American Medicine: I survived the death knell thanks to the devil.

Upon witnessing this scene, Tuco, who was being held firmly in his seat by Lynn, instantly became furious, his muscles bulging, like a wild beast about to go berserk.

But Lynn's scalpel tightened instantly, the blade piercing the skin and forcefully suppressing his riot.

Thankfully, things stabilized in the end.

"Don't be afraid, Grandmother..."

Tuco continued to comfort his grandmother in Spanish.

Unable to move, he could only stretch his neck, his voice gentle, his eyes full of longing.

Then, he casually glanced at the unsteady-footed underling.

The younger brother's face turned ashen instantly, and he trembled like a leaf, but he dared not loosen his grip.

The elderly woman was carefully lifted into the RV.

The interior of the RV is strictly divided, with the rear half being a sterile operating room that has undergone the highest level of renovation, and the front half being the living and driving area.

With a new hostage, Lynn's scalpel left Tuco's neck.

He turned and stepped forward, quickly completing the physical examination.

The patient had significant tenderness in the right upper quadrant of the abdomen.

Lynn pressed her fingers against the lower edge of her right rib, and the old woman gasped sharply in pain as she took a deep breath, forcibly holding her breath.

A typical positive Murphy's sign, accompanied by high fever and abdominal muscle tension.

"Acute suppurative cholecystitis."

Lynn put on sterile gloves.

"The gallbladder's drainage channel is completely blocked, and it has swollen into a toxic balloon filled with high-pressure pus, which could burst at any moment."

"Once the pus bursts into the abdominal cavity, causing diffuse peritonitis, the person will die."

Tuco's eye twitched, and he gripped his hair tightly with both hands:

"Then get that damn balloon out of there! Now! Right now!"

"Prepare for general anesthesia and intubation."

Ignoring his agitation, Lynn turned to Cassie and said, "Laparoscopic surgery requires absolute muscle relaxation. Prepare to open the laparoscopy."

Cassie and Lynn quickly completed the sterile procedures such as scrubbing their hands and changing clothes.

Tuco also wanted to follow suit and go into the operating room.

Lynn turned and yelled at him:

"Get out. The mud and cocaine on you will kill her."

Tuko, panting heavily, glanced at his grandmother who was groaning in pain, and abruptly pulled back the leg he had taken out.

The door to the sterile room slowly closed.

Outside the vehicle, a dozen short-barreled AK-style Dracula pistols and Glocks equipped with drum magazines were simultaneously loaded.

Some were even equipped with sights; several red laser beams pierced through the windows of the living area, moving around the RVs, ready to riddle them with bullets at any moment.

Sachs' M45A1 was firmly gripping the back of Tuko's head, his finger pressed hard on the trigger.

Tuco didn't care at all about the gun barrel behind him.

He was pressed against the small observation window of the sterile room, his face contorted from the pressure.

He stared intently at the operating table, his eyes bloodshot, his heavy breathing creating puffs of white mist on the glass.

In the sterile room just a door away, Cassie took a deep breath.

Her calves were still spinning as she faced a car full of drug dealers outside who could open fire at any moment.

But when her gaze swept over the Stryker laparoscopic tower that Arjun had just delivered, a number instantly popped into her mind.

High-risk laparoscopic surgery on the black market starts at $20,000.

A 30% commission is about seven thousand US dollars!

Oh, no, we also need to deduct the cost!

never mind!

No, that doesn't count!

Cassie slapped her cheeks twice.

Screw drug lords!

This isn't a drug lord's grandmother, she's a walking banknote!

As a partner and CFO who is expected to take 30% of the profits, I absolutely cannot become a burden at this time.

The fear was instantly suppressed by the intense desire for money.

Cassie's eyes sharpened, and his demeanor changed abruptly. He skillfully tore open the sterile package, connected the pneumoperitoneum tube, cold light source, and camera, his movements as swift as if he had spent more than ten years in the operating room.

"Propofol injection completed, muscle relaxant in effect, intubation successful," Cassie reported.

"Connect propofol to a micro-infusion pump and continuously infuse 20 ml per hour."

Lynn responded, "The monitor's alarm threshold is set. If the heart rate drops below 50 or the blood oxygen drops to 92, call me immediately."

