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

Chapter 33 'Appendicitis Surgery'

"Xiao Lu, don't be nervous later. Appendicitis is a basic surgery for many surgeons."

"Although you were a resident in orthopedics before, once you have a general understanding of the surgical procedure, it is much simpler to perform than suturing tendons."

“If we really want to relax, even an intern’s first time performing this kind of surgery is enough to handle it. You already have experience as the lead surgeon, so there’s no need to be nervous,” Chen Song reassured Lu Cheng as they walked side by side into the emergency operating room.

Orthopedics and general surgery are different specialties. Lu Cheng used to be a resident in orthopedics, and Chen Song was worried that Lu Cheng would be particularly nervous.

The incandescent lights overhead came and went, making Lu Cheng's eyes dazzle, but Lu Cheng was relaxed: "Teacher Chen, it shouldn't cause any problems, right?"

"I have never treated appendicitis before. When I was doing my orthopedic residency and rotating through the general surgery department, I didn't encounter a single case either, because the general surgery department at Zhongnan Hospital doesn't treat appendicitis, and the emergency department rarely does either."

"There won't be any problems, don't worry..."

"Actually, appendicitis is best treated laparoscopically, as the incision will be smaller. However, in your county hospital, you don't need to be so particular."

"Just make a small incision and you can do it..."

After helping the patient into a supine position, Lu Cheng went out to wash his hands, then routinely disinfected the abdominal skin, laid out sterile drapes, and exposed the surgical area...

Lu Cheng waited until Chen Song also put on a sterile surgical gown and a sterile mask before glancing at his skill panel.

[Basic Surgical Procedures: Appendectomy (Introduction 1/5)...]

Having never practiced surgery or watched many instructional videos, Lu Cheng's operational proficiency was inevitably low. However, this did not prevent him from remembering the surgical procedure for appendectomy and then using his basic skills to proceed step by step.

Lu Cheng had watched instructional videos and had some basic skills in incision techniques, so he found McBurney's point very skillfully.

After using tweezers to trace the outer line of the incision, Lu Cheng looked at Chen Song with a questioning gaze.

After the other party nodded, Lu Cheng immediately made a 5-centimeter-long oblique incision, aligned with the line connecting the navel and the right anterior superior iliac spine.

Without much hesitation, Chen Song cut open the skin and subcutaneous tissue. After Lu Cheng finished, Chen Song wiped the incision with gauze; there was very little bleeding.

He then praised, "Not bad, your basic skills in cutting are solid, and you have a good grasp of the depth of the first cut."

"Next, we'll use an electrosurgical unit."

“Go around and adjust the electrosurgical flow rate,” Chen Song said.

"It's all set." The circulating nurse, a veteran, was busy dispensing saline solution for the patient's irrigation.

After using an electrocautery knife to stop the bleeding locally, Lu Cheng bluntly dissected the aponeurosis of the external oblique muscle along the muscle fiber direction. He then skillfully continued to bluntly dissect the muscle layer alternately with forceps along the muscle fiber direction.

After confirming there were no intestinal adhesions by lifting the peritoneum, Lu Cheng made a small incision and then cut the peritoneum upwards and downwards...

“Teacher Chen, there isn’t much pus or exudate, so the appendicitis should be localized. We’re lucky,” Lu Cheng explained, trying to gain more time to operate.

He needed to explain to Chen Song that he was very familiar with the surgical procedure, and that even if he had never performed it before, his basic skills were enough to cover his own shortcomings!

Assessing the severity of appendicitis is also a reflection of cognitive ability.

If it is a periappendiceal abscess, an appendectomy is not suitable.

"Okay, continue. First, find the colon, then follow the intersection of the taenia coli to find the appendix," Chen Song instructed.

The three taenia coli converge at the blind end of the cecum, which is where the root of the appendix attaches.

Lu Cheng found it easily.

After confirming the location, Lu Cheng immediately used appendix forceps to clamp the tip of the appendix along the mesentery and gently pulled it out of the incision.

The process went smoothly without any sticking, making it ideal for beginners to practice, and even interns with strong theoretical knowledge could do it. However, Lu Cheng still cautiously asked, "Teacher Chen, can I continue?"

Learning surgery requires a gradual approach. Even the simplest surgical techniques are still techniques and require a safety net.

Chen Song is Lu Cheng's biggest source of confidence in performing the surgery, so Lu Cheng won't get carried away!
“Continue. Finish it now.” Chen Song nodded.

Lu Cheng has a medical license, practices at this hospital, and his scope of practice is surgery. This is only the simplest level one surgery, and it does not count as a surgery that exceeds the level required.

Even without his presence, Lu Cheng could master the basic skills as long as he didn't act recklessly.

Lu Cheng meticulously treated the appendix mesentery at its base with curved hemostats, and after opening the window, he used two hemostats to clamp the appendix mesentery and the appendix artery within it.

The mesentery was cut, and the proximal end was sutured twice with absorbable sutures.

After achieving local hemostasis, Lu Cheng continued to gently clamp and compress the appendix at its base, approximately 0.6 cm from the cecal wall, using straight hemostatic forceps to thin the tissue. After purse-string sutures of the cecal wall, he continued to clamp the appendix...

After the appendix is ​​cut off with a scalpel close to the proximal hemostat, it is routinely sent to a pathological specimen bag.

After treating the appendiceal stump mucosa with iodine-soaked cotton swabs, Lu Cheng loosened the proximal squeezing forceps, then used mosquito forceps to clamp the stump and gently inserted it into the center of the purse-string suture of the cecal wall.

At just the right moment, Chen Song tightened the knot in his purse.

Then, we begin to check whether the embedding is satisfactory and whether there is any bleeding or leakage.

After confirming everyone's satisfaction, Chen Song smiled and said, "Not bad, very standard, very methodical, basically following the textbook instructions, which proves that you have read the book and watched the instructional videos carefully."

Lu Cheng replied, "Teacher Chen, appendectomy is a proper surgery, not a joke."

"I did see some of them, since they are routine cases treated in the emergency department."

"I may not have the chance to do it, but I can't be completely clueless, can I?" Lu Cheng wasn't being too modest.

Chen Song didn't praise it much: "Let's finish it..."

In fact, for Lu Cheng to perform an appendectomy with his current basic skills is like using a cannon to kill a mosquito; he doesn't need such solid basic skills to complete the procedure.

"Hmm." After rinsing the area, Lu Cheng continued the suturing procedure...

The surgery was completed without incident, as expected.

The panel has changed slightly: [Appendectomy (Beginner 2/5)...]

[Performed an appendectomy independently, alleviated the patient's acute abdominal pain, and provided professional postoperative guidance, earning skill point 1.2]

The gains were significant. Performing one surgery directly increased my proficiency in appendectomy by 1 point due to my solid foundation.

I also got an extra 1.2 skill points, it's a win-win situation.

It's actually quite easy to understand. Basic skills are the outward manifestation of a person's comprehensive surgical ability, much like a person's literary talent.

A writer who excels at writing novels can switch careers and learn to write poetry. Although they may not be proficient, they don't have to start from scratch and learn step by step.

Their innate literary skills allow them to improve rapidly in the early stages.

Appendectomy is not difficult to perform and is simple to operate. With a basic foundation, there is no need to improve skill points. Instead, skill points should be used on more critical surgeries.

For example, in key surgical procedures such as splenectomy, spleen preservation surgery, cholecystectomy, and gallbladder stone removal with gallbladder preservation.

(End of this chapter)