Chapter 224: A High-Risk Operation in the Neck

After the patient was successfully anesthetized, Zhou Can took his position at the head of the operating table, ready to begin the surgery.

“Xiao Zhou, this is your first time performing this surgery. There are a few key precautions you must follow,” Mr. Liu cautioned before Zhou Can picked up the scalpel, underscoring the high risks involved.

“During the procedure, avoid damaging the carotid artery, internal jugular vein, vagus nerve, hypoglossal nerve, and accessory nerve.”

It was just a routine reminder.

Even if Mr. Liu hadn’t said anything, Zhou Can would have operated with utmost care.

“This condition causes recurrent inflammation, so after controlling the acute phase, early surgical removal is advised. However, if the fistula is narrow with little or no secretion—or if the patient is under two years old—surgery should be postponed.”

If the surgery’s indications aren’t met, the operation must not proceed.

Otherwise, overtreatment could be more harmful than beneficial.

Zhou Can listened intently, etching these invaluable clinical insights into his memory.

“Preoperatively, you must perform a fistulogram—needless to say. This operation easily triggers massive bleeding, so have blood ready for transfusion.”

Mr. Liu continued to guide Zhou Can and the junior doctors through the key surgical steps.

For fistulograms, iodine oil is usually employed.

Its purpose is to delineate the fistula’s direction, depth, and trajectory.

Some fistulas may have multiple tracts, which demands extra caution.

Without a preoperative fistulogram, rushing into surgery—even for an experienced surgeon—could prove disastrous.

“For this patient, two horizontal incisions are required. When all fistula openings are located in the lower third of the neck, two horizontal incisions must be made. Make a spindle-shaped horizontal incision along the lower neck skin surrounding the fistula, and add a larger horizontal incision at the bifurcation of the common carotid artery.”

Mr. Liu had already marked the incision sites in advance.

Nevertheless, he explained the process once more to Zhou Can and the others.

“If the fistula is positioned higher, a single horizontal incision will suffice. The incision’s placement should be determined by the imaging results to avoid major vessels and critical nerves.”

Neck surgeries have always been viewed as high-risk by doctors.

After nearly a year of internship, Zhou Can had barely managed to convince Mr. Liu to let him handle even a neck suture.

If it weren’t for his outstanding performance in that thyroid surgery, he would never have been given the chance.

This small incident revealed just how highly senior doctors regarded the risks associated with neck procedures.

Times have certainly changed.

Nowadays, not only is Zhou Can allowed to suture the neck, but he’s even entrusted with making the incisions.

In just a year and a half, his progress was nothing short of remarkable.

Under normal circumstances, a general surgery doctor would need at least six years after finishing their internship before being permitted to make an incision on a patient’s neck—even if it was only a superficial cut.

Typically, after three years of residency and another three years of surgical training, a senior doctor might consider giving a junior the chance to incise just the skin layer of the neck.

And that opportunity would only ever be given to exceptionally outstanding residents.

Those who were careless or hasty wouldn’t even be considered.

In reality, neck operations are essentially major surgeries—classified as third-level or above.

The risks involved are extremely high.

Even attending physicians are usually limited to an assistant role in such operations.

Zhou Can carefully made a straight incision along the marked line. As he cut, Mr. Liu’s nerves were taut and his hands instinctively clenched into fists, anxious that Zhou Can might cut too swiftly, thereby nicking the patient’s major artery in the neck.

Plasma had already been prepared.

In an emergency, blood could be transfused immediately.

This level of preparation highlighted how much Mr. Liu was betting on Zhou Can’s future—a gamble with his career and livelihood.

【Incision Experience +1】

【For successfully making your first neck incision, you earn +100 Incision Experience】

Zhou Can was pleasantly surprised that this operation netted him a 100-point reward in incision experience.

His heart leapt with joy.

For him, making a neck incision was hardly a formidable challenge.

It felt no different than incising during an abdominal or chest operation.

Now that his incision skills had reached a mid-level proficiency, his tactile feedback from the scalpel was far more precise, allowing him to discern whether he was cutting through skin, subcutaneous tissue, blood vessels, or muscle.

Each tissue type provided its own unique feedback.

It was this tactile sense that enabled surgeons to deftly navigate around nerves and blood vessels with their scalpel.

Once the incision was made, it wasn’t easy to visually distinguish the fistula tract.

But that was no challenge for experienced doctors.

They had devised a method: after an incision, inject methylene blue into the fistula so that the tract would become easily identifiable during dissection.

Next, Zhou Can carefully incised along the planned line, cutting through the skin, subcutaneous tissue, and platysma; then he used hemostatic forceps to grasp the spindle-shaped skin containing the fistula, proceeding with meticulous sharp dissection along the tract.

Although the dissection sounded simple, the procedure was incredibly challenging.

The separation had to progress gradually upward until reaching the bifurcation of the common carotid artery.

