A Surgeon Who Uses Martial Arts [EN]: Chapter 224

“Huh… I can’t believe it.”

Min-seok was filled with admiration.

Ever since he started working with Jun-hoo, he had been constantly surprised.

He succeeded in the chicken wing vascular graft on his first try.

He identified the source of a headache patient’s pain with an MRI.

And now, he was performing a craniotomy with both hands during surgery, a truly remarkable feat.

Every time Min-seok entrusted something to Jun-hoo, the results exceeded his expectations.

‘Professor Seo…’

‘He’s more astute than I realized.’

‘No wonder he chose Jun-hoo as his assistant for the glioblastoma [a type of aggressive brain cancer] resection.’

‘Did he recognize Jun-hoo’s potential early on?’

While admiring Jun-hoo, Min-seok also grew more wary of Professor Seo Dong-hoon.

A rival who would be competing with him for the position of associate professor next year.

“Professor, was there anything lacking in my craniotomy?”

Jun-hoo asked Min-seok cautiously.

“There’s only one thing lacking.”

“I’m curious to know what that is.”

“You lack humanity,” Min-seok joked.

While the other staff members looked puzzled, Jun-hoo smiled knowingly. He immediately understood Min-seok’s humor, showing that Jun-hoo was not only skilled but also quick-witted.

At this point, he was more than qualified to be the second assistant for the Moyamoya disease [a rare, progressive cerebrovascular disorder] surgery next week.

“Your craniotomy was much better than expected. The surgery time was shortened, and as you said, I was able to reduce my physical burden.”

“You’re welcome… Thank you for believing in me.”

“Because you’ve consistently delivered trustworthy performance.”

Min-seok nodded and continued. “Jun-hoo and Si-hoo, switch positions again. Let’s resume the surgery. The real challenge starts now, so stay focused.”

“Yes, Professor.”

“Yes, Professor.”

“Ultrasonic aspirator.”

Min-seok held the ultrasonic aspirator handed over by the scrub nurse.

Wee-ing.

The aspirator rotated with a high-pitched sound.

Min-seok began to incise the meninges [the membranes that surround the brain and spinal cord] with the ultrasonic aspirator.

The dura mater, located on the outermost part of the brain.

The arachnoid mater, located in the middle.

He carefully incised the pia mater, which was closely attached to the brain.

With Min-seok’s delicate touch, the meninges were pierced, and the surgical field deepened towards the brain.

The process of incising the meninges might have seemed easy, but it was by no means a simple procedure.

If done incorrectly, there was a risk of damaging the cerebral blood vessels or cranial nerves along the way.

But Min-seok was a veteran in cerebral blood vessel surgery, so there was no room for error in the meningeal incision.

The assistance of the staff helping Min-seok was also excellent.

While Min-seok incised the meninges, Si-hoo secured Min-seok’s surgical field and effectively controlled the inevitable microbleeds.

Using bleeding gauze and a suction device.

Jun-hoo also fulfilled his role perfectly.

Chik! Chik! Chik!

The meninges and blood vessels were cauterized.

A spray bottle containing warm saline was frequently used to prevent additional bleeding.

He also handed over the necessary surgical instruments to Si-hoo without delay.

It was an action that could only be done by someone who understood what the first assistant needed and how the surgery was progressing.

‘If it continues like this…’

‘It would be difficult to fail this surgery. Was I too nervous because it was a pregnant woman’s surgery?’

A faint smile appeared on Min-seok’s lips.

“Adson forceps.”

With the received forceps, Min-seok peeled off the pia mater, which was thin and translucent like a milk film, covering the brain.

Only then did the brain reveal its complete form.

The human control tower, the brain.

The brain, often called the 1.4-kilogram universe.

The remarkable brain that consumes 20 percent of the body’s total energy despite its small size.

The brain was a fascinating organ every time he saw it—no, the more he saw it, the more fascinating it became.

At the same time, it was also a bloody battlefield for Min-seok.

“I’ll adjust the microscope magnification.”

Jun-hoo brought his eyes close to the microscope and adjusted the magnification.

Drip, drip, drip.

