Fifth Vital [EN]: Chapter 391

392. In the End, Part of the Small Intestine

“Hello. How did you sleep, patient?”

As Jo Eung-gi was lying on the bed, about to be wheeled into the operating room, Tae-kyung greeted him.

“Yes, Doctor. I slept well, so I feel good, but I’m still a bit nervous about going into surgery.”

“That’s perfectly normal. I and the medical team will do our best, so just think of it as taking a good nap and waking up feeling better. Relax.”

“I understand. Please take good care of me.”

Regardless of the specific ailment, patients undergoing surgery are bound to be nervous, no matter how minor the procedure.

Tae-kyung, understanding this anxiety better than most, always reassured his patients with comforting words.

While Jo Eung-gi was being anesthetized, Tae-kyung thoroughly scrubbed his hands and entered the operating room.

“Doctor, patient Jo Eung-gi is under anesthesia.”

“Please monitor him carefully until the surgery is complete. Let’s begin.”

Tae-kyung announced the start of the surgery and prepared to insert the laparoscope [a surgical instrument with a camera] into the patient’s abdomen.

“Alright! Laparoscope in.”

A small incision was made in Jo Eung-gi’s abdomen, and the camera was inserted.

Inside, the mesentery [a fold of tissue that attaches organs to the body wall], a fatty tissue, partially obscured the small intestine, and blood vessels were visible.

To some, the faint red blood vessels and internal organs might be a terrifying sight, but to Tae-kyung, it was a familiar scene.

In fact, it was so familiar that it felt almost comforting. When his thoughts became too complicated, focusing on surgery actually brought him a sense of peace.

As he carefully lifted the mesentery, the flesh-colored small intestines were visible.

When Tae-kyung grasped the small intestine about 40cm (15.75 inches) from the top with an instrument, Lee Chan-hee, who was assisting, cautiously remarked,

“Doctor, this might sound strange, but it looks different somehow.”

“What do you mean?”

Tae-kyung, focused on the patient, responded casually as he inserted a relatively thick GI stapler [a surgical stapler used in gastrointestinal surgery] deeply.

“Ever since operating on pig intestines during that training, I’ve been noticing every little detail in the operating room more acutely.”

“Oh, right. Dr. Lee, you went to the surgical training center, didn’t you?”

“Yes.”

Lee Chan-hee had recently visited the surgical training center affiliated with the general surgery department, which was funded by a medical device company.

The center allowed surgeons to practice on animal organs, and Tae-kyung actively encouraged his juniors to attend whenever possible.

“How was it? Did you find it helpful?”

“I worked hard, but it wasn’t as easy as I expected.”

“No one is proficient from the start. But practicing with animal organs at the center is invaluable, so treat it like the real thing when you practice.”

“Yes, Doctor.”

Tae-kyung grabbed a section of the small intestine with the GI stapler and activated the machine. The targeted section was then cut, and dense steel staples were embedded in the cut surface, simultaneously suturing and severing the tissue.

“That action of grasping the small intestine… It was easy to tear the tissue if you gripped it too tightly, but if your grip was too weak, you couldn’t manipulate it effectively. It was really challenging.”

Lee Chan-hee continued, his eyes filled with admiration.

He hadn’t fully appreciated the nuances of assisting in the operating room until he practiced with animal organs at the center. Now, he was more attentive than ever.

A moment ago, when grasping the patient’s small intestine, he had been extremely mindful of controlling his strength. Human organs are more fragile than one might think, so caution is essential.

“Of course, it’s difficult. That’s why controlling your grip is so important. You can tear pig organs as much as you want during practice, but it’s a serious matter with human patients, so you must have been nervous when handling the organs.”

“These days, I often worry about whether I’m truly capable.”

“Your skills will undoubtedly improve. Don’t worry too much just yet.”

“It’s amazing.”

“What is?”

“When you say that, Doctor, it makes me believe I really can do it. It gives me strength.”

Tae-kyung was that kind of mentor to Lee Chan-hee. His words always instilled confidence and resolve.

“If that’s the case, I’ll continue to give you that strength in the future, so don’t worry and focus on the surgery at hand.”

“Yes, I understand.”

Even as he spoke, Tae-kyung’s gaze remained fixed on the surgical site. His mouth moved, but his eyes and hands were unwavering in their focus on the procedure.

When Tae-kyung pulled the far end of the severed small intestine upward, a whitish-red cyst became visible in the pancreas. He positioned the cut end of the small intestine near it.

“Suction with a long needle, please.”

The nurse handed Tae-kyung a suction device with a thick, long needle attached.

*Swoosh*

He inserted the needle deep into the pancreatic cyst, and a thick, dark red fluid was drawn into the suction device. The taut cyst appeared to shrink slightly.

Soon after, Tae-kyung created an opening in the cyst with a Ligasure [a device that uses radiofrequency energy to cut and seal tissue] and then made a corresponding opening in the small intestine that he had pulled to the side.

He then opened a large, chopstick-shaped stapler and inserted one end into the cyst opening and the other into the small intestine opening.

Using laparoscopic forceps, he carefully aligned the cyst and small intestine, then secured them together with the GI stapler.

The cyst and small intestine were clamped between the machine’s jaws, and with a rattling sound, a passage was created between the two.

As the nurse prepared the GI stapler for another application, Tae-kyung said,

“That’s not it.”

“Yes?”

“I’m not going to use that. Give me a round 8/5 circle [a type of curved surgical needle].”

“Here it is.”

“Dr. Lee?”

“Yes, Doctor.”

