The Surgeon’s Studio Chapter 106 - Crossed Hands Maneuver

Chapter 106: Crossed Hands Maneuver

Shenzhen City, a city open to all.
The phrase, “everyone is welcome to Shenzhen City”, was deeply ingrained in the hearts of all of its people. Following the construction of the Hong Kong-Zhuhai-Macau Bridge, Shenzhen City received another boost to its already rapid development.
People of all creeds and origins swarmed into Shenzhen City from all over the country, and to sustain this influx, hospitals with multiple specialties were established. In addition, there was a massive influx of medical professionals into the city due to the shockingly high wages on offer.
…
…
Shenzhen Economic Development Zone People’s Hospital was a large, newly-constructed Class Three Grade A general hospital. Its bright, spacious corridors coupled with clean wards were eye candy.
However, what attracted visitors most was the presence of metaphorical demons of the medical field from Mainland China, which the People’s Hospital had hired for a king’s ransom.
One of them was Wu Haishi, a retired senior consultant in interventional radiology, who had been re-employed in the People’s Hospital.
The elderly man, who was already sixty-four years old, was one of the first few people in China to study interventional radiology and was an eminent authority in the domain.
He had a smaller workload due to fewer consultations in the newly established People’s Hospital and the standardization of various treatment programs, which were still in progress.
Old Wu adhered to the style of the older generation—being down to earth and hardworking. Even in Shenzhen City, without fail, he insisted on exchanging views and theoretical knowledge with his fellow colleagues every day.
After the morning ward round, Old Wu sat in his office, put on his spectacles with presbyopia lenses and began preparing materials for his next lecture. He also added footage of digital subtraction angiography so that junior doctors could better understand the process and potential difficulties of surgery.
“Knock-knock-knock!” Someone was at the door.
“Please come in.”
“Master,” greeted a man in his thirties who entered and stood in place ceremoniously.
He was Mu Tao, a thirty-eight-year-old closed-door student[1] of Old Wu. He had taken a successive undergraduate-graduate program before furthering his studies as a doctoral student under Old Wu’s guidance. When Old Wu had been re-employed to Shenzhen Economic Development Zone People’s Hospital, he had followed suit and moved to the rapidly changing city.
Despite his advancing age, Old Wu’s hearing was flawless. Still reviewing his materials, he nodded. “Yes?”
“Recently, there has been an anonymous account in Xinglin Garden that broadcasts its surgery live. Its host surgeon has just finished a renal artery embolization for post-partial nephrectomy hemorrhaging today, and I thought it was very interesting…”
“Oh? Let me see it. Footage for this type of surgery is quite rare.” Old Wu immediately raised his gaze and pushed his spectacles up, interested.
Mu Tao quickly took out his phone and transmitted the video to an LCD television in Old Wu’s office via Bluetooth.
In the video, the host surgeon was performing a femoral artery cannulation.
His maneuvering was proficient and effective, and every step was done accurately without haste. In a blink of an eye, the introducer sheath successfully entered the femoral artery.
In Old Wu’s opinion, it was only to be expected for the host surgeon to be adept at artery cannulation, which was why he had no criticism to give the beautiful maneuver.
When the micro-guidewire was in place, the imaging system was activated and the operative field was adjusted upward.
“Eh?” mumbled Old Wu this time.
Mu Tao quickly paused the video, perking his ears attentively.
He had followed Old Wu for more than a decade. Without the need for words, he knew Old Wu had discovered something.
That “something” was most likely related to the host surgeon’s precision in blind manipulation of the micro-guidewire. In the video, the micro-guidewire made contact perfectly at the end of the renal artery, which saved a lot of time for subsequent superselective catheterization.
“The crossed-hands maneuver?” said Old Wu as he pointed at the host surgeon’s hands on the screen.
Mu Ta froze for a moment. From his perspective, the host surgeon’s surgery had multiple highlights, but the pair of hands that would soon disappear from the screen had definitely not been one of them.
