I Am Diagnosed as a Medical Titan

Chapter 99: Chapter 98: The Convention-Defying Posterior Approach

’Peel it off? Huh? For real?’

Everyone present was thinking the same thing.

Even Yang Xu frowned deeply.

Although he wasn’t completely unfamiliar with the desmoplastic reaction theory Jiang He had mentioned, he still shook his head.

”Even if it’s as you say, how would we execute it? What do we do about the variant right hepatic artery? With the standard anterior approach, dissecting from right to left, there’s no way to get around that vessel. No matter how you try to peel, you’ll end up facing a mess of complex adhesions in a blind spot. One wrong move with the scalpel, and you either rupture the artery or sever the liver’s blood supply.”

In 2008, nearly all pancreaticoduodenectomies performed in China and abroad used the traditional anterior approach.

This involved mobilizing from the right side and dealing with the superior mesenteric artery, the deepest structure, last.

Faced with this skepticism, Jiang He’s expression remained perfectly calm.

In the decade that followed, this surgical procedure would be perfected and improved through the collective efforts of countless individuals in the medical community.

The techniques honed in the world’s top pancreatic surgery centers were the source of his absolute confidence to speak up in this deadlocked situation.

”Professor, if we can’t take the road ahead, then let’s not go that way.”

”Not go that way?” Yang Xu was taken aback.

”That’s right. Since the superior mesenteric artery is the biggest problem, let’s just abandon the traditional approach, flip our perspective, and go in from the back to defuse the ’bomb’.”

”We can perform an extensive Kocher maneuver, completely flip the entire duodenum and pancreatic head to the left, enter through the space between the inferior vena cava and the abdominal aorta, and directly expose the root of the superior mesenteric artery from behind.”

”From the posterior side, we prioritize dissecting the tissue surrounding this major artery.”

”I call this procedure a variation of the artery-first approach—the Posterior Approach.”

In a very level tone, Jiang He uttered a technical term in the operating room that would completely revolutionize the field of pancreatic surgery years later.

Hearing this unfamiliar term, Yang Xu was a bit stunned.

His first thought was: ’Flipping again?’

Then, trusting Jiang He, his mind began racing.

’Abandon the clear path from the front, perform a wide-angle flip, pass through the ’minefield’ of the inferior vena cava, and circle around to the back to control the core vascular trunk?’

’What a brilliantly unconventional idea!’

’And yet...’

’Anatomically, this path... seems viable.’

”A posterior flip... prioritize control of the SMA root...”

Yang Xu took a sharp breath, and the way he looked at Jiang He completely changed.

This student of his had given him another huge surprise today.

’Could I bring him along for all my surgeries from now on?’

Yang Xu shook his head, reigning in his thoughts.

After all, on the operating table, time is life. There was no room for hesitation.

Once he made a decision, he quickly entered a state of intense focus.

As a top surgical expert at Affiliated Hospital No. 1, once his conceptual blind spot was broken, his masterfully honed anatomical skills were beyond question.

”Jiang He.”

”Yes, sir.”

”I’ve never performed this approach before, and there are no established guidelines in the country to reference. Since you’re the one who proposed it, you must have a solid grasp of the anatomical layers in your mind. Act as my first assistant, and you call out the key anatomical landmarks.”

Jiang He gave a firm nod.

’On the operating table again, I’ve skipped from third assistant to first.’

Yang Xu issued his commands.

”Chen Jing, switch to a long-handled electrocautery pencil. Prepare an atraumatic vessel loop.”

”Peidong, keep his blood pressure stable. I’m preparing to flip the pancreatic head to the left.”

The commands were short and clear.

After everyone acknowledged.

A top-tier surgical procedure, far ahead of its time, began within the confines of the operating room.

Yang Xu took the long-handled electrocautery pencil, its tip precisely incising the retroperitoneum lateral to the duodenum.

”Retractor. Pull up and to the left,” Yang Xu said.

Jiang He immediately followed, his deep retractor fitting securely into the tissue space, flipping the entire duodenum and pancreatic head to the left.

The surgical field instantly changed.

The previously hidden inferior vena cava and abdominal aorta were starkly exposed under the surgical lights.

”We’re in the space between the inferior vena cava and the abdominal aorta,” Jiang He reminded him softly.

”I see it.” A faint SIZZLE came from the electrocautery pencil in Yang Xu’s hand as he meticulously cut through the retroperitoneal connective tissue.

He dissected his way up along the path of the abdominal aorta, then paused the electrocautery.

On the anterior wall of the abdominal aorta, the thick root of an artery was revealed.

”The root of the superior mesenteric artery.”

They found it!

They had bypassed the tangled maze of the tumor at the front and reached their target directly from the rear.

’What a truly genius idea!’

”Dissectors,” Yang Xu said, holding out his hand.

The next steps had to be absolutely perfect.

Yang Xu began to dissect with extreme patience along the adventitia of the SMA.

Time passed slowly... No one dared to interrupt.

Chen Jing, too, was silent.

Finally, with top-tier coordination, the master-disciple duo of Yang Xu and Jiang He used the dissectors to gradually pry open the layer of dense fibrous tissue that had been mistaken for cancerous infiltration.

When that rock-hard shell was lifted, revealing the smooth, intact vessel wall underneath—

”They... they actually peeled it off...” Lin Peidong, behind the anesthesia machine, couldn’t help but murmur, his eyes wide with disbelief.

Pseudo-encasement!

Jiang He’s theory had been flawlessly proven in practice!

”I see the origin of the replaced right hepatic artery (rRHA),” Jiang He said at the perfect moment, simultaneously guiding the suction tip in to clear away a bit of oozing blood and maintain a perfectly clear field.

”Pass the vessel loop.”

Chen Jing quickly passed over a red silicone loop.

Yang Xu carefully guided a right-angle clamp around the variant right hepatic artery, passed the red loop through, and gently tightened it.

With that, the two most critical vessels—the superior mesenteric artery and the variant right hepatic artery—were both safely isolated and protected.

Yang Xu paused his hands and let out a long, heavy breath.

’The hopeless situation... was actually salvaged just like that?’

Only those standing at this operating table could truly understand the terrifying significance of what they had just accomplished.

This was no longer just a surgery; this could completely rewrite the world’s textbooks on pancreatic surgery!

For a rare moment, Yang Xu’s mind wandered.

A thought suddenly struck him.

’If this keeps up, is Jiang He going to turn me into an academician? Huh?’

...

Several hours passed.

「Outside Operating Room 3.」

A man in a tailored suit was pacing anxiously, while the VIP patient’s family members stood by with red-rimmed eyes.

Just ten minutes earlier, they had begun an urgent internal discussion.

They were strategizing how the corporation should handle the impending stock market turmoil after the opening bell, should the doctor emerge to announce the surgery had failed.

DING—

Just then, the red ”Surgery in Progress” light finally blinked off.

Immediately after, the automatic doors slid slowly apart.

Yang Xu walked out.

Jiang He followed behind his professor, his hands in his pockets...

Anyone who knew Jiang He could tell that although his expression was placid, he was definitely playing his own theme music in his head.

The surgery was a success.

The patient was safe.

And Jiang He, as the person most responsible for the success, naturally felt... indescribably cool.