(Thanks to the mortal who treads on divinity for the reward and monthly ticket encouragement, and thanks to the rebellious soul for the monthly ticket encouragement.)

"Because we need to race against time for this surgery, the explanation I'll provide next will be much less detailed. This is a tough battle."

After the patient was successfully anesthetized, Liu Banxia said.

"In fact, it's just two routine surgeries, but putting them together increases the difficulty factor significantly, proving that one plus one is greater than two."

"If you have some impressions from our last operation, it was a right hemihepatectomy. This time, it's a left hemihepatectomy and caudate lobe resection."

"However, there's a roadblock before that. The enhanced CT shows that although the tumor hasn't invaded the right hepatic artery, there's an aneurysm on the right hepatic artery. Okay, Liu Yiqing, open the abdomen."

Upon receiving the order, Liu Yiqing promptly began the procedure.

As the abdomen was opened, even the people in the observation room furrowed their brows. The adhesion in the hepatobiliary area was indeed severe, undoubtedly adding a significant level of difficulty to the surgery.

"It's progressed quite rapidly, expanding significantly compared to when they last explored. It's already affecting the abdominal cavity; let's clean it up slowly." Liu Banxia said.

"Yes, seeing it like this means we need to work hard. If you put in some effort, I can do less work." Shi Lei added.

There's no other way. The most severe adhesion he dealt with was when he and Liu Banxia worked on a delayed rectal cancer patient.

Although the adhesion this time wasn't as severe as that, this was an adhesion in the hepatobiliary region; he didn't know if the patient would still have the chance for surgery after the adhesions were cleared.

Meanwhile, people in the observation room were also watching intently. Liu Banxia's debridement skills were impressive, and today they felt they were witnessing and verifying it again.

Even though many of them had seen it before, they still couldn't get enough of it.

Adhesions are something many surgeons encounter. The severity of this patient's adhesion indicates that the tumor has already metastasized to a certain extent.

Now it's a matter of observing the extent of the metastasis; if it's widespread, then surgery loses its value.

"Exploration shows a mass located at the bile duct, approximately 3X3 cm. It invades the left branch of the portal vein and the left hepatic artery, with multiple lymph node enlargements in the hepatic hilum. A 0.3X0.5 cm aneurysm on the right hepatic artery." After clearing the adhesions, Liu Banxia carefully examined and said.

"Left hemihepatectomy and caudate lobe resection can proceed, regional lymph node dissection, and biliary-enteric drainage. To be honest, after cleaning it up, it looks quite promising, seems like there's a chance."

"Don't get too excited yet; we've only completed the basic preparatory work." Shi Lei said.

"I'll clamp first to see if it affects the blood supply to the liver. If there's no issue, we can proceed with the ligation. Alright, let's observe."

It's true that surprises abound in life. Despite the severe adhesion, which had spread to the intestines, the situation was looking much better than anticipated.

"OK, clamping didn't affect the blood supply; aneurysm ligation is feasible." After observing for a while, Shi Lei said.

The liver's blood supply is abundant, and currently, the patient is indeed very fortunate; all the results are heading in a positive direction.

"Wait a moment, the patient's blood pressure has risen a bit."

At this moment, Wang Lei called out.

Shi Lei, just about to proceed, quickly stopped and awaited the latest information from Wang Lei.

"It's okay, it's under control now, proceed with the ligation." After observing a bit longer, Wang Lei said.

Only then did everyone breathe a collective sigh of relief.

Shi Lei planned to use aneurysm neck ligation, perhaps because this patient was very lucky; the aneurysm neck was long enough for manipulation.

This method could occlude the aneurysm while ensuring smooth blood flow. However, it also had surgical requirements. The aneurysm clip needed to be appropriate, and the patient's blood pressure must be well controlled.

If the blood pressure is too high, it can easily cause the aneurysm to rupture. This was also why everyone was so worried when the patient's blood pressure spiked earlier.

Even though the liver has dual blood supply, a less invasive surgery is preferable.

"Sigh... later, also collect more samples from the distant lymph nodes, always feel a bit uncertain."

Shi Lei was operating, and on the side, Liu Banxia, who was observing closely, provided the observation results.

Overall, the situation was quite good. The aneurysm that they had been worried about didn't cause trouble, merely giving them a little scare.

"OK, next is my part, let's remove the gallbladder first."

Once Shi Lei finished dealing with the aneurysm, Liu Banxia shook his neck.

"Just as you eat a meal bite by bite, you must address each step at a time. All surgical procedures follow the same routine; dissection is a crucial step."

