158: Chapter 158 Wang Hui's Hepatic Artery Has a Variation
Professor Liu Chongli's eyebrows twitched slightly, but he said nothing more, turning back to continue examining the patient.
He personally performed a physical exam and pulled up all the imaging data, including the Abdominal CT, MRI, and 3D vascular reconstruction images.
The entire review process lasted nearly an hour.
During this time, Professor Liu Chongli asked Professor Feng Yuan a few questions about the medication plan and asked Lu Chen two questions regarding the details of bleeding control.
Lu Chen's answers were precise and professional; Professor Liu Chongli did not follow up with more questions and simply nodded.
After finishing the examination, everyone moved to the Emergency Department's small Conference Room.
Professor Liu Chongli opened his laptop and projected the patient's imaging data.
"Regarding the preoperative assessment, I'll start with the conclusion: this patient's liver no longer has any value for preservation. A total hepatectomy and transplantation are mandatory."
"There are currently no suitable cadaveric liver sources, so a living donor transplantation is the only option."
He switched to the examination data for the donor, Wang Hui.
"I have already reviewed the donor's preoperative examination results at the Provincial Hospital. Liver function is normal, and the liver volume meets the requirements."
"The plan is to harvest the right hemi-liver and preserve the donor's left hemi-liver."
At this point, he paused.
"But there is a problem with this donor."
The Conference Room fell silent.
"Wang Hui's hepatic artery has a variation."
Professor Liu Chongli pointed at the 3D vascular reconstruction image.
"Under normal circumstances, the Right Hepatic Artery branches off from the proper hepatic artery with a clear course, making it relatively standard to handle during harvesting."
"However, this donor's Right Hepatic Artery originates from the Superior Mesenteric Artery, which is a Michel's Type III Variation. Furthermore, the vessel diameter is somewhat thin, at only 2.1 millimeters."
Lu Chen looked at the image.
2.1 millimeters.
A normal hepatic artery diameter is usually between 3 to 4 millimeters; 2.1 millimeters meant the vessel was extremely thin.
In living donor transplantation, the hepatic artery on the donor side must undergo anastomosis reconstruction on the recipient side after being harvested.
The thinner the vessel diameter, the greater the difficulty of the anastomosis.
Anastomosis of a 2.1-millimeter vessel was already approaching the realm of microsurgery.
"This variation increases the difficulty of the surgery, but it is not impossible," Professor Liu Chongli said calmly.
"I will personally handle the liver harvesting and arterial transection on the donor side, and I will also be the lead surgeon for the vascular anastomosis on the recipient side."
"Professor Liu, how are the vascular conditions on the recipient side?" Professor Feng Yuan asked.
Professor Liu Chongli switched to the vascular reconstruction image of the recipient, Wang Jianguo.
"Not great. Long-term cirrhosis has caused the quality of the vessel walls in the Hilar Region to decline, resulting in poor elasticity. When performing the vascular anastomosis, the sutures might cut through the vessel walls; this is the greatest risk factor."
Lu Chen's eyes narrowed slightly.
Fragile vessel walls and sutures that cut easily.
This meant that conventional vascular anastomosis methods might not work.
It required a more refined Suturing technique, less force during needle insertion, and more precise suture spacing.
And these were precisely what he was best at.
Professor Liu Chongli continued explaining the surgical plan.
"The surgery will be conducted by two teams simultaneously. The donor team will be responsible for harvesting the right hemi-liver, while the recipient team will be responsible for removing the diseased liver and preparing the vascular bed. Once both teams are finished, we will merge to perform the implantation and vascular anastomosis."
"Estimated surgical time?" Director Li Sen asked.
"If things go smoothly, eight to ten hours. If not, it's hard to say."
"When is the surgery date set for?"
"Looking at the patient's current state, the coagulation function still needs two to three more days of optimization. It's tentatively set for Thursday."
"Thursday," Director Li Sen repeated.
"Yes, the operation starts at 8:00 AM on Thursday."
Professor Liu Chongli closed his laptop.
