A Surgeon Who Uses Martial Arts [EN]: Chapter 470

Chapter 92: A Divine Move (1)

“Scalpel, number 11.”

Jun-hoo reached out to the scrub nurse.

But there was no sensation of anything being placed in his hand.

“What are you doing? Are you spacing out?”

“No, Doctor. It’s just that…”

The scrub nurse hesitated before continuing.

Both the resident and Yena were staring at Jun-hoo with wide eyes.

However, Jun-hoo’s gaze remained fixed on the surgical microscope.

He was more focused than ever, intently examining the dura mater [the tough, outermost membrane covering the brain and spinal cord].

“I thought I might have misheard. Did you just ask for a scalpel?”

“Yes, why?”

“I thought we usually use an electric scalpel for dural incisions.”

“A scalpel is more suitable for this patient.”

Jun-hoo replied in a dry voice.

Click!

Only after hearing Jun-hoo’s explanation did the scrub nurse attach the blade to the handle and hand it to him.

The blade of the scalpel gleamed dazzlingly in the shadowless operating light.

‘This is the first hurdle in the bloodless surgery. I need to get off to a good start.’

Jun-hoo’s eyes sparkled as brightly as the scalpel.

The scalpel approached the dura mater.

Gulp!

The observing staff swallowed hard in unison. Their gloved palms were damp with sweat.

They knew that the success or failure of the surgery depended on Jun-hoo’s fingertips.

The dura mater was filled with countless tiny blood vessels.

Therefore, when incising the dura mater,

bleeding was unavoidable.

Under normal circumstances, it wouldn’t be a problem.

The amount of bleeding during a typical surgery wasn’t significant, and it could be compensated for with a transfusion.

But!

This surgery was not ordinary.

It was a bloodless surgery.

Even with the use of a cell saver [a medical device used during surgery to recover blood lost by the patient], autologous blood [blood donated by the patient for their own use] couldn’t be utilized 100 percent, so every drop of blood lost was a precious treasure.

Ssssk.

The scalpel sliced through the dura mater.

The dura mater was cut cleanly, like a sheet of paper.

The incision was made in two locations.

It was the location of the anterior cerebral artery, located 3 centimeters below the crown of the head.

The length of the incision was approximately 4 centimeters.

Usually, Jun-hoo’s incisions were as straight as if they had been drawn with a ruler, but today’s incision looked somehow strange.

It was crooked, like an earthworm crawling.

Perhaps that was why.

The expressions of the staff watching Jun-hoo were anxious.

They wondered if his condition was poor,

or if he was ruining the incision due to the pressure of the bloodless surgery….

However, Jun-hoo’s eyes and hands remained calm.

Jun-hoo was seeing what the other staff members couldn’t.

“Retract the dura mater superiorly and inferiorly.”

“Yes, Doctor.”

At Jun-hoo’s instruction, the resident held retractors in both hands and widened the incision superiorly and inferiorly.

The arachnoid mater [the second of three layers of membranes that cover the brain and spinal cord], the second meningeal layer inside the dura mater, was revealed.

‘I’ll go once more.’

Jun-hoo also cut the arachnoid mater with the scalpel.

This incision was even more bizarre. The incision had a ‘∩’ shaped curve.

At first glance, it looked like Jun-hoo was playing around with the patient’s meninges [the membranes that cover and protect the brain and spinal cord].

Regardless of the surrounding concerns,

Jun-hoo pushed ahead with his unique incision.

Because only this incision was the only way to save the patient.

Jun-hoo finished the incision with delicate yet lightning-fast skill.

“Retract the pia mater [the innermost layer of the meninges] and arachnoid mater together and fixate.”

“Yes, Doctor.”

“Widen it more than now. The surgical field is still narrow.”

At Jun-hoo’s urging, the resident widened the meninges further.

Then, a blood vessel extending from the thick anterior cerebral artery, like an electric wire, appeared.

The blood vessel was torn.

A dark red hematoma [a localized collection of blood outside the blood vessels] dangled from the torn opening of the blood vessel.

The estimated volume of the hematoma was approximately 35ml.

