Special Forces Medic

After perfusion, the kidney presents a pale exterior, and the transparent flushing fluid helps easily identify bleeding and other conditions during dissection. Sequentially, the Gerota fascia is opened and after the bilateral adrenal glands are removed, the entire bilateral kidney can be excised along the distal abdominal aorta, with the ureters severed near the renal pedicle.

After confirming the anatomical positions of the bilateral renal pedicles, Xiao Lin successfully severed them, completing the excision surgery, and handed the kidney to Li Jingyi: "The further away from the renal pedicle, the better, as it is beneficial for the subsequent choice of the kidney implantation surgery."

Li Jingyi nodded understandingly and wiped the sweat off Xiao Lin's forehead. The latter glanced at the clock on the wall—it was already two o'clock in the morning: "Next, we will perform the transplant surgery."

"Do you need a rest?"

"The sooner the surgery is over, the better it is for Dan Qing. Her physical condition cannot withstand a prolonged procedure." Xiao Lin shook his head. In truth, he didn't favor the idea of resting midway during surgery. A perfect operation should be completed in one go. He doesn't oppose or endorse the habit of taking breaks during long surgeries, nor does he imitate them.

The kidney bag used for housing the kidney is sewn from four layers of gauze into two layers, with the kidney placed in the middle, frozen at a temperature between 0 and 4°C. Li Jingyi took the kidney bag out of the freezer, added water into the basin, and clamped the gauze's outer layer with forceps to prevent the kidney from being compressed.

Because the renal vein, when exposed, is prone to adhere to ice chips, wrapping it with wet gauze is necessary for renal vein anastomosis. Li Jingyi carefully used saline spray to detach the gauze, until the artery and vein were completely open, then she took out the kidney bag and soaked it in saline.

The process is slow and patient, and Xiao Lin did not rush Li Jingyi, using the waiting time to address some minor issues inside Dan Qing. To him, time symbolizes life, and he would not waste this precious time waiting in vain.

"Dr. Xiao, you can proceed now."

Li Jingyi placed a single cloth under Dan Qing's hip to elevate the surgical blood vessel area, and Xiao Lin smiled at her, satisfied with her steadily progressing state.

Open the abdominal external oblique and transverse muscles with an L-shaped incision on the lower abdomen, without severing the rectus abdominis, but with an incision on the front sheath of the rectus abdominis. Li Jingyi performed electrocautery hemostasis, coordinating accordingly.

Xiao Lin pushed the peritoneum inward, protecting the inferior abdominal arteries and veins. After exposing the internal iliac, external iliac arteries, and external iliac vein, an automatic retractor was used.

A layer of loose fibrous tissue and reticulated lymphatic vessels were distributed on the iliac vessels' surface. The connective tissue between the arteries and veins was meticulously ligated with 0 number thread.

"Here, we must pay attention to the direction of ligation, which should follow along the blood vessel direction, reaching the common iliac artery upward and the groin downward."

Li Jingyi stared at Xiao Lin's unusual technique; it was a bizarre gesture she hadn't used before, swift and accurate. She couldn't help but raise her head to gaze at the person explaining in a specialized tone.

Why would someone with such superb medical skills come to a small school hospital? This question, winding around her heart from the beginning, tumbled back from memory once more. But these didn't matter; she saw hope for her son in him.

"Improper handling of lymphatic vessels here may lead to lymphatic leaks or lymphatic cyst formation post-surgery. Therefore, we must note this point to prevent continuous seepage of clear lymph fluid from the wound site after surgery, which is hard to distinguish from urinary fistula or lymph leakage."

Xiao Lin used a dissector to push the loose connective tissue on the vein away, fully exposing about 4-5 centimeters of the external iliac vein, enabling the auricular clamp to clamp the vein smoothly and allowing renal vein and iliac vein end-to-side anastomosis.

"See here?" Xiao Lin nudged the area around the external iliac artery: "Here, for anastomosis with the external iliac vein."

Li Jingyi glanced at it and said to Xiao Lin: "You can draw two stitches on the fibrous membrane of the external iliac artery to suture with the lateral muscle, but don't pull too tight, as it might hinder removal post-surgery."

"Excellent." Xiao Lin handed the tool in his hand to Li Jingyi: "You'll complete this part."

Li Jingyi didn't expect Xiao Lin would propose such a request; she stared at him in a daze: "I can't do it!" After a long time, she found her voice. This isn't child's play; she hesitantly rejected Xiao Lin's kindness.

"No one is born knowing how. If you can't manage such simple suturing, how would you operate on your son later?" Xiao Lin's stern voice was accompanied by his undeniable authority, and Li Jingyi took the tool from his hand and began to complete her earlier description.

Holding the surgical instrument imbued with Xiao Lin's body heat, her anxious heart calmed down. With her years of experience in surgical operations, Li Jingyi executed the suturing carefully and conventionally in the unnecessary places before handing the instrument back to Xiao Lin.

"Beautiful suturing technique."

Time continued to slip away, and Xiao Lin said no more. The separation of the internal iliac artery begins outside the common iliac artery and extends along the internal iliac artery 3-5 centimeters toward the distal end.

"Note the branch on the posterior side of the internal iliac artery; here, one needs to ligate and suture once to prevent slippage. If the patient is older and often has arteriosclerosis formation, for those with smaller arterial diameters, the arterial plaque should be removed to enlarge its caliber to match the renal artery diameter, employing the external iliac artery for end-to-side anastomosis. A sufficient caliber and shallow position for renal artery-external iliac artery side anastomosis facilitates and shortens the time compared to anastomosis with the external iliac artery, and the bladder sidewall separation can be performed during ureter-bladder anastomosis."

After Xiao Lin finished this step, Li Jingyi handed the auricular clamp to him, clamping the external iliac vein at 3/4. Using vascular scissors, the vein was cut open, and Li Jingyi flushed the vein lumen with heparinized water until the caliber matched the renal vein.

"The incision on the vein is best placed on the outer anterior side, as the kidney is placed in the iliac fossa, facilitating smooth renal blood return." Xiao Lin glanced at Li Jingyi: "You handle the venous anastomosis."

This time, Li Jingyi didn't refuse.

Venous anastomosis typically involves two-point suturing, where one stitch at each upper and lower end of the iliac vein serves as a fixing point, followed by continuous suturing from the inner and outer sides.

Watching Li Jingyi maintain a stitch distance of 1.5mm, about 1mm from the incision edge, allowing the vein to be flipped outwardly, maintaining good intima alignment, Xiao Lin couldn't help but admire Li Jingyi's suturing technique. Perhaps women are always slightly better at this than men.

Upon the final stitch, Li Jingyi could inject 5-8 ml of heparinized saline with a fine angled needle, tighten the suture without leakage, filling the renal vein with heparinized saline, and she tied the knot. Then, she clamped up the renal vein, released the auricular clamp, and observed for any bleeding at the anastomosis, ensuring no leakage before nodding to Xiao Lin. (To be continued. If you enjoy this work, you are welcome to vote for recommendation or monthly tickets at Qidian (qidian.com); your support is my greatest motivation.)