A Surgeon Who Uses Martial Arts [EN]: Chapter 525

Chapter 103: Cutting to the Chase (1)

Hwang Jeong-hun entered operating room number 8.

Swaaaaa.

White disinfectant gas sprayed from the ceiling in a fluffy cloud.

Hwang Jeong-hun liked this moment. He liked the feeling of being cleansed, the feeling of pure white.

Thump. Thump.

He walked toward the operating table with determined steps.

The staff had already finished preparing for the surgery and were waiting for him.

“You’re here, Professor?”

“You’ve arrived.”

Hwang Jeong-hun raised his hand to acknowledge their greetings.

He stood at the head of the operating table and looked down at the patient. The patient, under general anesthesia, was completely still. Wires from the patient monitoring device and IV lines were connected all over.

The completely shaved head of the young patient shone bluish under the operating lights.

Pediatric brain tumor resection.

It wasn’t a surgery he performed just once or twice, but today he felt particularly nervous and burdened.

This was because the tumor was located near the cerebellum and the fourth ventricle, making it difficult to access surgically.

Hwang Jeong-hun suddenly raised his head and looked up at the second floor.

Hyeonjong was in the observation operating room.

It was against the rules for Hyeonjong, as a guardian, to enter the observation operating room.

However, Hwang Jeong-hun had made a special exception.

Hyeonjong was like family, having shared meals together.

And he sincerely hoped that this surgery would help Hyeonjong return to pediatric neurosurgery.

“Wouldn’t Gamma Knife treatment [a type of stereotactic radiosurgery] have been better?” Yena, the first assistant and a second-year fellow, asked cautiously.

“The surgical site seems too difficult to access.”

“There are surgeries that must be done even if they are difficult and dangerous. If the patient were older, I would have reduced the size of the tumor with Gamma Knife.”

“Then why…”

“The patient is too young. Considering their life expectancy, it’s right to remove the tumor for the long term.”

Hwang Jeong-hun finished speaking and nodded, as if rationalizing himself.

“I will now begin the resection of the neuroglioma [a type of brain tumor] that occurred in the cerebellum.”

Hwang Jeong-hun’s voice echoed.

The curtain of surgery rose.

The staff turned the patient’s head to the side and disinfected the area 4 centimeters away from the ear.

They covered it with a blue surgical drape.

“Number 10.”

With the scalpel he received from the scrub nurse, Hwang Jeong-hun made a ‘C’-shaped incision.

It was the ‘transmeatal approach’ [surgical approach through the ear canal].

In fact, it wasn’t Hwang Jeong-hun’s preferred incision method.

The transmeatal approach was more difficult and complicated than general craniotomy [surgical opening of the skull] in terms of accessing the surgical site.

There was also a risk of damaging the nerves or structures related to hearing if something went wrong.

However, Hwang Jeong-hun followed Jun-hoo’s advice that the transmeatal approach was necessary.

At least when it came to surgery, he had never suffered a loss from listening to Jun-hoo.

Fortunately, the past ten days of training had not been in vain.

He delicately dissected the soft tissue without damaging it.

Weeeeng.

Weeeeng.

The sound of the drill spread loudly. The operating room instantly became a woodworking shop. Fine bone particles, like slush, flew around like sawdust.

“Suction, irrigation.”

“Yes, Professor.”

Yena’s assistance was flawless.

There was no need to spell out specific instructions.

Ssssh!

Yena neatly aspirated the bone fragments. The bone fragments disappeared in an instant.

The residue was thoroughly washed away with physiological saline solution.

The assistant was good.

The vitals were good.

Above all, the sensation in his hands was good.

It was as if his wrist had wings.

Perhaps it was thanks to the massage Jun-hoo had given him after the conference, but his body and mind felt refreshed.

Hwang Jeong-hun drilled four holes in the occipital bone and connected the holes with a scalpel.

He removed the occipital bone without difficulty.

The dura mater [outermost membrane surrounding the brain and spinal cord], the outermost layer of the meninges [membranes that surround the brain and spinal cord], appeared like a milky white film.

Creak. Creak.

As Yena used a retractor to widen the incision, the surgical view became much wider.

It was like a vast wilderness unfolding.

