159: Chapter 159 Don't take the initiative unless absolutely necessary

Seven-thirty.

Surgical preparation room.

Professor Liu Chongli's team had already arrived.

Anesthesiologist Anesthesiologist Guo Zhengyang was checking the anesthesia equipment, while two assistants were verifying the surgical instruments.

Lu Chen stood to the side in his capacity as the third assistant, waiting quietly.

Director Li Sen stood nearby, wearing surgical scrubs.

He wouldn't be going onto the operating table today, but he would be on standby outside the Operating Room throughout the procedure.

"Lu Chen," Director Li Sen said in a low voice.

"Yes."

"Professor Liu is the lead surgeon for this operation. Your role is to assist and handle emergencies. Do not take the initiative to act unless it is absolutely necessary, but if that moment truly comes, do not hesitate."

"I understand."

...

Seven-fifty.

The two patients were wheeled into two adjacent Operating Rooms respectively.

The donor, Wang Hui, was in Operating Room One.

The recipient, Wang Jianguo, was in Operating Room Two.

Lu Chen followed Professor Liu Chongli into Operating Room Two.

Eight o'clock sharp.

The surgery officially began.

On the donor side, Professor Liu Chongli's senior assistant acted as the lead surgeon, performing the right hemihepatectomy in Operating Room One.

On the recipient side, Professor Liu Chongli personally led the surgery to perform the diseased liver resection.

Lu Chen stood in the third assistant position, holding the suction device, his eyes fixed intently on the surgical field.

Simultaneously, he silently activated the Eye of Truth.

A holographic projection unfolded in his field of vision, revealing the internal structure of Wang Jianguo's abdominal cavity in minute detail.

The path of every blood vessel, the location of every adhesion, and every anatomical structure requiring attention were all clearly visible.

Professor Liu Chongli's hands were steady, and his operations were efficient and precise.

He truly lived up to his reputation as a veteran who had performed over two hundred transplantations; every step was methodical.

The process of the diseased liver resection proceeded very smoothly.

The division of the Perihepatic Ligaments, the dissection of the First Hepatic Hilum, and the mobilization of the suprahepatic and infrahepatic vena cava—each step advanced in an orderly fashion.

Two hours later, the diseased liver was removed in its entirety.

It was a shrunken, cirrhotic liver covered in nodules.

It had completely lost its function.

"Diseased liver resection complete. Prepare to receive the donor liver," Professor Liu Chongli said.

News arrived from Operating Room One.

The surgery on the donor side was also nearing its end.

But immediately following that, the assistant's voice came through the intercom.

"Professor Liu, we've encountered a problem on the donor side."

Professor Liu Chongli's hands stopped.

"What problem?"

"The variation in the right hepatic artery is more complex than the preoperative imaging assessment suggested. Besides originating from the Superior Mesenteric Artery, the main trunk of the artery also has a sharp turn within the Hepatoduodenal Ligament. During dissection, we found the vessel wall to be extremely thin, and the branches are exceptionally fine; the narrowest point is only 1.8 millimeters."

1.8 millimeters.

Even thinner than the 2.1 millimeters estimated before the surgery.

Professor Liu Chongli's brow furrowed.

"Can it be harvested intact?"

"It can be harvested, but the trimming after harvesting and the subsequent anastomosis will be extremely difficult. With this diameter, when performing the anastomosis on the recipient side, the slightest carelessness will damage the intima and lead to thrombus formation."

Professor Liu Chongli was silent for a few seconds.

"Securely harvest the liver first. I'll go over and look at the artery."

He turned his head to glance at Lu Chen.

"Keep an eye on the recipient side here. Don't touch anything. Wait for me to come back."

"Okay."

Professor Liu Chongli strode out of Operating Room Two and went next door.

Lu Chen stood by the operating table.

Before him was Wang Jianguo's abdominal cavity, from which the diseased liver had already been removed.

It was empty.

The Eye of Truth's holographic projection was still running, clearly displaying every blood vessel within the recipient's abdominal cavity.

He saw the stump of the Portal Vein.

The stump of the hepatic artery.

And the opening of the Inferior Vena Cava.

These were the interfaces where the new liver would soon be connected.

And the Eye of Truth simultaneously issued a warning he had already anticipated.

[Warning: The vessel wall of the recipient's hepatic artery stump has extremely poor elasticity, with multiple micro-injuries to the intimal layer. The risk of suture cutting under conventional Suturing methods is extremely high. It is recommended to use Modified Interrupted Suturing or Parachute Suture techniques.]

Lu Chen silently noted this information.

Fifteen minutes later, Professor Liu Chongli returned.

His expression was significantly more solemn than before he left.

"The donor liver has been harvested and is currently being trimmed, but the condition of the artery is indeed more complex than expected."

