Chapter 2582: The Remarkable Aspects

The most important thing is, it doesn’t require splitting the sternum or cutting off ribs, so the damage to bone is minimal and the overall trauma to the body is small. Those are all advantages. You can basically call it a minimally invasive surgery in the field of surgery.

That said, this kind of incision is used mostly in pediatrics, and very rarely in adults. The reason is that adults have a bigger thorax, so when you go in from the right-side incision, the heart lies very deep; it’s hard for the surgeon to see that deep, and hard to operate. All these rules and constraints mean that obese patients and tall, strongly built male patients are essentially not suitable candidates for this approach. Thin adult men and women can give it a try.

The development of a surgeon’s technical skills doesn’t happen overnight; it progresses step by step. In the past, this incision was only used for children under ten. Later it gradually expanded to eighteen-year-olds, and now some hospitals dare to use it in the type of adults mentioned above. On one side, that’s an expansion of the age and body-build range of suitable patients. On the other side, the surgeons doing this type of incision have moved from using it only for simple cardiac procedures to applying it to some complex heart surgeries.

Because right-side incisions are more difficult than standard median sternotomy, any surgeon who can perform this type of incision is, technically speaking, playing at a higher level. Not every cardiac surgeon can do right-side incision surgery.

So how difficult is this operation, specifically? Just how far does that difficulty go? Take Guo Zhi Hospital, for example, that famous heart specialty hospital: there was once a public flap where a doctor came out saying the right-side incision was bad, claiming it would make children develop scoliosis.

What was the underlying problem there? Theoretically, if you don’t cut ribs and only go in through the intercostal muscles, you don’t touch the spine, so it’s impossible for the spine itself to develop issues.

There’s only one possibility: during the operation, faced with difficulties and a prolonged surgical time, they were forced to maximally expose the operative field, and in the process of going in from the right side they were yanking on muscles so hard they were dragging on the spine, knocking the small facet joints related to the patient’s spine out of alignment. That will inevitably lead to relevant postoperative complications. When you boil it down, the problem isn’t that this surgical approach has some inherent flaw; it’s a question of how refined the surgeon’s technique is. In the operation, you have to both keep complications from happening and still complete the surgery smoothly within a limited field of view and access. You can imagine just how much that tests a surgeon’s intraoperative "eye"—their judgment in the field.

From the example above you can see that this kind of surgery is tough enough that even at Guo Zhi Hospital, a few specialists couldn’t handle it well, and then they chirped about how the surgery was bad, advising colleagues not to do it and to switch to lower sternotomy incisions, which can also be marketed as cosmetically pleasing minimally invasive procedures. Of course, many doctors at Guo Zhi Hospital have continued doing right-side incisions and have no intention of giving them up.

Same thing at Shou’er: the doctors who can really do a good job with right-side incisions are a minority. The reason Immortal Brother is called the new star pillar of pediatric cardiac surgery is that, although he doesn’t do many heart transplants (supposedly because he’s not the competitive type and doesn’t like fighting others over donor organs), his right-side incision work is downright gorgeous. Take a sixteen-year-old patient like this one—this counts as a higher-difficulty right-side incision case. Immortal Brother just says he’ll do it and does it, without needing to agonize over it. The family, likewise, asked around extensively before bringing the child to Immortal Brother in hopes that he would do this operation well.

Which brings us to why Xie Wanying and her classmates were all quite curious: who did Immortal Brother study under? After finishing ward rounds today, they discovered that Director Lu is not good at right-side incision surgery.

So is Immortal Brother self-taught?