Chapter 149: A Breakthrough in the Operating Room

Zhou Can remained remarkably steady as he carefully drained all the accumulated blood from the patient’s brain.

Using the endoscope’s probe, he began to locate the bleeding source.

A hematoma forms when a ruptured blood vessel causes bleeding that can’t drain out, trapping the blood in a confined area.

Usually, when a hematoma appears on the limbs or skin, it’s not a major issue.

If the bleeding is minor, you might not even need a hospital visit – simply apply an ice pack.

The cooling effect constricts blood vessels, stopping or reducing further bleeding.

Many people who twist an ankle end up rubbing red oil or herbal injury remedies into the swelling, but that can actually worsen the situation.

This is especially dangerous if a fracture has occurred.

Instead, splashing cold water on the swollen area is the proper remedy.

The water’s temperature quickly constricts the ruptured blood vessels, automatically stemming the bleeding. While it doesn’t remove the hematoma, it prevents it from worsening.

Which areas are most at risk from hematomas?

Inside the skull and along the spine – here blood infiltration or pressure is most dangerous.

The patient under treatment had developed an intracranial hematoma, causing high intracranial pressure. This pressure on the brainstem, cerebral hemispheres, and critical nerves led to his coma and rapid decline in vital signs.

Draining the accumulated blood now lowers the intracranial pressure, achieving the same effect as a brain puncture for drainage.

“Director Wen, I’ve found two bleeding points. Shall I use the electrocautery to achieve hemostasis?”

After his performance over the last two days, Zhou Can had earned Director Wen’s absolute trust.

Electrocautery in non-critical areas carries minimal risk.

But when it’s used inside the skull near the brainstem…

The risks become exceedingly high.

Director Wen fixed his gaze on Zhou Can and asked, “Have you ever used electrocautery in surgery before?”

Zhou Can couldn’t help but smile broadly.

Among all his medical skills, his hemostasis technique was the best.

It had already reached an associate chief physician’s level.

“I’ve participated in numerous surgical hemostasis cases. I’m about 80% confident I can control these two bleeding points without damaging any other brain tissue.”

Saying only 80% is extremely conservative.

Leaving some room for uncertainty is always a wise approach.

It’s like eating until you’re 80% full or brewing tea until it’s seven-tenths steeped.

“Alright, give it a try!”

Director Wen recalled the earlier incident when his hands trembled during an endoscopic procedure and decided to delegate the operation. Even if he had performed it himself, he doubted he could match Zhou Can’s skill.

Under normal circumstances, a surgeon’s hands don’t shake during any operation.

Only extreme nervousness can cause such tremors.

It’s the body’s natural, loyal reaction.

Zhou Can manipulated the endoscope to perform electrocautery hemostasis. Compared to a standard electrocautery knife, its use was slightly different.

It mainly tested his ability to maneuver with extended reach.

With his superb hemostasis skills—and considering his Placement Technique and Grasping Technique were at least level three—the entire hemostasis process proceeded flawlessly and was completed effortlessly.

“Dr. Zhou, your hemostasis skills rival those of a senior associate! And your natural talent for endoscopic operations is, well, enviable!”

Director Wen kept his eyes glued to the endoscopic screen, following every step of Zhou Can’s procedure.

Each movement was precise and efficient; the bleeding was halted quickly and effectively.

Notice how Director Wen casually used the word ‘enviable’ at the end.

That was because his own talent in endoscopic surgery was rather average.

Seeing Zhou Can excel in both traditional and endoscopic procedures stirred his admiration.

Surgeons who master both techniques are exceedingly rare.

Domestically, training in endoscopic surgery starts with assessing traditional surgical skills – a basic prerequisite.

Particularly the four fundamental surgical skills of the Surgical Department.

Once a solid foundation is built, candidates for endoscopic surgery are chosen for further training.

That’s why hospitals across the country – even county-level tertiary hospitals – can now perform some endoscopic procedures.

