godfather of surgery

Chapter 1397 Simulated Surgery
Animal Experimentation Department, Sanbo Hospital.

Zaxi followed Yang Ping through the last door and changed into a light blue surgical gown, cap, mask, and shoe covers. Once fully dressed, he looked no different from someone entering an operating room, except that he wasn't wearing a name tag on his chest. Instead, he had a temporary access pass with his photo and the words "Animal Experimentation Permit" printed on it.

Yang Ping was already washing his hands.

He stood before the sink, meticulously cleaning his fingernails and webbed toes with a brush, his movements mirroring every step he took in the operating room. After scrubbing and disinfecting his hands, he raised them to his chest, maintaining a height where they were out of sight but wouldn't become contaminated. The entire process was executed with utmost care, as if he were performing a real, life-or-death surgery.

Zaxi stood beside him, following along. As the water washed the foam off his hands, he suddenly realized something: this was the animal testing department, not the operating room. Experimental pigs wouldn't sue the hospital for infections, nor would they complain about unsightly incisions. But Yang Ping still treated a pig's skin with the same standards he applied to humans. This almost obsessive rigor wasn't about risk aversion, but a deeply ingrained habit, a professional instinct that wouldn't waver under any circumstances—a habit he wanted to cultivate as well.

"Ready?" Yang Ping glanced at him.

Tashi nodded.

They entered the operating room. It wasn't large, but it was fully equipped with an operating table, shadowless lights, anesthesia machine, monitors, electrosurgical unit, and suction device—almost indistinguishable from a real operating room. The only difference was that the person lying on the operating table wasn't a human, but an experimental pig.

The pig was already anesthetized, lying supine on the operating table, its limbs strapped to the edge, its belly shaved to reveal pinkish-white skin. The monitor displayed heart rate, blood pressure, and blood oxygen saturation numbers—everything was prepared exactly like for human surgery. The anesthesiologist stood beside the equipment, holding a whiteboard, glancing at the monitor screen periodically to adjust the depth of anesthesia.

Tashi stood before the operating table, looking at the pig's abdomen. It was quiet, its chest rising and falling rhythmically, its breath condensing into a thin mist at the interface of the anesthesia tubing. Its eyes were closed, its eyelashes long and slightly curled. Tashi suddenly remembered back in Tibet, when his family's yaks lay like this before being taken to slaughter, not struggling, not bellowing, just opening their eyes and looking at the sky. An indescribable emotion welled up inside him, but he quickly suppressed it. He knew this wasn't slaughter; it was to save lives. Every laboratory animal was a stepping stone on the road to medical progress; their sacrifice was for the lives of countless future patients.

"We're performing a laparoscopic cholecystectomy today." Yang Ping's voice brought him back to reality. "You'll be the lead surgeon. We'll alternate between basic skills training and animal surgery; that way, we'll improve faster."

"The surgeon?" Zaxi asked, a little nervous.

"Don't be nervous," Yang Ping said calmly, as if he were talking about something very ordinary. "I'll be watching from the side. Just do what needs to be done, take your time, don't rush, and do every action and every step well."

Zaxi took a deep breath and walked to the surgeon's position. The scrub nurse had already prepared the laparoscopic instruments: trocars, lenses, forceps, electrocautery hooks, suction devices, and titanium clamps, all neatly arranged on the instrument tray, each piece gleaming. He picked up the scalpel and made four small incisions in the pig's abdomen, inserting trocars into each to establish pneumoperitoneum. Carbon dioxide gas was injected into the abdominal cavity through the pneumoperitoneum machine, supporting the abdominal wall and creating an operating space. The monitor displayed the image inside the abdominal cavity: pale pink peritoneum, dark red liver, yellowish-white fat, and the gallbladder hidden beneath the liver, appearing grayish-blue and filled with bile.

Zaxi's heart raced. In the simulator, he was dealing with silicone and plastic, the colors artificially applied, the layers molded out. Now, he was facing real tissue, warm, elastic, with pulsating blood vessels and the rise and fall of breath. He needed to complete each step under these realistic conditions: separation, exposure, dissection, clamping, cutting, and peeling.

He picked up the electrocautery hook and began to dissect the Calot's triangle. The tip of the hook moved through the interstitial spaces, emitting a soft hissing sound and a wisp of smoke each time it encountered a tiny blood vessel. He stared at the monitor, trying to pinpoint the locations of the cystic artery and cystic duct. These two structures had to be accurately identified and clamped; if he clamped the wrong one, the consequences would be unimaginable.