The sound of the adjustment knob moving was distinct.

As the magnification increased, the landscape of the brain changed.

The structure of the brain, which had simply looked like a walnut, came into view in detail.

The protruding gyri [ridges of the brain].

The sunken sulci [grooves of the brain].

Nerves spreading like spider webs and numerous microvessels, etc.

However, the cerebral aneurysm [a bulge in a blood vessel in the brain] to be operated on was not yet visible.

This was because the cerebral aneurysm was located within the folds of the brain, so the brain had to be retracted to see it.

“The magnification is set to 15x, is that okay?”

“That’s perfect.”

After checking the magnification set by Jun-hoo, Min-seok nodded with satisfaction.

“Let’s insert an ICP (intracranial pressure monitoring device) and check the intracranial pressure first. Si-hoo, you’ll have to work hard this time.”

“Yes, Professor.”

“How’s the patient’s condition?”

Min-seok asked Sung-eun, who was standing to his left.

He suddenly became curious about Sung-eun’s opinion.

How would the obstetrician evaluate the current situation?

“The vital signs are still stable. No abnormalities in the electrocardiogram. The oxygen saturation is also within the normal range.”

“……”

“I was worried that her blood pressure would spike due to preeclampsia [a pregnancy complication characterized by high blood pressure], but that hasn’t happened.”

“That’s good news.”

“But don’t be too complacent. A pregnant woman’s condition can worsen at any time.”

“You’ll take care of that somehow, right? I’ll just focus on the cerebral aneurysm surgery.”

“Isn’t that too irresponsible?”

Sung-eun retorted bluntly.

“Isn’t it because I trust you too much?”

“You’re so bold.”

“Professor, the patient’s intracranial pressure is measured at 10 mmHg [millimeters of mercury].”

In response to Si-hoo’s report, Min-seok nodded instead of answering.

Since the normal intracranial pressure was 0 mmHg-15 mmHg, the patient’s intracranial pressure was normal.

This was also good news.

Was that why?

Min-seok imagined himself successfully completing today’s surgery and boasting in front of the chief.

He was already feeling pleased.

“Jun-hoo, retract the brain. The retraction site is the middle temporal gyrus [a region of the brain]. Be careful not to damage the nerves.”

“Yes, Professor.”

Jun-hoo held retractors in both hands.

He widened the middle temporal gyrus, where the cerebral aneurysm was hidden, to the left and right.

As the gap widened, the bulging cerebral aneurysm came into view.

“Okay, that’s enough, fix the retractor.”

“Yes.”

“I’m glad I decided to operate. If this had burst, I would never have been able to handle it.”

After examining the cerebral aneurysm with a fine microscope, Min-seok shook his head.

The size of the cerebral aneurysm was 20mm x 20mm.

A cerebral aneurysm larger than 25mm x 25mm is called a giant cerebral aneurysm, and the patient’s cerebral aneurysm was close to being a giant cerebral aneurysm.

It had a balloon-like shape called a berry aneurysm [a type of aneurysm that looks like a berry].

In other words, the risk of blood vessel rupture was high.

“Doppler ultrasound.”

Min-seok pushed a metal rod-shaped ultrasound device between the opened brains.

He examined whether the posterior communicating artery [an artery in the brain], the parent artery of the cerebral aneurysm, was occluded [blocked].

After reading the image displayed on the ultrasound monitor, he found that, fortunately, the parent artery was normal.

If he just clipped the cerebral aneurysm, the surgery would end safely.

“Hemostat.”

Click!

Min-seok blocked the blood flow of the parent artery with a hemostat.

The clipping of the pregnant woman’s cerebral aneurysm was heading towards the end.

* * *

‘It’s going too smoothly.’

‘I’m almost annoyed that I was so worried?’

Until the surgery reached its final stage, Jun-hoo had been very nervous.

He had imagined various emergency situations in his head and had planned out all the emergency treatments and actions to be taken.

The patient was pregnant, and there were various restrictions to prevent fetal malformations.

But all of those concerns had become unnecessary.

The surgery had progressed so smoothly that it felt anticlimactic.

