Chapter 253: Mastering Endoscopic Surgery: Gaining Experience One Procedure at a Time

“You seem pretty confident! Let me test you—where should the incision be made for this endoscopic surgery?”

As Director Shang asked, his gaze naturally fell on the patient’s abdomen.

“If we were doing laparoscopic surgery, we’d make two ports right where you’re looking. But that’s only for mid-stage stomach cancer patients. Since this patient is still in the early stage, I believe we can complete the operation via endoscopy through the nose.”

Zhou Can had performed more endoscopic surgeries than he could count—none of them were in vain.

Still, Director Shang threw him this easy question.

He was basically just handing him free points.

“Alright then. Looks like you really know the procedure. I’ll let you handle this one.”

Director Shang only quizzed him for formality’s sake before agreeing to hand the surgery over.

It felt more like he was going easy on Zhou Can on purpose.

Probably so he could explain himself in front of the other doctors.

He had plenty of doctors working under him and always pushed for fair competition: the most capable gets the case.

In terms of qualifications, Zhou Can really wasn’t senior enough to take on this endoscopic surgery alone.

If Director Shang approved him without question, then next time other doctors wanted a surgery slot, he’d have to say yes to them too.

So he set a barrier on purpose, just to silence the naysayers.

With Director Shang’s approval, Zhou Can was thrilled. This was a golden chance to rack up some experience points.

He was sure this operation would earn him a ton of surgical experience.

First, he gently inserted the endoscope through the patient’s nasal cavity, guiding it down the esophagus into the stomach.

[Device Implantation Experience +1.]

Since this wasn’t his first time threading an endoscope through the nose to the stomach, he only gained one point of experience for this part.

The entire maneuver was smooth and practiced.

Zhou Can steered the endoscope straight towards the cancerous area in the stomach.

He found the cancer site with barely any effort at all—easy work that looked simple, but really was the result of years of training for every moment of smooth execution.

Beyond honing his endoscopy skills, he’d always made sure to study up before every surgery.

He already had the cancer site memorized down to the smallest detail.

That was why his operation now went off without a hitch.

Spotting the cancer didn’t mean he could just slash it out in a few moves. Endoscopic surgery for stomach cancer was nowhere near that simple.

Zhou Can first used the endoscope to mark the margins around the tumor for removal.

It’s just like drawing a circle before a battle—marking out the territory.

That way, once things get busy, you don’t accidentally damage other areas.

Once he marked the boundaries, he injected saline into the base of the cancer.

Why do that?

So that the mucosal layer to be removed would lift up from the stomach wall.

All these surgical techniques were hard-won—pioneered by surgeons abroad who went through countless patient failures to find methods that worked.

“The predecessors plant the tree, the successors enjoy the shade.”

Zhou Can had learned these tricks and now used them all in live surgeries.

His goal: minimize the patient’s harm with every procedure.

Once enough saline was injected and the affected mucosa lifted, he moved to the third step.

He used the endoscopic scalpel to slice a complete circular line along the marked border.

If the cancer wasn’t round, the excision could be any other shape as needed.

No rule said it had to be a perfect circle.

Still, most stomach cancers—especially in early or even mid-to-late stages—tend to be clumped and round.

So today, Zhou Can marked a circle.

He trapped the entire cancer inside that border.

The scalpel made the first cut and fresh blood welled up from the incision. Unfazed, Zhou Can calmly handled the bleeding.

He kept cutting along the marked line, finishing the circular excision.

Now the cancer and its base tissue came away together.

At this point, it’s important to note—the removed cancer can’t be pulled out through the nose. The nasal passage is just too narrow.

So the best option is to retrieve it via the patient’s mouth.

Throughout the surgery, the patient is under general anesthesia.

That usually means their mouth is tightly shut.

So you need a retractor to pry the mouth open. And when pulling out the extracted tissue, you have to be very careful—not to suffocate the patient.

Zhou Can’s hands were steady as ever. No chance he’d make a mistake so severe.

He retrieved the excised tissue smoothly. Once the operation was done, the specimen was sent for examination to determine exactly what kind of tumor it was and how clear its edges were.

During removals like this, some normal tissue around the tumor is always taken as a safety margin.

Even then, there’s always the risk it wasn’t enough.

Sometimes cancer cells are especially sneaky, quietly infiltrating surrounding organs or tissues and easily spreading along lymph nodes and blood vessels.

That’s why pathological tests after surgery are so crucial.

With the stomach cancer excised, Zhou Can double checked the patient’s stomach and performed a cleaning procedure.

With that, the surgery was over.

But if, after a while, a checkup revealed new tumors or more cancerous changes where he’d operated or elsewhere, then another surgery would be needed—a second, even a third operation.

Usually, if a patient needs repeated surgeries, the outlook isn’t very good.

When cancer relapses, it means it’s spread throughout the body. That’s what makes tumors so frightening—they’re as stubborn as weeds, impossible to fully eliminate.