In truth, using the GI stapler would have been perfectly acceptable, and even more convenient. But Tae-kyung deliberately chose to suture stitch by stitch to demonstrate two important principles to his junior, Lee Chan-hee.

“Watch carefully how I suture from now on.”

“Yes. I understand.”

Lee Chan-hee, already attentive, focused even more intently on Tae-kyung’s suturing technique, not daring to blink.

Suturing within the abdominal cavity using a 70cm (27.5 inches) instrument in a laparoscopic setting was challenging, but Tae-kyung made it look effortless.

Moreover, he worked quickly, maintaining consistent and accurate intervals between sutures, and exhibiting perfect control over the tension.

“There are two reasons why I’m doing this even though I could use the GI stapler. Dr. Lee, do you know what they are?”

“One is to practice the suturing method… I don’t know the other one.”

“That’s right. One is to show you, and the other is because of the GI stapler itself.”

“GI?”

“Yes. That machine is incredibly convenient, but don’t become overly reliant on it.”

“Ah…”

“The GI stapler can’t be used if the surfaces are irregular, easily torn, or if there isn’t sufficient length. If you only know how to use the stapler, you won’t be able to operate in such situations. No matter how thorough your pre-operative examination, surgery can be unpredictable, and you never know what changes might occur. You must always be prepared for situations where you can’t use machines.”

“Yes, Doctor, I understand.”

“Good. Then…”

Tae-kyung trailed off, focusing intently on his fingertips.

The surgery would be complete once the cut end of the small intestine was connected to the section of small intestine that had been pulled up to connect to the cyst.

Using the Ligasure, he created an opening in the vertically oriented small intestine and another opening in the small intestine to be connected. Once again, a passage was created between the two using a GI stapler.

Now, all that remained was to suture the openings made with the Ligasure.

“How does it look here?”

“Yes? Ah, yes. The margin is smooth and there’s sufficient length, so I think it can be finished with a stapler.”

“Right? We can finish with a stapler, right?”

“Yes.”

“So, give me one more round.”

“No, just now…!?”

Lee Chan-hee was confused by Tae-kyung’s words, as he had clearly stated that they would finish with the GI stapler. But he soon understood the reason for what followed.

“I’m going to use a stapler. If you use a machine, that much of the end will be cut off. Right?”

“Yes.”

“You don’t need that cut-off part, right?”

“That’s right.”

“Alright! Then do it now.”

“Yes?”

“Don’t just say yes, do it. Why are you so surprised?”

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

Lee Chan-hee’s eyes widened as he looked back and forth between Tae-kyung’s expression and the hand offering him the laparoscopic needle holder.

“Me?”

For a moment, he wondered if he had misheard, but Tae-kyung nodded firmly.

‘The doctor is telling *me* to do this? Wow! I’m going crazy.’

Lee Chan-hee swallowed hard, his mind racing.

The cool operating room suddenly felt stifling, and he imagined sweat erupting on his back. At the same time, the fine hairs on his body seemed to stand on end.

‘I’m suddenly so nervous.’

This was completely different from simply assisting. He was about to perform a task that the chief surgeon, Tae-kyung, would normally handle himself.

It was a natural part of a senior surgeon’s mentorship, but anyone would feel a tremor of anxiety when placed in charge, especially for the first time.

That’s why Lee Chan-hee’s sudden surge of nervousness was understandable.

Tae-kyung, with his exceptional skills, had gone through this process countless times, as had many other doctors who had grown into accomplished surgeons.

“Are you nervous?”

“Ah, yes. Very much.”

“Don’t be too nervous. I’m here.”

“Yes. Doctor.”

That’s right. Tae-kyung’s presence was a source of strength for Lee Chan-hee.

“Take this.”

“Yes.”

Tae-kyung pulled the mesentery and positioned it underneath to prepare for any unforeseen complications. Then, he handed the instruments to his junior and took the camera.

“Lee Chan-hee! Remember just one thing. Never drop the needle and don’t let it go out of the screen.”

“Yes! I will keep that in mind.”

Lee Chan-hee, repeating Tae-kyung’s advice in his head, moved his hand holding the tool calmly and carefully.

“No! No!”

And Tae-kyung’s voice, which had always maintained its composure and calmness even amidst the unpredictable variables of the operating room, rose involuntarily.

“Hey! That’s not it!”

The rising voice echoed loudly in the operating room, and the staff showed considerable surprise at Tae-kyung’s uncharacteristic outburst.

“Not there! Yes! That’s right, a little more! No, that’s not it…”

“I’m, I’m sorry!”

In the end, a portion of the small intestine was torn by the thread. The cause was excessive force applied to the instrument.

As Lee Chan-hee apologized, Tae-kyung quietly inserted the stapler.

“I’m really sorry, Doctor.”

“No, it’s just because you’re not used to it yet. It’s okay because it doesn’t affect the patient at all.”

“I don’t think I’ve ever seen our director raise his voice like this in the operating room.”

“Me neither. I was so surprised a moment ago.”

“It’s always the most difficult to teach others.”

That was true.

Even Tae-kyung, who was usually so composed, couldn’t help but lose his cool when teaching his junior. Moreover, this wasn’t like teaching someone to drive; it involved a living person whose heart was beating, so it was understandable that his voice would rise.

“Dr. Lee, it’s okay.”

Tae-kyung, having raised his voice louder than he had in years, finished the surgery successfully and comforted Lee Chan-hee, who was still shaken.

“Thank you all for your hard work.”

“Thank you for your efforts.”