"Xiao Lu, don't be nervous later, appendicitis is a common entry-level surgery for many surgeons."
"Even though you were previously in orthopedic training, once you know the surgical process, it's simpler than suturing tendons."
"If you really open up, even a freshman can handle this type of surgery, and since you've had experience as the lead surgeon before, there's no need to be nervous." Chen Song reassured Lu Cheng as they walked into the emergency surgery room.
Orthopedics and general surgery are different specialties, so Chen Song was concerned that Lu Cheng might be especially nervous.
The incandescent lights overhead flickered as they approached and then receded, making Lu Cheng's eyes flutter, but his mood was relaxed: "Teacher Chen, it shouldn't lead to any problems, right?"
"I've indeed never performed surgery for appendicitis. During my orthopedic training rotation in general surgery, I didn't encounter a single case, as the general surgery department at Zhongnan Hospital doesn't treat appendicitis, and the emergency department rarely receives such cases."
"There won't be any issues, don't worry…"
"Actually, for appendicitis, it's best done with laparoscopy, as the incision would be smaller, but in your County Hospital, there's no need to be so particular."
"Just make a small incision and go in…"
After helping the patient lie supine, Lu Cheng left to wash his hands, then routinely disinfected the abdominal skin, laid down sterile drapes, and exposed the surgical area…
Lu Cheng waited until Chen Song also donned sterile surgical garments and a mask before glancing at his skill panel.
[Surgical Basic Techniques: Appendectomy (Entry Level 1/5)...]
He hadn't practiced the surgery nor properly watched many tutorial videos, so his skill level was inevitably low, but it didn't hinder Lu Cheng from remembering the appendectomy process and then advancing one step at a time using basic skills.
Lu Cheng had watched tutorial videos and had some basic skills in incision techniques, so he easily found the McBurney point.
After marking the exterior line of the incision with forceps, Lu Cheng looked at Chen Song for confirmation.
Upon receiving a nod, Lu Cheng promptly made an obliquely oriented incision about 5 cm in length, consistent with the line between the navel and the right anterior superior iliac spine.
Without overthinking, he cut through the skin and subcutaneous tissues. After Lu Cheng finished the incision, Chen Song wiped the site with gauze, noticing minimal blood loss.
He praised, "Good, solid basics in incision techniques, well controlled depth for the first cut."
"Next, use the electric knife."
"Circulating nurse, adjust the electric knife's flow," Chen Song instructed.
"It's already adjusted." The circulating nurse was experienced and was currently busy preparing saline for irrigation.
Lu Cheng localized coagulation with the electric knife for hemostasis, then bluntly dissected the aponeurosis of the external oblique along the muscle fiber alignment. He continued adeptly using the vascular clamps to bluntly dissect the muscle layers in alternation along fiber direction.
After lifting the peritoneum to confirm the absence of intestinal adhesions, Lu Cheng made a small incision and proceeded to cut the peritoneum vertically…
"Teacher Chen, there isn't much pus or exudate. The appendicitis appears to be localized. We're lucky." Lu Cheng explained to earn more chances for operation.
He explained his thorough familiarity with the surgical process, even if he hadn't performed it; his fundamental skills were sufficient for back-up!
Assessing the level of appendicitis is also a manifestation of cognitive ability.
If there's an abscess around the appendix, the appendectomy is unsuitable.
"Mm, continue, first find the colon, follow the intersection of the colon bands to locate the appendix." Chen Song advised.
The three colon bands converge at the blind end of the cecum, which is the point where the appendix base attaches.
Lu Cheng easily found it.
After confirming the location, Lu Cheng used the appendix forceps to clamp the mesentery edge of the appendix tip and gently extracted it through the incision.
The procedure was smooth without adhesions, ideal for beginners; a well-grounded intern could handle it.
Still, Lu Cheng cautiously asked, "Teacher Chen, can I continue?"
Learning surgery requires gradual progression, even the simplest techniques need robust foundational skills.
Chen Song was Lu Cheng's main source of confidence during the operation; Lu Cheng wouldn't be 'overly confident'!
"Continue. Finish the procedure." Chen Song nodded.
Lu Cheng was certified with a medical license, registered at the hospital with a scope in surgery. Such a straightforward level-one surgery doesn't count as performing above his competency.
With solid foundational skills, even in Chen Song's absence, Lu Cheng could proceed as long as he remained prudent.
Lu Cheng meticulously managed the appendiceal mesenteric root with curved vascular clamps, opening windows and using two vascular clamps to clamp the mesentery and the appendiceal artery.
He severed the mesentery and proximally used absorbable sutures to tie it securely twice.
After local hemostasis, Lu Cheng continued about 0.6 cm from the cecal wall at the appendiceal base, gently pinching with vascular clamps to compress the appendix, thinning the tissue, and performing purse-string sutures on the cecal wall before continuing to clamp the appendix…
Close to the proximal vascular clamp, he cut the appendix off with a scalpel, sending it for pathology in a specimen bag as routine.
Using iodine-soaked cotton swabs, Lu Cheng treated the appendiceal stump's mucosa, then released the proximal compressive clamp before using mosquito clamps to hold the stump and gently place it within the purse-string sutured center of the cecal wall.
Chen Song deftly tightened the purse-string suture at this moment.
Then began inspecting the embedding for satisfaction, checking for bleeding or effusion.
Once satisfied, Chen Song laughed appreciatively: "Good, very standard, following textbook procedures, proving you have read the books and watched teaching videos attentively."
Lu Cheng replied, "Teacher Chen, appendectomy is a legitimate surgery, not a joke."
"I have watched some, given it's a routine case for the emergency department."
"You might not have had the chance to perform it, but it's not something you can completely avoid." Lu Cheng wasn't too modest.
Without over-praising, Chen Song said: "Continue to finish it up…"
Actually, with Lu Cheng's current foundational skills, performing an 'appendectomy' is akin to using a cannon to kill a mosquito, overly competent for this simple procedure.
"Mm." Following a local rinse, Lu Cheng started the suturing process…
The surgery was completed without surprises as expected.
The skill panel showed some change: [Appendectomy (Entry Level 2/5)...]
[Individually completed an appendectomy, alleviating the patient's acute abdominal pain and providing professional post-operative guidance, earning 1.2 skill points]
Quite rewarding – a single surgery increased his appendectomy skill level by one point given his strong foundations.
Also gained an extra 1.2 skill points – a double win.
This is understandable – foundational skills reflect surgical compositional level, similar to a person's literary attainments.
A novelist transitioning to writing poetry, though not initially skilled, doesn't need to learn from scratch.
Their inherent literary knowledge allows rapid initial improvement.
The difficulty in performing appendicitis surgery isn't high; the operation is straightforward. With foundational skills as backup, there's no need to use skill points for enhancement; they're better used for more critical surgeries.
Such as Spleen Removal Surgery, Spleen Preservation Surgery, Gallbladder Removal Surgery, Stone Extraction Gallbladder Preservation Surgery, and other essential techniques.