“Professor, was there such an approach when performing cerebellar surgery? This is my first time seeing it.”

Yena said with admiration.

“It exists, but it’s a difficult approach that’s not often used. I wouldn’t have used it if I hadn’t learned it from Director Kwak. Or rather, I wouldn’t have been able to use it.”

“As expected, Director Kwak is truly amazing… Ah. I’m sorry. I didn’t mean to bring up unnecessary things…”

Yena’s eyes smiled awkwardly, as if she was embarrassed to praise Jun-hoo so openly in front of Hwang Jeong-hun.

“It’s okay. It’s something everyone acknowledges. Shall we check if there’s any damage to the auditory nerve and structures?”

“Yes. I understand.”

The two brought their eyes close to the microscope.

The facial nerve, internal auditory canal, labyrinth, sigmoid sinus, mastoid process, etc.

The structures related to hearing were unharmed, without a single scratch.

The amount of bleeding was also minimal.

It was all thanks to performing the surgery exactly as Jun-hoo had instructed.

So far, the surgery had been a smooth journey.

There was no guarantee that it would continue to be so.

The cerebellum observed under the microscope had significantly fewer wrinkles than the cerebrum.

If the cerebrum was like a walnut, the cerebellum was like an almond.

“Let’s incise the cerebellar dura first. Bovie [electrocautery device].”

Cheeee.

Hwang Jeong-hun boldly incised the dura mater first.

The dura mater split to the left and right from the heat of the Bovie. White smoke danced flutteringly.

The smell of burning tissue tickled his nose.

However, the feeling wasn’t good from the start.

There was quite a bit of bleeding.

Yena had to pause the incision from time to time because she was using suction frequently.

“Professor. Is there a problem…?”

“The bleeding is unusual.”

“Isn’t there usually bleeding when incising the dura mater because there are many microvessels distributed in the dura mater?”

“I mean it’s severe even considering that.”

Hwang Jeong-hun’s furrowed brow never smoothed out.

Still, he had already crossed the point of no return.

Hwang Jeong-hun steadfastly incised the dura mater. Only then did the neuroglioma, the source of all this, reveal itself.

‘No matter how many times I look at it, the location is truly bizarre.’

The jugular vein and carotid artery pass above and below, and the auditory and optic nerves spread to the left and right.

‘I would never have done the surgery if Director Kwak or Hyeonjong hadn’t been involved.’

Hwang Jeong-hun shuddered with a look of disgust.

“Still, it’s fortunate that the size of the tumor was reduced with Gamma Knife. Surgery would have been impossible if it were its original size.”

“Perhaps. When you’re determined to save someone, you can only think of ways to save them.”

“…”

“That’s why Director Kwak is amazing.”

After lightly drawing a circle with his right wrist, Hwang Jeong-hun began the radical resection [complete removal of the tumor].

Radical resection was a surgical method of removing the brain tumor as widely as possible.

Cheeee.

Hwang Jeong-hun cauterized the center of the tumor and used an ultrasonic aspirator to excavate the center of the tumor.

Considering the location and size of the tumor, it was more advantageous to remove the tumor from the inside out.

Hwang Jeong-hun had already fallen into a trance. It was as if only he and the tumor were left in the world.

It was as if time had stopped.

“Professor, the patient’s vitals are dropping rapidly. The electrocardiogram rhythm is also becoming unstable!”

At that moment, the anesthesiologist shouted from behind the curtain.

Hwang Jeong-hun’s mentality began to waver like a reed.

* * *

Tick. Tick. Tick.

Hyeonjong was anxiously grinding his upper and lower teeth.

He was taking the urgent situation unfolding on the monitor as his own.

Until 20 minutes ago, the surgery was going smoothly.

Hwang Jeong-hun’s method of accessing the surgical site, his skills, and his proficiency were all beyond expectations.

The staff’s assistance was also outstanding.

‘Heaven isn’t heartless after all.’

Although Somyeong was given the ordeal of a brain tumor, it was an ordeal that could be overcome.

…he sighed in relief.

But in an instant, the situation reversed.

Perhaps it was because the surgical site was adjacent to the medulla oblongata [part of the brainstem].

Sudden cardiac arrest occurred.

