This doctor is already middle-aged, and he's only just started practicing medicine.

Chapter 29 Professor Tong's Approval
Summer rains come and go quickly, with rain curtains and rainbows simultaneously hanging in the azure sky.

His parents had already left, but Lu Cheng kept the door to the practice room tightly closed. Then he looked up and asked, "Teacher Tong, from this angle, can you see the control panel?"

“The practice room at home is rather small, so I only bought one camera, which makes it difficult to control your field of vision,” Lu Cheng said in an exceptionally ingratiating manner, his expression slightly fawning.

Professor Tong Yuan'an from Xiangya Hospital was the 'examiner' that Professor Chen Song invited for Lu Cheng. After Chen Song sent the video of Lu Cheng practicing the modified Tang method to Tong Yuan'an, he waited a few more days before finally finding some free time during his lunch break.

Tong Yuan'an's voice was rather deep: "Keep it in this direction, don't move it anymore."

“Dr. Lu, I understand that you want to learn more professional hand surgery techniques. However, there are many tendon suturing techniques that can be learned. The modified Tang method is one of the more difficult ones to learn and requires a higher level of skill.”

Even seasoned hand surgeons need to practice continuously for several weeks to become proficient.

"If the technique of the modified Tang method is not skillful enough or the operation is too clumsy, it is not as good as the other types of tendon suturing techniques."

"Actually, it's not cost-effective for you."

Tendon suturing is, after all, just an introductory procedure in hand surgery, and tendon injury is an even more minor condition. In Tong Yuan'an's understanding, for hospitals like Lu Cheng's that have never performed hand surgery, it would be enough to learn the modified Kessler technique to a certain extent and be able to manage it to some extent.

Like individual technical learning, comprehensive technical learning in a region should be a gradual process; don't try to become an expert overnight.

Therefore, Tong Yuan'an always advised Lu Cheng not to waste time, and that if the opportunity arose, he could practice flap transplantation techniques.

"Thank you for your advice, Teacher Tong. However, I'm already halfway there, and it wouldn't be good to give up halfway, otherwise all the time I've invested in the early stages would be wasted."

Lu Cheng then showed Tong Yuan'an his training method: "Professor Tong, this is the 'three-needle bidirectional puncture method' that I practice on a silicone plate."

"According to the precise information I found earlier, the starting point, ending point, and puncture angle of the three needles are different."

"First needle: 8mm from the cut end, insert the needle at a 60° angle to the long axis of the tendon, and exit from the opposite side at an equal distance."

While Lu Cheng was dictating to Tong Yuan'an, he picked up the silicone plate and began to operate on it himself. The 7-0 Vicryl sutures in his hand were almost invisible.

"Teacher Tong, can you see my needle insertion and withdrawal points? Would you like me to demonstrate it for you again using a normal-sized needle?" Lu Cheng asked.

Tong Yuan'an, with a full beard and bulging arm muscles, gently shook his head: "You continue."

“If you really want to learn more specialized hand surgery suturing techniques and are willing to invest the time, I would certainly like to welcome you, Dr. Lu, on behalf of the hand surgery department.”

When Tong Yuan'an first heard from Chen Song, a friend from the Second Hospital's "sister hospital," that a young man in the emergency department was only thirty years old and was about to implement a modified Tang method, his first reaction was, "What the heck is that?"

Medicine is still "overspending" and causing problems...

After Chen Song sent over the recorded video of Lu Cheng's actions, Tong Yuan'an realized that Lu Cheng's "overspending" actually had some merit.

Although his basic suturing skills were 'just average,' and many areas were not handled with sufficient skill and precision, and at least they didn't bring him any surprises, he was still very proficient in the technique.

Lu Cheng then continued to demonstrate: "Second stitch: 5mm from the broken end on the same side, diagonally through at a 45° angle to form the first 'Y' cross; the third stitch is a mirror operation on the opposite side to complete the first set of inner core anchor points."

"Teacher Tong, the overall time and stitch spacing error should be acceptable, right?"

Tong Yuan'an said, "It's pretty much the same. You're just doing simple tendon suturing, there's no need to be so demanding."

“In our clinical team, the standard for mastering the technique is a stitch distance error of ≤0.2mm (measured under a microscope at 20x magnification) and a total time of <90 seconds for 3 stitches. Your operation speed meets the standard, but the accuracy is not.” “However, it doesn’t matter. For simple tendon sutures, an error within 2mm has little impact, unlike anastomoses of nerves, blood vessels, etc…”

"Take another chicken leg tendon and perform the 3D manipulation once more, then use a force gauge to verify its approximate tensile strength..."

Lu Cheng responded quickly, took a fresh chicken leg, and began to use a microscope to vertically trim the tendon, preserving about 1 mm of the perianal membrane.

Tong Yuan'an said, "Let me see the cut surface of the tendon you trimmed? It's not clear in the video. Was there a bevel cut?"

"If you practice with beveled cuts, it's not suitable for practicing your techniques."

The learning and teaching of medical skills are very private matters, so clinical teaching is necessary.

These video tutorials don't provide enough detail.

Tong Yuan'an specifically mentioned that the error must be within 0.2mm. How can a camera accurately determine such a precise distance?

After a brief pause, Lu Cheng examined the situation himself and said, "Teacher Tong, it meets the requirements."

"Then you can start sewing the first knot..." Tong Yuan'an instructed.

The core of the improved Tang method is the suture of a multi-tendon core with three bundles and six strands.

Lu Cheng began operating the machine, carefully estimating the distance visually—

You can only rely entirely on feel to insert the needle 10mm from the broken end → exit at an angle 5mm on the same side → insert at an angle 5mm on the opposite side → exit at 10mm (forming a "W" trajectory)...

Immediately afterwards, Lu Cheng added another bundle 1.5mm to each side of the first bundle, which penetrated the middle layer of the tendon thickness in a standard manner.

When all three strands are pulled at the same time, the gap between the broken ends instantly tightens, leaving only a gap of less than 0.1mm that is barely visible to the naked eye...

"Test the tensile strength," Tong Yuan'an instructed.

Lu Cheng used a force gauge to pull it, and the force finally stopped at about 40N. Lu Cheng dared not pull it any further.

"Yes, next time you can use the pig's trotter tendon to increase the load to 80N and complete the three-bundle suture within a 5mm×5mm surgical field, then you can handle this surgery more securely."

"The field of vision for tendon suturing in real patients is extremely narrow. Your current skill level is quite good, and you are quite diligent and motivated..."

"Your hospital doesn't have a hand surgery department, so you went to the emergency room, right?" Tong Yuan'an asked.

Tong Yuan'an naturally assumed that Lu Cheng was a master's student in hand surgery, or at least a resident in hand surgery.

In the video call with multiple people, Chen Song also explained in the channel: "Professor Tong, there is indeed no hand surgery department at Longxian People's Hospital. Dr. Lu was indeed an orthopedic surgeon before."

Tong Yuan'an smiled and encouraged him, "Everyone starts from nothing. I see that you are not very old, but your technical accumulation and learning efficiency are really good."

"At such a young age, to have such skill and basic expertise in suturing shows that you have the potential to develop hand surgery in your area in the future..."

Lu Cheng thanked her earnestly: "Thank you, Teacher Tong..."

(End of this chapter)