Surgery Godfather
Chapter 1003 - 837 - : Am I not an assistant? Why am I in the audience?

Chapter 1003: 837 Chapter: Am I not an assistant? Why am I in the audience?

The liver is very close to the pancreas, and they are neighbors, which makes it possible for pancreatic tumors to invade the liver in many different ways. Right now, the metastatic liver tumors are especially complex as they somehow grow around the hepatic portal artery, veins, and various other conduits.

If the tumor needs to be removed, the blood vessels must be severed along with it, and these vessels must then be reconstructed. Of course, such intricate tumors cannot be excised internally, hence the existence of ex-vivo resection techniques.

Now, Yang Ping views the liver and the tumor as one entity, without intending to separate them internally. The separation of the tumor will be handled externally. For now, Yang Ping’s goal is to separate this "organ+tumor" whole from the surrounding normal tissue.

Even so, this task is not easily accomplished because the tumor ultimately encompasses the blood vessels and crawls towards the inferior vena cava.

The scalpel is the best tool for sharp separation. Compared to the various modern "knives," such as laser knives, ultrasonic knives, and waterjet knives, the scalpel’s efficiency, in the hands of an expert, remains unmatched. Moreover, it is the most accessible weapon available in any hospital.

Currently, the video of the liver and tumor’s anatomy is indescribable; it’s impossible to recognize what this thing is.

Yang Ping and the assistants are now wearing fluorescent navigation glasses. Through these glasses, the tumor tissues, stained with indocyanine green, emit a faint green fluorescence, while the normal tissues do not. So, the tumor-invaded tissues clearly demarcate from the normal ones into two distinct camps. The scalpel navigates between these two camps to ensure the thoroughness of the resection by extending beyond the dividing line to include some of the surrounding normal tissue.

Remove first, then reconstruct—this is the inevitable choice in surgery. Once vital structures are involved, they are mercilessly eliminated, and these structures are reconstructed afterward.

The scalpel now navigates through a dangerous area: the outlet for the blood outflow from the liver—this is the "junction" where the three hepatic veins meet the inferior vena cava. All blood "detoxified" by the liver must exit here and return to the inferior vena cava.

These blood vessels are severely compromised, so they cannot be preserved. However, until the entire surgical target is removed from the body, Yang Ping temporarily maintains their presence, allowing them to ensure that the liver’s blood circulation continues normally.

If the entire surgical target is taken out of the body, these blood vessels will be cut at a normal section, and the blood vessels along with the tumor will be removed together. After the tumor is removed ex-vivo, these vessels must necessarily be reconstructed with transplanted vessels.

Director Shi’s heart endures immense pressure. If it weren’t for the matter of those seven organs, if it were only this one organ, the liver and the tumor currently seen, it would still be a major surgery.

This operation is called ex-vivo liver resection + autologous liver transplantation.

Typically, liver transplantation usually refers to allogeneic transplantation, where the transplanted liver comes from another person. Now, the transplantation involves one’s own liver, which might seem easier.

On the contrary, autologous liver transplantation is much more difficult than standard allogeneic liver transplantation, and it is known as the Mount Everest of hepatobiliary surgery.

Because autologous liver transplantation involves two challenges, first, after the patient’s liver is removed, there’s a liver-less period for the patient. During this time without a liver, the surgical team must ensure he stays alive.

Secondly, after the liver is removed, it must be meticulously repaired before being reinserted, and this repair must be flawless. If the liver is repaired incorrectly, the patient lying on the operating table is certainly doomed.

Allogeneic liver transplantation is different, utilizing someone else’s liver. Although this liver might not function well, it’s better than none. In case the new liver encounters problems and cannot be implanted, the patient faces no immediate life-threatening issue.

Both scenarios are akin to changing the CPU in a functioning computer.

With autologous liver transplantation, the original CPU is removed, repaired, and replaced without shutting down the computer, which must continue functioning normally. If the CPU repair fails, and it can’t be reinstalled, the computer is effectively useless. For allogeneic liver transplantation, a new CPU is acquired to replace the original one. Even though the computer shouldn’t shut down during this process, the computer still has its own CPU, making the operation less risky. If the new CPU is damaged accidentally, it doesn’t matter much; the failed attempt can simply be tried again later since there is still an operational CPU inside.

In this case, even if all steps of ex-vivo liver resection + autologous liver transplantation go smoothly, there are still complex reconstructions like the hepatic artery, common bile duct, portal vein, hepatic upper and lower inferior vena cava afterward—

If any step is not performed well, and the patient is replanted, such as if the blood vessels are not properly reconstructed causing massive bleeding, there’s no rescue. If the common bile duct leaks, causing bile leakage, it again poses a life-threatening situation.

Director Shi Guosheng is one of the few professors in the country who performs such surgeries, and so far, his accumulated cases are not numerous. Ex-vivo liver resection + autologous liver transplantation roughly takes him about a dozen hours or so.

Recently, Pengcheng performed an ex-vivo liver resection + autologous liver transplantation, said to be the first in the medical history of Pengcheng, taking over twenty hours, illustrating the difficulty of such surgeries.

This is merely ex-vivo liver resection + autologous liver transplantation, and the surgery Yang Ping is performing involves eight organs, the difficulty of which is like the Mount Everest upon Mount Everest, the tower reaching to the skies in general surgery.

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