"Attention!" Yang Ping's voice came from the side. "The cystic artery is on the left side of the cystic duct. The one you see is the cystic artery, but its course is a bit different, splitting into two branches. You need to find both branches and clamp them separately."

Zaxi slowed down. He gently lifted the gallbladder with forceps, adjusted the angle of his view, and dissected it bit by bit with an electrocautery hook. The layers of tissue gradually became clear under his manipulation: the cystic duct, cystic artery, common hepatic duct, and common bile duct were revealed one by one, like an archaeologist brushing out the outline of an ancient artifact in the sand. His fingers subtly adjusted the angle and pressure on the instruments; each movement was clumsy, but he strived to do it well. He found the first cystic artery, clamped it with titanium clips, and then cut it. He then found the second one, hidden behind the cystic duct, covered by a thin layer of fascia. He gently parted the fascia with forceps to confirm it was correct, and then clamped and cut it in the same way.

The gallbladder was completely removed. He placed it in a specimen bag and removed it through the puncture hole. The gallbladder fossa was clean, with no active bleeding or bile leakage. He rinsed the surgical field, confirmed that no collateral damage had occurred during the procedure, and then began to close the abdomen, suturing the puncture hole, subcutaneous tissue, and skin.

The whole process took more than two hours and felt awkward to do.

When Zaxi put down the instruments, he found his back was soaked with sweat. The surgical gown clung to his skin, feeling cool. His fingers were trembling slightly, not from nervousness, but from the physiological reaction of intense concentration. He glanced at the last glimpse of the surgical field on the monitor; it looked pretty good.

Yang Ping walked over and stood next to him, looking at the monitor. He didn't speak, but Zaxi could feel his gaze scrutinizing every detail: the length of the incision, the position of the puncture, the layers of separation, the precision of the clamping, and the neatness of the suturing.

"First time, not bad. Surgery is all about practice makes perfect," Yang Ping finally spoke, his tone still calm. "But there are a few areas for improvement. First, the exposure of the Calot's triangle wasn't sufficient. You spent too much time searching for the branches of the cystic artery; this will take even longer with more complex anatomical variations. Second, the angle at which you used the electrocautery hook was incorrect. Twice you used the side of the hook for dissection, which easily damages surrounding tissue. You should use the tip, like a pen nib. Third, when suturing the puncture site, the alignment of the subcutaneous tissue wasn't neat enough, and the stability of your left hand holding the needle needs improvement. You need to review each surgery to improve."

As Tashi listened, he took notes, etching every word into his mind. He knew this wasn't criticism, but refinement, like a blacksmith placing a red-hot iron block on an anvil and hammering away impurities to carve out its shape. The process was painful, but the result was solid.

"We'll train in the training room tomorrow, and then come here the day after to continue animal simulation surgery," Yang Ping said, taking off his mask. "We'll do the gastrointestinal anastomosis tomorrow."

……

Next, Tashi practiced in the training room of the animal experiment department and the research institute every afternoon.

In the animal department, he performed laparoscopic cholecystectomy, laparoscopic gastrointestinal anastomosis, laparoscopic splenectomy, and laparoscopic nephrectomy. He practiced each procedure repeatedly until Yang Ping said "that's enough," before moving on to the next. His fingers became increasingly steady, his field of vision more accurate, and his instrument manipulation more fluid. He began to anticipate the rhythm of the surgery, knowing when to go fast, when to go slow, when to stop to confirm anatomical structures, and when to complete the procedure in one smooth motion.

But he gradually realized that surgery is more than just a technique.

Once, during a laparoscopic gastrointestinal anastomosis, he was on the third stitch when he suddenly noticed tension at the anastomosis. The distance between the stomach and intestine was greater than he had anticipated. If he continued suturing, the anastomosis would be stretched too tight, potentially leading to postoperative leakage. He stopped suturing, hesitated for a moment, then loosened all the sutures, freed the mesentery of the stomach and intestine, allowing them to come together without tension, and then resumed suturing. Yang Ping stood by, silent throughout. After the surgery, he only said one thing: "This time, your judgment was more valuable than your technique."

Zaxi suddenly understood that the judgment on the operating table is not innate, but is slowly honed through repeated hesitation, trial and error, and correction. Every hesitation trains the brain to perceive risk; every correction strengthens the respect for mistakes.

On another occasion, while dissecting the Calot's triangle, the electrocautery hook struck a mutated small artery. The blood vessel ruptured, and blood gushed out, instantly blurring his vision. The monitor showed only red; he couldn't see anything. Zaxi's hand froze in mid-air. This was the red-blindness scenario he feared most during real surgery, and in animal experiments, it had finally arrived.

