasted over a month.
“The manager found another staff member, right?”
“…yes.”
“I had a hard time, so I’ll go up and get my mind together. We’ll talk about the details after the surgery.”
Jose nodded weakly at his words.
Buck. Buck. Buck. Buck.
Choi Ki-seok scrubbed again and entered the rosette. Unlike before, Jace was lying on the operating table.
“What is your name?”
“Dr. Choi. Are you asking my name?”
“It’s a surgical procedure called time-out. In rare cases, the surgical patient changes.”
“Then there’s nothing we can do. It’s Jace.”
“How old are you?”
“I’m forty-seven.”
“Are you sure you are here for laparoscopic living liver transplant surgery?”
“Yes, that’s right. But Dr. Choi.”
Jace spoke to Choi Ki-seok, who turned around.
“Did William’s surgery go well? He’s a very scared guy… Did he make a fuss before the surgery?”
“There were no major problems. That means we can perform Jace’s surgery.”
“Whew… That’s good. Then I’ll take a nap.”
Jace lied down comfortably.
Soon, the anesthesiologist went into general anesthesia and Rahul, Jose’s substitute, came in as a rosette.
“The recipient’s liver transplant surgery will now begin.”
Choi Ki-seok, who received a glance from Smith, disinfected his abdomen and covered it with a cloth.
First assistant Todd then made an incision in the abdomen and inserted a trocar and surgical instruments.
“It would have been dangerous if it had been later.”
Smith clicked his tongue while looking at the monitor.
The patient’s liver was filled with convex regenerative liver nodules.
In some areas, tissue that appeared to be in the early stages of liver cancer was even visible.
“There doesn’t seem to be any metastasis.”
“I feel the same way as the Head Chief.”
Todd added a word to his words.
The liver transplant surgery has finally begun.
Smith cut out Jace’s liver the same way he removed William’s. The surgery time had already passed four hours, but there was no disruption in the surgery.
Empty!
A hideous-looking liver fell on the bench.
This is the liver that Jace has been tormenting Jace for so long.
“Send biopsy.”
“yes!”
Rahul, the new assistant, put the liver in a sterile bag and handed it to the circulating nurse.
Thanks to Choi Ki-seok’s tips for assisting Smith’s surgery, his actions were quick and accurate.
After the liver resection, William’s liver was placed into Jace’s resection site through a laparoscope.
This is the moment when the father’s body and the son’s liver come face to face for the first time.
‘It’s just the beginning.’
Ki-Seok Choi was alert and focused on clearing the surgical field.
From now on, surgery will be performed to connect the hepatic vein, portal vein, and hepatic artery sequentially.
Sophisticated and detailed work that requires a micro microscope.
Communication between staff was very important.
“5-0 Prolene.”
Smith tightened the suture needle with a laparoscope-specific needle holder and then pushed it into the trocar. Then, with Todd’s help, the hepatic vein was sutured.
This is the process of suturing major blood vessels within the liver.
If you make a mistake, a blood vessel may burst and massive bleeding may occur. Because everyone was well aware of the danger, none of the staff could even breathe comfortably.
“It’s over. Wipe off your sweat.”
“yes.”
A disinfection nurse nearby wiped Smith’s neck and face with gauze.
It is a task that makes even those who watch it nervously, so how much attention does he, the surgeon, pay?
“Then the portal vein is sutured.”
The portal vein is a blood vessel in the right upper abdomen where the veins from the pancreas, gallbladder, and spleen join.
In short, it could be seen as a strategic point for liver blood vessels.
“I need to do a graft (blood vessel harvesting) from the inferior vena cava.”
“Head Chief, it would be best to take a moment to catch your breath. Me and Mr. Choi will do the grafting.”
“Please.”
Smith accepted Todd’s offer.
Soon, Todd and Ki-Seok Choi began the graft in earnest.
As Ki-Seok Choi firmly fixed the blood vessel, Todd carefully removed the blood vessel with a scalpel.
‘Didn’t you just know how to focus?’
Todd was amazed as he performed the graft.
Choi Ki-seok looked like a robot.
There was no tremor at all even though the small blood vessels were held with long laparoscopic forceps.
Rather, it was Todd himself who was shaking his hands slightly.
“Rahul, get your perspective right. The image keeps going back and forth left and right.”
“Ah… I’m sorry.”
Rahul hurriedly fixed his gaze upon Todd’s point.
After the graft collection was completed, Smith began the full-scale portal vein anastomosis. Because the work involved connecting graft blood vessels, the work speed was slower than that of the hepatic vein.
“That’s enough.”
Smith touched the anastomosis site with forceps and continued speaking.
“Next is the hepatic artery anastomosis…”
“The condition is worse than I thought. I don’t think I can use the iliac artery removed from the donor.”
“Let’s check it first.”
The iliac artery fragment was inserted through the trocar.
As Todd said, the iliac artery had a thick blood vessel wall, so it did not fit the hepatic artery.
“You did the iliac artery graft earlier, right?”
“Yes, that’s true, but…”
“It’s okay. Don’t worry about it. I just need to get another graft.”
“What about the radial or splenic artery?”
Smith looked disapproving at Todd’s suggestion.
After a moment of silence, Choi Ki-seok opened his mouth.
“I think the superior omental artery is a suitable graft.”
“Superior omental artery?”
“yes. I recently read a paper that said the superior omental artery is effective for hepatic artery anastomosis. The superior omental artery is in a relatively better location for sampling compared to other blood vessels. Also, the size of the blood vessel matches the hepatic artery.”
“I guess you read the Korean paper.”
“Yes. That’s right.”
“Okay. “I’ll do as Mr. Choi says.”
“Professor. As far as I know, the superior omental artery has never been used as a graft. Do I really need to take the risk now?…”
Todd trailed off, looking at Smith.
“If you say it right, there is no need to do laparoscopic living donor liver transplant surgery itself. “Isn’t there one?”
“….”
“Stagnant water rots.”
“I understand.”
With Todd’s help, Smith took the graft and applied it to the hepatic vein.
The size of the blood vessel was perfect.