What the hell was the crossed-hands maneuver?
Old Wu stood up with a smile, walked to the large screen and pointed at the host surgeon’s crossed hands wrapped in sterile gloves. “This is an operative habit only used by the older generations who first learned interventional radiology.
“Look, the left hand is securing the guidewire on the right and the right hand is inserting the catheter on the left.
“Here, you can clearly see the assistant’s hands, but the host surgeon still habitually uses the crossed-hands maneuver to perform the surgery. Do you know why?”
Mu Tao was perplexed after hearing Old Wu’s question.
Were he honest with himself, he considered the maneuver flawed or at least unnecessary as it largely made the assistant’s role obsolete during the surgery.
“I don’t know,” answered Mu Tao truthfully.
“When it all began, the few surgeons who were interested in interventional radiology had difficulty hiring assistants. Therefore, they had to set the guidewire and insert the catheter all by themselves, and thus developed the crossed-hands maneuver where their more nimble right hand would manipulate the catheter while their left secured the guidewire.
“However, you youngsters don’t have to learn that technique now.”
Old Wu felt a little emotional and nostalgic. He missed the old days, where he would perform surgery patiently and meticulously under a large amount of radiation.
Now, every procedure—contrast agent injection, superselective catheterization and insertion of absorbable gelatin sponge—was done smoothly and successfully without pause.
Following the embolization, the host surgeon waited for a few moments before performing another imaging test to ensure the complete absence of the previously massive hemorrhage from the renal artery. With that, the surgery video ended.
“That was good,” said Old Wu softly.
“Their maneuvering was very fast.
“Every act of superselective catheterization was successful, meaning the host surgeon is incredibly precise. Let me try to guess who they could be.” Old Wu sat in his chair, closed his eyes and began meditating.
Mu Tao waited patiently without a sound.
A few minutes later, Old Wu shook his head and said, “Those who used the crossed-hands maneuver have basically retired from the clinical field. Even when invited to attend surgeries, they will guide the surgeon rather than perform it personally. This host surgeon is meticulous, with stable hands and superb eyesight, so I suppose they are a young man.”
Surgeons and boxers shared a common trait—experience and physical fitness never occurred together.
The peak period for surgeons was when they were between forty to fifty years old. This was when they had both significant amounts of experience and were still in a good physical form—not yet assailed by blurry vision or trembling hands.
The heights of surgical proficiency would be reached within this age group.
However, this did not account for wunderkinds.
For example, in the last decade of the twentieth century, a cardiothoracic surgeon reached the pinnacle of his career in his thirties. Unfortunately, he was excluded from Fuwai Hospital in Imperial Capital due to his lack of sociability. Thus, he returned to his hometown in the northeast and established a specialty hospital for cardiovascular disease.
In just a few years, the hospital became the best hospital in the country.
There were many incredible stories surrounding this legend. A few years later, he became a secretary in a medical department at the Chinese Academy of Sciences.
After his retirement, he suffered tachyarrhythmia and required surgical intervention.
However, he trusted only himself as he was the best cardiothoracic surgeon in the country, and therefore other surgeons’ skills and experience were simply inferior to his…
Thus, he laid on the operating table with a screen suspended above his head.
Looking directly at the screen, he guided a doctoral student through his own operation.
Ventricular fibrillation had occurred intraoperatively. After successful resuscitation, he continued guiding the doctoral student through the surgery.
In the end, the surgery had been successful!
Of course, it was merely an anecdote, but the main point was that he was indeed a demon who had reached the pinnacle of his career at thirty-five years old.
Mu Tao felt ashamed of his inferiority, but did his master mean that… the host surgeon in Xinglin Garden was of the same mold?
“Perhaps one of my old friends taught him, who knows?” Old Wu smiled and continued, “Pay attention to this live broadcast room. By the way, save this video to a USB flash drive and inform everyone that we have a training session this afternoon.”
[1] Usually refers to the master’s favorite student who trains separately from normal classes and has the luxury of learning the master’s secret techniques.