But truly exceptional performers are extremely rare.

The most concerning are those surgeons who arrogantly assume that endoscopic surgery is simple. They might manage basic procedures like appendectomy or polyp removal with an 80% success rate and then get overly cocky.

They even promote minimally invasive surgery when a tumor is detected.

Especially for conditions like breast fibroadenoma or granuloma in women, where the small incision is thought to preserve a patient’s figure. Most female patients opt for the more expensive minimally invasive option.

The result? Incomplete tumor removal leads to recurrence and pus formation.

Many patients then lose the chance for a second surgery.

Such doctors are terribly unethical.

They ignore the severe consequences patients may suffer in pursuit of personal accolades and so-called endoscopic achievements.

Zhou Can reviewed the endoscopic images carefully and then discovered another bleeding point.

This time, without further consultation, he directly performed electrocautery hemostasis.

At last, everything was under control.

After draining the new accumulation of blood, Zhou Can asked, “Director Wen, can I now withdraw the endoscope?”

“Withdraw it!”

Director Wen agreed enthusiastically.

Zhou Can gently retracted the endoscope.

【Placement Technique EXP +1】

【For your first intracranial endoscopic surgery, Placement Technique EXP +100, Grasping Technique EXP +100, Hemostasis EXP +100】

Wow, he just bagged a whopping 300 EXP reward in one go.

This was the highest EXP reward Zhou Can had ever received for a surgery.

Risk and reward go hand in hand.

It seems that any future chance to prove himself must be seized without hesitation.

【Congratulations! Your Grasping Technique has risen to Level 4 – Current EXP 60 / Associate Level. You can now perform endoscopic canal grasping, precisely reposition implanted spring rings, and assist with endoscopic resection of pathological tissues.】

Goodness, just when things seemed to go wrong, fortune smiled on him in heaps!

Zhou Can relished the fresh power of Level 4 Grasping Technique, feeling as if he was sipping honey.

He’d just unlocked another advanced surgical skill at the associate level.

At this rate, it wouldn’t be a dream to upgrade all his basic skills to deputy chief level and his advanced skills to associate level within a year.

“Does the skull drilling need repair?”

“Not at all!”

Director Wen answered immediately.

“What about the dura? Should it be sutured?”

Zhou Can was clearly eager for every surgical opportunity he could grab.

“Theoretically, as long as hemostasis is maintained and postoperative infections are managed, the dura, which naturally has some self-healing capability, will eventually merge with the temporalis muscle.”

Director Wen patiently guided Zhou Can.

Three graduate students busily took notes.

Several resident doctors were also recording, as surgical knowledge must be accumulated continuously.

Surgeons encounter myriad challenges during procedures.

The best strategy for newcomers is to take copious notes and review them frequently to solidify their memory and skills.

That way, troubleshooting during future surgeries becomes second nature.

“Of course, if you wish to repair it, that’s also an option. Typically, a tension-reducing suture is used,” Director Wen added after examining the wound.

Zhou Can’s interest was immediately piqued.

“May I handle the suturing? I promise I’ll do my very best.”

Suturing – Zhou Can had practiced this countless times.

But it was his first time suturing the dura.

“How’s your suturing skill? If your level meets that of a mid-level resident, I might let you take charge,” Director Wen admitted, no longer underestimating Zhou Can.

After all, each of Zhou Can’s surgical abilities surpassed the last.

Especially his endoscopic hemostasis skills, which were nothing short of astonishing.

Even Dr. Zou, who had been critical of Zhou Can, couldn’t help but be impressed – his hemostasis skills rivaled those of a 40-year-old associate physician.

One might even wonder how on earth this kid trained so intensively?

“Your suturing is pretty good – at resident level, at least,” Zhou Can noted, his EXP in suturing and ligature already at an excellent associate level.

He was only a thousand points away from promotion to deputy chief.

No resident could compare to him; they’d all be left questioning their lives.