“Xiao Zhou, when dissecting along the fistula up to the carotid bifurcation, use 1% Procaine to block the carotid sinus to prevent carotid sinus syndrome,” Mr. Liu reminded promptly.

“Understood!”

Zhou Can swiftly completed the required steps, then made a second horizontal incision along the same plane, pulling the already separated cord-like fistula tissue out through this incision.

Even though his first neck incision had already showcased his skill, Mr. Liu remained on edge during the second cut, fearing any potential mishap.

After all, the risk was enormous.

Fortunately, Zhou Can was both fast and steady, leaving no room for error.

He then executed the next steps, fully displaying his exceptional dissection skills.

This fistula, which wound between the internal and external carotid arteries before curving toward the pharyngeal wall, further amplified the difficulty of the operation.

Even if Mr. Liu were in Zhou Can’s position, he wouldn’t dare be any less meticulous.

Zhou Can carefully separated the fistula from the internal and external carotid arteries, then retracted the external carotid forward.

In doing so, he also had to pull the sternocleidomastoid and the hypoglossal nerve upward.

He continued the dissection along the fistula until reaching the pharyngeal wall.

Every step of the separation was exceedingly challenging.

Yet each step greatly enhanced his dissection skills.

At this point, Mr. Liu himself assisted by using a finger to push the pharyngeal wall outward, flattening the fistula to facilitate the remaining dissection.

Finally, Zhou Can successfully dissected the fistula.

【Dissection Experience +1】

【For successfully dissecting this highly challenging fistula, you earn +200 Dissection Experience】

This was the first time Zhou Can earned a 200-point reward in dissection experience.

Only he knew just how arduous the dissection had been.

It had truly been a treacherous journey.

Thus, he felt that the 200-point bonus was completely well earned.

It was far more challenging than earning two separate 100-point bonuses.

“Excellent work! After flushing the wound, proceed to suture!”

Mr. Liu, who had been sweating coldly through the procedure, finally exhaled in relief as he saw the fistula completely separated, a joyful smile breaking across his face.

Through consistently flawless operations, Zhou Can had won Mr. Liu’s deep trust.

So much so that even high-risk surgeries were entrusted entirely to him.

After irrigating the wound and achieving complete hemostasis,

these procedures seemed like child’s play to Zhou Can.

The five-level hemostasis technique and the four-level debridement method were far from complimentary.

Over the past month, he had performed over 700 general surgeries, amassing an abundance of debridement experience.

Yet, bridging the gap to five-level proficiency remained a distant goal.

High-difficulty debridement cases were rare, meaning bonus experience points were hard to come by.

Earning a single experience point per case made advancing to five levels extremely challenging.

He would need to complete a staggering 10,000 debridement surgeries.

Many surgeons might never achieve that in their entire career.

Once debridement and hemostasis were achieved, Dr. Wu Ziyu watched on with envy.

“Director Liu, Dr. Zhou, may I handle the suturing?”

Watching Zhou Can take on ever more advanced tasks while she couldn’t even secure a slightly challenging suturing assignment made her anxious.

Surrounding herself with top professionals naturally pushed her to improve, and she longed to close the gap with Zhou Can.

“This surgery’s suturing requirements are extremely high. You’re not yet ready! Next time, I’ll give you a less challenging case to practice on,” Mr. Liu explained, not wanting to discourage her enthusiasm.

Senior doctors rarely delegate such responsibilities lightly.

Even though Mr. Liu entrusted Zhou Can with high-difficulty neck fistula dissections and incisions, it was because Zhou Can had steadily proven his competence, whereas Dr. Wu’s skills still lagged far behind.

Thus, her rejection was not surprising at all.

“Dr. Wu, there’s no need to rush. When the time is right, your opportunity will come,” Zhou Can reassured her.

He completely understood her eagerness to advance.

Zhou Can had once been in her shoes, frustrated at being unable to operate while watching others take the lead.

He had been ruthlessly turned down by Dr. Xu more than once.

Now, with his skills refined, senior doctors entrusted him without even a word from him.

Next, he performed layered suturing on the wound and placed a rubber drainage tube.

He then applied a pressure dressing with a neck sandbag.

With that, the surgery was essentially completed.

Postoperative care was handed over to the Inpatient Department’s doctors and nurses.

“Alright, move the patient to the recovery room! For postoperative care, use antibiotics to prevent infection, apply Dexamethasone if necessary to reduce swelling, and administer nebulization. Drainage tubes should be removed within 24 to 48 hours, and sutures taken out after 7 days.”

These were Mr. Liu’s precise postoperative orders, to be meticulously executed by the Inpatient Department.

Zhou Can glanced at the remaining ten-plus surgeries and felt the weight of immense pressure.

Looks like he’d be working late tonight!

His tireless efforts were part of establishing the newly-formed Jiaru Surgery.

Once Jiaru Surgery was up and running, those early members would undoubtedly be remembered with strong loyalty—and for Zhou Can, that would surely be to his advantage.

