A Surgeon Who Uses Martial Arts [EN]: Chapter 225

Chapter 42: Success (5)

It was worth using two clips.

The re-administered contrast agent glowed fluorescently only within the aneurysm.

The blood flow blockage was perfect.

Without blood supply, the aneurysm was destined to gradually disappear.

Unless it’s a special case, there shouldn’t be any problems.

Thank goodness.

I can sleep soundly tonight.

Jun-hoo sighed in relief inwardly.

According to Master Jae-hyun’s secret manual.

According to the data Master had written about all the surgeries he had performed.

There were two major side effects that appeared after aneurysm clipping.

One was the clip that secured the aneurysm coming off.

This was a very rare case where a hidden aneurysm grew and pushed the clip away.

This is something that no famous doctor could.

Neither predict nor prevent.

However, in the case of the patient in this surgery.

If reoperation is necessary, the risk of surgery will be reduced because she will have already given birth.

The second side effect of aneurysm surgery.

That was hydrocephalus.

Hydrocephalus is a disease in which cerebrospinal fluid does not circulate properly and accumulates in the brain.

This was a side effect that Jun-hoo could handle sufficiently.

If the patient is thoroughly managed, prevention and treatment were possible.

“Jun-hoo, remove the retractor.”

“Yes, Professor.”

Jun-hoo followed Min-seok’s instructions.

He released the fixation of the retractor that was retracting the brain and slowly closed the retractor.

But it was at that very moment.

“Wait!”

Min-seok urgently stopped Jun-hoo.

“What’s wrong, Professor?”

“It looks like we’ll have to use the clip again.”

“Wasn’t the blood flow blockage perfect?”

Jun-hoo asked, tilting his head. Si-ho and Seong-eun also looked at Min-seok with puzzled eyes.

Min-seok’s face had darkened.

Something was going seriously wrong.

“If we close the brain like this, the trigeminal nerve will be pressed against the body of the clip. Ha… Just my luck.”

“I don’t understand what you mean? Didn’t the surgery go well?”

Seong-eun raised a question.

“Let me explain it easily. The brain is open from side to side right now, right?”

“That’s right.”

“We’re going to insert the clip and close the brain.”

“That’s right.”

“But if we close the brain like this, the body of the clip will press on the trigeminal nerve. As the opened brain comes together.”

Min-seok continued in a voice of dismay.

“To think that the body of the clip would be placed in the path of the trigeminal nerve.”

Listening to Min-seok’s lament, Jun-hoo brought his eyes close to the microscope.

Indeed, it was as Min-seok said.

If the brain were closed as it was, the patient’s trigeminal nerve would be compressed.

This would create a side effect called trigeminal neuralgia [a chronic pain condition affecting the trigeminal nerve in the face].

The trigeminal nerve is the largest nerve that controls the muscles and nerves of the face, and if a problem occurs.

The patient had to experience a burning pain in the face from time to time.

There was a flaw in the clip ligation that was thought to be perfect.

With Min-seok’s bad news, the atmosphere in the operating room rapidly became heavy.

Throughout the surgery.

Even Jun-hoo, who had been so sharp, couldn’t step in.

This was a picture that Jun-hoo had not anticipated or prepared for.

It took time to recover from the embarrassment.

“Professor. Wouldn’t it be possible to adjust the position so that the body of the clip does not compress the trigeminal nerve?”

Jun-hoo barely managed to ask a question.

“If that were possible, why wouldn’t I be doing it? If you move the clip after ligating the aneurysm, the aneurysm can burst.”

“Then, how about replacing the clip with another one?”

“I don’t see a suitable combination… It doesn’t look like there’s any other way right now.”

Min-seok nodded weakly.

From then on, a quest began to find a clip that would completely block the blood flow to the aneurysm and not compress the trigeminal nerve.

The quest continued to fail.

If the blood flow was blocked, there was pressure on the trigeminal nerve.

If the trigeminal nerve was fine, the blood flow was not blocked.

