Welcome to Surgexperiences – the bi-weekly compendium of the best surgical-related posts in the medical blogosphere!

This week, monash medical student, that is I, am honored to host the “pilot” episode of Surgexperiences. Following various encouraging replies from established members of the medical blogosphere, i have decided to go ahead with it.

The condensed version is available at my blog.

Hopefully, this will take off and gather many hosts and future episodes to come.Without further ado, let’s “fire” away (like a surgeon, perhaps?)

The history of surgery

What cannot be cured with medicaments is cured by the knife, what the knife cannot cure is cured with the searing iron, and whatever this cannot cure must be considered incurable.

– Hippocrates (460-370 BC)

Hippocrates was the first documented chest surgeon and his findings are still valid. (Major, Ralph H. (1965), Classic Descriptions of Disease, Springfield, Illinois.) But is he the first surgeon? Far from it.

• ~ 10,000 to 6000 BC: first surgical procedures were performed in the Neolithic Age
• ~ 8000 BC: Trepanning, a procedure in which a hole is drilled in the skull to relieve pressure on the brain
• ~ 2500 BC: In Egypt, carvings dating to 2500 BC describe surgical circumcision – the removal of foreskin from the penis and the clitoris from female genitalia. Operations such as castration (the removal of a male’s testicles); lithotomy (the removal of stones from the bladder); and amputation (the surgical removal of a limb or other body part) are also believed to have been performed by the Egyptians. Ancient Egyptian medical texts have been found that provide instructions for many surgical procedures including repairing a broken bone and mending a serious wound.

• ~2000 BC: In ancient India, the Hindus surgically treated bone fractures and removed bladder stones, tumors, and infected tonsils. They are also credited with having developed plastic surgery at around this period in response to the punishment of cutting off a person’s nose or ears for certain criminal offenses. Using skin flaps from the forehead, Hindu surgeons shaped new noses and ears for the punished criminals.
• ~ 400 – 300 BC: The Greek physician Hippocrates published descriptions of various surgical procedures, such as the treatment of fractures and skull injuries, with directions for the proper placement of the surgeon’s hands during these operations.

Surgery has come a long way since then, and has progressed massively to reach the advanced stage it is at now.

 

A cardiothoracic surgeon performs a mitral valve replacement
at the Fitzsimons Army Medical Center.

The art of surgery

Sid Schwab shares how he would dictate a post-op report with an example following a successful sigmoid colectomy.

Dr Bard Parker from Cut to Cure shares tales from the operating room, with 10 issues. The last one is particularly interesting, and graphic.

Bongi, a general surgeon from the notorious South African province of Mpumalanga, tells us about a tragic story involving a bull’s supposed “powerful” horn and his HIV patient.

The apprenticeship: Resources for trainees

A sound knowledge of anatomy is definitely needed. Apart from the use of a main textbook, like Gray’s, or Moore’s, or Last’s, students and trainee surgeons often use atlases, made up of beautiful and illustrative medical drawings.

We are lucky to have some available online. Street Anatomy is one example. We find out more here about medical-legal illustrations, and their role in the court today. We also learn that the Visible Human Project was possible, kudos to a criminal convicted of burglary and murder.

Over at Brain Blogger, Sudip Ghosh shares with us that expert video gaming skills might actually mean better surgical performance.

 

The training pathway

Most doctors begin their formal surgical training after medical school. For our colleagues over in the States, PGY 1 is spent as an intern in the relevant specialty straightaway. That would mean they have to decide in their clinical years which specialty they wish to embark on. It isn’t good enough to know you want surgery. You have to decide which kind of surgery. Do i want to drill skulls and “improve upon millions of years of evolutions with a single brain operation”, as Frank Vertosick mentions in his extremely entertaining and honest book “When the air hits the brain: Tales of Neurosurgery“? Or do i want to be a “GP of surgery” as a general surgeon? Do i fancy the thoracic cavity? Or perhaps urology? Or perhaps i like the musculo-skeletal system? After all, i have no problem classifying open fractures (#s)? (warning: link contains a few bloody pictures of open #s)

A cartoon depicting an orthopod

For doctors in the UK, Australia, and Singapore, application to a surgical program can start as early as PGY 2. The Royal Australasian College of Surgeons has just come up with a new 5-year Surgical Education and Training program (SET) that promises “to train surgeons, and not BST trainees, or AST trainees”. This means whoever enters the program will train to become a fully-fledged surgeon, no matter what, by the end of the program. (of course unless something medico-legal or disciplinary in nature happens) This was particularly welcome, especially by Craniotomy.

Early surgical exposure

However, surgical exposure begins way before any form of formal SET. Some students get early exposure by scrubbing in to assist for surgical procedures. They speak fondly of it, here.

Craniotomy however was more privileged. He has had “the honour of giving the local anaesthetic, incising, removing and stitching up the patient (or you might think in my case, the victim). The whole shebang!” Read about his first surgical experience here.

All might not be pleasant and rosy, however. When Anthony Rudine shares on The Differential “Why do attendings verbally abuse med students?“, comments were aplenty about incidents in the OR. Anna Burkhead also graciously shares a fainting incident she terms as “a story no one wants to tell“, and hence paved the way for many to share about similar incidents.

Apart from traditional sources of surgical training and education, it seems like a certain Dr. Preston Burke, from Grey’s Anatomy, has inspired many, including Angry Medic.
The culture of surgery

It seems as if the surgeons or surgical trainees are viewed as the “jocks” in the hospital, while the internists are viewed as something else. I see them as the brainiacs! But it seems that a derogatory term “flea” has been coined, and according to Michael Collins, he reveals in his book “Hot lights, cold steel” that it was because they bum around in big groups and make lots of noise, just like fleas that buzz around.

A flea-resistant shirt. (no offense intended)

However, sometimes it seems that even a general surgeon can sometimes be a flea, “only by necessity”, he mentions.Aaron Singh over at The Differential examines also, why do surgeons have such big egos, and inadvertently generates 100s of comments with regards to surgeons’ work ethics, attitudes and behaviour. He then goes on to explain himself and gives further insight into surgery, with special mention of Mr. Philip Henman, an orthopod for the Taliban.

Over in India, the work ethic of a scrub nurse in the OR has impressed Orthodoc so much so to trust him completely, even when he asks for monetary aid.

Over on the surgical aspect of obstetrics, Midwife with a Knife shares with us “how to save lives, one rectum at a time“.

The ethics of surgery?

Dr Youn over at Celebrity Cosmetic Surgery shares with us the importance of knowing when NOT to operate. (pls be advised of potential traumatizing picture)

The future of surgery

To all surgeons, the future of surgery is an exciting new world. Surgeons can give ideas to current procedures and suggest methods to integrate more and more technology into their art. To students, the future is something we have to keep abreast with, as it might just be the very way we do things next time.

Associates in Urology’s Robotic Surgery Blog reports that 3 experts in the field discuss robotic surgery and how it might or might not be a reality in their field of urology. Robotic surgery has its benefits and promises for the future; mind you, robotic surgery was performed on a 94-year-old diagnosed with invasive bladder cancer.

Unbounded Medicine also alerts us as to how technology will change neurosurgery in the future, with NeuroArm. However, surgeons have not been spared from experiencing hand pain during a hand-assisted laparoscopy (HAL) (which may be due to ischemia secondary to the pneumoperitoneum).

Next edition:

I have yet to find a host. If you enjoyed this first edition, or have suggestions for future editions, kindly leave your comments. Also, if you are willing to host the next edition, kindly email me.

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