Changing of the guard
// March 30th, 2009 // No Comments » // Surgery
Today I helped a surgeon remove someone’s entire large bowel and form a new rectum, laparoscopically. This is high-sweat surgery, which was heart-wrenching even a few decades ago. It still can be, but the use of new technology, a laparoscope (or keyhole surgery), has made it into a completely different experience. Where patients once had a zipper of staples from pubic bone to ribs, now they escape with a little scar that we most commonly associate with a caesarian section for childbirth, and a few stitches in the their belly button.
As you can imagine, this makes recovery comparitively easy for the patient There is less pain, and they can usually walk around fairly quickly afterwards. They can even have a good cough, if they need to.
Surgeons today are learning totally diffferent techniques and skills than 40 years ago. So we can now do operations in ways that are perhaps a bit more fiddly, but can give a better view of the operating field, and a better recovery for the patient. But equally, we are becoming bad at operations that used to be bread and butter.
Earlier this century, surgeons were excellent at dealing with stomach and duodenal ulcers. They used to rupture, or bleed, and usually in the middle of the night. Surgeons learnt how to deal with them quickly in an emergency. They regularly took out gallbladders through big cuts under the ribs on the right side, which ended up in a deep dark hole under the liver. In Victoria, where I live, general surgeons managed hydatid cysts in liver - something I can’t even imagine, despite the extensive descriptions of “old-timers.”
All these forms of surgeries have become uncommon. We have great medications for ulcers, and gastroscopes, which mean they don’t usually come to surgery. We use keyhole surgery to take out gallbladders now, and I bet I don’t take one out through a big hole more than ten times in my four years of training. We have good drugs for hydatids, too, and the special equipment developed to deal with them have been removed from the sterile cupboard.
“New” surgery is exciting, and has opened up wonderful possiblities. But, occasionally, we will still be called on to perform the old favourites. Just we won’t be very good at them. Nothing like only doing open gallbladders on the difficult ones. So maybe the choice is now between a really little wound, or a wound much bigger than the old-timers would have managed.
Image credit: Wonders and Marvels