The medulla oblongata was an organ that connected the brain and spinal cord and had a huge impact on life activities.

The reason why cerebellar surgery was particularly complex and dangerous was that the cerebellum and medulla oblongata were attached.

CPR continued for nearly 10 minutes, and during that time, Hyeonjong wrung his hands in sweat.

He couldn’t sit still and wandered around the observation operating room restlessly.

The heart rhythm barely returned, but it was one problem after another.

As the intracranial pressure increased, bleeding occurred in the cerebellar microvessels.

Blood filled the brain cavity.

The blood was sloshing like waves.

Suctioning.

Applying pressure with gauze.

Cauterizing with an electrocautery device, etc.

They put on all sorts of shows to solve the bleeding, but then Hwang Jeong-hun was the problem.

His face turned white, and his frightened eyes blinked incessantly.

Hwang Jeong-hun’s worst habit, being chicken-hearted, had been activated.

The surgery had been so perfect until now, so the shock Hwang Jeong-hun was receiving now would be unimaginable.

‘Should I step in after all?’

Hyeonjong lowered his head and looked down at his palms.

While staying at the hospital as a guardian, Hyeonjong had all sorts of thoughts because he had nothing to do. Of course, among them was the scenario of Hwang Jeong-hun’s surgery failing.

So every dawn, he practiced and practiced in his head.

If he were to enter the operating room, how he should perform the surgery.

If Hwang Jeong-hun just turned a blind eye, Hyeonjong could perform the surgery.

In the first place, Hyeonjong was also a pediatric neurosurgeon with a medical license.

However, when the actual situation came, his hands trembled despite his firm will.

They became damp with sweat.

It had been a whopping 4 years since he had put down the scalpel.

Could he restore his dulled and rusty skills from the past 4 years with just mental training?

He didn’t have confidence after all.

However, if he left Hwang Jeong-hun alone like this, it was obvious that the surgery would fail.

Hwang Jeong-hun’s hand holding the Bovie was faintly vibrating.

This wasn’t just someone else’s problem after all.

It was his problem.

Hyeonjong bit his lower lip with his upper teeth.

When he left the priesthood, he believed that the fate of pediatric neurosurgery had nothing to do with him.

However, when Somyeong was diagnosed with a brain tumor, the situation was reversed.

A contradictory thing happened where he had to receive help from the place he had left.

There was no tragedy like this tragedy.

Perhaps, depending on the interpretation, Somyeong had to die like this because Hyeonjong had left the priesthood.

Karma was so cruel and scary.

‘Please. Someone help me.’

Hyeonjong put his hands together and prayed. Just in time, the operating room door opened.

* * *

‘I wondered if it would happen, and it did?’

Jun-hoo advanced towards the operating table.

Everyone was so preoccupied with regaining their composure that they didn’t even notice Jun-hoo approaching.

“Is the surgery going well?”

“Dire… Director?”

“How did you get here, Director?”

The staff asked with wide eyes.

He used Heavenly Craftsmanship for each surgery to buy 30 minutes of time, but he couldn’t tell the truth.

“The surgery finished earlier than expected. I came to observe.”

“That’s… I’m sorry.”

Hwang Jeong-hun lowered his head with a mournful face.

He reported the progress in a voice as small as a mosquito.

Jun-hoo listened silently.

Hwang Jeong-hun’s surgery was like a textbook, so there was nothing to criticize. He was just unlucky and caught up in variables.

In the first place, cerebellar tumor resection was a very difficult procedure.

“But Director, I don’t know if we should continue the surgery as it is.”

“Why?”

“While resecting the tumor, the adhesion between the tumor, brainstem, and lower nerves was much deeper than I thought. The capsule is also thick.”

“…”

“The nerves and blood vessels are about to be damaged while resecting the tumor.”

“Is that so?”

Jun-hoo put his eyes on the microscope and examined the tumor and surrounding area.

Hwang Jeong-hun was right.

The tumor had infiltrated the normal tissue more than what was confirmed by CT and MRI.

Sometimes there were things that could only be seen by directly opening the surgical site.

This surgery was exactly like that.

Jun-hoo calmly made eye contact with the staff and said.

“The surgery will proceed as planned. I will completely remove it.”