The more you cut, the faster they seem to grow back.

You remove one, and a dozen more pop up elsewhere, like opening a Pandora’s box—each cut seems to multiply them, speed up the spread, and bring the patient closer to the end.

That’s why, once doctors realize the cancer has likely spread, they have to regretfully say there’s no point in more surgery.

At that stage, only interventional or chemo-radiation treatments are possible.

Whatever the approach, it comes down to using drugs to kill or suppress cancer cells. At this stage, the best we can hope for is to extend the patient’s life, not cure the disease.

For stage II or even stage III stomach cancer, if treated aggressively, the five-year survival rate is still about 60%.

A lot of people wonder—if the cancer has already spread, why go through all that pain and spend so much on treatment? Is this struggle even worth it?

The answer is yes.

Not only does it give doctors valuable clinical data, but it also buys time—someone might just survive until a new treatment comes along that can truly cure them.

In an era where technology is booming and innovation thrives, anything’s possible.

Every year, tons of new cancer drugs are developed—some target specific types. A few lucky patients have actually beaten cancer thanks to new medicine.

Having successfully removed the gastric tumor, Zhou Can was awarded 100 experience points for incision technique and another 100 for tissue separation.

He couldn’t have been more satisfied.

Endoscopic procedures were always his favorite.

These surgeries just made it easier to rack up big experience rewards from the system.

Now, both his incision and tissue separation skills were closing in on level 5. His anastomosis still lagged behind—still only at the lower attending level.

“Director Shang, is there anything I should improve? If not, I’ll remove the endoscope now.”

After finishing up, Zhou Can reported to Director Shang.

“Hmm, the surgery went excellently. Take out the endoscope, then send the patient to recovery. Can you handle the postoperative orders yourself?”

Director Shang asked him.

“I can give it a try, but I’ll still need you to check over my work.”

Zhou Can had never handled postoperative orders for a stomach cancer patient alone before.

But since Director Shang was giving him this chance, he wasn’t shy. He started writing out a set of orders for the patient.

Director Shang watched over him, correcting any mistakes.

In the end, together they produced a complete and accurate set of instructions.

[Pharmacological Reasoning Experience +1.]

[You’ve completed your first postoperative order set for a stomach cancer patient. Reward: Pharmacological Reasoning Experience +100.]

He never expected he’d earn an extra 100 experience points after the procedure was over.

It was a rare bonus—for a skill that was notoriously hard to level up.

For a moment, Zhou Can felt like he was looking at a smooth road to cracking the pharmacology skill ceiling.

His pharmacological reasoning had just reached the intermediate resident level: currently at level 3 with 705/1000 experience. With this new batch of 101 points, he jumped to excellent resident. Two more rewards like this and he’d be at the attending level.

“Gaining medical experience in Internal Medicine is just too satisfying.”

Zhou Can was all smiles.

After that surgery, Director Shang had two more procedures lined up.

Next up was a 42-year-old male patient, with an intestinal tumor.

Zhou Can felt a pang of envy.

He’d barely ever done intestinal endoscopy, and this would be a perfect chance to practice.

But he wasn’t reckless. He didn’t rush to fight for the surgery spot.

Instead, he carefully went over the patient’s test results. Once he was sure he could handle it, he looked at Director Shang with a sheepish smile: “Director Shang, if I want to try for this operation too, would you call me greedy?”

“At least you know your limits, kid.”

Director Shang let out a grunt. His face looked unreadable, but there was a hint of amusement in his eyes as he glanced at Zhou Can.

Zhou Can was well-known—when it came to snatching surgery opportunities, he was as persistent as they come.

Even the strict Dr. Xu could barely keep him in check before.

What chance did Director Shang have?

“After looking carefully at the tumor’s size and location, I’m confident. I’ve performed similar colorectal cancer operations in both Gastrointestinal and General Surgery. If you’d let me, I can take this one off your hands.”

Zhou Can looked up eagerly.

“You’re sure you can handle it?”

Director Shang narrowed his eyes, all seriousness.

Dr. Huang Xinggui muttered to himself that this trainee was shameless—snatching up one surgical training opportunity after another.

Yet, as an attending physician, his own surgical skills didn’t match this trainee’s.

He couldn’t confidently complete either of these two surgeries.

All he could do was watch as Zhou Can seized every chance, totally helpless.

If you don’t have the skill, the smartest move is to stand back and watch. If you force your way, mess up, and ruin the reputation you’ve worked so hard to build, your chances for future surgeries will go up in smoke.

Afterwards, you’d find it nearly impossible to compete for surgery slots.

So Dr. Huang could only watch, burning with envy.

As for the three postgrad scholars under Director Shang, dreaming of performing endoscopic surgery any time soon was wild fantasy.

They needed to master the four basic puncture skills and hone their surgical fundamentals before even thinking of anything else.