Shaking off his complacency, Jun-hoo stared at the surgeon, Min-seok.

Min-seok was choosing a clip to ligate [tie off] the cerebral aneurysm.

Cerebral aneurysm clipping was a surgery that involved securing the cerebral aneurysm with a medical clip to prevent blood from flowing into the blood vessel.

If blood didn’t flow through it, there was no risk of the cerebral aneurysm rupturing.

‘Shall I show off my skills?’

Jun-hoo cleared his head and began his own test.

The highlight of cerebral aneurysm surgery was choosing the right clip for the cerebral aneurysm.

Choosing the right clip was essential to properly block the blood vessels flowing into the cerebral aneurysm.

Therefore, based on the secret techniques of his master Jae-hyun, which he had studied so far, Jun-hoo chose a clip himself.

Considering the size and shape of the cerebral aneurysm, Jun-hoo looked back and forth at the clips placed on the dressing cart and chose one.

How would his choice differ from that of the surgeon, Min-seok?

His heart was already pounding.

“Yang, use this one.”

Min-seok pointed to a clip with his index finger.

[Sugita clip, straight type 6.]

Surprisingly, the clip Jun-hoo chose was the same as the clip Min-seok chose.

Jun-hoo’s judgment was correct.

‘Yes, that’s it!’

Jun-hoo clenched his fist without realizing it.

It was worth reading his master’s cerebral blood vessel thesis in the duty room even when it wasn’t his shift.

Sugita clip, straight type 6, was a clip with a well-opened clip head that blocked blood flow effectively.

It was also a clip that his master Jae-hyun often used for cerebral aneurysms larger than 15mm x 15mm.

“What are you doing?”

Si-hoo looked at Jun-hoo strangely, noticing his sudden excitement.

“Why are you suddenly so happy?”

“Something good suddenly came to mind.”

“What is it?”

“It’s a little difficult to talk about it now.”

“You’re boring.”

Si-hoo quickly lost interest in Jun-hoo.

In the meantime, Min-seok held the clip handed over by the scrub nurse with forceps and examined it from every angle, as defective products, though rare, could exist among medical clips.

“Starting ligation.”

Min-seok brought his eyes close to the fine microscope and pushed the clip between the opened brains.

Jun-hoo memorized the process by simplifying it.

Skill was also required to ligate the clip.

If the blades of the clip were misaligned, a mishap could occur in which the clip ruptured the cerebral aneurysm.

Click!

With a steady hand, Min-seok tightly gripped the neck of the cerebral aneurysm.

It was indeed the skill of a seasoned professor.

“Jun-hoo, let’s do a blood flow test.”

“Yes, Professor.”

Jun-hoo stabbed a 1cc syringe containing a luminescent substance into the cerebral aneurysm and injected the substance.

“I’ll turn off the lights.”

After briefly leaving his seat and turning off the lights, Jun-hoo returned to his seat.

When he looked into the fine microscope, he could see the luminescent substance injected into the cerebral aneurysm escaping from the blood vessel.

The clip had failed to properly close the blood vessel.

‘That’s strange.’

‘I’m sure I chose the right clip.’

‘Is it because there’s a berry aneurysm?’

Although his first choice had failed, Jun-hoo was not greatly embarrassed.

Originally, cerebral aneurysm clipping sometimes involved trial and error several times to find the optimal clip.

Even his master Jae-hyun experienced this.

“It seems like one clip isn’t enough? Then we have no choice but to use two this time….”

Min-seok tilted his head as if he was surprised.

In the meantime, Jun-hoo turned on the lights again and returned to his seat.

[Yasargil clip, L-shaped 8, 2EA]

Again, the clip Jun-hoo chose was the same as Min-seok’s clip.

Although it was only two cases, Jun-hoo’s clip judgment had reached a level similar to that of Min-seok.

After removing the existing clip, Min-seok tightly ligated the top and bottom of the neck of the cerebral aneurysm with two clips.

‘Hey, surely there won’t be a problem this time.’

While going to turn off the lights again, Jun-hoo shook off the ominous feeling rising in his heart.