Surgery Godfather

Chapter 137: Chapter 0133: Perfect Suture

There were few patients, so rounds were quick. Once complete, Zhang Lin and Little Five escorted the patient to the operating room.

Meniscal repair and cruciate ligament reconstruction are signature surgeries of arthroscopy. Although Director Han had full confidence in Yang Ping, he still went to observe these signature surgeries to assess Yang Ping’s skill level in arthroscopy.

Huang Jiahui arrived early in the operating room, standing by a cart of instruments. She neatly stacked twenty individually sterilized meniscus suturing guns on the cart and parked it in an out-of-the-way corner.

After careful thought, she had chosen this corner as the ideal location.

It allowed her to observe the progress of the surgery without hindering any of the operating room staff.

She originally had enviable long hair but she decided to cut it short upon joining this profession. Short enough to tie up.

Today, she had her hair tied up, tucked under a cap, and put on a sterile hat without a single hair sticking out. She had practiced putting on the sterile cap countless times at home, in front of a mirror, until not a single hair was exposed.

The anesthesia was administered, Song Zimo hung the patient’s X-rays and MRI images on the viewing light, guiding Little Five and Zhang Lin to position themselves properly. He then went to scrub his hands, sterilize the sheets, and do the preparatory work. He was meticulous about every detail.

By the time Yang Ping came in to wash his hands, all preparations had been made and they were ready for surgery.

As Yang Ping was getting into his surgical gown, Director Han walked in. n/ô/vel/b//jn dot c//om

“Hello, Director!” Everyone greeted.

“Hello, Professor Han!” Jiahui greeted Professor Han and bowed.

“Hello!” Seeing that she had a laser pen in her hand and was standing next to a sterile box of instruments, Director Han knew that she was from a supplier company.

“Which company do you work for? Are you new here?”

Director Han had never seen this young woman before.

“Professor Han, I’m new. I’m from Sharp Medical, specializing in sports medicine products.” Jiahui introduced herself.

Director Han picked up a packaged meniscus suture gun and said, “Sharp Medical! A domestic brand, we should really give more support to our own country. This suture gun sometimes jams, be careful!”

“There’s sometimes a 0.5mm discrepancy between the first and second shots, which might jam the gun. The key is not to release the trigger after the first shot. You need to keep pulling back until the first shot is confirmed to be removed. Then you can loosen the trigger and take the second shot. Thus, there won’t be any jamming. The design needs some improvement.”

Yang Ping has conducted extensive research on Sharp Medical’s instruments. He was aware of this flaw long before Huang Jiahui could remind him, and he already had a solution in place. He was not concerned.

“It’s good that you have deep knowledge about the instruments. As a doctor, you must master the instruments, and you can’t rely on the explanation from the company representative.” Director Han admired Yang Ping’s attitude.

“What’s the patient’s situation?” Director Han asked while viewing the films.

“Male, 14 years old, a professional football player, with complex tear of the medial meniscus in the left knee. The tear is located at the posterior horn and the body.” Yang Ping introduced the patient’s condition to Director Han.

“Hmm, looking at the MRI, the meniscal tear is severe, the suturing technique will be challenging. Take your time, don’t rush.” Director Han instructed Yang Ping.

Huang Jiahui brought a stool over for Director Han to sit on.

Pre-operation checks were completed, blood was driven out, and the tourniquet was inflated.

Yang Ping started with the scalpel, skillfully making the lateral incision, inserting the trocar with the sheath, straightening the knee joint, entering the suprapatellar pouch, withdrawing the trocar, and inserting the arthroscope.

In the blink of an eye, the examination under arthroscopy was completed. The medial meniscus was torn, no other obvious abnormalities were detected. It was time for the medial meniscus to be sutured.

Director Han moved to the side of the monitor to view the video image, “The tear is severe. A portion of the meniscus has flipped over. Is this a recent tear?”

“The injury occurred just two days ago. This patient was referred by Su Nanchen, he’s an athlete in the provincial youth soccer team.” Yang Ping started inserting the needle from the inside to create an opening.

Once the opening was created, he inserted the probe. The probe was an extension of the doctor’s fingers in arthroscopy, providing further insights into the pathological changes and damage.

Yang Ping closed the irrigation tube to reduce the water disturbance to the torn meniscus. Using the probe, he repositioned and smoothed out the torn edges of the meniscus. Since it was a fresh tear, it could be directly sutured without the need of freshening the tear edges.

“Suture gun!”

Xiao Su had also researched the manufacturer’s instruments. Before Huang Jiahui could quiz her about sterile knowledge, Xiao Su had sought advice from Huang Jiahui about the details of these instruments.

Yang Ping took the suture gun, entered through the medial portal, and started suturing the posterior horn of the meniscus. The gun was aimed at the chosen puncture point, the trigger was pressed, and the needle tipped with a suture anchor pierced the meniscus until it breached the capsular attachment of the meniscus. The suture anchor was left outside the joint capsule.

Clasping the trigger tightly and not loosening his grip, he gently pulled back. The first needle successfully exited. With the gun against another chosen point 0.5 cm away from the first needle, he squeezed the trigger. The second needle smoothly went in and he withdrew the gun.

By pulling tightly on the suture, the two suture anchors which initially entered longitudinally were now positioned transversely, serving as an anchor point for the suture outside the joint capsule. The knots on the suture were pre-made, irreversible, and could only be tightened, not loosened.

