Surgery Godfather
Chapter 1036 - 854: Incidentally Removed the Tumor as Well_2

Chapter 1036: Chapter 854: Incidentally Removed the Tumor as Well_2

The pancreas, duodenum, and stomach are intricately related at this location, which is why pancreoduodenectomy is considered the pinnacle of digestive tract surgery.

After clearing the periphery, especially around the liver, Yang Ping began to focus on the pancreas, duodenum, and stomach, where the blood vessels were in extreme disarray.

The main blood vessels of the duodenum include the superior duodenal artery of the first segment, the branches of the gastroduodenal artery, and the posterior superior pancreaticoduodenal artery branches; the gastroduodenal artery itself is a branch of the hepatic artery, and these vessels are intricately intertwined.

The blood supply for the remaining three segments of the duodenum comes from the anterior and posterior arterial arches, from which branches extend to the pancreas and duodenum. The branches supplying the duodenum are known as terminal arteries, sometimes embedded within the pancreatic tissue.

However, the blood supply to the pancreas itself is even more complex, with vessels originating from the celiac artery and the superior mesenteric artery. These vessels are highly atypical and frequently exhibit variations, which is the most frustrating aspect for surgeons. Blood vessels do not conform to the textbook nor to others’ anatomies, which sometimes necessitates spending a considerable amount of time to locate them, akin to going to battle without a map, or having an erroneous one and having to navigate on the fly.

"How’s it going? What stage has been reached?"

The doctors, graduate students, and attending physicians on the periphery were restless, only able to inquire about the surgery’s progress from those with a view.

"It seems like the pancreatic tumor blood vessels are being separated."

The ones with a good view, in reality, didn’t see much; the surgery was too fast to follow. They only saw instruments moving in and out, constantly switching in the surgeon’s hand, but even without watching the surgery, just observing the handling of the instruments was thrilling enough. In fact, many probably weren’t watching the surgery itself but solely the manipulation of instruments.

Vascular arches of the pancreas, dorsal pancreatic artery arches, transverse pancreatic arteries, distal pancreatic arteries, splenic artery branches, and veins of the pancreas were meticulously dissected one by one, followed by the tumor’s blood vessels, which were also dissected one by one, then clamped, cut, and ligated.

All the major arteries of the pancreas are located behind it, making the procedure extremely challenging, and this accounts for why some surgeries must resort to ex-vivo resection to achieve their targets.

With so many blood vessels in the pancreas and around twenty or so vessels associated with the tumor, it was nearly impossible to differentiate between the pancreas’s vessels and those of the tumor. It was essential to clarify the details of their origins and courses.

Doctor Liao grew increasingly impressed the more he watched, feeling his own pride fading in the face of Professor Yang’s expertise. His own skills were nothing in comparison—it truly was a case of ’there’s always someone better.’

Director Long, for one, was thoroughly enjoying the procedure. The separation of each vessel, preserving what needed to be preserved and handling what needed to be addressed, unfolded without a single error.

The most terrifying aspect was that, despite the surgery’s lengthy duration, there was almost no bleeding, as if it were a simple gallbladder removal. Such a level of skill was unparalleled in the country.

With the pancreas handled, the focus shifted to the adjacent stomach and duodenum.

By now, everyone had lost track of time. The surgery was expected to carry on into the night; a duration of a dozen or more hours was the norm. Director Long seemed to forget how long the surgery would take, having even asked Dr. Lv to order meals.

Large gauze pads were steadily laid around the surgical area, and many traction strings were tied to the tumor, each with a vascular clamp attached at the end, neatly arranged around the incision into the abdominal cavity.

Dr. Lv, who hadn’t joined the operation, was also on standby below. He, too, had just realized this logistical issue—Director Long was treating everyone, but the surgery could take over a dozen hours by the book; hence engaging such hospitality wasn’t that straightforward.

However, since Director Long was busy on the operating table, it didn’t seem appropriate to ask; so, they decided to wait and see, perhaps inquiring once Director Long had the chance.

Professor Liang felt out of place alone in the operating room and, with Yang Ping busy, went over to orthopedics to lend his presence.

The anesthesiologist, seasoned and knowledgeable, also made his rounds by the operating table from time to time. While he couldn’t see the specifics of the surgery, he paid attention to the used gauze pads. If they were soaked with blood and numerous, it would indicate significant bleeding.