"I hope your side will provide full cooperation for the preoperative preparations."
"No problem."
After the meeting ended, Lu Chen followed Director Li Sen back to the office.
"Director Li, what specifically will I be doing during Thursday's surgery?"
"Professor Liu's intention is for you to be on standby as the third assistant for the recipient team, primarily responsible for emergency handling during the procedure. If the surgery goes smoothly, you basically won't need to step in."
"And if it doesn't go smoothly?"
Director Li Sen glanced at him.
"If it doesn't go smoothly, you'll need to play it by ear."
Lu Chen nodded.
He knew in his heart that the System wouldn't issue an SSS-rank mission for no reason.
There would definitely be a complication during this surgery.
And when that complication occurred, it would be his time to step up.
Over the next three days, Lu Chen continued his dual-track rhythm.
Normal work plus monitoring patients during the day, and studying Liver transplantation materials at night.
Wang Jianguo's physical condition continued to improve.
By Wednesday night, the final day before the surgery, the coagulation function results were quite ideal.
PT 16 seconds, INR 1.4, Fibrinogen 2.5.
It was close to the normal range.
The hepatic encephalopathy had also decreased from grade two to grade one.
The ascites had almost disappeared.
After reviewing the final re-examination results, Professor Feng Yuan gave a clear opinion.
"The surgery can proceed."
That evening, Professor Liu Chongli personally came to the Red Zone for the final preoperative rounds.
After finishing, he stopped Lu Chen in the corridor.
"Xiao Lu."
"Professor Liu."
"The preoperative management for this patient was done very well. I've reviewed the records of the entire process; the medication adjustments were very precise, and every abnormality was handled promptly."
"Thank you, Professor Liu."
Professor Liu Chongli sized him up.
"You're twenty-four this year?"
"Yes."
"A Resident Physician?"
"Yes."
"For a Resident Physician to manage an S-rank end-stage liver disease patient like this—in all the teaching Hospitals in the province combined, I haven't seen a second person like you."
Lu Chen did not respond.
"For tomorrow's surgery, although you are the third assistant, I hope you maintain a high level of focus throughout. This surgery might be more complex than expected."
"I understand."
Professor Liu Chongli patted his shoulder and turned to leave.
Lu Chen returned to the Duty Room.
There was a message from Shen Xiaoning on his phone.
[Xiao Ning: Dr. Lu, I've already applied with Sister Meng for tomorrow's surgery. I'll be on standby outside the Operating Room!]
[Lu Chen: You can just stay on standby in the Red Zone; there's no need to wait outside the Operating Room.]
[Xiao Ning: No! I want to wait for you in the closest possible place! In case you need anything, I can send it in immediately!]
Lu Chen looked at the message.
[Lu Chen: Okay.]
[Xiao Ning: Go to sleep early tonight and don't read anymore! You'll be in surgery for so long tomorrow, you must be in good spirits!]
[Lu Chen: Yeah.]
[Xiao Ning: Dr. Lu.]
[Lu Chen: Hmm?]
[Xiao Ning: You can definitely do it.]
Lu Chen typed two words.
[Lu Chen: Goodnight.]
[Xiao Ning: Goodnight!]
...
Thursday.
6:30 AM.
Lu Chen woke up on time.
He washed up and changed into clean surgical scrubs.
When he walked out of the Duty Room, Shen Xiaoning was already waiting at the Nurse Station.
She was holding a bowl of hot porridge.
"Drink it while it's hot. I got up at 4:30 to cook it."
Lu Chen took it from her.
The porridge contained red dates and goji berries, and the temperature was just right.
"Thanks."
"Do you want some Sesame Fried Dough Sticks? I brought those too!"
"No thanks, the porridge is enough."
After Lu Chen finished the porridge, he handed the bowl back to her.
As Shen Xiaoning took the bowl, her fingers accidentally brushed against his fingertips.
Her face instantly turned red.
"G-good luck."
"Yeah."
Lu Chen turned and walked toward the Operating Room.
Shen Xiaoning watched his back, her hands clutching the bowl tightly.