Using a knot pusher, he pushed the knot to the appropriate position and cut the thread with a thread cutter. The first stitch was beautifully completed. It was the perfect tension and accurately placed.

The tear was complex and irregular, so the suture gun had to be inserted from different directions. Sometimes it was easier to enter from the inner side, and sometimes from the outer side.

Doctor Yang had already planned how many stitches and their distribution; he first stitched up a few spots on the inner side. Then he moved the scope to the inner side and inserted the suture gun from the outer side to sew the outer portion.

Each stitch was skilfully and effortlessly placed with just one swift movement. In total, six stitches were made, with horizontal, diagonal, radiating, and flap-like tears all stitched up nicely.

The meniscus was perfectly pieced back to its original state; a glance at the video after sutures looked like a few stitches had been made on a healthy meniscus.

With the water pipe inserted, the joint cavity was flushed. After closing the water pipe, the water in the joint cavity was sucked out and the scope was pulled out. Doctor Yang stepped back, leaving Song Zimo to complete the finishing touches.

The exterior of the knee joint was dried with sterile gauze. The skin was disinfected with 75% alcohol, and the two small incisions were sutured, one stitch each. They used cotton padding and elastic bandage for pressure dressing, released the tourniquet, and thus, the surgery was over.

Director Han was staring at the screen; the surgery ended in just a little over ten minutes, even before their conversation fully began.

The suturing was perfect. The torn meniscus was gradually restored to its original state, slick and tidy. The edges matched perfectly, with no wrinkles after suture, it was a visually appealing work of art.

This kind of result can’t be achieved without extensive surgical experience. To achieve smoothness without wrinkles, every stitch’s tension needs to be perfectly controlled. It’s not about controlling the tension of each stitch independently, but coordinating several stitches to achieve balanced tension.

“Perfect!” Director Han gave him a thumbs up.

Huang Jiahui had been standing by his side, constantly praying silently that the suture gun wouldn’t jam.

Having watched the whole surgery process, she could tell that Doctor Yang’s proficiency with the suture gun was as if he had designed it himself – it seemed even more perfect than the company’s surgical demonstration video.

Earlier, he had casually mentioned how to handle a jammed suture gun, indicating that he had a strategy prepared. While knowing about this flaw, he still opted to use their product. This naturally invoked some gratitude in her.

“Dr Yang, was our equipment handy to use?” Jiahui asked nervously, rushing over to help Doctor Yang untie the straps of his surgical gown.

“Not bad, very good!”

“Thank you, Dr Yang!”

“Get the reconstructive equipment for anterior and posterior crossed ligament ready.” Doctor Yang instructed her.

Remembering that last night, this young lady had urgently asked her brother to arrange a meeting just to report the deficiency of the meniscus suture gun, Doctor Yang was touched, whether it was due to her sincerity or other reasons – at least she put heart into it. Such earnestness deserved acknowledgment.

“Okay, I will have it delivered to you in a moment, along with the documentation.” Jiahui responded enthusiastically.

Although the surgery center already had some of the equipment ready, Jiahui, having heard Doctor Yang’s request, assuredly wouldn’t mention it. Why would she ask them to fetch the equipment when she could deliver it herself?

She would deliver it as promised! She adhered to her brother’s instructions: Always keep the hassle on our side, never to burden the clients.

“How is our domestically produced equipment?” Director Han asked.

Doctor Yang replied, “Very smooth! It’s no way inferior to imported ones.”

“If you need equipment or supplies, let me know anytime. Just focus on the surgery.” Director Han was always ready to provide support if needed.

The surgery was over, and as the effects of the anesthesia wore off, Liang Fatty’s true character started to shine through. Zhang Lin helped the patient put on a knee brace, and Song Zimo handed a pair of crutches to him, instructing, “Make sure to avoid putting weight on this leg for the next six weeks. Begin your recovery exercises in the afternoon. The doctor will explain the postoperative precautions in detail.”

The instructions in the operating room were always concise, focusing on key points, so the patient could remember them.

Little Five, who was monitoring the video system, captured a few key images and sent them to Doctor Yang and Song Zimo, who would later discuss them with the patient’s family.

Outside the operating room, the family was waiting. Upon seeing Luo Xiaohu come out himself, leaning on crutches, his parents immediately rushed forward to support him.

“Was the surgery that quick? He just went in a while ago.” Father Luo asked worriedly.

A lengthy surgery would warrant worry, as it could mean that problems had arisen. But an unexpectedly short one also raised concerns – was the procedure hastily done?

Song Zimo showed the images on his phone. “Doctor Yang is very skilled at this type of surgery, that’s why it was so quick. Look, this is the meniscus before the surgery, and this is it after it. Doesn’t the suturing look wonderful?”

After careful inspection, Father Luo was very satisfied. The chaotic tears seen in the pre-surgery images, when compared to the flawless meniscus post-surgery, made it nearly impossible to see that it had been torn at all. He was by no means a doctor, but he had a visual understanding.

The same way a patient could judge the quality of a wound suture. A nicely done suture was neat and orderly with skin edges aligned beautifully, whereas a poorly done suture would be uneven with misaligned skin edges, rather unappealing.

Having cleared this hurdle, Father Luo felt as though a weight had been lifted off his chest.

Doctor Yang sent the images to Su Nanchen, along with a brief description of the findings during the surgery. It was important to provide feedback for a referral.