There is no end to learning (1)
Operating room.
Thoracic surgery staff members preparing for lung cancer surgery were gathered together.
The staff was as follows:
Yasada, first assistant, Ki-seok Choi, second assistant, and Marilyn, third assistant, Khan.
“Have a final briefing.”
“yes.”
At Yasada’s words, Marilyn cleared her throat.
“The patient’s name is Kane. He is a 60-year-old male patient. He visited the outpatient clinic due to coughing and hemoptysis. A chest CT result revealed a mass in the right lower lobe of the lung.”
“….”
“After a detailed examination after hospitalization, I was diagnosed with TNM classification stage 3 A. In today’s surgery, we plan to use a thoracotomy to remove the lung lobe and mediastinal lymph nodes where the cancer cells are located and perform pleurodesis.”
Yasada nodded as if satisfied with Marilyn’s briefing.
“Anyone have any questions?”
“I have a question.”
Choi Ki-seok raised his hand.
“say it.”
“Considering the patient’s age, I think thoracoscopic surgery would be better… but I’m curious why you chose thoracotomy.”
Just as there are trends in fashion, there are trends in surgery as well.
In the case of lung cancer surgery, there is a recent trend of performing thoracoscopy or robotic surgery. These two surgeries were evaluated as being more effective in reducing pain and recovering patients compared to thoracotomy.
“The patient’s family is burdened with the cost of surgery. Is that reason enough?”
“…yes.”
Choi Ki-seok responded briefly to Yasada’s immediate reply.
An important fact was overlooked.
The fact that the patient’s pocketbook is as important as the effect of treatment.
“Let’s go in quickly.”
As Yasada scrubbed his hands and arms with a brush dipped in povidone, other staff members also started scrubbing at once.
Buck. Buck. Buck. Buck.
Choi Ki-seok scrubbed and pictured the surgical process in his mind.
In fact, today was not the first time I had a lung cancer surgery scrub. I had several more experiences, starting with assisting Jo Ji-hwan during his time at Uijin University.
Naturally, I had to have a special attitude toward assisting.
Yasada would have assisted in the surgery due to his experience, but Ki-Seok Choi was planning to go beyond this and provide complete assistance.
Tiring!
[You have obtained the special mission ‘Beyond Expectations’. If you succeed, you can get a certain reward.]
Choi Ki-seok’s resolve became even hotter after checking the notification window.
Jiiiing.
The rosette door opens and the staff enters at once.
Preparations such as connecting the time-out patient monitoring device, preparing surgical tools, and providing general anesthesia continued in a smooth manner.
“Aren’t you nervous?”
“yes.”
Yasada burst into laughter at Choi Ki-seok’s quick answer.
“It was an awkward question to ask. Then, do you have any idea why I chose you as the surgical assistant today?”
“I think it means experiencing a difficult surgery. The patient is elderly, and the size of the cancer tissue and the extent of metastasis are significant.”
“That’s correct. The patient’s cancerous tissue is located in the middle and lower lobes of the right lung. It’s a unique case. You will probably experience a surprising experience about halfway through the surgery.”
After finishing speaking, Yasada had a naughty smile on his lips.
The current Choi Ki-seok could not understand its meaning.
“General anesthesia is over.”
There was tension on the staff’s faces as they reported to the anesthesiologist.
MHC Cardiothoracic Surgery Head Chief Yasada.
Although he was a pulmonary and esophageal surgeon who was respected by his patients, he was also an object of endless fear to his subordinates. Even second-year fellows often received nagging and swearing when performing surgery with him.
“From now on, we will begin lobectomy for patients with TNM classification stage 3 A.”
Yasada’s voice rings out loud.
Second assistant Marilyn disinfected the patient’s back and ribs as if she had been waiting.
While cardiac surgery prefers anterior sternotomy, pulmonary esophageal surgery prefers posterolateral thoracotomy.
So the patient is currently lying on his side.
“Meth.”
Yasada cut the patient’s skin with the scalpel he was given.
As a result, a U-shaped curve was created from the patient’s upper back to the ribs area, lying on his side.
“Retractor.”
“yes.”
The third assistant and the intern put a retractor on the incision site and opened it to the side. The skin gradually opened to the side, revealing the surgical site.
Choi Ki-seok frowned as he looked at his completely exposed lungs.
Is it because the patient has been a smoker for a long time?
Large, pitch-black spots covered the lungs, and lumpy cancerous tissue was located throughout the middle and right lobes of the lungs.
“The cause of lung cancer is mostly smoking. Toxic substances from cigarettes remain in the lungs. Well, I wonder how I will survive this harsh world if I can’t even smoke…” “…
.
” When you see it, the desire to smoke disappears. What do you think?”
“Head Chief, you’re right. I heard that it’s best not to learn how to smoke from the beginning if possible, but I guess I was lucky that I never had the chance to try it.”
“Okay. It’s better to keep that luck going forward.”
Yasada nodded and continued speaking.
“From now on, we will check for cancer with the naked eye. In some ways, it is a more important process than surgery, so everyone should stay alert.”
“yes!”
With exciting answers, the entire staff examined the cancer tissue.
Confirmation of preoperative test results and surgical site during surgery.
Sometimes these two results are inconsistent.
Blindly trusting only the test results could result in unexpected side effects for the patient after surgery.
‘Where should I look?’
Choi Ki-seok examined the lungs using the dragon’s eye zoom-in mode and zoom-out mode alternately. He also actively tried to feel the lungs with his hands.
The squishy feel of the lungs from your fingertips.
