(Thanks to Xiaodaotong3, ICEfire, Book Friend 20190625124024721, Book Reader Ah, Rebellious Soul De, for their encouragement with monthly tickets)

"Anyway, being idle doesn't help, since you don't have anything you want to ask, let me ask you something."

While freeing the colon, Liu Banxia spoke up.

"Actually, it's a very simple question. What's the key factor to determine if anus-preserving surgery can be performed? Is it the distance? Often, when we find low and super-low tumors, we directly suggest digging out the entire rectum, right?"

"You can freely speak up, Xu Yino, just watch the fun, as these are beyond the scope she needs to master."

Listening to Liu Banxia's sudden question, the four interns did not immediately answer. Their minds involuntarily began to analyze whether there was a trap in the question posed by Liu Banxia.

Having interned at the emergency center for quite some time, directly or indirectly, they were not unfamiliar with Liu Banxia. When first entering the operating room, they experienced it, so caution was necessary.

"Why is there no response yet?" Liu Banxia asked while cleaning the lymph nodes and fatty tissue around the inferior mesenteric artery.

Xu Yino winked at Chen Dongmei.

"For low and super-low rectal cancer, recommending extensive rectal surgery is to prevent future postoperative recurrence and improve better survival prognosis," Chen Dongmei said.

"Yes, that's roughly the idea. When all the initial conditions are met, the only benefit is this, all the rest are drawbacks," Liu Banxia stated.

"However, this point is equally crucial, because dealing with recurrence becomes incredibly difficult. It's not just because it develops quickly; often the patient's body cannot withstand more surgeries."

"Then this raises a new question. If a patient comes in during your consultation wanting anus-preserving treatment, how do you make an initial judgment on whether he can preserve the anus? Be enthusiastic, folks, everyone seems tired."

"One must still look at the tumor's instrument examination." This time, it was Li Tianyang who spoke.

"If the patient's tumor has invaded the sphincter or is very close to it, anus-preserving treatment is not recommended. The former requires extensive rectal surgery, while the latter has a higher chance of recurrence."

"Yes, that's a factor, and it's the simplest point. But you passed, as you reacted quickly. We, as doctors, especially emergency doctors, must react quickly," Liu Banxia commented.

"Forget it, it seems you're a bit confused, let's not make it difficult for you for now. Listen carefully, once I've finished speaking, our surgery will be almost at the closing stage."

"As a basis for judgment, we must not only consider the tumor's location and infiltration level, but also consider our medical skills. This is also very important; if you lack the confidence to complete it, you should simply let the patient find another doctor."

"This is also critical. When faced with emergency surgery that must be done immediately, there is no choice because if you don't do it, the patient will certainly be finished."

"For us doctors, we often can't afford to be aggressive. I used to have a bit of this problem, but fortunately, I'm very aware and have corrected it."

Wang Chao and Wang Lei both glanced at him; this guy's temper has indeed improved a lot compared to before, which is equally important.

"Another major factor is the patient's overall physical condition," Liu Banxia continued.

"Before performing surgery, we always need to assess the patient's physical condition. Conditions related to whether rectal cancer radical surgery can preserve the anus are numerous; it's not just about wanting to preserve it."

"First, male patients have narrower pelvic cavities than female patients, limiting operation space and naturally requiring higher skill from the surgical team."

"Then there's the patient's BMI index; if too high, it also increases the difficulty of surgery. With current living standards, this index often exceeds 30, 35, or even goes above 40."

"There are many variable factors in surgery; we cannot look at just one factor. The situation of this patient is just like that; it has a high index, so the operation is quite complex, and it's easy to cause anastomotic leaks during the anastomosis."

"That's the crux of it— isn't it interesting? Anastomotic leaks have been mentioned again. This is the interplay of influencing factors, truly a case of converging paths."

"Another factor we must consider is the functional state of the anastomosed tissue. This is crucial too, but it can often only be discovered during surgery."

"The tension, blood supply, whether it has experienced chemotherapy, they all have enormous impacts and anastomotic leaks are prone to occur."

"Fascinating indeed, back to anastomotic leaks again. All right, colon transection, protect the stump. Next is tumor resection, let's push forward."

The interns were enthusiastically listening; they wanted to hear what came next, then inadvertently realized they had zoned out and missed Liu Banxia's earlier actions.