Cassie adjusted the pump speed, confirmed that the monitor parameters were correct, and then turned around to take the equipment.

The surgery officially began.

Lynn marked four tiny puncture points on the old woman's abdomen, made the first incision below the navel, and blindly inserted a pneumoperitoneum needle.

"Establish pneumoperitoneum, target pressure 12."

Laparoscopic surgery requires injecting carbon dioxide gas into the abdominal cavity to stretch the abdomen like a tent, giving the instruments enough space to operate.

Kashi opened the CO₂ gas cylinder and watched the reading on the insufflator slowly climb.

But just after the number went past 8, the blood oxygen saturation on the monitor suddenly dropped.

97, 95, 93...

"Blood oxygen 91, still dropping," Cassie immediately reported.

Lynn didn't even look up: "The pneumoperitoneum pressure dropped to 10. The high-pressure gas pushed up the old man's diaphragm, causing the alveoli to collapse and leaving insufficient space for ventilation."

Cassie quickly reduced the data usage.

A few seconds later, the blood oxygen level slowly rose to 96, barely stabilizing.

The pneumoperitoneum space is therefore nearly half the size of that in conventional surgery, and all procedures are compressed into an extremely narrow cavity.

Lynn inserted four puncture devices in sequence, and a camera was inserted into her abdominal cavity.

The moment the screen lit up, Cassie's breath hitched.

The elderly man's gallbladder had swollen to three times its normal size, and its surface was covered with necrotic purplish-black patches.

The hepatobiliary triangle, which is the core anatomical region formed by the cystic duct, common hepatic duct, and lower border of the liver, is a jumbled mess.

This is the most dangerous area during gallbladder surgery.

If the bile duct gets lost due to adhesions and is accidentally severed, the consequences would be catastrophic.

"The adhesions are too severe."

Cassie adjusted the camera angle, trying to find a clear view of the structure, "but the lower edge of the liver was also blurred."

"Move the camera 15 degrees to the side of the head."

Cassie fine-tuned the camera, revealing a small gap in the image that had not yet been covered by glue.

"This is it." Lynn manipulated the Maryland splitter to probe into the only opening.

"Laparoscopic Cholecystectomy - Advanced" combined with "Fingertip Blunt Dissection - Master" activates instantly.

Through the long laparoscopic instruments, the master-level touch seemed to extend along the metal rod to the fingertips.

He used the tip of the pliers to probe and advance little by little into the necrotic tissue, which was as fragile as tofu.

Picking, plucking, tearing, peeling—each movement is precisely controlled to the millimeter level.

"attract."

Cassie precisely inserted the suction tip into the surgical field and aspirated the oozing pus and inflammatory exudate.

The murky liquid was pumped away through the pipes, and the view became clear again.

As the adhesions were peeled away layer by layer, a tiny artery hidden deep within the inflamed tissue was suddenly revealed, pulsating violently.

"Cystic artery variation".

Normal arteries have a fixed course, but abnormal blood vessels are like landmines buried in the dark.

If the camera is cut blindly, high-pressure arterial blood will spurt out instantly, and the bright red blood will completely obscure the camera, leading to fatal hemorrhage due to blindness.

"It came from behind the adhesion, and its position is almost two centimeters higher than normal."

"I see it." Cassie steadied the camera, keeping the image firmly locked on the displaced blood vessel.

Lynn bypassed the mutated artery and continued the separation.

Every millimeter the forceps tip penetrates, it must be repeatedly probed between the abscess wall and the bile duct wall to confirm that the anatomical layers are completely accurate.

The monitor suddenly beeped three times in quick succession.

Heart rate 138, systolic blood pressure 85, diastolic blood pressure 50.

Cassie continued the broadcast.

This is a warning from the elderly person's body.

The prolonged general anesthesia, coupled with the large influx of inflammatory toxins into the bloodstream, is weakening this aging cardiovascular system, triggering a blood pressure collapse in the early stages of septic shock.

"Increase the drip rate of lactated Ringer's solution to expand the intravascular volume. Infuse norepinephrine at 0.05 micrograms per kilogram per minute to constrict blood vessels and raise blood pressure."