“I’m going to perform a cerebral tumor embolization first, and then resect the tumor using LITT,” Li Yun further explained the surgical plan to Chief Gao. He needed the chief to back him up before heading into pre-op meeting with the neurosurgery department.

“You want Dr. Pixing to assist?” asked Chief Gao.

“Probably,” said Li Yun. “Mi Xuan had been practicing on the ROSA machine, but I don’t think she’s ready or have enough expertise on neurology.”

“But is he going to be okay with not using a MRI?” Chief Gao felt uncomfortable operating without a CT or MRI like any other surgeon, but Li Yun only need a final scan as documentation for the patients. Whereas, all of LITT surgery was MRI-guided.

“We will use real time MRI during the operation,” said Li Yun. He didn’t need the MRI, but it was necessary for others.

Li Yun couldn’t perform the procedure by himself. He had only practiced the ROSA using Zaowang and far from capable of operating the equipment his own; there were a lot of technical inputs in the machine he wasn’t familiar with. It was better to have someone more experienced to handle the ROSA, especially one already available in the hospital. Also, robotic surgery was a team effort, so using real-time MRI was important for the others to follow along. Lastly, Shang Cang was young and healthy enough to recover from any side effects of dying agents.

After discussing his plan with Chief Gao, they went to the neurosurgical department. Typically, for a new surgery, there would be an interdisciplinary pre-surgery meetings. Li Yun had bypassed the meeting, which caused dissent from the other departments. Director Hong had given Li Yun a bit more leeway than most doctors. In the medical field, Li Yun’s name was on the rise and his patient list included many wealthy patrons.

During the meeting, Li Yun spoke with the top two in the neurosurgery department, the chief and Dr. Pixing. Dr. Pixing was hired at the same time as the ROSA robot acquisition last year and had been trained exclusively with the ROSA three years prior to his employment.

The meeting proceeded as planned with everyone in agreement. The neurosurgical department was glad to be involved, especially because LITT was a new technology for the hospital and it was an opportunity to learn a new technique. Once they had the experience under their belt, it could open more options for their department.

****

Shang Cang arrived at a rental property in Qinbei feeling a bit lost as he searched for direction. The front lobby directory revealed that there was a wine and cheese bar called the Dixia Wine Bar and a veterinary office on the first floor. As instructed in Li Yun’s email, he walked into the bar and approached the front bar counter.

“Hi, is there someone named Nimbo here?” Shang Cang asked the pretty bartender in English.

She stared at him blankly, not understanding his question. She signaled him to wait for one moment by sticking out one forefinger. She left momentarily and returned with an ugly looking manager.

“Hey, are you Shang Cang?” Nimbo inquired in Cantonese.

“Yes, yes,” he replied.

“Follow me, I’ll take you to your apartment,” said Nimbo.

Li Yun had assigned him to one of the rooms at his Qinbei’s property. The apartment was a simple one bedroom apartment, but it looked many times more comfortable than Cang Zhang’s old apartment in Maple Country. As Shang Cang settled down, he looked at the itinerary. His surgery was scheduled the week following his arrival, so he was a bit nervous about the procedure.

During the week, Shang Cang requested to clean the hallways and common areas. Nimbo thought it was odd, but Shang Cang needed to do something other than sleep.

On the day of the surgery, Shang Cang took a taxi to the hospital. He felt uncomfortable not being able to understand what people were saying.

“You can’t speak Mandarin?” Doctor Hao asked in Cantonese.

Shang Cang shook his head but was relieved someone could speak Cantonese. He couldn’t speak well, but at least he could understand what the doctor was saying.

“You’re the patient little Yun bought in?” asked Doctor Hao. “Interesting since he doesn’t normally search for patients. Your operation bumped Mayor Shu’s surgery to this afternoon.”

“Really?” Shang Cang didn’t know about Mayor Shu, but he didn’t know how else to respond. Should he feel glad that his surgery took priority over a mayor?