"You'll get used to it; this is training for dealing with noisy environments. Often when we receive emergency patients, the environment isn't great, so while improving emergency skills, we must handle more complex settings," Xu Yino reminded.

"Correct, it's not about multitasking perfectly, but about increasing your ability to respond as much as possible." Liu Banxia began to separate the rectum and mesorectum.

"When we choose the surgical approach, we must not only consider the success rate of the operation but also the patient's prognosis."

"Anastomotic leakage is one of the most important complications of this surgery, and its incidence is quite high. So, many recommend avoiding it when choosing the surgical method."

"If you only focus on the immediate results and ignore the surgical prognosis, can you still call it a qualified surgery? It's like joking with the patient and being irresponsible to yourself."

"We need to consider everything when performing surgery. Have I not mentioned it before? Treating a patient is a comprehensive process, and the surgical operation is just one small part."

"This is why, during rectal cancer surgeries, we often accompany it with a stoma surgery to avoid anastomotic leakage."

"Can anyone answer why I didn't choose a stoma for this patient but opted for a double stapler procedure instead?"

"Teacher Liu, was it because of the patient's financial situation?" Zhang Hongfei asked.

"That's roughly it, plus I'm now quite skilled with the double stapler technique and have some confidence." Liu Banxia replied.

"If there are no issues in the subsequent pathological examination during the sphincter-preserving treatment, then everyone is happy, and we don't need to perform a closure surgery, saving a procedure."

"If unfortunately, there is a spread, there's nothing we can do; however, we can also handle it during the resection surgery. For this particular patient, the current surgical plan is the most suitable and appropriate."

"Although the double stapler procedure has a certain risk of anastomotic leakage, its incidence has significantly decreased in recent years with improved surgical quality."

"This is also something we've discovered through surgeries. Previously, many patients with anastomotic leakage after sphincter preservation weren't thoroughly evaluated before and during surgery, leading to problems."

"In my free time, I've been studying. Currently, the NOSES procedure is quite popular. Compared with traditional open and laparoscopic surgery, it results in better prognoses for patients."

"However, I haven't encountered a suitable patient lately. Once I do, we'll perform one. It has shown great results for colorectal cancer radical surgery and is used in several hospitals now."

"It involves removing specimens through natural orifices, reducing the need for an abdominal incision, leading to better prognoses."

"Personally, I see it as an improvement in laparoscopic techniques, but it demands more from suitable patients."

"Many male patients might not care about these things, but for some female patients, aesthetics should be considered; the fewer scars, the better."

"Okay, remove the specimen and clean the pelvic cavity. We've completed most of it; the next step is trimming the proximal sigmoid colon stump, placing the purse-string suture, and inserting the stapler."

"This is also a crucial point of the surgery; you need to observe closely. The patient's indicators are good, allowing us to proceed with the double stapler procedure."

Liu Banxia carefully operated, placing the anvil head of the stapler into the colon, cautiously tying the purse-string at the central rod. He then inserted the stapler from the anus, with the central rod passing through the closure line and combined it with the anvil head's central rod.

Liu Banxia observed carefully for a moment and adjusted the intestine's proximal mesenteric direction before tightening the stapler and firing. 𝕗𝚛𝚎𝚎𝐰𝗲𝗯𝗻𝚘𝚟𝚎𝗹.𝕔𝐨𝕞

Everyone held their breath; with Liu Banxia mentioning anastomotic leakage several times, this was a crucial moment.

After waiting fifteen seconds, Liu Banxia loosened and rotated the stapler, withdrawing it. He checked the excision ring, which was intact.

"Alright, perform the air leak test." Liu Banxia said.

Feeling quite good, the surgery had been successful so far.

"Teacher Liu, the air leak test shows no leak at the anastomosis." Xu Yino reported.

"Rinse and place the drainage tube; I'll handle the closure." Liu Banxia said.

"It's actually to save time, otherwise you could've done it all. Old Wang, what's the current time?"

"Two hours and three minutes," Wang Lei replied with a smile.

"Haha, we've saved quite some time for the next surgery. Wang Chao, quickly tell Zhou Qiang to start cooking, so we can go and eat soon." Liu Banxia said happily.

Everyone was in good spirits; this was one of the hidden benefits of working with Liu Banxia, as surgeries were performed quickly.