godfather of surgery

Chapter 1396 Strict teachers produce outstanding students

Yang Ping's office.

Zaxi sat down, his notebook already open, ready to take notes. This was a habit he had developed since following Yang Ping; whenever he entered Professor Yang's office, he was always prepared to take notes. Because every word Yang Ping spoke could be a piece of knowledge or a reminder that could change his career.

Yang Ping placed the teacup on the table, took a folder from the drawer, and opened it. Zaxi glanced at it and saw a form inside, densely covered with writing, and some squares, some checked and some blank.

"This is your training plan." Yang Ping pushed the folder over. "I customized one based on your foundation."

Tashi took the form and looked down at it. The heading of the form read "Tashi's Training Plan," and below were several major sections: not only theoretical knowledge but also practical operation, including many practical operation items, such as basic surgical skills, basic microsurgical skills, and basic laparoscopic skills. Each major section was further subdivided into several sub-items, and each sub-item was marked with the learning duration, assessment method, and reference books.

Tashi looked at each item one by one, and the more he looked, the sweatier his palms became. This was not a simple training plan; it was a map leading to a certain height, but every path on the map was so steep that it made one's legs weak.

“Song Ziming, Xu Zhiliang, Xia Shu, and Li Min,” Yang Ping said in a very calm tone, as if he were talking about something very ordinary, “they all got by like this.”

These people were all trained by Yang Ping personally.

And that's how they all got through it.

Zaxi suddenly felt a surge of warmth in his chest. It wasn't because he'd been praised—Yang Ping hadn't praised him—but because of a feeling of entering a higher realm. Before him, four people had already walked this path, and after him, many more would follow. The end of this path wasn't a title or honor, but an ability—the ability to heal and save lives anywhere, under any circumstances.

“Starting today,” Yang Ping’s voice pulled him back to reality, “every afternoon after the surgery, you will go to the training room and train for two hours without fail.”

Tashi nodded excitedly.

At 4 p.m., after undergoing surgery, Zaxi appeared in the training room of the Sanbo Research Institute.

The training room was divided into several areas. Along the wall was a row of instrument cabinets, which were neatly arranged with various surgical instruments: hemostats, tissue forceps, needle holders, scissors, retractors, suction heads... Each one was polished to a shine, gleaming with a cold metallic luster under the light.

In the center were several training tables, each equipped with a shadowless lamp and an equipment tray. On the tables were models simulating the texture and layers of human tissue. The skin was light yellow, the fat orange-yellow, and the muscles dark red, with distinct layers and a realistic feel. Zaxi pressed one with his finger; the elasticity and resistance did indeed resemble real tissue—though only "resembling" it, but it was enough for practice.

The innermost area was the microsurgery section. Three surgical microscopes stood quietly in the corner, heads bowed, objectives pointing downwards, ready to be used at any moment. Next to the microscopes were microsurgical instrument cases, containing microforceps, microscissors, microneedle holders, and sutures finer than a human hair, as well as simulated blood vessels. Zaxi leaned closer to look; the sutures were so fine they were almost invisible. He doubted whether he could even hold them, let alone use them to suture blood vessels.

Further inside, there's a laparoscopic simulation training area. Several laparoscopic devices are connected to monitors, and next to them are several training modules: a bean transfer module, a perforation module, and a suturing and knotting module. Zaxi had seen laparoscopic surgery in the operating room before, but back then he just stood in a corner observing, watching the surgeon stare at the monitor, his hands manipulating outside the patient's body, the instruments moving precisely inside. He felt it was like playing a game, a game with extremely high difficulty and zero room for error.

In the training room, several graduate students were already training on their own. They were very focused and didn't notice Tashi coming in at all.

"Let's begin."

Yang Ping's voice came from behind. Zaxi turned around and found that Yang Ping had been standing beside him at some point, wearing a scrubs under a white coat. He held a pair of hemostats in his hand, twirling them between his fingers with the practiced ease of a Western cowboy handling a revolver.

Immediately afterwards, the hemostat in his hands moved like an acrobatic act, from one finger to another, then flipped to the back of the hand, then to the front, and then onto the finger again, starting to rotate the patient's finger. His finger rotation, opening and closing, and grasping were so skillful and masterful that Zaxi watched in a daze.

"Today we'll practice the basics first. We're not intentionally making the surgical instruments look like acrobatics, but this will help you develop your ability to control them." Yang Ping walked over and handed the hemostats to Zaxi. "Instrument identification and use. You need to be able to identify all the instruments with your eyes closed, name them, explain their uses, and know the standard way to use them."

Zaxi took the hemostat, his palms slightly sweaty.

Next, Yang Ping taught him to identify and use surgical instruments one by one. Even the most ordinary instruments that Zaxi already knew were taught to him by Yang Ping.

