Sunday, September 28, 2008

Wow! the rare surgery...

Voluminous books and small brain, what to read and what to remember? Various surgical procedures and various results, which one to do and what to follow? More than that is the surgeon’s experience and preferences. For what he is comfortable and what is his limitations? If any one is sure about his expertise, one can do any surgeries. After all who so ever has described the procedure must have done hundreds of such surgery, however difficult it may be!

Our team was prepared for once in a life time surgery in the theatre. All were busy since last few days to sharpen our surgical intellect. Two teams for two different surgical sites of same limb. Last night we were almost awake planning the surgery. Every 4 members were busy finding and collecting what is available from various publications. Thanks for providing the recorded similar surgery, though the surgery was done somewhere in Europe. Old CD and low quality print, still the theme and message was clear. Surgery was all about a middle aged man with osteonecrosis of left femoral head. And plan was core decompression and vascularized fibula grafting. This was one of the most difficult and challenging procedure for such cases. This was not only a challenge in soft tissue handling but also demands microsurgical expertise. The vessels of barely hair like are sutured with a thread barely visible with naked eyes and blood flow across it is ensured.

The anastomosis is most challenging, time taking and tiring too. This must be the reason for not doing this surgery everywhere. In fact, when it was posted for surgery everybody was doubtful for it’s completion. Yesterday our team discussed the entire procedure. Though I am not a regular member of the team, I was called to help them with my little knowledge of microsurgery with small slender steady hands. This strongly inculcates me to become a micro surgeon. Though orthopedics does not demand such perfection but if one has great tissue handling quality, nothing like it.

Big boss and me one team and young boss and my senior colleague another team. Big boss being hand surgeon once again proved his vast experience and perfection. My assistance spared the time and we could finish our part in 2 and half hour. We took 15 cm fibula with a long vascular pedicle of 7 cm. Finally at the end of 4 hours another team finished the dissection around hip and isolated the required the vessel for anastomosis. Core decompression was done and fibula was inserted gently and fixed with K wire. Half of the job was done. What left was vascular anastomosis. Too thin artery and collapsed veins, God it’s very difficult to anastomose vessels without microscope. And I had no loop for magnification. But for me there was no problem to identify lumen and thread. May be my eye sight is adequately corrected or overcorrected!

Finally big boss passed on suture. Single suture and he says laxman occupy my place and assist to get other. Saying so, he left the theatre. I was then assisting our young boss. But we did the anastomosis under operating microscope. Wow! Great experience, at the end of arterial anastomosis the artery started pulsating as if a small round worm moving or crawling. This is what we were eagerly waiting. Though it was my second time triangulating under microscope I did not feel like I was doing for second time. Confident and smooth movements of my hands confused me how it is possible? I thought I could do micro surgery if I am trained properly.
Finally at the end of 7 hours we finished the entire procedure. We all had a terrible back pain because of awkward posture both in standing and bending. We were trying to make the position comfortable but nothing worked well. May be it was the first time so we could not fix in comfortable position as it should be. Even after a hurting back, empty stomach and dehydrated mouth we all were happy cause the surgery was being done for the first time and it was successful.

At the end of day I barely can stand for a while but was smiling for being an important member of micro-orthopedic surgical team. I am happy not because I saw the rare surgery, I was happy that I was contributing a lot to it. On top of that we four were operating and our junior and seniors were watching the surgery and enjoying. Who knows they may be thinking AIIMS makes everything possible………

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