“Alright, give it a try!”

This suturing also required endoscopic guidance.

The small hole beneath the skull wouldn’t even allow a standard suturing needle.

Zhou Can delicately conducted endoscopic suturing – his first ever under such conditions.

His plan was simple:

While Director Xie hadn’t yet reined in his propensity to lower him, this chance for surgical practice was too good to pass up.

Opportunities like this under endoscopic guidance were hard to come by when shadowing other doctors.

Fortunately, Director Wen, who lacked advanced surgical talent himself, had given Zhou Can an exceptional opportunity.

Barely after his first suture, the operating room filled with a collective intake of breath.

Dr. Zou and Tang Li stared in disbelief as Zhou Can completed the endoscopic suturing, leaving them far behind.

“My God! Dr. Zhou’s suturing is practically at the deputy chief level already,” Tang Li exclaimed. Although she prided herself on her own suturing, compared to Zhou Can, her skills paled drastically.

“This kid is simply outstanding!” Dr. Zou murmured.

As for the other residents and graduate students, they couldn’t even begin to tell what made Zhou Can’s suturing so extraordinary.

All they could see was clean, rapid suturing.

Director Wen’s eyes remained fixed on the screen in silence, worried that any interruption might disturb Zhou Can’s concentration.

He even pressed his hand down to quiet any voices.

Zhou Can had just demonstrated how impressive a trainee could be – in under five minutes, he had completed all the suturing.

“Director Wen, please inspect it.”

After finishing, he respectfully requested Director Wen’s final check.

【First Endoscopic Suturing Completed – Suturing EXP +100, Ligature EXP +100】

What a rush!

For his first endoscopic operation, the rewards were magnificent – EXP was added in full hundreds.

“No, no, no!”

Director Wen shook his head repeatedly, his expression serious as he fixed his unwavering gaze on Zhou Can.

His words hit Zhou Can like a bucket of cold water, chilling him to the bone.

All the excitement and joy instantly melted into a humble readiness to accept criticism.

“Ah… this is my first time suturing the dura. If I missed something, please point it out and I’ll correct it immediately.”

Zhou Can had felt confident about his suturing initially.

But Director Wen’s harsh evaluation struck him hard.

“No, no, I’m not saying your suturing is poor. Rather, I’m questioning your very identity. In my over thirty years at Tuyu, I’ve never seen a trainee as bizarre as you. Your Placement Technique is superb and confirms your advanced surgical talent. Yet, your levels in hemostasis, suturing, and ligature are at the associate level. This is simply unprecedented.”

Director Wen wasn’t naive.

It’s understandable for a trainee to excel in one area through excessive practice.

But to be proficient in every surgical discipline – that’s almost impossible unless you were honing your skills since before birth.

The training cycle for surgeons is inherently long; achieving even modest success in a decade is challenging.

Even the most talented don’t reach such heights.

“Hehe, that scared me. I honestly thought you hadn’t sutured properly.”

Zhou Can let out a huge sigh of relief – as long as the surgery was a success, that was all that mattered.

“Maybe I just really love surgery, and I practice constantly. My foundation is just a bit stronger than that of an average trainee. It’s nothing as exaggerated as you say!”

His explanation was admittedly a stretch.

But since the matter was trivial, no one would probe further.

Even if they did look, there wouldn’t be much to find.

Zhou Can was undoubtedly diligent – practicing surgery every day after work.

“Not long ago, I overheard some directors talking about this year’s trainees. They mentioned two prodigies: one with a truly extraordinary surgical ability and another whose theoretical knowledge outclassed all department heads. I was skeptical at first, but now I’m convinced.”

Director Wen’s comment on the other prodigy clearly referred to Du Leng.

The returned overseas PhD was indeed impressive.

Though sometimes his credentials were somewhat inflated.

From what Du Leng had shown so far, he was the real deal.