"This is a mosquito-type hemostat, used for stopping bleeding in small blood vessels. The jaws are smaller than those of a regular hemostat, the spring is softer, and it feels lighter in the hand."

"These are tissue forceps. The toothed ones are used to grasp dense tissues such as skin. The toothless ones are used to grasp delicate tissues such as blood vessels and nerves. Remember, the toothed ones cannot be used to grasp blood vessels, nerves, or other tissues that need protection, as they will damage them. We must be mindful of protecting tissues during surgery."

"This is a needle holder, used to hold the suture needle. When holding it, slip your thumb and ring finger into the ring, and place your index finger on the handle to control the direction. Don't grip it too tightly, or your hand will shake; don't grip it too loosely, or the needle will spin."

Yang Ping explained and demonstrated at the same time. His movements were not fast, but every movement was clean and crisp, without any unnecessary frills, like an experienced craftsman demonstrating basic skills. His fingers were long and steady, with flexible joints, and the needle holder in his hand was like a pen, incredibly obedient.

Zaxi followed suit. He picked up the needle holder and tried to clamp a suture needle. He deliberately let the needle fall onto the tray, then picked it up and clamped it again, repeating this process each time using a different angle he wanted to hold the needle.

“The position of the needle clamp,” Yang Ping walked over, took his hand, and adjusted the angle of the needle holder, “is at the junction of the middle and rear third of the needle. If it’s too far forward, too much of the needle tip will be exposed, making the suturing unstable; if it’s too far back, the needle tip will be clamped and unable to pass through the tissue. Try to get it in place in one go each time you clamp it.”

Yang Ping's hands were warm, with thin calluses on some parts of his fingers, the result of long-term use of instruments. His hands were steady, without a tremor even when instructing others. Zaxi recalled an old saying: a surgeon's hands are a gift from God. But now he felt that this wasn't a gift, but rather the result of day after day of training. God only gave you a pair of ordinary hands; you yourself transformed them into precision instruments.

Zaxi took a deep breath and clamped the needle again. This time, he clamped it in the correct position on the first try. The needle was firmly in the jaws of the needle holder, at the right angle, with the tip pointing down and the tail pointing up.

"Okay!" Yang Ping nodded.

In the days that followed, Tashi's life was divided into several fixed segments.

He gets up at six in the morning and arrives at the hospital at six-thirty. He first briefly goes through all the patients' medical records, paying close attention to the latest test results, noting any abnormal indicators in his notebook and memorizing them. At seven o'clock, he goes to the wards to make rounds, checking on the patients under his care, asking about changes in their conditions, performing physical examinations, and recording progress notes. His ward rounds have become increasingly skillful; he knows what questions to ask, what tests to perform, and what details to pay attention to. His progress notes have also become more standardized, no longer as verbose as they were at the beginning, but concise, accurate, organized, and logically structured.

At eight o'clock, he would hand over his shift and then accompany Yang Ping on outpatient visits or surgeries. When on outpatient visits, he would sit next to Yang Ping, responsible for taking patient histories, writing outpatient medical records, and ordering tests. Yang Ping saw patients very quickly, but he examined each patient carefully, taking their medical history, conducting physical examinations, reviewing X-rays, making diagnoses, and writing prescriptions—all in one smooth motion. Sometimes, Zaxi couldn't keep up with his pace; before he could finish writing the medical records, the next patient would come in. He could only use the breaks to finish writing or stay after the outpatient clinic ended to organize the records.

During surgery, he stood opposite Yang Ping, serving as his assistant. Yang Ping's surgical style, like the man himself, was clean, efficient, and methodical. He made no unnecessary movements; every incision, every needle, and every attempt to stop bleeding was precisely calculated.

What Zaxi fears most is Yang Ping suddenly asking questions.

What is this anatomical structure called?

"What area does this blood vessel supply?"

What symptoms would occur if this nerve were damaged?

Every time he was asked, Zaxi would get so nervous that his palms would sweat. When he knew the answer, he would reply quickly; when he didn't know, he could only honestly say "I don't know." Yang Ping never scolded him, but would say, "Go back and check." This meant that he had a gap in his knowledge, and that gap might one day cost a patient's life.

After finishing his surgery in the afternoon, without fail, he went to the training room.

The two hours in the training room were the most focused time of his day. There were no patients to disturb him, no nurses to call him, and no family members to ask questions. There was only him, the equipment, the operating lights, and the models.

He started practicing from the very basics: holding the needle, clamping the needle, threading the needle, pulling the needle out, tying a knot. He repeated each movement dozens, even hundreds of times, until his fingers developed muscle memory. When tying knots, he was initially very slow, taking more than ten seconds to tie a square knot, and often making slip knots. Yang Ping stood beside him watching without saying a word, only occasionally correcting his technique: "Push your index finger forward, not press it down," "Pull the thread taut, not stretch it," "Tie the knot on one side of the cut, not directly above it."