It was truly a dilemma.

The tragedy occurred because the location, size, and shape of the patient’s aneurysm showed a different pattern from that of a typical aneurysm patient.

The aneurysm was unique.

There was no clip that fit it perfectly.

As a suitable clip could not be found, the surgery time exceeded the estimated time by 40 minutes.

The anxiety and fear of possibly failing the surgery began to stir in the operating room.

“We need to make a decision soon. The patient’s blood pressure is rising little by little. There’s a limit to how long we can hold out with antihypertensive drugs.”

Seong-eun began to urge Min-seok.

“It’s not like I’m doing this because I like it! I’m doing this because I want to treat the patient safely.”

Min-seok’s voice rose.

As the surgery hit a wall, emotional turmoil arose.

Crack.

Jun-hoo thought he heard the sound of teamwork cracking.

Something had to be found.

If more time was wasted, the patient and the fetus would not be able to withstand it.

Jun-hoo’s gaze anxiously went back and forth between the wall clock and the patient monitoring device.

It felt like being chased by a villain in a martial arts novel.

“Professor, is it possible to replace the clip ligation with coil embolization [a procedure where coils are inserted into the aneurysm to block blood flow]?”

“No. Absolutely not. The aneurysm is too large to be handled with coil embolization. The blood vessels are complex, making it difficult for the catheter to enter.”

Min-seok, who pointed out Jun-hoo’s suggestion, nodded as if he had made up his mind.

“There’s no other choice now. We have to go down a difficult and dangerous path… Bipolar Forcep Coagulation [using heat to shrink the aneurysm].”

At Min-seok’s instruction, the scrub nurse handed over the bipolar forceps coagulator.

The bipolar forceps coagulator looked exactly like forceps, but it had needle-like prongs at both ends.

High heat flowed through the prongs at both ends, allowing for more precise coagulation.

“There was still a way left?”

Seong-eun asked.

“I’m going to apply heat to the aneurysm to shrink it. If I reduce the size of the aneurysm, I’ll be able to find a decent clip.”

“Then why haven’t you been doing it until now?”

“Because it’s dangerous. If I make a mistake, the aneurysm could rupture. I didn’t want to touch the aneurysm directly if possible, but now there’s no other way.”

Min-seok’s eyes were full of determination.

However, Jun-hoo couldn’t hide his anxiety about Min-seok’s decision.

The procedure of shrinking the size of the aneurysm by cauterizing it.

This was a procedure that even Master Jae-hyun only succeeded in 40 percent of the time.

It would be one thing if the patient was a normal person.

If the patient was a pregnant woman suffering from preeclampsia [a pregnancy complication characterized by high blood pressure], it would be difficult to clean up after a failure.

Because blood pressure and intracranial pressure would skyrocket.

Did he really have to take a gamble?

Was there no way to end the surgery safely?

Jun-hoo desperately racked his brain.

Jun-hoo had special abilities that other surgeons did not have: martial arts and internal energy.

He wanted to use this weapon in the current situation.

To finish the surgery safely, he would have to use a clip.

Something had to be added to the clip.

Jun-hoo, who was staring intently at the clip, finally came up with a brilliant idea.

Necessity was the mother of invention.

“Professor. I think clip ligation is possible.”

* * *

“Professor. I think clip ligation is possible.”

Jun-hoo’s cheerful voice echoed in the operating room.

The staff’s eyes turned to Jun-hoo as if they had promised.

“Seo Jun-hoo, what nonsense are you talking about!”

Min-seok burst out in anger.

Min-seok was already sensitive because he had failed clip ligation.

It was Min-seok who failed the ligation not because of his lack of ability, but for the absurd reason that there was no clip to ligate the aneurysm.

But in that situation.

To dare to say that clip ligation is possible?

Of course, he couldn’t help but be furious.

“This guy, I’ve been too lenient with him, and now he’s climbing too high.”

“How could I talk nonsense in front of the patient and the two professors? I really came up with a good idea.”