“No skill, no surgery—it’s as simple as that. I’m not saying I’m absolutely confident, but I wouldn’t even ask if I didn’t have a good shot.”

Zhou Can replied earnestly.

“Alright. Go ahead!”

Director Shang was happy to oblige. As long as his doctors had the skill, he was all for giving youngsters a chance.

He was perfectly willing to let the younger generation get more practice.

……

All in all, they managed three endoscopic surgeries that morning.

None of them were easy—each had its own technical challenges.

Zhou Can landed two full endoscopic cases and wrote up three full postoperative orders, all under Director Shang’s personal, one-on-one guidance.

Despite the supervision, he felt his gains were huge.

He’d improved both his pharmacological reasoning and postoperative medication management. After writing the third set of orders, he even earned an extra 10 experience points in pharmacology.

He also got to take part in part of the third surgery.

One particularly tough anastomosis, though, he didn’t dare attempt—he just watched as Director Shang did it.

He still remembered vividly the patient who’d had a leak at the jejunal to esophageal anastomosis.

Until his own anastomosis skills reached level 5, he wasn’t taking unnecessary risks with high-difficulty tasks. Better safe than sorry—for the patient’s sake.

By the time surgeries were done, it was past noon. Director Shang generously ordered food for all the medical staff who’d participated.

Everyone ate together, discussing issues they’d come across in the operations. The atmosphere was lively and cheerful.

After those three endoscopic surgeries, Zhou Can had proven his skills to Director Shang and his team. Director Shang looked to be in high spirits, his face breaking into smiles now and then.

Having recruited such an outstanding trainee, he’d have a reliable assistant for the next few months—any chief physician would be thrilled.

For attending and chief physicians, trainees, interns, and visiting staff were basically free labor.

After lunch, Zhou Can headed back to the office, turned on his computer, and started updating his patients’ records.

He also checked up on the progress and latest test results for his seven assigned patients.

“As I expected, the patient in bed 79 really does have portal vein thrombosis.”

After reviewing the results for the female lawyer in bed 79, he finally let out a sigh of relief. They’d finally pinpointed the true cause: a chronic portal vein clot, together with splenic vein thrombosis.

[Diagnosis Experience +1.]

[You’ve successfully diagnosed a challenging hidden case. Reward: Pathology Diagnosis Experience +100.]

Yet again, he’d netted a hundred experience points—this time in pathology diagnosis. Zhou Can couldn’t help grinning more broadly than ever.

Internal Medicine really was his lucky ground.

Skills he struggled to improve in Surgery started climbing fast once he switched to Internal.

At this pace, hitting level 5 in both pathology and pharmacology within a year seemed totally doable.

If, by the end of his three-year residency, he maxed out all his core skills—he could hardly imagine it.

When he returned to the Emergency Department, he’d be unstoppable—and give Dr. Xu and Director Lou a huge surprise.

If he wanted to help the Emergency Department grow stronger fast, he needed solid skills—in every field, inside and out.

Only then could he make a name for himself and carve out a reputation in short order.

With the real cause found for the female patient in bed 79, surgery should sort things out. She’d be back on her feet soon enough.

Watching each of his patients make major progress and regain their health filled Zhou Can with satisfaction and hope.

He was falling more in love with medicine every day.

The more he learned, the more tricky cases he could solve. For patients, having a doctor like him who grew so rapidly was a genuine blessing.

For Zhou Can, this journey of constant improvement was exactly what he wanted in life.

The world of Chinese medicine needed people like him—committed to pushing the profession forward.

……

Days passed. By the next week, the patient in bed 71—the one with a jejunal anastomotic leak and blockage at the site—could finally eat again.

After months of struggle, he drank his first sip of water.

The operation was a huge success.

Not only did it clear the block between the esophagus and jejunum, it also fixed the leak. No more worrying that every meal would just run out through the fistula.

When the patient managed his first sip of water and felt food enter his intestines, he was so moved he burst into tears.

Total gastrectomy stopped the cancer from spreading and saved his life.

But because the earlier surgery hadn’t been well done, his quality of life had taken a major hit.

Now, Tuyu Hospital had resolved the problem.

His elderly wife was moved to tears as well.

She praised Tuyu Hospital’s medical prowess, calling the doctors living Bodhisattvas who save lives.

His daughter, whose worry had been written on her face for months, finally broke into a heartfelt smile. Seeing her father swallow food again, she told hospital staff and nearby families, “It feels like winning the lottery—like some miracle just fell from the sky!”

She never imagined a true medical miracle could happen.

That very day, she had a special banner made, emblazoned with the words ‘Savior of Lives, Boundless Merit.’ To the side, it thanked Director Shang of Tuyu Hospital for his excellent skills in treating her father.

And as for the other unsung hero of this treatment—Zhou Can? He remained anonymous, hidden in the background.

Not that Zhou Can minded in the least.