But, after making several rounds, he observed that aside from the previously accounted for gauze, only a few additional pads had been added to the collection basin, and those were faintly tinged with blood.

Glancing at the patient’s blood pressure, it had been stable since Professor Yang took over. Owing to fluid resuscitation, the blood pressure was now on an upward trend.

This is a true master, the anesthesiologist concluded.

The anesthesiologist was older, about fifty-something, with a wealth of experience in the operating room. Even without understanding the intricate details of the surgery, he could tell at a glance the proficiency level of the chief surgeon — this was a fundamental skill for all senior anesthesiologists.

Surgery was at a critical moment, the scalpel navigating the most perilous area. Director Long, being the nearest witness, now felt as if he were not just performing surgery but participating in some sort of extreme sport, or perhaps this surgical method could be named extreme surgery.

Because the surgery constantly emitted a different aura—extreme, high-risk, and not allowing for mistakes—Director Long poured all his learning into the surgery and became a qualified experiencer.

As the blood vessels were dissected and ligated, the surgery proceeded methodically. If this state could be maintained, even if the Blood Transfusion Department couldn’t provide more blood, Director Long believed the surgery could be completed safely. He felt instantly reassured.

The tumor had not only invaded the duodenum but had also reached the stomach. The Left Gastric Artery, Right Gastric Artery, Left Gastroepiploic Artery, Right Gastroepiploic Artery, Short Gastric Arteries, Post-Gastric Artery—a plethora of supplying arteries, alongside the Left and Right Gastric Veins, Left and Right Gastroepiploic Veins, and Short Gastric Veins, the former two flowing directly into the Portal Vein, with the latter three indirectly joining the Portal Vein via the Superior Mesenteric Vein and Splenic Vein.

Such a complex vascular network system, the scalpel was unstoppable like a force to be reckoned with. But it always moved through various interstices, and even when there weren’t gaps, it would create them.

Doctor Liao was the second assistant, and he had become completely engrossed. His understanding of this scalpel had evolved beyond a mere surgical knife, but rather into some kind of weapon with superpowers.

How did he swiftly determine the positions of the blood vessels and differentiate normal blood vessels from those belonging to the tumor? Every time he clipped and ligated a vessel, there was no hesitation, showing his judgment was extremely confident and precise. How was this achieved?

Doctor Liao couldn’t help but ponder this simple question.

Within those complex anatomical spaces, Yang Ping had dealt with numerous blood vessels, continuously weaving between blood vessels, the tumor, and organs. Even the nearly impossible-to-access blood vessels behind the pancreas and at the hepatic portal were completed in an incredibly cramped operating space.

Director Long had seen with his own eyes how several blood vessels were picked out directly from behind the organs with curved clamps—that is, not even in direct view.

That was because those few vessels were impossible to deal with under direct visualization, blocked by the liver and pancreas. Unless the liver and pancreas were cut out, cutting those vessels was simply out of the question.

Surgery was thrilling, but the people involved found it extremely taxing, both Director Long and Doctor Liao. Their attention needed to be highly focused, and their brains’ nerves were stretched taut.

"It’s done!"

Yang Ping finished dealing with the last blood vessel.

As long as the blood vessels were managed properly, the remainder of the surgery should be straightforward. Director Long felt greatly relieved.

At that moment, Yang Ping, holding several vascular clamps attached to the tumor traction threads, directly lifted the tumor out of the abdominal cavity. It was a whole tumor.

Wasn’t he just dealing with blood vessels? How was the tumor also excised?

Director Long had been seeing Yang Ping separating blood vessels all along and hadn’t noticed him isolating the tumor. He thought it was just a matter of handling blood vessels.

But Yang Ping was making progress on both fronts; overtly, he was separating blood vessels, covertly, he was isolating the tumor. Just now, everyone hadn’t paid attention, thinking he was only dealing with blood vessels. A substantial part of the tumor was hidden behind the organs, which Yang Ping had turned over while handling the vessels, but it didn’t seem enough to have separated the entire tumor.

"Director Long, take a look, I’ve also taken out the tumor for you."

Director Long immediately checked inside, feeling around for a full ten minutes. The entire tumor had already been removed.

Was the surgery over? Was it time to close the abdomen?

Did he incidentally remove the tumor for me?

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