Soon, he could tie twenty square knots in a minute, each one tight, neat, and secure. Next, he began practicing sewing. He cut a five-centimeter slit in a silicone mold and then sewed it up using various methods, including interrupted sew, continuous sew, mattress sew, and intradermal sew. At first, his sewing was crooked, with uneven stitch spacing, asymmetrical edges, and inconsistent knot tightness. He unstitched and sewed again, practicing repeatedly until the two sides of the slit aligned neatly, the stitch spacing was even, and the knots were tight.

Yang Ping examined his sutures, cutting each thread one by one with scissors, then using tweezers to open the incision and check the alignment of the subcutaneous tissue. He looked for a long time, then nodded.

“Microscopic manipulation and laparoscopy can also be trained now.”

Several surgical microscopes were arranged against the wall, each equipped with a height-adjustable chair and an instrument table. On the instrument table were microsurgical instrument boxes containing various microforceps, microscissors, microneedle holders, and several boxes of 10-0, 11-0, and 12-0 microsurgical sutures. These sutures are finer than a human hair and are almost invisible to the naked eye, requiring microsurgical manipulation.

Yang Ping was already seated in front of one of the microscopes. He wasn't wearing a white lab coat, just a light blue scrub shirt. His left hand rested on the microscope's focusing knob, and his right hand held a pair of microscopic tweezers. He was relaxed, as if he were doing something completely ordinary.

“Come here!” he said. “First, learn how to use a microscope.”

Zaxi sat down next to him and brought his eyes close to the eyepiece. All he could see was a blurry, grayish-white blur. He adjusted his interpupillary distance, but it was still unclear. He adjusted the focus again, and the image gradually became clearer—it was a simulated blood vessel, about one millimeter in diameter.

"Look with both eyes at the same time, don't close one eye," Yang Ping's voice came from the side. "The essence of microsurgery is the coordination of both eyes. If you close one eye, you will lose the sense of depth and you won't be able to judge the depth."

Zaxi tried to open his eyes, struggling to merge the images from both eyes. At first, it felt very strange; his vision was blurry, and he felt like his eyeballs were fighting each other. He blinked a few times, relaxing his eye muscles, and slowly, the two images overlapped, becoming a clear, three-dimensional picture. The simulated blood vessel appeared very large in his field of vision, its surface texture clearly visible, like a giant pipe magnified countless times.

“Okay!” Yang Ping said, “Now get the micro forceps.”

Zaxi reached into the instrument case, his fingers pausing briefly on the micro-forceps. These forceps were several sizes smaller than the tissue forceps he usually used; in his hand, the tips opened and closed repeatedly. They were so light he could barely feel their presence, only his fingertips controlling two hair-thin tips.

"Clamp that line."

Zaxi looked in the direction Yang Ping was pointing. Next to the simulated blood vessel, there was a black microsurgical suture, as thin as a spider's thread, lying on a blue silicone pad. He tried to pick it up with microsurgical forceps. The tip of the forceps touched the suture, but it didn't pick it up; instead, it slid to the side. He tried again, and this time he managed to pick it up, but he used too much force, and the suture was deformed by the tip of the forceps.

"Gently!" Yang Ping said, "Microsurgery is about feeling, not strength. Your fingertips must be able to feel the moment the forceps tip touches the line, and the force must be just enough to grip it so that it doesn't slip or deform."

Tashi took a deep breath and tried for the third time. This time, he slowed down, the tweezers tip slowly approaching the thread. The instant they touched, he felt an extremely faint, almost indescribable resistance. He gently closed the tweezers; the thread was clamped, firmly, without slipping or deforming.

"Okay! Put it down."

Zaxi released the tweezers, and the thread fell back onto the silicone pad.

"Do it a hundred more times."

Zaxi didn't look up; he knew Yang Ping wasn't joking. He picked up the micro-tweezers and began repeating the action: clamping the thread, releasing it, clamping the thread, releasing it. Each time, he tried to make his fingertips more sensitive, to make the tactile sensation of the tweezers more distinct. After fifty repetitions, his hand began to ache, but he didn't stop. After a hundred repetitions, he could accurately clamp the thread in a second, with just the right amount of force, ensuring the thread didn't deform or slip.

"We'll practice vascular anastomosis tomorrow." Yang Ping stood up and pushed the chair back into place. "That's all for today."

Tashi looked up and realized that two hours had passed. His eyes were a little sore, and his fingers were a little stiff, but he felt a strange sense of fulfillment. He knew that in these two hours, he had not learned a technique, but an attitude, an extreme pursuit of precision, and an almost obsessive attention to detail.

