Today is Monday, July 14, 2014

Difficulty getting started

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By GEORGE ROBERTSON, M.D.

Every year that we go to Honduras, it is the same with our first surgical procedure. It is always hard to get going. This year it was especially difficult because of our crew of only five people. Linda and Kitty were the best of help but very poorly prepared for surgery.

As we go the first patient back to the operating room, I helped them scrub and get in their sterile gown and gloves. We had pulled the instruments and supplies from the shelf that we would need for this procedure and for these things to be used they had to be organized on the table and stands. It was cross between a game of charades and Twister to show them how to do it.

The first problem was the camera which gave a blurred picture complete unacceptable for surgery. The focus button was the problem and it was jammed. We made the incision with some difficulty because of a dull surgical scalpel. Our next hang up was the electrical cautery which had to be connected and adjusted. There were a dozen sockets available for plugging in the device and only one of them was the appropriate socket.

On the several other trips we’ve had experienced operating room nurses who knew the proper connections and settings for the machine. This time it would be a trial and error process to connect the vital part of the equipment. We tried each socket one at a time and finally found the right connection. Finally we had a good operating camera and electrical cautery, but as soon as we had a good picture for the surgery, the electricity for the whole operating room went off. The clinic has a backup generator, but someone has to inform the staff to turn it on. It seemed like an eternity waiting for the operating lights and respirator to kick back in. When all the machines turned off with the loss of electric power, they all had to be reset and then readjusted. Finally everything seemed to be working properly when my first assistant across the table from me said she was going to faint. We stopped the surgery and helped her to a seat while the circulation came back to her head. It was only a short time until she regained her skills and we were able to once again start with the procedure.

It took only a few minutes to complete the gallbladder dissection. As I prepared to retrieve the organ from the abdominal cavity, another problem presented itself. Back home I use a 5 mm camera which can be inserted into an upper abdominal port so that a larger retrieving forceps can be inserted through the camera port. The camera I was using here was a larger one and would not go through the upper abdominal opening. We eventually figured out that we would have to insert a larger port so that the camera could be transferred to it. Needless to say, we did not make this mistake again the rest of the week.

I was certainly thankful to have this first case behind me and hopefully all of the bugs worked out. The whole procedure took about two hours which compares with a half-hour back home. In spite of our inefficiency, the patient did quite well and was very happy with this outcome.

Editor’s Note: Robertson is a physician with Family Medical Associates, PC, in Lebanon.

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