It’s a good thing I have to admit so many kids with appendicitis and non-appendicitis, because I need more work on laparoscopic appendectomies.
This became abundantly clear last night when, two-thirds of the way through a case, the attending commented, “Do they do laparoscopic appendectomies at your hospital?”
“Well, yes sir, they do, but I haven’t gotten to do any there yet.” [so the fact that I seem to have two left hands is really not my program's fault]
The appendix being at the other hand of the abdomen from the stomach and gallbladder, which is what I’ve mostly worked on (or tried to) laparoscopically, appendectomies feel like working upside down and backwards – and it shows in my random sweeps which usually don’t even get my instrument onto the screen, let alone do anything helpful to peel back the inflamed tissue and expose the parts that we need to be working on.
December 16, 2008 at 12:08 pm
lap surgery takes some getting used to, and you WILL get there, esp once you start doing ventral hernias and bowels and have to find yourself in multiple quadrants. One trick I tell people that I am training is to locate the target area on the outside and then head your trocar over there rather than trying to find yourself on the inside. Ie. look on the belly wall and see where the camera and/or the attending’s trocar is pointed, then direct yourself over there…if you kwim.
good luck.
December 17, 2008 at 12:18 am
Don’t fail to learn to do a nice quick open appy. I keep thinking — nay, hoping! — the day will come when people will realize the cost savings over lap appy, when a properly done open appy is done via a properly placed (people usually put it too medial) small incision. Adding up the extra time, extra personnel, extra set-up, extra disposables, and given the same hospital stay afterwards (again, when done properly) it’s not even a close call. If we ever get serious about economic profiling, you’ll need the skill!