"I want to train a little longer." Zaxi had nothing to do after get off work anyway, and he felt that two hours was far from enough.

Yang Ping checked the time: "Then let's practice laparoscopic surgery. I'll teach you these procedures. Whether I follow you around every day or not depends on your self-discipline in training, but I'll come to check on your progress from time to time."

Laparoscopic training is a whole different world.

The laparoscopic simulator consists of a training box, a camera, a monitor, and a set of laparoscopic instruments. The top of the training box has several piercing holes through which the instruments are inserted. The camera projects the image inside the box onto the monitor. The operator watches the monitor while manipulating the instruments from outside the box, using the piercing holes as a fulcrum to control the instruments' movement inside the box.

When Zaxi first stood in front of the laparoscopic training table, he felt like he was playing an extremely awkward game.

He saw his own hand on the monitor—no, not his hand, but the tip of a device moving inside the box. But there was a fulcrum separating the direction his eyes saw from the direction his hand actually moved, creating an inverse relationship. To move the device to the left, he had to push to the right; to lift it upwards, he had to press down. This separation between vision and movement initially overwhelmed his brain.

He tried using the endoscopic forceps to pick up a bean from the box and place it on another plate. The bean looked large on the monitor, but he couldn't get a good grip on it. The forceps would either slide past the bean, flick it away, or pick it up only to drop it again. It took him ten minutes to finally move the bean.

“Hand-eye coordination,” Yang Ping stood behind him, his voice calm, “hand-eye separation, triangular technique! This is the foundation of laparoscopic surgery. The image your eyes see and the actual movement of your hands are separated by a coordinate system transformation, and your brain needs to be reprogrammed.”

Tashi nodded and continued practicing. One, two, three... he transferred the beans one by one, his speed increasing and his mistakes decreasing. Half an hour later, he could transfer ten beans in a minute without dropping a single one.

"Okay, let's move on to the next module."

The next module is perforation training. Inside the box is a perforated training board with holes of various shapes—round, square, triangular, and irregular. The trainer needs to use a laparoscopic needle holder to hold a suture and thread it through these holes, following a prescribed order and path. The purpose of this training is to improve spatial positioning and path planning skills under laparoscopy.

Zaxi tried several times and found it much more difficult than transferring beans. The sutures were soft and difficult to control under the endoscope, and the holes were very small, requiring extremely precise positioning. Several times he threaded the sutures into the wrong holes, or the sutures bent halfway through and got stuck in the holes.

“Take it slow!” Yang Ping said. “Laparoscopic surgery is not about speed, it’s about precision. Speed ​​can be improved gradually, but precision must be established from the very beginning.”

Zaxi slowed his movements, confirming the direction and path each time he threaded the needle, then completing the task in one smooth motion. Gradually, his hands and eyes began to coordinate; his eyes would see the location of the hole, and his hands would automatically adjust the direction and angle of the instrument, no longer requiring conscious calculation from his brain. This feeling was amazing, as if his hands had learned to think for themselves.

"Try the sewing and knotting module too. You can practice by doing more exercises and cross-training. You don't have to strictly follow the order." Yang Ping saw that Zaxi was starting to get a feel for it.

On the monitor, the pink simulated tissue was magnified several times, its surface printed with a fine coordinate grid. His left hand held the endoscope forceps, and his right hand held the needle holder. Both hands controlled the instruments inside the box by using the puncture hole as a fixed fulcrum. His eyes were fixed on the screen, and his breathing was slow and deliberate. This was an experience he had developed on his own; if his breathing became rapid, his hands would tremble.

He painstakingly stitched up two stitches and began stitching the third.

The first two needles were already knotted and lay quietly on the left side of the incision, crookedly. The third needle had just pierced the tissue, its tip protruding from the opposite side. He gripped the needle tip with forceps, gently pulled it out, then released the needle holder, gripped the needle body again, and prepared to tie a knot.

Tying knots under laparoscopy is the most patience-testing part. Without the tactile feedback of fingers directly touching the sutures, all tension assessments must be transmitted through a 30-centimeter-long instrument. With a long lever arm and a distant point of force, even the slightest mistake can cause the knot to loosen. He wrapped the suture around the needle holder twice, then gripped the end with pliers and gently tightened it. The first knot was tied. He changed direction, wrapped it once more, and tightened it again. The second knot. Wrapped it once more, and tightened it again. The third knot.

The knot was secured to the tissue surface, and he used pliers to cut off the end of the thread, leaving a small, neat piece of thread.

The three stitches took a lot of effort, and the quality of the stitches was questionable; it was good enough that it was completed at all.

"Any operation is like swimming. Theory is just a guide. In the end, you have to experience, figure it out and become proficient by yourself. Just practice slowly on your own. It won't be too tiring."

Yang Ping finished speaking and left.