For any surgeon, the experience of leading their first appendectomy is always unforgettable.
The appendectomy is known as a surgeon’s "rite of passage," a testament to its significance.
Wu Ting arrived at the ward early in the morning. The patients in beds 17 and 6 were scheduled for surgery today.
Qin Donglai had assigned Wu Ting his tasks the day before. Arriving at the ward, Wu Ting meticulously inquired about the patients’ medical histories and diligently completed their progress notes.
The patient in bed 17 was a 39-year-old woman who had been experiencing recurring, dull pain in her lower right abdomen for some time. She had been diagnosed with chronic appendicitis...
After Wu Ting finished his rounds, Cheng Feng arrived at the ward. He was incredibly envious to learn that Wu Ting would be leading an appendectomy today.
"Brother Ting, congratulations."
Cheng Feng wondered when he would ever get his hands on his own first appendix.
"Brother Ting, once you’re done with the surgery, you have to tell me what it feels like to remove an appendix. What’s its texture like in your hand?"
Cheng Feng said enviously, then handed over a copy of the *Textbook of Surgery*.
Wu Ting was a little surprised.
Cheng Feng grinned. "I’ve reviewed this *Textbook of Surgery* so many times, but I still haven’t had a chance to put it to use. One of my seniors told me that before your first appendectomy, you have to review every single step. You need to try and anticipate any potential difficulties during the operation and figure out how you’d handle them."
"Brother Ting, your performance in your first appendectomy is crucial. If it goes smoothly, you’ll get a steady stream of opportunities. But if you screw it up, you could get benched. Your next chance to operate might not come for another six months."
Although Cheng Feng had never performed an appendectomy himself, he’d asked plenty of seniors for their insights on doing it for the first time.
"Brother Ting, after your surgery, give me a detailed rundown, too. I need to prepare for my own first time as lead surgeon."
"No problem."
Wu Ting sighed. ’If I didn’t have Luo Ming’s Appendectomy (Yellow) skill, I’d probably be just as nervous as Cheng Feng.’
Wu Ting picked up the *Textbook of Surgery* and reviewed it seriously anyway. He had to admit, there was a certain sense of ceremony to it.
In the afternoon, Wu Ting returned to the ward early, waiting for Qin Donglai to take him to the operating room.
Even though it wasn’t his first time in an OR, this time felt different.
Soon, the OR staff arrived at the ward with a gurney to collect the patient. The surgery was about to begin.
A moment later, Qin Donglai arrived and waved him over.
"Let’s go."
Qin Donglai led Wu Ting to the changing room. After they had both changed into their scrubs, they proceeded to the scrub sinks.
Looking at Wu Ting, Qin Donglai was reminded of his own first appendectomy.
"Wu Ting, under normal circumstances, an appendectomy is a relatively simple procedure. But it can also be very difficult—in cases of an ectopic appendix, for example. So, remember this: even if your first surgery is a success today, you must maintain a healthy respect for the procedure. Never assume an appendectomy is just a ’minor surgery.’ That’s the only way to avoid or minimize postoperative complications and lingering issues."
Qin Donglai was now holding nothing back, teaching Wu Ting everything he knew.
"Understood, Dr. Qin."
Looking at the young man before him, Qin Donglai’s mind drifted back to his own past.
"Wu Ting, when I performed my first appendectomy, things were nothing like they are now. Our sterilization conditions were terrible. After scrubbing our hands with soap, we had to plunge both arms into a bucket of alcohol and soak them for ten minutes. It was winter back then, and the cold was bone-chilling, but I was fired up inside. I couldn’t wait to get into the OR and start my first surgery as lead surgeon."
"In the winter, our ORs relied on space heaters for warmth. Sterilizing your arms in ice-cold alcohol for ten minutes really took some endurance. The moment my time was up, I’d rush into the operating room and get my surgical gown on. Only then would I finally feel warm again."
Listening to Dr. Qin’s story about his first appendectomy, Wu Ting felt his own sense of anticipation grow.