A hematoma larger than 40ml is called a giant hematoma, and the hematoma in front of him was of a similar size.

‘As quickly and cleanly as possible.’

Swoosh!

The scalpel left a flashing trail in the air.

The blade cut through the hematoma.

The hardened blood clot surrounding the hematoma burst with a pop.

Cheee!

Yena sucked up the blood flowing from the ruptured hematoma with the suction device as if she had been waiting for it.

“Bovie (electrocautery) [a device used to stop bleeding by using heat].”

Jun-hoo temporarily put down the scalpel and cauterized the blood vessel with the electrocautery.

Cheee.

White smoke rose from the burning tissue. A sweet smell brushed the tip of his nose.

As the hematoma was removed, the trickling blood disappeared.

Only then did Jun-hoo straighten his back, which had been bent for a long time.

There were two urgent fires that needed to be put out immediately through surgery.

One was the hematoma caused by the subarachnoid hemorrhage [bleeding in the space between the brain and the surrounding membrane] right in front of him.

The other one was….

The hematoma caused by bleeding within the brain parenchyma [the functional tissue of the brain].

One of them had just been removed.

“Yena, can you measure the intracranial pressure?”

“Yes, Doctor.”

Yena inserted a probe to measure intracranial pressure into the incision.

The gauge on the measuring device, which had been pointing to 0, began to rapidly swing to the right.

Since the start of the procedure,

Jun-hoo, who had always been confident, was nervous for the first time.

There was no more important value than intracranial pressure in neurosurgery.

Because intracranial pressure indicates the overall state of the brain, such as bleeding, cerebral edema [swelling of the brain], and cerebrospinal fluid circulation.

“The intracranial pressure is 27mmHg.”

Yena’s voice was bright as she reported. Jun-hoo’s face, which had been momentarily distorted, relaxed again.

The scrub nurse was delighted.

The resident breathed a sigh of relief.

Normal intracranial pressure is 0-15mmHg, but considering the patient’s urgent situation, 27mmHg was close to a miracle.

This was thanks to the craniectomy [surgical removal of part of the skull] being completed quickly,

and the hematoma being removed at the right time.

“What about blood pressure?”

“It’s 140mmHg/100mmHg.”

“That’s not bad. How many units of alternative plasma have we used?”

“We’ve used 3 units.”

“What about the blood being stored by the cell saver?”

“It’s about one unit in transfusion packs.”

Jun-hoo nodded after hearing the reports.

The situation was unfolding as well as it could possibly be.

But complacency was forbidden.

Jun-hoo had experienced many absurd cases where the surgery was successful but the patient died.

For example, bleeding occurs in completely unexpected areas as hemodynamics [the dynamics of blood flow] become unstable,

or sudden cardiac arrest occurs for truly unknown reasons, and so on.

“But Doctor, I have a question.”

Yena cautiously opened her mouth.

“Go ahead.”

“I’ve been wondering since the beginning, why didn’t you use an electric scalpel and instead used a regular scalpel for the meningeal incision?”

“…….”

“And why is the incision shaped like a child’s drawing of shapes?”

“Ah, that?”

Jun-hoo chuckled.

The other staff members couldn’t see his smile because he was wearing a mask.

“I don’t have time, so I’ll explain while I’m operating.”

* * *

‘Crazy. He’s crazy.’

Since meeting Jun-hoo, Yena had been constantly shocked.

The situation in front of her was no exception.

Jun-hoo was performing a difficult surgery while also telling the truth about the subarachnoid hemorrhage he had just finished.

Usually, talking would reduce concentration on the surgery, but Jun-hoo didn’t expose such weaknesses.

In any case, the truth that Jun-hoo revealed was as follows.

As for why he used a scalpel instead of an electric scalpel….

It was to prevent dehydration of the meningeal tissue,

to prevent tissue contraction,

and to avoid tissue necrosis [tissue death].

In a normal surgery, even Jun-hoo would have used an electric scalpel, but because it was a bloodless surgery, he paid special attention to potential future problems.

“But Doctor, then there’s something that doesn’t make sense.”