Unlike the angry Min-seok, Jun-hoo’s eyes and voice were calm.

It seemed that he had not come forward without thinking.

But still.

In a situation where even he, as a professor, had no good solution, what ingenious plan could Jun-hoo, a first-year resident, have come up with?

It was hard not to be skeptical.

“Don’t tell me you’ve found a clip combination formula that I don’t know about?”

“Yes. How could I, with my humble skills, have discovered a clip combination technique that the professor has not seen?”

“Then are you thinking of going out and buying a clip?”

Min-seok asked, calming down his anger a little.

There were dozens of types of clips used for aneurysms.

The Department of Neurosurgery at Shinwon University Hospital did not have all the clips.

So, if clip ligation were to be continued, there seemed to be no other way than to get a new clip.

‘If I had known this would happen, I would have obtained non-mainstream clips in advance.’

Min-seok regretted it belatedly, but the ship had already sailed.

“That’s not it either. I don’t think there’s enough time to get a new clip.”

“Huh… Then what are you going to do?”

“Didn’t Yasargil clip [a type of surgical clip], L-shaped 8, 2EA completely block the blood flow to the aneurysm?”

“It did. It also compressed the trigeminal nerve because of its shape.”

“Then, how about folding the horizontal part of the ‘L’ shaped clip to make it ‘I’ shaped? Wouldn’t this avoid pressure on the trigeminal nerve?”

“……”

“I think we can solve the problem by folding the aneurysm clip in half.”

“Hmm… It’s theoretically possible. Because the horizontal surface of the clip is compressing the trigeminal nerve. But still.”

Min-seok snorted at Jun-hoo’s suggestion and continued.

“That’s realistically impossible. Aneurysm clips aren’t made of plastic. No one can bend a clip with human strength.”

“Jun-hoo, you’ve crossed the line this time. Don’t overdo it and stay still.”

“Professor. That’s a bit…”

Si-ho and the scrub nurse, who had been silent, scolded Jun-hoo.

The reason why they had no choice but to do so.

That was because the aneurysm coil was made of surgical steel, that is, stainless steel specially made for medical use.

Bending specially made stainless steel by hand?

How could that be possible?

“I think I can do it.”

“Oh, stop talking nonsense. There’s a limit to how much you can show off. Jun-hoo, you’ve already increased the surgery time that was already delayed because of you.”

“Still, shouldn’t we let him try it once?”

“What? Why are you doing that too?”

Min-seok glared at Seong-eun, who was defending Jun-hoo.

To think that she would take Jun-hoo’s side in this situation.

“It’s okay to scold him if he can’t do it after trying, right?”

“Do you think a person can bend surgical steel with strength? Seriously?”

Seong-eun did not answer.

Instead, she grabbed Yasargil clip, L-shaped 8, 2EA, which was placed on the dressing cart, and approached Jun-hoo and handed it to him.

Two clips were placed in Jun-hoo’s hand.

“Give it a try.”

“Thank you, Professor.”

Jun-hoo held the first clip in his left hand.

He began to bend the ‘L’ shaped clip into an ‘I’ shape with his right thumb.

It wasn’t some cheap street performance.

It wasn’t some third-rate gag show.

What was he doing in the sacred operating room?

He would have to scold Jun-hoo severely when the nonsense was over.

Min-seok was changing his mind, thinking that he should cancel the Moyamoya disease [a rare progressive cerebrovascular disorder] second assist.

Something unbelievable happened even though he was watching with his own eyes.

The clip began to bend under Jun-hoo’s strength.

No way.

Bending surgical steel with strength?

Was Jun-hoo some kind of psychic?

In this absurd situation.

As the eyes of the embarrassed staff grew larger.

Jun-hoo instantly folded the ‘L’ clip into an ‘I’ shape.

A miracle had become a reality.

Min-seok couldn’t hold back the vulgar words that came out of his mouth.

“Holy shit, what kind of crazy bastard is this?”