“Dr. Zhou, don’t just stand there – why not finish suturing the scalp too? Let me admire once more your superb suturing skills, reminiscent of Dr. Xu in his prime.”

Director Wen casually mentioned the late Dr. Xu, underscoring his monumental influence in the Surgical Department.

“Thank you, Director Wen, for your trust.”

Without another word, Zhou Can took the needle holder and suturing needle from the instrument nurse and resumed suturing.

He noted that for such major surgeries, the instrument nurses were always highly experienced and professional.

They were prepared with the appropriate threads for different suturing areas – there was no need for Zhou Can to request anything.

Everything was ready to use, including various details executed to perfection.

Earlier, during the endoscopic suturing, no one had clearly seen his techniques. But now, as he sutured the scalp, everyone’s eyes were opened.

“His suturing skills beat mine. Today has truly been an eye-opener,”

Dr. Zou admitted with a tinge of dejection.

What was meant to be a Level 4 procedure turned into Zhou Can’s personal showcase.

After all, this was a Level 4 surgery! Who would have thought a trainee could effortlessly handle most of the critical tasks?

Zhou Can’s speed was clearly inheriting Dr. Xu’s famously fast style.

He quickly finished suturing the head wound.

“Not bad at all – this suturing is truly uplifting. The patient is still extremely weak, and the knee surgery will be postponed by the Orthopedics later.”

This car accident victim had injuries not only to his head but also to his knee and other areas.

While the trauma had largely been addressed,

“After clearing the intracranial hematoma, the patient’s vital signs have improved dramatically – it’s night and day compared to when he first entered the operating room. At this rate, I wouldn’t be surprised if he could move from the ICU to a general ward in just a day or two.”

The anesthesiologist’s confidence in the patient was unmistakable.

After all, he was the one most familiar with the patient’s condition.

“Haha, with such an optimistic evaluation, it seems this surgery went quite well. Once the patient awakens from general anesthesia, send him back to the ICU for observation!”

Director Wen had successfully completed a highly challenging surgery and was in high spirits.

Glancing at the clock on the wall, he mused,

“Looks like I can head off to do some research early today! Endoscopic surgery definitely has its advantages over traditional methods!”

Based on his earlier estimates, a traditional craniotomy would have taken at least four to eight hours.

And that’s assuming nothing unexpected happened along the way.

With vital signs plummeting, the surgery would have to be halted for emergency rescue – further extending the duration.

“Endoscopic surgery is indeed a major development trend. Yet, for some conditions, minimally invasive procedures can’t completely replace traditional surgery. So I don’t believe traditional operations will ever be entirely phased out.”

Tang Li, whose advanced surgical talent was lacking, had clearly pondered the future of both techniques.

After all, as young doctors, the greatest fear is being rendered obsolete by the times.

“You’re right. Traditional surgery will maintain its niche for a long time. But we also must recognize the rapid advancement and numerous advantages of endoscopic procedures. It’s similar to how our traditional Chinese medicine, in just a century, has been squeezed into a niche by Western medicine.”

Director Wen remained rather pessimistic about the prospects for traditional surgery.

He even cited traditional Chinese medicine as an example.

“Our traditional Chinese medicine isn’t bad. In fact, some of my classmates who studied abroad told me of a strange phenomenon – domestically, we neglect and look down on traditional Chinese medicine, yet overseas they’re heavily investing in it. They’ve quietly developed over ten thousand varieties of Chinese herbal medicines and even set up dedicated research centers, poaching top talents from our country.”

Dr. Zou spoke with a tone of deep sorrow.

The market for traditional Chinese medicine remains tiny – an undisputed fact.

Visionary doctors and scholars are calling for its preservation, albeit with little success.

Zhou Can shot Dr. Zou a meaningful glance. His earlier words had certainly swayed his view.

To be honest, Zhou Can’s attitude toward traditional Chinese medicine had always been neutral.

He neither overly praised nor disparaged it – simply viewing it objectively.