(Thanks to Zixing87, Xing for the encouragement with the monthly ticket)

"It's a very simple surgery, and there's no external incision at all. Don't worry."

Liu Banxia, who had arrived at the operating room, was also calming the patient's nerves.

The intubated patient nodded.

"I've explained why we need to intubate you, right? It's because you're in a prone position, which helps keep your airway clear," Liu Banxia said.

"Alright, we've verified the patient's information. The patient's mood is very positive, and after the surgery, we can face things more easily. An endometrial tumor is not very severe."

This was also for the patient's benefit, as she hadn't informed her family and had only a friend accompanying her.

Luckily, this wasn't a major surgery; otherwise, it would have been difficult to handle.

After a while, Li Liwei nodded at him, indicating that the anesthesia was successful.

Liu Banxia stretched his neck, "Today's surgery is very new because we've never done it before. But it's also very old because it's a technique that appeared long ago."

"The reason we're doing it here is to gain experience and prepare for the upcoming NOSES procedure. Question one, Li Tianyang, why do we use the prone position?"

After speaking, he gave Guan Wei a glance, prompting Guan Wei to start connecting the tubes.

"With the patient in the prone position, the lesion is directly below, making it easier to operate," Li Tianyang answered succinctly.

"Not bad," Liu Banxia nodded.

"But there's a flaw because this definition assumes a right-handed person. What if I suddenly turn left-handed? That would be tricky."

"Second question, what's the key to this surgery? Is it the patient's choice or some other factor? This is my first time too, so let's discuss it together. Liu Yiqing, give us your thoughts."

"Like with laparoscopic surgery, the most critical aspect is the proficient use of instruments and suturing skills," Liu Yiqing said.

She had a touch of pride on her face, having avoided falling into Liu Banxia's trap.

This really surprised Liu Banxia, "Remarkable, the usually clueless Liu Yiqing isn't so clueless anymore. I thought you'd focus on patient screening, you've got potential."

"She isn't wrong; mastering surgical instruments and intracavitary suturing techniques is crucial. That's also what I wanted to talk about next."

"When it comes to tumors, we have two choices: total resection or partial resection. In previous cases, early-detected patients were rare and often malignant."

"Benign tumors rarely reach us; they're usually removed during a colonoscopy. In this field, Teacher Guan is an expert too."

"Having him connect the tubes on-site is also to reinforce your memory. You might use it in the future, but it depends on your skill level."

"The connections are complete; it's ready to use," Guan Wei said.

"Now watch my operation. Why am I nervous too?" Liu Banxia said.

"The technique isn't that complicated. Even if I don't tell you, you should know the first step, which is gentle dilation of the anus. Causing harm isn't the right way to learn from me."

"After dilation, insert the specially designed rectoscope. See it? The fixation of the rectoscope is flexible, as long as it provides the best view and facilitates your operation."

"It's an auxiliary tool, and if it doesn't help, what's the point? This goes for other instruments too, there aren't many rigid standards. What's suitable for your operation is the only standard."

"Okay, it's secured. Next is inflation, which is also simple. For most patients, automatic pressure adjustment suffices; otherwise, it might over-expand the colon. Pressure at 12-15mmHg is fine."

"Our patient here is somewhat special, as she has three small 'companions.' The first and second are well-positioned, while the third one is not ideal."

"But although it's slightly less favorable, I think I can still remove it with the rectoscope in its current position. Be cautious of taking risks in the future."

"Xu Yino, I think you should consider spending some time in the anorectal department. Many of our patients have rectal cancer and there's a high demand for sphincter-preserving procedures. What should be noted in rectal tumor surgery?"

Xu Yino was a bit frustrated, "Avoiding nerve damage, vascular injuries, and being cautious of prostate and vaginal injuries during surgery is crucial."

"Hold on, Banxia, is this how you usually teach?" Guan Wei asked, helping Liu Banxia place instruments into the cannula.

"You see? That's just how he is. But now it's becoming increasingly difficult to find any fault with them; they have a very thorough understanding of many surgeries," said Li Liwei.

"Brother Li, don't praise them. As soon as you do, their tails will start wagging," laughed Liu Banxia.

"Oh... it's really incomparable. If I had asked these kinds of questions during teaching, many would have been completely at a loss," Guang Wei said with a sigh.

This isn't flattering Liu Banxia; it's his genuine feeling.