He walked to the operating table and glanced at the vascular stumps on the recipient side.

He used forceps to gently touch the wall of the hepatic artery stump.

The vessel wall had almost no elasticity.

Professor Liu Chongli's brow furrowed even tighter.

"The quality of this vessel wall is too poor."

He muttered to himself in a low voice.

Then he looked up at everyone in the Operating Room.

"We'll do the Portal Vein anastomosis first; it's relatively simple."

The Portal Vein anastomosis began.

Professor Liu Chongli operated personally, performing an end-to-end anastomosis of the donor's Portal Vein with the recipient's Portal Vein.

This step proceeded smoothly; the Portal Vein's diameter was thicker, and the condition of the vessel wall was also relatively better.

Half an hour later, the Portal Vein anastomosis was complete, and the blood flow was opened.

The new liver began to fill.

Turning from pale to reddish-brown.

"Portal Vein blood flow is unobstructed, and the liver is filling well," Professor Liu Chongli said.

Next step: Hepatic Artery Anastomosis.

This was the most critical step of the entire surgery.

And also the most difficult.

Because the donor's hepatic artery was only 1.8 millimeters, and the quality of the recipient's arterial stump wall was extremely poor.

The two most difficult factors were superimposed.

Professor Liu Chongli put on his surgical loupes.

He picked up the 9-0 suture.

This was a microsurgical-grade suture, thinner than a strand of hair.

Everyone held their breath.

Professor Liu Chongli began to insert the needle.

The first stitch.

The suture passed through the donor's arterial wall without issue.

Then it passed through the recipient's arterial wall.

The moment the suture was tightened, a tiny tear, almost invisible to the naked eye, appeared on the recipient's vessel wall.

Professor Liu Chongli's hands stopped.

"Damn it."

He loosened the suture and re-examined that tiny tear.

The tear wasn't large, but on such a fine vessel, any tiny tear could lead to postoperative thrombosis or hemorrhage.

Professor Liu Chongli tried a second time.

This time he moved the needle entry point away, avoiding the site of the tear.

The suture passed through.

But as it was tightened, the vessel wall once again showed a tendency to cut.

He was forced to stop.

"This vessel wall is too brittle," Professor Liu Chongli's voice turned somber.

The atmosphere in the Operating Room suddenly became tense.

Anesthesiologist Anesthesiologist Guo Zhengyang looked up from behind the anesthesia machine.

"Professor Liu, the liver has been filling for twenty minutes. If the arterial blood supply isn't restored soon, the ischemia time will keep getting longer."

Professor Liu Chongli naturally knew this.

In Liver transplantation, the hepatic artery is the primary source of oxygenated blood for the liver.

Although the Portal Vein was already connected, the Portal Vein supplied deoxygenated blood.

If the hepatic artery remained blocked, the newly implanted liver would gradually suffer damage due to hypoxia, eventually leading to functional failure.

Time waits for no one.

Professor Liu Chongli tried a third needle insertion.

This time he used even lighter force.

The suture passed through the donor side.

Passed through the recipient side.

Tightened.

The tendency to cut still appeared.

Although it didn't tear, Professor Liu Chongli could feel the suture sliding toward the outer edge of the vessel wall.

An anastomosis sewn this way would not be secure.

Once the blood flow was opened, the arterial pressure would directly blow the anastomosis open, leading to fatal massive hemorrhage.

Professor Liu Chongli put down his instruments.

He stood there, his gaze fixed intently on those two vascular stumps that were less than two millimeters wide.

The entire Operating Room was so quiet that only the beeping of the monitors remained.

Lu Chen was also looking at those two blood vessels.

The Eye of Truth's holographic projection magnified the structure of every layer of the vessel wall to the extreme.

He could see that multiple micro-injuries had already appeared in the intimal layer of the recipient's arterial wall.

The elastic fibers in the medial layer were severely degenerated.

The adventitial layer was so thin it was almost transparent.

This was the devastation long-term cirrhosis wrought upon blood vessels.

Conventional anastomosis methods simply wouldn't work on such a vessel wall.

If the force of the suture was slightly too much, it would cut through the vessel wall.

If it was slightly too little, it wouldn't hold.

It was an almost unsolvable dilemma.

But Lu Chen knew that the system wouldn't give a truly unsolvable task.

He closed his eyes for a moment.

His mind raced at high speed.

The passive effect of the God-level Suturing Technique: Hand tactile sensitivity increased by 25%, allowing perception of tissue layer differences invisible to the naked eye.

The entire technical accumulation of Perfect-level Vascular Anastomosis.

The liver transplant vascular reconstruction materials he had been frantically studying for the past four days.

And the real-time anatomical information provided by the Eye of Truth.

All the knowledge, skills, and system assistance converged in his mind.

Then, a plan took shape in his brain.