Chapter 330 - 224: Friendly Sparring

Chapter 330: Chapter 224: Friendly Sparring

Huang Chengjun took a step forward and extended his right hand. "Jiang He, I’ve heard a lot about you. I’m Huang Chengjun."

"Hello, Dr. Huang. This is Chen Hao, a core member of my team."

Huang Chengjun immediately nodded to Chen Hao in acknowledgment, without any hint of condescension.

As Professor Zhong Shouxian’s most prized student, Huang Chengjun wasn’t just a gifted surgeon; his interpersonal skills were equally outstanding.

The logic was simple: anyone a genius like Jiang He kept by his side was bound to have extraordinary qualities of their own.

Chen Hao quickly returned the gesture.

’He was actually panicking a little inside.’

After all, he was facing some of the top medical students in all of China.

’But I can’t embarrass Old Jiang. I have to at least pretend to be calm.’

"Please, have a seat. Make yourselves comfortable."

After getting them settled, Huang Chengjun picked up the remote and rewound the surgical recording to the point where the abdominal cavity had just been opened.

"Since Dr. Jiang has studied the posterior approach, why don’t we use this operation as a basis and walk through it directly?"

"Alright."

After Jiang He sat down, the atmosphere in the demonstration room shifted slightly.

It was like a summit between the chosen prodigies from two top Sects in the martial arts world.

A cup of fine tea, a game board.

The two sides placed their pieces on the board.

They were competing over their understanding of human anatomy, their innovations in surgical techniques—a pure contest of inner strength.

On the screen was the recording of a pancreatic head cancer surgery performed by Professor Zhong Shouxian.

In the video, the chief surgeon swiftly performed a Kocher incision.

He mobilized the duodenum to the left, exposing the inferior vena cava and the abdominal aorta.

Huang Chengjun pressed pause.

"For a Whipple procedure, we’re accustomed to mobilizing from right to left. But at this stage, Professor Zhong discovered the tumor had already invaded the superior mesenteric vein and encased the celiac trunk. According to the posterior approach concept, at this very moment when the abdomen is first opened, where should we make the first cut?"

Jiang He answered, "Bypass the right side and enter directly from the left. Find the Ligament of Treitz, dissect the suspensory ligament of the duodenum, and mobilize the proximal jejunum."

A glint flashed in Huang Chengjun’s eyes. He picked up a marker and quickly sketched a simple diagram of the abdominal vascular anatomy on the whiteboard.

"Starting at the Ligament of Treitz does indeed bypass the right side. However, when you lift the pancreas from behind, the root of the superior mesenteric artery (SMA) is covered in a dense nerve plexus. Without transecting the pancreatic neck, the surgical field is extremely narrow. How would you determine if the artery has been invaded?"

"That’s where the core value of the posterior approach lies."

Jiang He stood up, walked to the whiteboard, and began to write and draw.

"Since the Ligament of Treitz is already incised, our first step is to retract the mobilized jejunum to the right side and, anterior to the abdominal aorta, directly locate the root of the superior mesenteric artery."

"We would incise from the left posterior aspect of the SMA root, performing a sharp dissection upward along the artery’s adventitia. If we can proceed smoothly up the left-sided plane of the SMA and completely separate the uncinate process of the pancreas from the artery, it means the artery is clear and the surgery can continue."

"And what if you can’t separate them?" another young doctoral student from Peking Union Medical College Hospital at the long table couldn’t help but ask.

"If the plane is gone, it means the tumor has invaded extensively. At this stage, the patient’s digestive tract is still intact, so we can immediately terminate the procedure, close the abdomen, and have the patient undergo neoadjuvant chemotherapy."

Huang Chengjun stared at the whiteboard, lost in thought.

’This concept has something to it. You could even call it audacious!’

The traditional approach is to first transect all the peripheral organs and veins, only attempting to dissect the artery at the very end.

If you discover the artery is compromised by the tumor at that point, there’s often no turning back. You just have to forge ahead and keep cutting, with survival being a long shot.

But Jiang He’s artery-first approach was like striking directly at the enemy’s headquarters.

It was a preemptive strike, directly probing the most dangerous territory—the forbidden zone of the artery.

If things go south, you can retreat completely unscathed!

"The theory is stunning," Huang Chengjun nodded, not stinting on his praise.

But then his tone shifted. "But Jiang He, how would this work in practice? The SMA is surrounded not only by the nerve plexus but also by aberrant vessels, like a replaced right hepatic artery. If you cause a tear while dissecting blindly from behind, the patient could bleed out and go into shock on the table in an instant."

"Yes, you’re right. We can handle that by..."

"That’s interesting, but how would you solve this part?"

"We could do this..."

The conversation between the two was rapid-fire, dense with technical terms.

The Sect’s prodigy had run into the prodigy of the human race.

Sharing the same intellectual lineage, their conversation flowed with great enthusiasm!

Meanwhile, a young doctor sitting at the far end of the long table was frowning ever more deeply.

His name was Wang Ke. He was Huang Chengjun’s junior and a brilliant clinical doctoral student newly recruited by Peking Union Medical College Hospital this year.

From the moment Jiang He had walked in the door, Wang Ke had felt a sense of displeasure.

’A medical student from Southern First Affiliated Hospital, barely in his twenties, dares to come to Peking Union, look at Professor Zhong’s surgical video, and teach *us* how to perform surgery?’

Wang Ke had the pride that came with being from Peking Union.

In his view, all these theories Jiang He was spouting were nothing more than armchair strategy, completely failing to account for the complexity of frontline clinical practice.

