19: Chapter 19 Lu Chen on the operating table is like a tyrant and a ruler.
The Emergency Department's Operating Room was small, but fully equipped.
Laparoscopic Systems, Ultrasonic Scalpels, Insufflators—it had everything it should.
After all, this was a Grade A Tertiary Hospital; the hardware conditions were right there.
Ten minutes later, Director Li Sen arrived.
He was wearing surgical scrubs and a mask, leaving only his eyes exposed.
When those eyes looked at Lu Chen, they carried scrutiny and severity, but also a faint, inexplicable hint of expectation.
"Ready?"
"Ready."
"Is the patient anesthetized?"
"Zhao Ming has already started. General Anesthesia, Laryngeal Mask Ventilation; vital signs are currently stable."
Zhao Ming from the Department of Anesthesiology was also there. He was the anesthesiologist who had performed that emergency surgery with Lu Chen in the General Surgery Department that night.
Zhao Ming was momentarily stunned when he saw Lu Chen.
"You again?"
"Me again."
Zhao Ming shook his head, but a hint of a smile touched the corners of his mouth.
"You really can't stay idle, can you?"
"How's the anesthesia?"
"Steady as a rock. You can operate with peace of mind."
Lu Chen nodded and walked to the side of the operating table.
Director Li Sen stood opposite him in the first assistant's position, but in reality, he was there to supervise.
There was also a Scrub Nurse on stage, an older, veteran Nurse.
Lu Chen hadn't met her before, but one look at her movements told him she was an old hand.
"Begin," Director Li Sen said.
Lu Chen took a deep breath.
Then, his gaze changed.
It was as if a switch had been flipped.
The gentle, low-profile Lu Chen from the consultation room earlier—the one who felt nothing even when surrounded by girls—was gone.
The person standing before the operating table had a sharp gaze and steady movements, exuding an unquestionable sense of control from head to toe.
This was Lu Chen's greatest contrast.
Usually as gentle as a good-tempered boy next door, he became a different person the moment he stepped onto the operating table.
A tyrant.
A ruler.
"Establish Pneumoperitoneum."
His voice was low and steady, devoid of any superfluous emotion.
The Veress Needle entered through the umbilicus with a precise Puncture angle.
Carbon dioxide began to fill the abdominal cavity, and the intra-abdominal pressure gradually rose.
"Pneumoperitoneum pressure at 12 mmHg, stable."
Lu Chen's hands did not hesitate for a moment.
The first Trocar Puncture, subumbilical, 10mm.
The moment it entered the abdominal cavity, the camera feed appeared on the monitor.
The view inside the abdominal cavity was clear at a glance.
"Camera's in. Locate the appendix," Director Li Sen's voice came from across the table, his tone calm but carrying a hint of a test.
Lu Chen manipulated the camera, exploring downward along the Ascending Colon.
The image moved smoothly across the monitor; Lu Chen's hands were incredibly steady, without a single tremor in the camera.
Ten seconds later, the appendix appeared on the screen.
"Found it," Lu Chen said.
Director Li Sen looked at the monitor, his gaze narrowing slightly.
The appendix in the image was clearly swollen, its serosal surface congested and red.
Purulent exudate was visible on the surface, and a small amount of turbid fluid had accumulated at the base.
Suppurative Appendicitis—confirmed.
Moreover, the degree of suppuration was more severe than what had been seen on the CT scan.
"The suppuration is quite heavy," Director Li Sen muttered under his breath.
"Yes, but it hasn't perforated yet. The integrity of the appendiceal wall is still intact," Lu Chen replied.
"What's your surgical plan?"
"Standard Laparoscopic Appendectomy, Three-port Method. First, handle the Mesoappendix and ligate the Appendicular Artery. Then, ligate and sever the appendix at the base, perform a Purse-string suture on the stump, and finally irrigate the abdominal cavity."
Director Li Sen nodded without speaking.
The plan was conventional and followed the standard procedure, with nothing flashy about it.
But for a newcomer to describe the entire process so clearly and fluently was already highly unusual.
"Second Puncture port, left lower abdomen, 5mm."
Lu Chen's hand precisely located the Puncture point, and the Trocar entered cleanly and efficiently.
"Third Puncture port, right above the pubic bone, 5mm."
All three operative ports were established.
With a Grasping Forceps in his left hand and an Ultrasonic Scalpel in his right, Lu Chen began the formal operation.
He first used the Grasping Forceps to gently lift the tip of the appendix, exposing the Mesoappendix.
This movement required extremely precise force control.
Too light and it wouldn't hold; too heavy and it would tear the already congested and fragile appendiceal wall.
Lu Chen's force was just right.
The Mesoappendix was fully exposed.
Then, the Ultrasonic Scalpel in his right hand hummed to life.
He separated it bit by bit along the avascular area of the Mesoappendix.
Every cut of the Ultrasonic Scalpel was precise to the millimeter level.
The small vessels on the Mesoappendix were coagulated and severed one by one by the Ultrasonic Scalpel, with almost no bleeding.
Director Li Sen stood opposite him, watching the screen without saying a word.
But his gaze was shifting.
From the initial scrutiny and wariness, it turned into serious observation.
Then it slowly morphed into a focus he wasn't even aware of.
Because Lu Chen's operation was too fluid.
It wasn't the crude fluidity of a novice, nor the mechanical fluidity of someone following memorized steps.
It was a fluidity born of experience.
The transitions between every movement were seamless, without any hesitation or pause.
The angle, force, and cutting rhythm of the Ultrasonic Scalpel were all at the level of a seasoned veteran.
This didn't look like a newcomer performing surgery.
It looked like an Attending Physician who had performed hundreds of appendectomies.
"Appendicular Artery," Lu Chen's voice interrupted Director Li Sen's thoughts.
On the screen, the Appendicular Artery had been fully exposed.
Lu Chen used the Ultrasonic Scalpel to precisely coagulate the Appendicular Artery and then severed it.
The cut was clean, with no oozing blood.
"Beautiful," Zhao Ming whispered from behind the anesthesia machine.
Director Li Sen didn't speak, but his brow had slightly relaxed.
Next was the most critical step.
Handling the base of the appendix.
Lu Chen used silk thread to tie two ligatures at the base of the appendix, spaced about 5mm apart.
His knotting technique was crisp and efficient, with the tension of the thread ends controlled perfectly.
Then, he used the Ultrasonic Scalpel to sever the appendix between the two ligatures.
The appendix was completely detached.
Lu Chen used the Grasping Forceps to hold the excised appendix and placed it into a specimen bag.
The entire process was smooth as flowing water.
"Stump management," Lu Chen said.
He began the purse-string Suturing.
This was the step in an appendectomy that tested Suturing technique the most.
It required making a circle of Purse-string sutures on the Cecal Wall around the appendiceal stump, then tightening the thread to bury the stump inside.
The stitch spacing had to be even, the depth consistent, and the tightening force moderate.
Too tight would tear the intestinal wall; too loose would result in incomplete burial of the stump.
Lu Chen's Suturing was at a perfect level.
Perfect level.
These two words weren't used lightly.
His stitch spacing was almost perfectly equal, and the depth of each stitch didn't vary by more than half a millimeter.
The Purse-string suture was completed stitch by stitch on the monitor, the visual effect so neat it seemed unreal.
Director Li Sen stared at the image, silent for a long time.
Then he spoke, his voice much softer than before.
"This Suturing of yours—who did you learn it from?"
"Practiced it myself."
"For how long?"
"A long time."
Director Li Sen didn't press further.
Because he didn't need to.
This newcomer's level had far exceeded his expectations.
Not just by a little, but by an entire magnitude.