Something interesting I learnt in the operating room…the subtle art of being a surgeon.

I have known anatomy is essential, so it is a big subject in my degree, but I could not imagine how important anatomy is in surgery to provide patient’s the best care.  What shocked me about surgery is the technical skills you need to have to carry out a procedure in a delicate way, but at the same time firmly and precisely. Not only have I learned technical skills in my rotation, but also non-technical skills for surgeons like team work, in which the entire operating room is capable of working as a team so that everything goes as expected. In my student practice I realized that surgeons help patients to face their deepest fears so when dealing with patients, closeness is very important so they can see you as someone trustworthy, human, approachable and professional all together.

Probably, of all techniques and procedures that I have learned throughout my entire rotation, the one that has caught my attention the most is gallbladder surgery and how little details can determine the postoperative course of patients. Cholecystectomy is a common procedure in general surgery. I have learnt how the laparoscopic approach has advantages over the open approach as it lessens the post-surgical pain, speeds up the recovery of the patient, and makes the hospital stay shorter. It might be a quite a complicated technique, but from a patient welfare point of view, it is worth it. 

My Professor, Dr. Moreno explained to me the procedure, the importance of the critical safety view of Strasberg when you dissect the triangle of Calot, but it was not until my rotation I understood that if you don’t develop this manoeuvre, it can threaten the patient’s life. Dr. Asensio-Gomez took me as a mentor in my stay at the hospital and he opened my eyes about how tricky little movements during laparoscopy dissection could avoid big problems. Nevertheless, I have learnt the importance of developing the procedure through the posterior view of the gallbladder with the critical view of safety technique (CVS) of Strasberg with the aim of reducing collateral damage in the bile duct or the arteries that supply it the gallbladder. 

The gallbladder has its blood supply from the cystic artery that arises from the right hepatic artery and it divides in two: anterior cystic artery and posterior cystic artery. In general, this is the norm, but anatomy is not always the same; there are variations that we must take in account. During my rotation in surgery I have witnessed one of those anatomical variations in which the anterior and posterior cystic arteries arose independently from the right hepatic artery. The surgeon Dr. Luis Asensio who was preforming the surgery, kept calm and applying the CVS, he gradually opened the cystic space to be able to clamp the necessary structures.

In these cases, the CVS is essential because this way you avoid unnecessarily cutting the hepatic artery or the common bile duct due to confusion, and causing future dangerous complications for the patient.  But what my mentors have stamped in my mind is that these kind of details and manoeuvres do not matter unless you think about patients. This is all about them and what I haven’t fotgotten is that do must your best, study your hardest and develop these skills in order to heal people and to avoid them problems that could affect them all their life.

To sum up, I find surgery a very complete medical specialty as not only do you need to have a broad knowledge of anatomy and possible variations, but also you have to know non-technical and technical skills that, even if they are somewhat more complicated, will benefit the patient the most in the long run.. We must not fall for the mistake of believing that we are superior just for being surgeons, we are still human and therefore we can still make mistakes. We need to seek the welfare of patients constantly.

As someone told me some time ago: the one who works with the hands is a craftsman; the one who works with the brains is a scientist; the one who works with the heart is an artist; but the one who works with the hands, brains and heart, all at once, is a surgeon.

Authors: Miryam Martínez 5 year Medicine Student, Asensio-Gomez L, Moreno Elola-Olaso A, Garcia Ureña MA   Department of General Surgery Hospital del Henares