Yena countered.

“Shouldn’t we use an electric scalpel for bloodless surgery? Doesn’t an electric scalpel have the effect of hemostasis [the process of stopping bleeding] while incising?”

“Usually, that’s the case 99.9 percent of the time.”

Jun-hoo briefly took his eyes off the surgical microscope and looked at Yena.

He flashed a smile.

“That’s exactly the part that’s related to the unique incision method.”

“How is it related?”

“I deliberately avoided the microvessels distributed in the meninges when making the incision. Because I was avoiding the blood vessels, the shape of the incision inevitably became strange.”

“Wow! Is that possible?”

“It’s possible for me.”

Jun-hoo’s voice was calm.

Of course, Jun-hoo had performed bloodless surgery several times during his residency at Mayo.

To make the surgery as fast and accurate as possible,

a staggering solution came to mind after much deliberation.

‘Yes. This will do!’

He decided to memorize the entire distribution of microvessels in the meninges.

What if he memorized the distribution of microvessels and skillfully avoided them when using the scalpel?

Wouldn’t it be possible to minimize bleeding while increasing accuracy and speed?

Since that day, Jun-hoo compared and contrasted MRIs of adult and pediatric patients to memorize the vascular distribution of the meninges.

Those with quick wits would have already realized this.

That the task of memorizing the vascular distribution of the meninges could not be perfect.

Because…….

The reason was simple.

That the distribution of microvessels could be somewhat consistent, but could not be perfectly consistent.

So Jun-hoo came up with a trick.

He added a new method.

He loaded internal energy into the scalpel and sent it to the patient’s meninges.

Woooong.

Woooong.

A resonance was transmitted from the meninges where the microvessels were located.

It was the resonance generated as the internal energy that Jun-hoo had sent out with the scalpel returned to the scalpel.

Accordingly, Jun-hoo incised the meninges, avoiding only the places where the resonance was felt.

A new meningeal incision technique.

It was the moment when a meningeal incision technique was born, solely for bloodless surgery patients.

However, it was impossible to explain this properly, so Jun-hoo only talked about the part where he memorized the vascular distribution.

“I have goosebumps all over my arms right now. How did you even think of memorizing the entire vascular distribution located in the meninges?”

“You’ll do it if you’re desperate.”

“Come to think of it, I don’t think I ever had to do suction when you were doing the meningeal incision, Doctor.”

“I also just thought it was strange why you were making the incision like that.”

“Me too.”

The scrub nurse and the resident added a word each to Yena’s words.

The atmosphere in the operating room had become amicable.

Jun-hoo’s divine performance had changed everything.

While removing the hematoma in the brain parenchyma,

the patient’s intracranial pressure returned to a normal value of 10mmHg.

The swollen brain returned to its original size.

Subfalcine herniation [a type of brain herniation where part of the brain shifts under a fold of the dura mater].

The brain, which had escaped its place due to high intracranial pressure, returned to its original place.

Now, no one doubted the patient’s recovery.

No one doubted the success of the surgery.

They even forgot that the patient had been transported to the hospital just before death,

and that the surgery they were performing was a high-difficulty pediatric bloodless surgery.

While the brain surgery was proceeding smoothly, only a total of 4 alternative plasma units were used.

The cell saver stored half a blood pack’s worth of blood.

Even if bleeding was minimized, it was impossible not to use autologous blood.

The brain surgery was completed 1 hour and 30 minutes after the start of the surgery.

Its perfection and speed were astonishing.

But that didn’t mean the surgery was over.

The patient had suffered a lumbar fracture from the fall.

The final hurdle of back surgery remained.

The lumbar reduction was as natural as flowing water.

It continued on the spot without a change of staff.

Jun-hoo was the strongest neurosurgeon who had mastered the 7 subspecialties derived from neurosurgery.

There was nothing he couldn’t handle.

40 minutes after starting the lumbar surgery,

the operating room was turned upside down once again.

“…….”

“…….”

Everyone, including Jun-hoo, was looking at the patient monitoring device with gloomy faces, as if they had visited a funeral home.

The vitals were plummeting.