He heard Yang Ping's voice, still as calm as a stagnant pool: "Attract attention, see the bleeding point clearly, don't panic."

Zaxi took a deep breath, picked up the suction device with his left hand, and began to suction the bleeding area. The red blood was suctioned away, and his vision gradually cleared. The ruptured artery was still oozing blood, but the bleeding had decreased significantly. He picked up the electrocautery hook, precisely clamped the severed end of the blood vessel, and electrocoagulated to stop the bleeding. A few seconds later, the bleeding completely stopped. He continued the surgery; the gallbladder was completely removed, and the surgical field was as clean as ever.

After the surgery, he stood in front of the sink, looking at himself in the mirror. His face was a little pale, and there were still beads of sweat on his forehead. His hands had stopped trembling, but his heart was still racing. He knew that those last few seconds were the most crucial step for him to transition from the simulator to the real operating table, not because of the technical difficulty, but because he hadn't collapsed under pressure and had remained calm—that was "battlefield" experience.

Yang Ping walked over to him and turned on the tap to wash his hands. The water flowed over his fingers, making a splashing sound.

"Do you know why you were bleeding just now?" Yang Ping asked.

"The angle of the electric hook was wrong; I underestimated the diameter of that blood vessel."

"anything else?"

Zaxi thought for a moment: "I didn't fully confirm the course of all the blood vessels before cutting them off, and I missed that mutated artery."

Yang Ping turned off the tap, took out two tissues, and dried his hands. "The silicone model you practiced on the simulator had no mutations, no bleeding, and no accidents. But real surgery is not a simulator. With a real human body, every incision may encounter situations you haven't anticipated. What you can do is not to memorize all the mutations, that's impossible, but to learn not to panic when unexpected things happen."

He threw the tissue into the trash can and turned to look at Tashi. His eyes were calm, like a lake on the plateau, unfathomable yet clear and transparent.

"You did it today."

Zaxi stood there, watching Yang Ping's retreating figure, the hem of his white coat swaying gently with each step.

He looked down at his hands and learned to find calm in chaos and order in the unexpected.

One afternoon, Zaxi completed another surgery in the animal experiment department: a laparoscopic distal pancreatectomy, one of the most challenging laparoscopic procedures, requiring dissection of the posterior pancreas, management of the splenic artery and vein, and complete removal of the pancreatic body and tail. He took an hour and a half, almost twice as long as Yang Ping, but there were no complications during the procedure, and the postoperative wound was so clean it could be photographed for teaching demonstrations.

After examining the surgical field, Yang Ping took off his glasses and rubbed the bridge of his nose.

"Do you feel it yourself? This kind of basic skills training and simulated surgery are carried out alternately, and you can improve very quickly. You can immediately apply the basic skills to the surgery and use the surgery to point out the direction of your basic skills training."

"Yes, I was terrified when I first started doing simulated surgery, but I did it with a heavy heart. Gradually, I became less afraid and learned how to do it."

Zaxi shared his experience.

“However,” Yang Ping’s tone suddenly turned serious, “human surgery is different from animal experiments. In animal experiments, you are dealing with a healthy pig with a clear anatomical structure, no inflammation, no adhesions, and no underlying diseases. But in human surgery, you are dealing with real patients who may have diabetes, high blood pressure, heart disease, or have had abdominal surgery with severe adhesions in their abdominal cavity. Their anatomical structure may have been completely altered due to long-term inflammation. Animal experiments cannot teach you these things.”

Zaxi nodded. He understood Yang Ping's meaning. Animal experiments could train techniques, but they couldn't train a surgeon to have a complete understanding of diseases. Real experience was accumulated slowly, through real patients, one surgery after another, one complication after another, and one late-night ward round after another.

“So,” Yang Ping patted him on the shoulder, “starting tomorrow, you’ll come with me to the operating table as my first assistant. Once you’ve assisted in a certain number of surgeries, I’ll let you be the lead surgeon.”

He spoke these words in a very soft tone, as if he were arranging a routine task. But Zaxi knew that if he were to perform the surgery and something went wrong on the operating table, the one who would bear the consequences would not be him, but Professor Yang, the person who stood behind him, guiding him through every movement and telling him "don't panic" when he hesitated.

Zaxi suddenly felt his eyes getting hot, and he lowered his head, not wanting Yang Ping to see.

“Professor Yang,” he said, his voice a little hoarse, “I will do my best.”