Because he had never seen such a "distinctive" teaching surgery. With questions coming from all directions, if one's train of thought couldn't keep up just a little, even if they're proficient, it's still easy to make mistakes when answering.

He had only heard that the interns under Liu Banxia were all impressive, but today he truly witnessed it. The trials this guy puts these interns through are not easy to endure.

"Actually, it's not so inhuman as it seems. If they themselves are not driven, hanging them on the operating table 24 hours a day would be pointless," Liu Banxia said.

"Brother Guan, do you think you could talk to Director Jiang to let us borrow this equipment for a few more days? Let them also get familiar with the usage techniques. If possible, I might actually apply for one in the future, as well as for the NOSES equipment."

"Didn't you also see Director Jiang yesterday? Why didn't you mention it?" Guang Wei asked.

"Teacher Guan, let us follow along and learn, please," Xu Yino said.

"Teacher Guan, could you possibly invite us to observe when you're performing similar surgeries?" Liu Yiqing also chimed in.

"Teacher Guan, actually, Teacher Liu can arrange a lunch one afternoon," Li Hao said.

"Stop, stop, I see it now; none of you are easy to deal with, you've all learned bad habits from him. A lunch at noon... yes, we can lend it to you for another day, mainly because this is the only one we've got," Guang Wei quickly interjected.

Could I not speak up? With everyone calling me Teacher Guan so pitifully, who's immune to that? If I didn't agree, it would hinder the growth of an outstanding surgeon.

"Thank you, Teacher Guan."

Seven voices all at once expressed thanks.

"Heh, heh, looks like you guys have some pull. It's necessary, you must treat Teacher Guan to lunch," Liu Banxia said with a cheeky grin.

Guang Wei rolled his eyes, sensing he should visit less in the future. Coming over feels like working for nothing, who knows what requests he might agree to next time.

"Alright, next up is a key part of the operation where we need to use the needle-shaped electric knife to mark the resection margins," Liu Banxia said.

"This is basic knowledge: benign tumors are controlled at 0.5 cm outside, malignancies at 1 cm. But unlike usual, we need to mark them artistically as well."

"Actually, the TEM surgical system can also perform full-thickness resection, it's just that the difficulty level is too high. For now, I don't want to attempt too much; we'll take things slowly. Eventually, we can offer multiple surgical approaches for patients who need them."

Watching, Guan Wei felt quite frustrated because this was Liu Banxia's first operation, yet he was very quick in using the needle-shaped electric knife to mark the margins.

In just a few sentences, he had already marked the first and second ones. He was now striving on the third, which was a bit tricky due to a slightly suboptimal surgical field. Nevertheless, Liu Banxia's movements were still smooth and coordinated.

From his judgment, there was no way he himself could work at this speed. Liu Banxia's level of proficiency didn't even remotely resemble someone using the equipment for the first time.

"Heh, heh, don't forget, before I came to the Second Hospital, I spent some time outside, so I'm somewhat familiar with this equipment," Liu Banxia chuckled and said.

"Honestly, I think marking margins or tumor removal isn't that hard. If you have a foundation in laparoscopic operations, it's just a matter of adapting to a new set of equipment and getting the feel for it."

"The key lies in mastering intracavitary suturing techniques. Good suturing can lead to better patient outcomes. Of course, this assumes that there's proper bowel preparation."

"After all, it's a lesion within the bowel; even after suturing, there might be some degree of pollution. Naturally, it's somewhat different from anal fistula, as anal fistula has a fistulous tract, hence the slow healing."

"Alright, let's switch to the curved ultrasound knife now. Work faster with this; it offers quick smoke dissipation and good hemostatic effects. It's a matter of personal preference; there's no fixed standard here."

"Alright, plucking out one. Actually, after cutting the first one, I feel confident it's an endometriotic tumor—so clean underneath."

"Also, the hemostatic effect is quite good. For convenience, let's take them all out first and then suture one by one. This procedure is quite interesting; I think I've suddenly developed a liking for it."

Xu Yino and the others listened, gritting their teeth, as did Guan Wei.

He agreed to Liu Banxia's request to guide and support, but performing this masterfully? How many skills is he hiding?

Xu Yino and others were frustrated because they all understood: watching Liu Banxia operate so easily and excize tumors so quickly, what if they were in his shoes? It would be very difficult.