Surgery Godfather

Chapter 246: Chapter 0230: They All Must Live

Fourteen casualties were smoothly transported back to the hospital, the pregnant woman that was brought back by helicopter, is already on the operating table. @@novelbin@@

Yoshino did not fail his mission, for now, they were all alive.

As a doctor in charge of pre-hospital emergency care, his duty ended the moment the casualties were handed over to the hospital.

Although sometimes, the surgeons needed a detailed understanding of the situation at the scene and would discuss it with Yoshino, his primary responsibilities were over nevertheless.

Wanting to light up a cigarette, Yoshino went alone to the smoking room.

He was aware of the health risks of smoking, and he advised others against it, but he needed some way to relieve the pressure.

“Good job Yoshino!” Sasaki called.

Yoshino, in the ambulance, decisively removed the skull cap of one casualty, adequately decompressed it, and even cleared some of the hematoma under very basic conditions.

His judgment based on the symptoms and signs was very accurate. Most of the hematoma was cleared, and the brain herniation was promptly handled, winning valuable time for the rescue.

Otherwise, the person brought back by the helicopter now would not be a living being, but a cold corpse.

“A few years ago, in a similar situation, I hesitated and eventually gave up. The patient ended up dying, and I have been living with regret, constantly questioning why. Today, I didn’t hesitate. Whether the mother can survive or not, I did my best, now it’s your turn.”

Yoshino was just a cog in the system. The system works well only when every cog is functioning properly.

Yoshino and Sasaki were about the same age. While Sasaki was already an associate professor, Yoshino was still a lecturer, but it didn’t bother him. The greatest joy for him lies in saving lives.

“The fetus is already five months old and there’s still a fetal heartbeat. We pulled up her past medical documents, and she had spent five years and visited numerous hospitals to become pregnant. It’s obvious how desperate she is to become a mother. I have decided to save the baby as well. Mr. Fujiwara agreed.” Sasaki shared the details of their surgery with Yoshino.

“That’s amazing! Keep it up!—” Yoshino felt a strong sense of accomplishment. He was hopeful that if they succeeded, he would have his share of the credit.

However, saving both the mother and the fetus was highly risky and difficult. It was not surprising that Sasaki made such a decision; he was always creating miracles.

He was Death’s rival, who knows how many lives he had snatched from the jaws of Death.

From the emergency center to a detailed examination, and then onto the operating table, it had taken less than ten minutes.

Because it was a pregnant woman, the best examination would be an MRI, but a metal piece had been inserted into the abdomen.

After contacting the car manufacturer to confirm that the piece of metal was magnetized, they had to forego the MRI. The powerful magnetic field of the MRI would move the metal, potentially causing it to be dislodged. Hence, a CT scan was performed on the pregnant woman instead.

Although X-rays could harm the fetus, at five months gestation, it would not cause any deformities. Compared to saving his small, young life, the potential harm was insignificant.

Niiroi Hiro was performing the surgery. With real-time infrared monitoring and the images obtained from the CT scan, they drafted a 3D image of a “Digital Human” that was displayed on a clear Sharp plasma screen.

The transparent 3D image could be rotated 360 degrees. The injured parts were marked in yellow, the blood vessels in red.

The imaging contrast agent that was bound to hemoglobin reached all over the body, capturing images of the bleeding points accurately and clearly. The system also indicated which part and which blood vessel the chief surgeon should prioritize.

The intracranial hemorrhage was precisely displayed, as was the damaged brain tissue.

The thermal parameters of the brain tissue and the changes in blood flow were calculated by the infrared monitoring device, determining the degree of contusion in the brain tissue, down to every functional area.

Niiroi was highly skilled. Using the opening made by Yoshino in the skull as the entry point, he carefully removed the remaining blood clots, and staunchly stopped the bleeding until all the red disappeared from the screen.

The brain edema due to the trauma would persist for some time. During this period, the brain tissue needed more volume and should not be compressed in any way. The original volume of the cranial cavity would not be adequate.

Niiroi then placed an artificial protective cover onto the patient, fixing it onto the surrounding skull bones. This could protect the brain tissue and also increase the volume.

When the edema subsides, the artificial protective cover would be removed and the patient’s cranial cap replaced.

Regarding the brain tissue contusions, there was no method to treat them. The only thing that could be done was to create the best conditions for self-recovery.

This method of cranial decompression by removing the cranial cap had more beneficial effects than the common method of decompression by removing a bone flap.

This technique originated from the Ilizarov Hospital in Siberian Russia. Tokyo University Hospital sent two doctors to study there for a year, and after their return, they improved and perfected the technique.

“The student has surpassed the master.” Their application of this technique, in terms of effectiveness and safety, had far surpassed that of Russia.

Life signs are stable!

The anesthesiologist said. Doctors loved to hear this.

All kinds of invasive and non-invasive monitoring data were fed into the giant computer. The computer processed at high speed, simulating the dynamic changes of the “Digital Human.”

Such amounts of data could almost be computed instantaneously by the hospital’s trauma emergency system host.

After completing the cranial surgery, it was time to start the thoracic surgery.

Niiroi decided to use thoracoscopy. The scope would enter the thoracic cavity through the intercostal space, washing away the blood inside with a saline solution.

Due to the severe compression, multiple rib fractures occurred. The fractured bone ends had punctured and caused severe lung damage due to this pressure.

Stopping the bleeding and repairing the fractures were constant themes in trauma orthopedics.

They performed single lung ventilation. The injured lung stopped receiving air and collapsed, as per the anesthesiologist’s control.