A few moments later, the nurse helped Shang Cang prepare and they headed into the operating room. There were video cameras set up. Although Shang Cang had signed the agreement to have his surgery broadcast on a medical forum, he didn’t know that there were more than a thousand doctors from various cities around China and even other parts of the world were watching the surgery.

Li Yun arrived inside the OR in his blue scrub. After reviewing the basic pre-surgery checklist, the anesthesiologist injected the anesthesia. The process for the cerebral tumor embolization was similar to the embolization for Minister Yue’s operation. Having more experience, Li Yun completed the first portion within ten minutes, shocking Dr. Pixing who was still preparing the ROSA.

Dr. Pixing had seen Li Yun perform surgery before, but it was the first time he worked alongside the infamous surgeon of Qinbei Hospital. Dr. Pixing could be intimidating to many peers and students, but he never thought there would be someone from the younger generation who could give him so much pressure.

Once the drilling apparatus was placed on Shang Cang’s head, ROSA drilled a 3mm opening into the skull and inserted the laser probe directly toward the location of the tumor. The direction and line of penetration to the tumor had been carefully calculated to minimize damage to the brain.

"Insert the probe a millimeter further," Li Yun instructed Dr. Pixing as he touched an exposed portion of Cang Shang's head. What he could see was much more accurate than the MRI.

The concept of LITT was simple. Place the probes over the tumors, and allow the thermal energy to destroy the cells. Unlike most standard operations, Li Yun was many times more precise without destroying the healthy cells. To many people, it seemed like an impossible task, but not for Li Yun.

Li Yun could see the gliomas and destroy it with the probe. When he used the Y-19 on Minister Yue, he was working with a microscopic scale bb gun. The laser probe was a flamethrower in comparison. He had to destroy the brain cells that were beyond repair and kill off all the gliomas. The problem with gliomas was intertwined with the healthy brain cells.

It was tricky to kill the gliomas without damaging the healthy cells. The more healthy cells he destroyed, the slower the recovery rate. For some surgeons, they prefer to remove the margins around the tumor as it would reduce the chances of recurrence.

Shang Cang’s tumor was 6 centimeters in diameter. A 2mm catheter laser was typically used to treat up to 3.5 cm diameter tumor. The laser could destroy a good portion of the mass, but the remaining fried tumor needed to be removed to avoid infection and swelling. For larger mass, a craniotomy was needed, but Li Yun opted for a suction catheter.

LITT surgery typically took three to four hours, but the majority of the time was spent positioning to the correct location. The procedure was MRI guided so Dr. Pixing could also see on the screen.

Dr. Pixing followed Li Yun instructions, but he wasn't sure how Li Yun was making such a decisive call. Even with his experience, he needed time to decide on the next positioning spot. The imaging wasn't in 3d type, but a screen with four different cross sections that mapped out the area of the thermal ablation. It would take Dr. Pixing ’s team of three neurosurgeons to calculate the next positioning.

Li Yun instructed Dr. Pixing to move the laser probe to a certain coordinate. "All right, start the ablation."

"Already?" Dr. Pixing was unsure as everything felt too quick.

"Yep," Li Yun continued providing them the next location based on his view.

Within an hour, the procedure was completed. In the afternoon, Shang Cang regained much of his consciousness and requested to meet with Li Yun.

Upon looking at Shang Cang’s complexion, Li Yun noticed that his demeanor was a bit different. There were more trust in his eyes. Some people believed that brain surgery could affect a person’s behavior and personality. Li Yun didn’t think it would affect him so dramatically.

“You’re feeling better?” Li Yun asked.

Shang Cang nodded.

“I’ll send you some herbal tea,” said Li Yun.

After brain damage and surgery, the neural stem cells generated new cells. They were more active in children, but Li Yun’s prescription would speed up the process.

“Thank you,” Shang Cang slowly took out a wooden disc from his bag. “This is the compass my grandfather had told me to carry if I ever want to see him in the dream world.“