System Came When the Doctor was Thirty

Summer rains hurriedly passed, with rain curtains and rainbows chasing each other in the azure sky.

The parents had already left, but Lu Cheng still kept the door to the Training Room tightly closed. He then looked up and asked, ”Teacher Tong, can you see the operating table from this angle?”

”The Training Room at home is relatively small, I only bought one camera, so it’s difficult to control what you can see.” Lu Cheng said flatteringly in the direction of the camera, with a slightly ingratiating expression.

Professor Tong Yuan’an from Xiangya Hospital was the ’examiner’ that Professor Chen Song arranged for Lu Cheng. After Chen Song sent the video of Lu Cheng practicing the Modified Tang Method to Tong Yuan’an, it took a few days before they found some free time during the lunch break.

Tong Yuan’an’s voice was deep, ”Keep it at this angle, don’t move it anymore.”

”Dr. Lu, I understand very well that you want to learn professional hand surgery techniques, but there are many tendon suturing techniques to learn, and the Modified Tang Method is considered high in both entry requirement and practice difficulty,”

”Even skilled hand surgeons need to undergo weeks of continuous practice to become adept.”

”If the technique isn’t proficient enough and is still awkwardly executed, it’s not as good as some other tendon suturing techniques.”

”Actually, for you, the cost-performance ratio isn’t high.”

After all, tendon suturing is just an entry-level surgery in hand surgery, and tendon injuries are a small condition. In Tong Yuan’an’s understanding, for a hospital like Lu Cheng’s that hasn’t developed a hand surgery department, just learning the Modified Kessler Method to a certain level should suffice.

The learning of comprehensive skills in a region is the same as personal technical learning, it’s all about gradual progression, don’t think you can swallow it all in one bite.

So Tong Yuan’an always advised Lu Cheng not to waste time. If the opportunity arises, he could practice flap transplantation techniques.

”Thank you, Teacher Tong, for the advice, but I’ve already come halfway, and abandoning it midway wouldn’t be good. Otherwise, all the time invested earlier would be in vain.”

Lu Cheng then demonstrated his training path to Tong Yuan’an: ”Professor Tong, this is the ’three-needle bi-directional puncture method’ that I practiced on the silicone board.”

”According to the precise information I found before, the starting point, end point, and puncture angles of the three needles are different.”

”First needle: 8mm from the cut end, inserted at a 60° angle to the tendon axis, exiting at an equidistant point on the opposite side.”

While explaining to Tong Yuan’an, Lu Cheng picked up the silicone board and started operating again, with the 7-0 Vicryl suture line in his hand being barely visible.

”Teacher Tong, can you see my puncture points? Do you want me to demonstrate again with a normal-sized needle?” Lu Cheng asked.

Tong Yuan’an, his arm muscles bulging, gently shook his head, ”You continue.”

”If you really want to learn specialized hand surgery suturing techniques and are willing to invest the time, I certainly welcome you, Dr. Lu, on behalf of hand surgery.”

When he first heard from a ’brother hospital’ friend at the Second Hospital, Chen Song, that an emergency department young man, only thirty years old, was about to work on the Modified Tang Method, Tong Yuan’an’s first reaction was, what the heck?

Medicine has ’advanced consumption’ and causes problems...

After Chen Song sent over Lu Cheng’s operation video, Tong Yuan’an realized that Lu Cheng’s ’advanced consumption’ indeed had some substance.

Although the basic suturing skill was ’ordinary’, and many parts were not handled with finesse, the mastery of the technique was very skilled.

Lu Cheng then continued to demonstrate: ”Second needle: 5mm from the same cut end, angled 45° in the opposite direction to form a ’Y’ shaped cross; the third needle is mirrored on the opposite side to complete the first set of internal core anchors.”

”Teacher Tong, the overall time and needle distance deviations should both be acceptable, right?”

Tong Yuan’an said, ”Pretty close, if you’re just doing simple tendon suturing, you don’t have to be that exact.”

”If it were our clinical group, the standard for mastering the technique is needle distance deviation ≤0.2mm (measured under 20x microscope magnification) and total time for 3 needles under 90 seconds. Your operation speed has reached that, but precision hasn’t.”

”But it’s okay, for simple tendon suturing, a deviation within 2mm is not a big issue, unlike nerve or blood vessel anastomoses...”

”Take another chicken drumstick and perform a three-dimensional operation and then use a force gauge to verify how much tensile strength there is...”

Lu Cheng responded, quickly fetched a fresh chicken drumstick, and began trimming the tendon vertically under a microscope, keeping about 1mm of the epitenon.

Tong Yuan’an said, ”Let me see the trimmed tendon section? It’s not clear on the video, is there inclined cutting?”

”Inclined cuts during practice are not suitable for practicing the technique.”

The learning and teaching of medical skills are very private matters, so clinical teaching is necessary.

Such video teaching is not detailed enough.

Especially since Tong Yuan’an mentioned, the deviation has to be within 0.2mm. How can the camera clarify such a detailed distance?

After a brief pause, Lu Cheng assessed himself, ”Teacher Tong, it meets the requirements.”

”Then start suturing the first bundle...” commanded Tong Yuan’an.

The core of the Modified Tang Method is multi-core, six-strand tendon suturing.

Lu Cheng then began the operation, carefully estimating the distance and—

Relied only on feel to insert the needle 10mm from the cut end → exit 5mm at an angle on the same side → enter 5mm at an angle on the opposite side → exit at 10mm (forming a ’W’ trajectory)...

Then, Lu Cheng added a bundle parallel to each side of the first bundle 1.5mm apart, penetrating the middle layer of tendon thickness standardly.

When the three strands were simultaneously pulled, the gap at the cut end immediately became tight, with less than 0.1mm of imperceptible gap...

”Check the tensile strength,” instructed Tong Yuan’an.

Lu Cheng used a force gauge to apply tension, eventually stabilizing at about 40N before he dared not pull further.

”Hmm, next time you can use pig tendon and increase the load to 80N. If you can complete a three-bundle suture within a 5mm×5mm surgical field, you can handle this surgery confidently.”

”In real patients, tendon suturing fields are extremely narrow, but you’re doing exceptionally well, demonstrating diligence and progressiveness...”

”Your hospital lacks a hand surgery department, so you went to the emergency department, right?” asked Tong Yuan’an.

Tong Yuan’an assumed Lu Cheng was at least a master’s student in hand surgery or undergoing standardized training.

In the multi-person video, Chen Song also explained in the channel, ”Professor Tong, Long County People’s Hospital indeed doesn’t have a hand surgery specialty; Dr. Lu previously was an orthopedic doctor.”

Tong Yuan’an smiled and encouraged, ”Everyone starts from nothing. I see that you, Xiao Lu, are young, but your technical accumulation and learning efficiency are impressive.”

”At this age, to have such accomplishment and basic skills in suturing means you have the opportunity to develop the hand surgery in your locality in the future...”

Lu Cheng sincerely thanked, ”Thank you, Teacher Tong...”