Surgery Without Wires

Surgery is messy... and I don't mean in terms of blood and guts...

What I mean are wires, cables, tubing, etc.

Let's take a routine tonsillectomy and adenoidectomy for example...

1. Electric cord for the operating table


2. Electric cord for the anesthesia machine


3. Electric cord for the surgeon's headlight


4. Light cord from the surgeon's headlight to the lightbox


5. Breathing circuit tube from the patient to the anesthesia machine


6. Carbon dioxide outflow tube from the patient to the anesthesia machine


7. Suction tubing from the surgical table to the vacuum canister


8. Vacuum cable from the vacuum canister to the wall socket


9. Electrocautery cable (along with electric cord to power the machine)


10. Coblation cable (along with electric cord to power the machine)


11. IV fluids lines from patient to IV bags


12. EKG lines


13. Grounding pad cable


14. All the wires and cables that go with running a computer


15. etc etc etc

It's an "organized" chaos of cords, tubes, electric wires, etc all emanating away from the patient like a Man-of-Wars jellyfish.

Pictures shown on the internet as well as movies are "staged" and appear to be neat and orderly, but believe me (as someone who has had pictures taken), surgeons and nurses take the time to "tidy" things up before the picture or video is recorded giving a false impression of neatness.

99% of the time, everyone knows where everything is, so it's not a problem. However, when an unanticipated emergency happens, things get confusing and in fact dangerous to not only the patient, but the staff (I recall one incidence of a nurse running to get a surgical tray, tripping on one of the numerous cords mentioned above, falling, and breaking her hand).

When something stops working... we literally have to trace the cord from source to origin to figure out why something stopped working. With all the cords present, this tracing needs to be done by hand and eye (analogous to an entertainment system with all the wires in the back, one would trace out the cords by hand and eye).

IS there a better way???

Of course the operating room staff takes the time to bundle and organize the various cords, but the fact remains that the cords are there.

What about wireless technology to power instruments or relay information?

Well, NPR reported on August 23, a young 22 year-old entrepreneur Meredith Perry, who has invented and patented a way to transmit power over the air without the need for wires using ultrasound. Yup... the same ultrasound used to look at a human fetus in the womb.

Her ingenious idea is to use ultrasound to "vibrate" the air which than vibrates a piezoelectric transducer contained within nearby devices. The vibration of the piezoelectric transducer will than generate an electric current which can be stored in a battery and used to power anything that requires energy.

I acknowledge that it may take time before such wireless power is available to power large surgical devices, but one can always hope!

Read the NPR story here.

Why Are You Looking in My Mouth When It's My Ear Hurting?

One June 20, 2011, NPR aired a great story about how a person may not "see" a person getting beat up on the side of a jogging path when they are focused on a task (pursuing another jogger)... even if they pass RIGHT BY THE FIGHT!!!

In fact, only a third of the subjects reported seeing this mock fight when the experiment was conducted at night. Even more surprisingly, broad daylight didn't improve the statistics (only 40% noticed the fight).

Though the situation and circumstances do not exactly correspond, there is a lesson to be learned here that applies to a medical visit.

As an ENT, I often see patients for a very specific complaint...

"My right ear hurts."
"I have a bad cough."

No matter what the complaint, unless it is for a specific task (there is earwax... can you remove it), I most always still do a complete ear, nose, and throat exam no matter the complaint.

Why???

Because often the symptoms are "the jogger" in the example above which is noticed to all exclusion when "the fight" is the more important event that should have been noticed.

Let's go to the examples stated above...

"My right ear hurts."

Though a patient may wonder why the heck I look in the mouth when their ear is the main complaint, it's mainly because there are other things that can cause ear pain... some of it life-threatening.

Tonsil cancer can cause ear pain (without any other symptoms) as well as a base of tongue abscess. Obviously, giving antibiotics to treat the right ear pain totally misses the fact that there was tonsil cancer that got missed or the tongue abscess which requires an emergency trip to the operating room followed by a few days in the intensive care unit.

"I have a bad cough."

This statement is pretty self-explanatory. Why bother looking in the ears??? A loose hair in the ear canal can cause a persistent dry cough. Why look in the nose if the cough is coming from the throat? Severe allergies and nasal polyps can lead to post-nasal drainage leading to a chronic cough. Why would an ENT than ask about my blood pressure medications? Because ACE inhibitors like lisinopril cause a chronic dry cough as a side effect.

The point being with these examples is that medical doctors are trained to not just focus in the exact symptom the patient is complaining of, but the entire picture. It doesn't do the patient any good if a doctor gets tunnel-visioned to the point where they don't notice what may be a very obvious thyroid mass or the large nasal polyp.

SO... next time you see a doctor for a specific complaint, humor us, and answer fully all questions about your medical history, surgical history, medications you are taking, and the physical exam we will perform on you... even if you are there for just a "simple" earache.

Read the NPR story here and the police beating that triggered this inattention experiment.

The Diane Rehm Show on NPR Examines the Human Voice

Diane Rehm who hosts an NPR show of her name, suffers from a voice disorder called Spasmodic Dysphonia. On April 18, 2011, she hosted a show on vocal issues with expert guests addressing what makes a healthy voice. The experts range from physician laryngologist Dr. Nazaneen Grant to voice coaches.

Listen to the show here!