144 – It’s like Bario Kart

The following day, everyone who wasn't examining a patient watched from their phones, or if they had the luxury, from the large projection screen.

Fan Geng was lucky Wei Bing dragged him up early to grab a seat in the conference room. Looking at the large projector screen, Fan Geng watched as the procedure was about to begin.

“Patient with stage IIIA unresectable hepatocellular carcinoma. We will use transarterial radioembolization using yttrium-90 to target two locations of tumors, tumor A is 3 cm and tumor B, near the vena cava, is 9 cm in diameter,” Li Yun explained to everyone as they waited for the local anesthesia to take effect.

There was a third location, but they weren’t visible in the CT scans. Li Yun planned to remove it to reduce any chances that it would grow bigger and spread. Typically, after surgery, a round of chemotherapy would be used to kill the remaining cancer cells, but there were too many side effects. 

From a quick scan of Minister Yue, Li Yun could see that tumor B had already reached the vena cava and the circulating tumor cells (CTCs) were already in the bloodstream, but it had not metastasized or attached itself to any organs. If they were not destroyed, they could create more tumors elsewhere in the body. Li Yun planned to search and remove as many CTCs as possible with the suction catheter. 

Once the anesthesiologist gave the okay, Li Yun inserted the catheter and quickly navigated to the liver. He was used to navigating through the blood vessels that it was like playing speedrun on a game he had played over a thousand time. 

Unlike typical procedure, Li Yun was able to actually gauge the best location to release the yttrium-90. He wasn’t concerned about missing tumors, so he wasn’t going to release it early and damage the healthy cells.

Arriving at tumor A, he used the guide wire to release yttrium-90 beads into the vessels and capillaries feeding the tumor. The beads would block off nutrients to the tumor and release radiation that would kill the tumor. Li Yun waited to check on whether yttrium-90 was also affecting the healthy cells. Yttrium-90 had a short half-life and had an area of effect of around 2.5 mm, so it was relatively safe to use. After verifying that the healthy cells were fine, Li Yun moved to the tumor C.

From the monitor’s screen, everyone was clueless as to what was happening. There wasn’t any live imaging for anyone to see.

"This is boring," Fan Geng commented.

"Sh!" Wei Bing was mesmerized despite not being able to see a thing. Just the movement of Li Yun's hands were amazing.

Once Li Yun finished the radioembolization, he removed the guide wire and quickly inserted another wire.

“What is he doing?” Academician Tan was curious as to why he was replacing the guide wire.

“Prepare blood transfusion and the aspiration catheter,” they heard Li Yun’s voice giving out commands to the nurse. “Dr. Lu, prepare for laparoscopic hepatectomy.”

Lu Anchang prepared for the second portion of the surgery, while Li Yun moved the specialized aspiration catheter to the center of the vena cava and waited for the circulating tumor cell (CTC) to pass through.

The CTCs were often bigger and less deformable than regular blood cells. They were either in clusters or single cells. His goal was to remove as many of the clusters as possible, which had a higher chance of metastasis than single cells.

As soon as he saw a cluster passing near, he would suck the clusters into the catheter like a slime rancher, although the clusters aren’t as cute as the slime or even as easy to remove. 

Blood cells and other miscellaneous hormones in the bloodstream travelled at 5-20 cm/seconds, but the movement felt quick from Li Yun’s point of view. He had to move the catheter ever so slightly to get a good angle. Li Yun’s upper body subconsciously moved around as he focused the view in his mind. He was not aware that his body was even moving.

“Uh, what’s up with Dr. Li's movement?” asked Wei Bing, questioning what was on everyone’s mind.

Most people shrugged, but Fan Geng recognized it. “It’s like he’s playing Bario Kart.” It was typical for gamers to move sideways as they steer. 

Wei Bing gave him a blank reaction.

“You know, the ones with Muigi and Princess Plum…." Fang Geng saw Wei Bing blank expression and waved his hand. "Nevermind.”