Surgery wasn’t something you could accomplish just by flapping your gums.

Wang Ke simply couldn’t hold back any longer.

He threw out a question:

"Dr. Jiang, I admit your posterior approach concept is very appealing. But when mobilizing the uncinate process of the pancreas from behind, you inevitably have to deal with the inferior pancreaticoduodenal artery (IPDA). This vessel is extremely short and often originates directly from the SMA, making it impossible to use conventional ligatures. If traction causes a tear at the root of the IPDA, the surgical field will be instantly flooded with blood. Without direct visualization, you can’t even apply pressure to stop the bleeding. So, tell me, how do you handle that problem?"

Huang Chengjun said nothing.

He also wanted to know if Jiang He had a contingency plan for this specific detail.

Just as Jiang He was about to speak, a voice suddenly came from his side.

"I can answer that question."

Chen Hao had spoken up!

In that instant, it was just like in *One Piece*.

Luffy fights the enemy boss.

Zoro fights the second-in-command!

A question from a Small Fry didn’t require Jiang He himself to answer.

During this time at Affiliated Hospital No. 1, Chen Hao had been through a lot with Jiang He.

He knew a fair bit about the posterior approach, too. Yang Xu had held so many hospital-wide meetings to popularize it that this particular issue had been discussed long ago.

Chen Hao said, "Who says we have to use conventional ligatures or bipolar coagulation when dealing with this vessel?"

Wang Ke was taken aback for a moment. "If not ligatures, then what?"

Chen Hao said, "Before beginning to mobilize the uncinate process, we can simply change the patient’s position. Tilt the operating table to the right and raise the head end. Gravity will cause the small intestine to naturally fall into the right lower quadrant of the abdomen."

Chen Hao paused, looking at Wang Ke’s somewhat surprised expression before continuing, "Once the tension is released, the angle between the IPDA and the SMA will widen. At that point, using an extended LigaSure vessel-sealing device, we can insert it through the incision at the Ligament of Treitz. Under direct vision, you only need a three-millimeter gap to directly seal a vessel up to five millimeters. Seal, then cut. The whole process is bloodless. The risk of tearing you mentioned simply doesn’t exist."

Wang Ke was stunned.

Huang Chengjun was stunned, too.

’Changing the patient’s position to use gravity to release tension, combined with a specific new device for minimally invasive sealing...’

’What kind of thinking is this?’

’Wait, is everyone at Affiliated Hospital No. 1 this incredible now?’

Wang Ke tried to find a point to rebut, but he found he had nothing to say.

Huang Chengjun took a deep breath, his estimation of Jiang He’s team rising another level.

He walked to the whiteboard, erased the vascular diagram he had drawn, and then said:

"Jiang He, I’ll admit, the logic of your theory is extremely tight. But the biggest problem with the posterior approach is that it’s *too* theoretical. In current clinical practice, it’s impossible to implement on a large scale. The risks far outweigh the benefits. Personally, I don’t approve of making the posterior approach a routine clinical procedure at this stage."

Huang Chengjun’s assessment was very fair.

No matter how perfect a theory is, if it demands a superhuman level of skill from the chief surgeon, it can never become a medical standard that helps the general public.

Jiang He nodded.

"Dr. Huang’s concerns are very professional. However, the low margin for error is a concern for the average surgeon. In fact, clinical trials for the new posterior approach have already begun in the hepatobiliary surgery department at Southern First Affiliated Hospital. We’ve started rolling it out department-wide. Professor Yang Xu is the chief surgeon, and he has already successfully completed several cases."

As soon as he said this, the entire demonstration room fell silent again.

They’ve already...

Started rolling it out?

Wang Ke couldn’t take it anymore.

He shot to his feet and asked:

"Dr. Jiang, you’re saying your Affiliated Hospital No. 1 has already started implementing this. Are you trying to say that your hospital’s surgical experience and techniques are more advanced than ours at Peking Union? More mature than ours?"

Wang Ke didn’t mean to turn the discussion into an argument. He just couldn’t believe it. A new technique that even Peking Union was hesitant to attempt had already been put into practice at a provincial hospital in Southern China?

In a way, this was a challenge to the authority of Peking Union’s surgical department.

Facing Wang Ke’s interrogation, Jiang He remained calm. "That’s not what I meant. I’m simply stating the facts."

Wang Ke was stopped in his tracks.

Huang Chengjun frowned, raising a hand to signal Wang Ke to calm down.

He was just about to ask for details about the patients’ surgical prognoses and specific metrics.

「Just then,」

The door to the demonstration room was pushed open.

The moment they saw who it was, everyone at the long table rose to their feet in unison.

Standing at attention!

"Hello, Professor Zhong."

"Hello, Professor Zhong!"

Everyone greeted him in chorus.

Zhong Shouxian nodded slightly and glanced around the room.

Finally, his gaze landed on a young figure.

Jiang He’s eyes also showed respect for a senior.

Zhong Shouxian looked Jiang He up and down.

After a moment, a kind smile slowly spread across his face.

"Jiang He, is it?"

Jiang He bowed slightly. "Yes. Hello, Professor Zhong."

Zhong Shouxian patted Jiang He’s shoulder lightly.

"Young and promising..."

Zhong Shouxian looked at him with admiration. "I’ve been waiting for you. Director Xu told me you know a great deal about the posterior approach. Come, let’s have a good talk."

After speaking, he turned to the others with a chuckle and said:

"All of you, sit down and listen carefully. Take out your notebooks. The main reason I had you come today was to learn from Jiang He. So learn well."