My first time

Salam

I wanted to document this yesterday but since it clashed with my lovely sister's birthday, so I thought I'ld do it today instead. Yesterday saw me for the very first time officially assist in surgery. Having the surgical team understaffed for the whole week, it was down to us student doctors to step up to the plate and prove ourselves worthy of the title in a few years time.

As for me, I wasn't quite lucky enough to be part of a highly sophisticated operation as one of my colleague was involved the day before yesterday. Imagine having no experience at all, suddenly you're called up into theatre to assist on a roux-en-Y gatric bygass. It might sound simple, but 4hours minimum on that one operation proved it has a lot more to it than it sounds. Anyway, that wasn't me, that was my groupmate.

My part of the game wasn't even planned. I turned up to Day Case theatre to 'observe' and learn from Mr White and his SpR. Mr White, being an angry surgeon like all surgeons are, started barking around asking where the cameraman was if there was going to be any. Unfortunately, being understaffed, there wasn't going to be one. His piercing gaze landed on my partner and I and as I anticipated: "So, which one of you is going to scrub up?"

To be honest I almost jumped at that question, rearing to go before my partner volunteered. But out of the spirit of teamwork and respect, I played it down a bit and looked at her. "You can go if you want", I uttered quitely despite knowing my partner has no interest whatsoever in a surgical carreer and the fact she hates standing in theatres. "Don't act, I know you're jumping to go", she said back with a wry smile. Mission accomplished.

Anyway, I got scrubbed up, gave my details to be recorded in the operation notes and also into the system. She briefed me what she was going to do (the SpR is a she). I nodded my head as if everything was new to me, her not knowing the fact that I've been talked through and observed laparoscopic cholecystectomies more times than the fingers on my hands (not many at all compared to the number the surgeons have done). But as I reminded myself, observing and doing are to different things. To know the theory of riding a bicycle and actually riding one are to worlds apart. So, that was my take on the briefing.

She handed me the scalpel and told me to incise to make openings for the ports. I literally stood and gaped. F*ck, I didn't know I was expected to do that much! After a moment of freezing and being speechless which felt like eternity, she laughed at me and retracted the hand which she had the scalpel in. "I was kidding!". F*ck again, you better be! I was shitting myself! Hahaha.

Anyway, she went in and opened up the skin for ports to go in. She handed me a port with a blunt trocar to put into place in the incision. I went in and secured it. CO2 went in and inflated the abdomen which was followed by my camera. I was now officially the cameraman. She made 3 more ports for the instruments and I had to manoeuvre an instrument in 1 of the ports while she took care of matters through another two ports. So it was 2 ports each. My camera arm was literally crying in pain as I stood there for 30mins static. As I switched side with the Reg, I had to handle the liver to get into the gallbladder fossa as she was dissecting it out after clipping and cutting the cystic duct and artery. This was all after sorting out Calot's triangle.

My arm dangling away from my body made it tire much more quickly compared to being able to rest it on my hip. Anyway, after we managed to get to get the gallbladder off the liver, a bit of diathermy then took place, sorting out the small arterioles that were bleeding. Zapping them with electric just fried them and stopped the bleeding. The next part was to yank out the inflamed gallbladder through the tiny incision. It took quite some effort but it went well. The Reg flushed the inside of the patient from blood and we deflated her. Took the ports out and closed her up.

Manoeuvering the laparoscope was definitely a lot harder than it looked. Imagine moving your hands for milimeters and suddenly everything on the screen moved like meters. A tiny gallbladder looked like the size of a small mineral water bottle. It was also ensuring the camera was always upright as you tend to get carried away when moving them around and not noticing the image is not upright (anterior abdominal wall should always be the superior border in the screen).

The Reg was super as she let me close up all 4 port wounds apart from constantly communicating and talking to me throughout the operation to ensure I wasn't bored and everything was done correctly. Finished off with some local anaesthetics (which she let me do again! I'm loving it!) and hey ho, there was my 1st ever experience properly assisting in an operation from start to finish. Just me, the reg and the scrub nurse. What an experience, one for me to remember if I make it to become a surgeon one day. =)

"Can I have a maryland with fire please. Mosquito please."

Thanks Hannah!

NB: maryland with fire: diathermed laparoscopic curved dissectors; mosquito: a type of clip/forceps