Li Yun's search and removal mission for the circulating tumor cells (CTCs) in the bloodstream was taking a bit longer than he thought. Li Yun didn’t think it would be possible for him to target all the cancerous cells that flowed through, but he spent close to thirty minutes making sure the bloodstream was cleared. 

There were still hidden dangers in the ductal glands, but eliminating the CTCs in the bloodstream should provide Minister Yue with a better chance of not having a recurring tumor. After removing the catheter, he finally gave An Luchang the signal to make three incisions.

An Luchang assisted him with camera positioning. Once Li Yun was able to see liver, he would be able to discern the location of the major vessels.

The doctors were all curious as to how Li Yun was able to see the liver with just one camera port. On average, surgeons needed 4-6 camera ports for a laparoscopic liver resection, and a minimum of two if the surgeon had close to perfect anatomical understanding. Li Yun was only using one camera port.

He moved the trocar with the scissor to an area closest to the tumor.

“He’s not using carbon dioxide to widen the cavity? How the heck is he going to see anything?” The doctors were all confused.

Li Yun only needed a camera to make sure the scissors were correctly positioned. Once in position, he was able to form a frame of reference to move the equipment within the body. Spatial awareness was something he had to practice with every piece of equipment. 

It was like a swordsman using an invisible weapon to attack the enemy. Without knowing what the weapon was, it would be difficult to use the weapon to its full potential. The swordsman would study the weapon first before using it.

Once he incised into the liver, it was easy for him to avoid all the major blood vessels.

The vessels going into the tumor were clipped, and the coagulating shear began to resect the tumor. Li Yun used his other trocar to clamp onto the tumor as he continued to shear and pull the tumor out of the liver. Once it was completely sheared, Li Yun pulled out the trocar and replaced it with a trocar with a retrieval bag. Once the tumor specimen was wrapped inside, Li Yun extracted the bag out and onto the surgical pan. Finally, Lu Anchang performed the finishing stitch work.

Everyone in the room couldn't believe their eyes. Within an hour, radioembolization and central liver resection of the tumor was completed. Not only was it quick, Li Yun had not completely used the contents of the blood bag.

After the surgery, Li Yun spoke with Academician Tan and Minister Yue's family.

“Although the embolization is successful, can it really be better than a liver transplant?”  Academician Tan asked.

“I can’t guarantee the possibility of a recurrence,” replied Li Yun. 

He was well aware that his biggest weakness was understanding the lymphatic and nervous system. If he was able to discern those systems from the meridians, he would be able to trace cancerous and foreign cells entering in those systems. If there were cancerous cells hidden in those systems, there were still chances of recurrence.

“But Minister Yue should be able to live well for another 4-5 years,” Li Yun reassured. “By then, I am sure there will be advances in medicine that will increase the survival rate.”

There were many types of cancer cells, and even ways to destroy them. The question was whether it was possible to develop medicine that could effectively stop late stage cancer without destroying the body? Many late stage prostate and lung cancers were difficult to treat because the organs were beyond repair and required a transplant.

Academician Tan sighed. “I am still shocked by your ability. I have heard rumors that you have the ability to analyze the flow of blood in the body, but this is too much for me to process. It’s too mythical. You understand how difficult it is for academia to accept this sort of ability?”

Li Yun nodded.

It was really difficult to explain. His reputation was actually better in the TCM community where the doctors had a better understanding of blood flow, circulation and patterns. Yet, even then, they were still skeptical of Li Yun’s ability. 

“If you have time, come visit Magic City,” said Academician Tan. “I would love to have a seminar to introduce your method.”

“If there is an opportunity.” Li Yun wasn’t sure if his method was applicable in the hospital setting. How many people could truly send the ebb and flow of the blood and pulse? On the fingers, there might not even be more than five in the history of the world. As for going to Magic City, Li Yun thought he should set up a time to visit Xuxu, Master Yi Bao and Ansha.

After seeing the live broadcast of Minister Yue's surgery, doctors all over the nation were beginning to realize what a monster he was.

<Fan Geng POV is used mainly to get in all the gaming references. Sad that metroidvania didn't make the cut>