"Dissection requires strong fundamental skills. If done well, you've already completed more than half of the surgery. What's left like ligation and suturing will become much easier."

"This patient has developed extensive adhesions due to the tumor, which seems to have also affected the surrounding tissues. So, we need to be extra careful during dissection; our preparation was somewhat inadequate."

"However, we have no choice. In theory, we should've adjusted first, perhaps with a round of chemotherapy, but his aneurysm doesn't afford us that much time."

"People often say that the liver and the gallbladder complement each other; the liver is the big brother, and the gallbladder is the little brother. Often, when we do gallbladder surgery, we can ignore the liver, but in liver surgery, the gallbladder is almost always involved."

"Because they're so close, many tumors or lesions will affect the gallbladder. OK, the gallbladder has been divided. Next, I'll have to carefully dissect this mass."

"As doctors, in the previous surgery, we discussed the importance and reasonableness of planning a surgery for a patient. Today, we're actually discussing the importance of dissection during the surgical procedure."

"People often say this doctor's surgical level is good, that doctor's surgical level is high, but this 'good' or 'high' typically involves a large part of the surgical operation assessment."

"It's not just about speed; pure speed isn't enough. It actually encompasses the overall quality assessment of your surgery. Study the surgical anatomy approaches of various areas more often; if you can't practice much, use your mind instead."

"If you always think operations are difficult, how difficult can they be? It's really just because you're lazy and practiced too little. Why is it that with the same surgery, the effects vary greatly between people? It depends on how familiar you are with the procedure."

"And you need good physical strength. Just now, clearing the adhesions was really tiring. If it were just me, who knows how long it would take. Old Wang, how are the patient's vitals?"

"The blood pressure is fluctuating a bit, but it's not significant. However, the heart rate is trending upward, so try to increase the speed as much as possible," Wang Lei said.

"The current speed is quite fast already. Luckily, we opted for open surgery; with a laparoscopy, the gallbladder might not even be out yet," Liu Banxia complained.

"Do I still need to go in?" At this moment, Chen Xuehai's voice came through.

"Yes, come in, just in case. Didn't you hear Old Wang say the heart rate is trending upward? It's only been a few hours, and it'll take at least another three hours to finish," Liu Banxia replied.

"Alright, I'm coming in," Chen Xuehai responded.

Many didn't know Liu Banxia had arranged for Chen Xuehai as a backup. This arrangement shows how comprehensive Liu Banxia's considerations were and how united the atmosphere in the emergency center was.

As a cardiac surgeon at Chen Xuehai's level, isn't he usually busy? Yet he could spare time to be a backup, which is remarkable.

This arrangement also highlights the severity of the patient's condition. Otherwise, under normal circumstances, if there were a cardiopulmonary issue, you'd typically call for immediate assistance.

Time passed second by second. Apart from occasionally explaining or emphasizing, everyone watched Liu Banxia's operations intently.

Even Shi Lei, despite being able to perform this surgery, would find it challenging, unlike Liu Banxia, who seemed so at ease.

That's what everyone admired about Liu Banxia; all surgeries he mastered reached a consistent standard.

Who would have thought that what appeared to be a routine surgical operation was actually the result of Liu Banxia's rigorous training in the dream space?

Even as a surgeon who loves performing surgeries, doing one after another like a production line operator isn't that easy.

"Chief Director Zhou, it seems like Banxia's skills have improved a lot compared to a few days ago," observed Sun Changhe, who also came to watch. 𝙛𝒓𝓮𝙚𝔀𝒆𝒃𝓷𝒐𝓿𝙚𝓵.𝙘𝒐𝒎

"Actually, though he seems a bit jumpy at times, he spends a lot of time learning," Zhou Shuwen said.

"But don't praise him in person; if you do, he tends to get cocky. Though his skills are solid, he still needs more experience."

"From the current situation, there might already be minor metastasis. After surgery, chemotherapy will show its results. If it can't be contained, all efforts could be in vain."

Sun Changhe nodded, "His condition progressed rapidly, possibly due to his own carelessness. Sigh... doctors can't treat themselves, not just in diagnosing illnesses but in daily life too."

"The most challenging part of this surgery has been overcome, so there's no need to worry too much," Zhou Shuwen reassured.

Naturally, they knew Sun Changhe's association with the patient was quite positive; otherwise, he wouldn't have recommended them.

Nevertheless, he was quite satisfied, not only with Liu Banxia's surgical operations but also with his guidance to the interns.

Unlike before, there was no rush. He proceeded step by step.

This shows Liu Banxia's improvement not just in teaching but also in his understanding of surgery.