Welll now........inn't that spatial.........hmmmm?

I was wishing for some general surgery. Well, the other week, I got what I wished for except, it came in the form of laparoscopic surgery. I also got my wish to work all day. Started at 0730, ended at 2100. Lap chole, revision gastric bypass, revision gastric bypass, ORIF distal ulna (different surgeon obviously), then back to join the bariatric surgeon, revision gastric bypass, and exploratory laporoscopy with repair of internal hernia.
There is something about laparoscopic gastric bypasses (or revisions of) and bandings that I can't seem to grasp. Pun fully intended. Perhaps it is the fact that I am on the patient's left side. When I am on the patients right side during a lap chole, I have very little trouble knowing where my graspers are and directing them without direct visualization. Put me on the other side though, and I am a spatial retard. Perhaps it is the fact that I am reaching across the patients upper abdomen. I am starting to figure out that if I look at (the outside of) the patients belly and aim towards the Nathanson liver retractor, I will be in the general area or at least be able to see the tip of my grasper come into camera range. The bariatric surgeon is kind to me and says that it is hard because I am working opposite of the camera. I have absolutely no idea what he means by that, but I'll take it.

Speaking of the camera, it is in my other hand, the left one, as I fumble around with the grasper in my right hand. My job as camera person is to provide the surgeon with a clear visual field without wobble or extraneous movement while keeping the area he is working in, in the middle of the screen, being careful not to come in too close nor too far away with the camera. If that sounds easy, it isn't. At least not at first. I still occasionally drift off and start looking at things I find interesting which isn't anything the surgeon wants to see. If you sense the surgeons movement you will sometimes gain a clue that you are in improper position with the camera. If he is squinting and leaning forward, you are too far away. If he is doing a sort of ducking stance and looking up at the screen as if he is trying to look under something, you are too low. Craning his neck to the left or right means you are too far right or left.

Since the patient is in steep reverse trendelenburg, or head up, my camera arm is sometimes locked in mid air with nothing to rest on. Being a bariatric patient they are often wide enough that I am sometimes accomplishing quite a reach between my camera arm and my grasper arm. It is a test of endurance for any one's left deltoid. I also often find my left foot going to sleep at the heel. Since you are operating in the upper abdomen, the video screens are at the head of the bed and your body is turned at about a 45 degree angle to the patient. Imagine someone laying on a table in front of you. Now stand at their left hip facing straight across the person's pelvis. Now turn your entire body so that you are looking over the persons opposite shoulder, or right shoulder in this case, and that is the approximate position one stands in in the assist spot. For some reason I tend to shift all of my weight onto my left heel and soon find it numb and tingly.

Another (assistant) side effect of laparoscopic surgery seems to be syncopal episodes. I have seen some bloody, gory stuff and never missed a beat, but put me in hours of intense laparoscopic surgery, and at some point I'm going to start to feel an episode coming on. By intense I mean prolonged periods of holding still. Holding the camera still, that bite of stomach you have in your grasper still, and holding yourself very, very still. All the while staring at a video screen in a darkened room. It all spells syncope for me. Fortunately I have never given in to the dark side. I have to look away from the screen, which can be tricky because everything but your eyes must remain put, or as I've said, still. I will take a quick survey of the clock, the anaesthesiologist, the circulator, the ceiling, the far wall, anything to get my brain disengaged, and then go back to the surgical field. The best advice I ever got was from a neurosurgeon who told me, as I was retracting a nerve root while he drilled, to remember to breathe. I am so intent on holding everything still, in neuro as well laparoscopic surgery, that I forget to breathe. Sometimes, just breathing will do the trick. I think this is why engaging someone in conversation also works, as I often hear anaesthesia say, "If your talking, your breathing."

By the end of the night, I was ready to go home. If you had given me five open abdominal surgeries to assist I don't think I would have been as wiped out. Another surgeon had come along and booked a lap chole to follow us when we had finished our line. He was waiting in the lounge for his case to start. I knew that at this time of night he probably had no assist. I felt guilty if I at least didn't offer, but instead I sat in the lounge with him as I decompressed from the day. He didn't ask, and the O.R. crew volunteered an extra staffer to scrub in with him. I hightailed it for home.