"Alright, let’s head into the OR."
When the two of them entered the operating room, the anesthesiologist had already administered the epidural.
After finishing the disinfection and draping, the first appendectomy of the day began.
"Wu Ting, watch and listen closely. I’m going to demonstrate for you."
Qin Donglai began his lesson in earnest. Even though Wu Ting possessed the skill, he still listened attentively. ’Having a system doesn’t mean I can stop trying,’ he thought.
"Wu Ting, your incision technique is already quite mature, so I’ll focus on teaching you the specific incision for an appendectomy."
"For a standard resection, we use a McBurney’s incision..."
Qin Donglai made an incision on the patient’s lower abdomen, expertly cutting through the skin, subcutaneous tissue, and the external oblique aponeurosis.
"Next, I’ll start using blunt dissection. You’ll assist me by retracting the internal oblique and transversus abdominis muscles..."
Wu Ting assisted with practiced ease. After the peritoneum was carefully lifted and incised, he helped fix it to the skin to protect the incision site.
"Wu Ting, watch this part carefully. The most important thing is to avoid contaminating the incision with fluid from the abdominal cavity..."
Qin Donglai was extremely serious and precise in his approach to surgery.
"Wu Ting, assist me. We’re going to collect a sample of the patient’s peritoneal fluid for a bacterial culture and sensitivity test..."
Under the influence of his Appendectomy (Yellow) skill, Wu Ting naturally began the next step before Dr. Qin had even finished his sentence.
"Huh? Kid, you’re pretty good at this."
’This Wu Ting must have watched a ton of surgical videos,’ Qin Donglai thought with some surprise. ’This level of coordination is perfect!’
"Next is the most critical step: finding the appendix!"
"In other words, it’s time to go rummaging through the guts."
Hearing Dr. Qin’s description, Wu Ting couldn’t help but smile. To be honest, he was eager to experience the feeling of reaching into a patient’s abdomen and searching.
In Medical College, they had all practiced on dogs. Facing a live human patient was a completely different story.
Even though Wu Ting now possessed a Grandmaster Level Tendon Repair skill, the visual and tactile experience of an open-abdominal surgery like this was entirely different.
The appendix is an intraperitoneal organ, about 5-7 cm long—though in rare cases less than 2 cm or as long as 20 cm—with a diameter of about 0.5-0.8 cm.
Overall, as long as you knew the technique, it was fairly easy to locate.
Qin Donglai seized the moment to pass on his own tips and tricks.
"To find the appendix, you can start by locating the ascending colon. Follow the taeniae coli down to the cecum; the base of the appendix is right where the three bands converge. Of course, you can also get to it by following the ileum to the cecum."
While he was still speaking, Dr. Qin had already skillfully located the patient’s inflamed and purulent appendix.
The next steps were to mobilize the appendix, retract it toward the cecum, dissect the mesoappendix, then clamp, cut, and ligate it.
"Wu Ting, watch closely. After gently crushing the base of the appendix with a hemostat, you ligate it with a size 7 suture. If the base is severely inflamed, you can just ligate it directly."
Qin Donglai deliberately slowed his movements. He then lifted the appendix, placed a purse-string suture at its base, and resected the appendix 0.3 cm from the stump.
"Saline... Ethanol... Carbolic acid..."
After sterilizing the stump, Qin Donglai began checking for any bleeding and then started the count of sponges and instruments.
"Wu Ting, remember: for any open-abdominal procedure, you absolutely must perform multiple counts of all sponges and instruments. I’ve known doctors who’ve made mistakes here—leaving a sponge or an instrument inside a patient. That’s a severe case of medical malpractice."
After Dr. Qin finished his count, the scrub nurse counted everything again. Once they confirmed nothing was missing, he began closing the peritoneum with a running suture.
Five minutes later, the procedure was complete.
Qin Donglai glanced at Wu Ting.
"So, are you ready? For the next one, you’re in charge!"