……

Four days later, Zhou Can appeared noticeably thinner from exhaustion; all the pending cases for Jiaru Surgery had been resolved.

His surgical expertise had made a quantum leap.

Previously, while assisting Mr. Liu, his cases had been mostly focused on thyroid diseases.

But over those four days, even though he had performed fewer than one hundred surgeries, the wide variety spanned numerous medical fields and greatly broadened his surgical experience.

It is rare for a surgeon to independently lead so many diverse procedures in such a short period.

The mix of major and minor surgeries allowed him to revisit every detail of human anatomy and pathological processes—a comprehensive learning experience that was invaluable.

This continuous, integrated learning was far superior to isolated experiences.

Nearly all cases had favorable outcomes.

His only regret was the patient with a massive facial lipoma—a case that later developed unavoidable postoperative syndrome. After the wound initially healed, the patient was transferred to the Internal Medicine Department for further treatment.

No one could predict that patient’s future.

Even though the surgery had been successful, the overall outcome was somewhat unsatisfying.

This patient’s case haunted Zhou Can.

It made him realize that a doctor’s abilities are far more limited than one might imagine—many situations can leave even the best feeling helpless.

In the office, Mr. Liu exuded a relaxed confidence and a hint of a smile.

After Zhou Can helped wrap up all the pending surgical cases, Jiaru Surgery faced no further issues.

Over those four days in the operating room under Mr. Liu’s guidance, even the other attending physicians had been busily engaged in their new assignments.

Jiaru Surgery was now firmly on track; every patient with a Jiaru condition was treated thoroughly, with not a single case missed or delayed.

The entire department operated with perfect order.

Patient experiences were undoubtedly excellent.

Doctors and nurses had quickly adapted to their new roles, each performing with impressive skill and dedication.

The Jiaru Surgery Department radiated a promising and thriving energy.

“Xiao Zhou, thank you for your hard work these past few days! If I could, I’d have you remain in Jiaru Surgery to help it grow even stronger.”

Mr. Liu knew that Zhou Can was destined to move on eventually—he simply couldn’t hold him back.

Like a fledgling eagle destined to soar, Zhou Can would one day venture out, refine his skills, and rise to soar among the clouds.

He still had a great deal to learn.

Simply being able to perform surgeries was not enough.

Internal Medicine is challenging, yet it is a mandatory discipline for every esteemed doctor.

“Thank you for your high praise. Once I’ve completed my training, I promise to return and help with General Surgery. I have to deeply study definitions, etiologies, pathogenesis, epidemiology, natural history, symptoms, signs, lab diagnostics, imaging, differential diagnosis, treatment, and prognosis. All these are crucial for paving the way to my future practice.”

During his three months in the Critical Care Department as a trainee, Zhou Can had come to fully appreciate the importance of Internal Medicine.

True medicine is born from Internal Medicine, not from Surgery.

Internal Medicine delves into pathology and pharmacology, while surgery relies more on technique than theory.

Traditional Chinese Medicine originally developed from classics like the Huangdi Neijing and the Suwen.

Zhou Can had a clear understanding of which was more fundamental.

Neglecting Internal Medicine just because one shows early surgical talent is like missing the forest for the trees. At this stage, such oversight might seem trivial.

But when he is finally required to work independently, those shortcomings will become glaring.

Every area will be held back by these omissions.

“Your perspective is excellent, and you haven’t let early success make you complacent. At your age, such clarity is rare. Rest assured, I’m not selfish enough to keep this to myself. This record of General Surgery is a compilation of decades of my insights, surgical strategies, and even my mistakes—all documented in detail. Take it, make copies, and then return the originals. If you find it valuable, use it to help other promising doctors with strong ethics.”

Mr. Liu, who had practiced for over thirty years and despite being only an Associate Attending in General Surgery, possessed extraordinary surgical skills.

The wealth of experience he had amassed was nothing short of a treasure for a newcomer like Zhou Can.

Thick volumes—over two or three dozen bound books—stood as a testament to his meticulous record-keeping.

It was hard to fathom that every word had been carefully penned by Mr. Liu.

Zhou Can stood up, respectfully accepting the documents and flipping through the topmost volume.

His admiration for Mr. Liu swelled naturally.

Every surgical record, every diagnostic mistake, and every pre- and postoperative incident was documented with precise handwriting, some even illustrated.

It was nothing less than a medical masterpiece.

Decades of painstaking notes were selflessly passed on to Zhou Can for his study and reference—Mr. Liu truly regarded him as his dearest protégé.

“Your gift is far too valuable. I’ll make copies of everything and then return the originals to you.”

Zhou Can felt that these materials were worth more than a mountain of riches.

“I’m getting old; in a few years I plan to retire. These notes are of no use to me now. Once you’ve studied them, if you believe they hold value, keep them for other promising doctors with strong ethics. Remember, no matter how high your achievements climb, never pass on core techniques to those of poor character.”

That was Mr. Liu’s one and only request.