As the scrub nurse trolleyed the operative bed into Operation Theatre number 2—or OT 2, for short—its versatile wheels clattered against the marble tiles lining the hospital floor. Large, dark-black colored surgical bins beckoned in the near distance, replete with bandages, gauzes, and used syringes. As I entered OT 2 from the adjacent side of the hallway, I caught sight of the patient, a morbidly obese teenager, huddled in one corner of the bed, apprehensive of the impending Laparoscopic Cholecystectomy.
Laparoscopic Cholecystectomy is a very standard surgical procedure in which the surgeon, who is specialized in Laparoscopy, intervenes by using a pin-hole camera and another surgical claw that has detachable tongs that allow the surgeon to appendage surgical scissors or coagulators upon his discretion. Despite being a procedure that usually merits no careful cogitation, however, it is an operation that can subsequently be complicated due to various factors such as obesity. It follows, then, that this case was no different.
The OTs, I have come to realize, have a very distinctive aroma, which can be attributed, in a large part, to the burning of human subcutaneous fatty-tissue using electrocuting devices. Although quite intensive, this stench has, over time, been etched onto my mind as being indicative of a dichotomous back-set: less than a few feet away, outside the OT, the patient’s relatives chatter on, assured that surgeons are nothing short of demigods and that surgery is a certain, concrete, and exact science. Inside the OT, however, the lines of this perceived certainty commix to fade into an abstract, grey and imperfect science.
Surgeons are, through their years of Herculean, onerous and (quite literally) blood-filled training, inured to this aforesaid uncertainty. Just when a certain surgical procedure seems to get vapid, complications arise, and it is within these complications that the surgeons must resolve to be the most composed they can be.
As the surgery went underway, the surgeon soon realized that Ms. P, who was morbidly obese, presented a case that at first sight had seemed very complicated but became surmountable through perseverance. My eyes affixed on the monitor, I noticed that the patient’s liver had been pushed upwards to an unusual place, and as is often the problem with Laparoscopic interventions, there is insufficient space in which to insert and in turn manoeuvre a pair of surgical retractors. The question, then, was how to cause the patient’s liver to droop without damaging the Superior Epigastric artery, an abdominal continuation of the Internal Thoracic artery that bleeds profusely when severed.
Amidst the frenzy, I resorted to my surgical handbook, but to my utmost dismay, only found suggestions such as, “free the liver from its surrounding peritoneum so that it is mobile enough, and then gear up the abdominal suction to an extent that causes the liver to protrude through its surrounding fat.” What no surgical handbook suggested, however, was that through simply tilting the versatile operating bed-head upwards to 45 degrees, we could allow the liver to move down to its usual position. This would also, of course, avoid the risks inherent in trying to manually move the liver down all the while running the risk of severing a blood vessel as crucial as the Superior Epigastric artery. In the end, a consensus was reached to try this manual tilt-up manoeuvre, and amusingly enough, this kind of physical manoeuvre is nowhere to be found in surgical texts. In the end, this move proved successful as I saw the surgeon seamlessly excise the Gall Bladder from its fossa on the underside of the liver, avoiding any potential damage to the Cystic artery that supplies blood to the Gall Bladder.
“The operation went well!” I told the patient’s family, as I stepped out to greet a congregation of anxious relatives. “Thank God,” exclaimed one of the older men, his grey hair glistening from the fluorescent ceiling tube-light. “This must have been a very straight-forward procedure for you, considering the innumerable operations of this nature that you have performed, “ the man remarked in a matter-of-fact manner, asking rhetorically.
And in the midst of trying to answer his rhetorical question in my head, I realized that ignorance is indeed a bliss at times.