Niiroi was very well-versed with the endoscopic technique. He calmly cauterized the ruptured blood vessels one by one to stop the bleeding. For larger blood vessels, cauterization would not work. He then sent in a silver clamp to firmly secure the end of the blood vessel.

While stopping the bleeding and inspecting the area, they found that the heart and aorta were fine. All bleeding points were eliminated.

The cleaned thoracic cavity was displayed on the screen thanks to the flushing with the saline solution.

It was time to repair the lung. The lung tissue was soft and fragile, making the repair rather challenging.

Nonetheless, Niiroi tried his best to repair it. Varying shapes of tears were stitched up one by one, restoring their normal shape.

The diaphragm was also torn, with the pressure difference pushing the abdominal organs into the thoracic cavity.

Niiroi made another laparoscopic entrance in the abdominal cavity, inserting another set of lenses and instruments.

The laparoscopic system’s screen began to split, the left side showing the thoracic cavity, the right the abdominal cavity.

The left hand used a blunt rod to enter the thoracic cavity; the right hand used a no-damage clamp to enter the abdominal cavity.

With both hands working together, pushing and pulling gently, parts of the pancreas and small intestine that had herniated into the thoracic cavity were returned to the abdomen and then repositioned.

He repaired the diaphragm under the scope, washed the thoracic cavity with saline once again, and there was no bleeding.

He reestablished ventilation to the damaged lung, with no noticeable leaks, confirming the repair was satisfactory.

Similarly, under the microscope, he repositioned the ribs using a simple wire for minimally invasive fixation.

Ten ribs, all repositioned and fixed, then the scope was removed from the thoracic cavity.

He began the laparoscopic procedure to stop bleeding from the ruptured mesenteric artery, then repaired the ruptured intestine and damaged pancreas.

The liver and spleen were fine, having dodged the pressure from the car seat. Even if the liver and spleen were ruptured, it would not be a problem for Niiroi, only requiring a minor adjustment to the surgical order.

Firstly, he’d deal with the liver and spleen injuries under the microscope, then he’d fix the pancreas and small intestine.

His adept laparoscopic skill made the operation seem no different from an open surgery, but with better results and less trauma.

Such complex chest and abdominal combined injuries were handled by Niiroi through only a few small incisions the diameter of a little finger.

The fetus’s heartbeat was still present, but the amniotic fluid had leaked due to a rupture in the uterine membrane.

Without amniotic fluid, the fetus cannot survive, so the assistant kept injecting artificial amniotic fluid.

A steel plate, likely part of the car seat, had punctured the pregnant woman’s abdomen, going from front to back, piercing the fetus’s body.

Open surgery was necessary; laparoscopy could not handle this type of operation.

There were very few cases of fetal trauma surgery. Niiroi lacked experience in this area, having only performed fetal orthopedic surgeries before.

The five-month-old fetus was only twenty centimeters long, slightly longer than two fingers.

To successfully perform the surgery, a microscope was needed. This might be the most difficult trauma operation in the world.

A warming lamp was adjusted to shine into the pelvic cavity from different angles to keep the fetus warm.

Niiroi cut open the abdominal cavity, opened the uterus, stopping the bleeding as he exposed the area, preparing to remove the metal shard.

Normally, during fetal surgery, the fetus needs to be partially removed from the uterus for visibility. However, it cannot be entirely removed, or the fetus would lose warmth; therefore, only part of the fetus can be moved out to expose the surgical site, and it has to be put back into the uterus after the surgery.

Extreme caution was needed for the procedure. Any incidence of placental abruption would put the fetus’s life in jeopardy.

The uterus was opened, revealing the fetus, the poor little thing.

“Sir, it’s my turn now.” Sasaki and Fujiwara were sitting in the operating room.

“Be careful, both need to survive the surgery,” Fujiwara had strong faith in Sasaki.

——

At Sanbo Hospital, the surgery was being broadcasted live on screens in both the main venue and sub-venue.

“Niiroi Hiro, Orthopedic Lecturer——”

Details of the Chief Surgeon were displayed in both Chinese and English on the screen.

Everybody watched intently, nobody moved or made any noise, even the act of drinking water was minimized.

From head, to thoracic cavity, to abdominal cavity, a young intermediate-level doctor performed a surgery so deftly.

His laparoscopic skills, in particular, the thorough inspection and meticulous repair in trauma surgery, and carpet-style hemostasis, was as fine as a teaching demonstration.

The computer-aided trauma surgery system, mainly monitoring with infrared, combined with CT scanning, could even reconstruct a digital human.

This was eye-opening indeed!

All of these real technologies and techniques could hardly be replaced by a keyboard.

Someone had a dry throat, swallowed several times, but still felt dry and uncomfortable.

Although it was originally planned for a young intermediate-level doctor, now that it was fetal surgery, it was reasonable to have a higher-ranking doctor take over.

The junior doctor had already performed splendidly; they had displayed world-class standards.

“It’s Sasaki’s turn now!”

Takahashi mumbled to himself, he believed in his junior.

Such a surgery required a microscope, and a full-time operation with both hands hanging in the air; compared to replanting amputated limbs with elbows resting on the table, the difficulty increased significantly.

This was indeed the pinnacle of microsurgery. What would a five-section replantation count for? Takahashi derided the idea in his mind.

The screen showed a clear and detailed view, the uterus opened, the fetus exposed.

Sasaki was already scrubbing his hands and putting on the surgical gown; he was about to perform a surgery that would astonish the world.