There was something firmly gripped within it. This is cancerous tissue that is afflicting the patient’s lungs.
Soon, Choi Ki-seok’s eyebrows furrowed as he touched the area around the cancerous tissue.
The hand that was tracing the cancer tissue suddenly reached the left ventricle.
“Head Chief. Could this patient be…”
“You finally noticed.”
Yasada nodded.
“The cancerous tissue is attached not only to the middle and lower lobes of the lung, but also to the adjacent left atrium.”
“Cancer tissue in the left atrium…”
Choi Ki-seok looked down at the patient’s heart with a dejected expression.
“What should I do in this case?”
“Don’t ask, but think for yourself. When you assist, you can follow the surgeon, but when you become a surgeon, you have to lead the staff. If the captain doesn’t steer the ship properly, of course the ship will sink. It’s the same for you all.”
Yasada said while looking at the staff.
Amid the heavy silence, Choi Ki-seok opened his mouth.
“It is a unique case where cancer tissue has metastasized to the left atrium, but I think the principles of surgery remain the same.”
“What do you mean?”
“Radical resection, in other words, means that all lymph nodes and lesions surrounding the tumor must be removed. So, I think the left heart vagina, where the cancerous tissue has metastasized, should also be removed.”
“Isn’t this too drastic? There can be a variety of treatment methods, including chemotherapy.”
“Isn’t this patient lying on the operating table because surgery is possible? In that case, it can be seen that resection, not chemotherapy, is necessary. If resection is possible, then of course radical resection should be performed.”
“You’re quick to notice. Isn’t this on a different level from your bear-like teacher?”
Yasada burst into laughter.
“Mr. Choi’s words are correct. The principle is to perform radical resection for patients who can undergo surgery. Even if the extent of metastasis is outside our expected range.”
“….”
“Everyone, let today’s experience be engraved deep in your bones.”
“All right.”
“Yes. I will keep that in mind.”
The staff’s answers came one after another.
“You’ve spent too long on training. Now, shall we begin the actual lobectomy?”
Yasada’s eyes became sharp after receiving the scalpel.
In response, Choi Ki-seok aroused tension and held forceps in both hands. The goal today is not to experience an unusual case of lung cancer, but to provide complete assistance.
I will show Yasada everything I have.
Click! Click!
Ki-Seok Choi measured the length of the pulmonary artery and vein and tied the blood vessels with vascular forceps.
This is to reduce bleeding that occurs when a blood vessel is cut.
Yasada raised his eyebrows at his treatment and cut the pulmonary artery and vein one after the other.
Next, the cancer tissue and adjacent bronchial tubes were cut out.
This concludes the preliminary work for lobectomy.
Choi Ki-seok held the electric cautery in his hand as if he had been waiting and made shallow and extensive cuts to the left ventricle and the middle and lower lobes of the lung.
The area of resection was marked using the person’s own senses.
‘Look at this guy?’
Yashada clicked his tongue as he watched his actions.
The range of resection he expected and the range of resection indicated by Ki-Seok Choi matched exactly.
This means that Choi Ki-seok has a good sense.
Suuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuu
Yasada moved the scalpel along the marked line. The scalpel never stopped working and there was no tremor in the hand.
The bold resection shined even brighter when resecting the left atrium.
Even though a heart-lung machine was not used and the heart was pounding, the part of the left atrium that had cancerous tissue attached was neatly removed.
Empty!
Lung lobes falling into a curved plate.
The lungs, saturated with cancerous tissue and harmful substances, looked like hideous monsters.
“This is a biopsy (biopsy). We remove the remaining lymph nodes and finish the left atrium resection area.”
“yes!”
The staff moved busily under Yasada’s command.
In particular, Choi Ki-seok has continued to show sharp assistance since the surgery began.
Holding blood vessels, controlling sudden bleeding that occurs during treatment, suction, saline solution cleaning, etc.
Even without Yasada’s instructions, he showed remarkable skill in reading the intention first and then acting. As a result, the surgery, which usually takes about three to four hours, was completed in just one and a half hours.
Tiririririn!
Most of the staff’s eyes turned to the sudden ringing sound of the phone.
Except for Yasada and Choi Ki-seok.
“Yes. Hello.”
[….]
“Ah. Because I’m having surgery right now… I understand. I’ll tell you first.”
The intern finished the call and returned to his seat.
Looking at his hesitant movements, it seemed like something had happened.
“What happen?”
“Well… an emergency call came from the general surgery department, and they said the patient suddenly coughed up blood during the appendectomy. After hemoptysis, his vitals were well below normal levels. I asked if he could come quickly….” “The patient is undergoing surgery
. So, call the ward and ask them to assign another doctor.”
Yasada joined the conversation.
“It’s a VIP patient, so Chief Yasada wants to take care of it…”
“It’s a pain in the ass.”
Yasada wrinkled his face and put down the surgical tool.
“There is nothing we can do. The core treatment is over, so all we have to do is close the surgical area. You can do this, right?”
“Yes!”
Marilyn, who caught his gaze, nodded vigorously.
“Mr. Choi is going to the general surgery department with me.”
“I understand.”
Yasada took the lead and left the rosette, followed by Mr. Choi. Choi Ki-seok followed.
A sudden hemoptysis occurred during an appendectomy.
What on earth happened to the patient?
Such questions filled Choi Ki-seok’s mind.
After the two scrubbed again, the general surgery staff visited J Rosette, who was undergoing surgery.
“Where is the patient?”
Yasada’s eyes were fixed on the empty operating table.
