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Sunday, November 19, 2006

Basic Surgical Skills

I recently attended a course on Basic Surgical Skills on 15-17 November 2006, organised at Kingston Hospital. Before the course itself, the postgraduate centre sent us a pack, containing the participant handbook, as well the DVD to read and watch, before the course.

However, nothing can prepare for you the course itself. With a timetable set out for the 3 days of the course, we knew what to expect for each day. There were 16 of us, from various hospitals all around the country, ranging from Brighton to Ireland. During the days, we would watch the DVD, stop and practise the skills shown, with the various instructors supervising.

It was a standard timetable, really. On Day 1, we did theatre safety - gloves and handwashing, then we fiddled around with the surgical instruments, and practised our knots and ties, followed by learning about the different types of suturing techniques. After lunch, we handled pig tissues, trying to ligate blood vessels using the various techniques, before doing the ultimate of an end-to-end anastomosis and an end-to-side anastomosis! Day 1 was fantastic, as I learnt to perfect my knot-tying, as well as be ambidextrous with both knot-tying and handling instruments. It was exhilarating to know that both my anastomoses did not leak at all! Well, the end-to-end one had one leak (which was quickly corrected). Out of it all, I was the first to finish, and my ties looked pretty good and neat, if I do say so myself! Even the instructors were quite impressed. =)

On Day 2, I had missed the video on Aberdeen knot (as we had arrived late due to the traffic jam), but we did an abdominal incision and closure. The thrilling part was when we did the arteriotomy and closure bit, as well as the vein patch grafting! It was an afternoon of trauma and orthopedics. We learnt about how to handle traumatised tissues (to take more is better than to leave some dead tissue in the region!) and debride it, as well as how to repair tendons, the principles of fracture management and complications, and we had a hands-on session with plastering as well as AO fixation with screws and plates. That was absolutely great, as we were not expecting to play around with drills and plates and screws. I must say, it feels good to actually have the drill in your hand and do the deed.

The last day was concentrated on minimal access surgery. As usual, we watched the video/DVD on the principles of minimal access surgery, as well as the concepts of diathermy. We learnt about open and closed methods of port insertion and management, and did multiple exercises to demonstrate our grasping and manipulative skills, as well as advanced dexterity exercises where we were taught to clip and do a loop ligation as a simulation of an appendicectomy. I also learnt how to do a Roeder knot, as well as to tie a laparoscopic knot. Last but not least, we had the chicken skin peeling exercise, to see if we could handle the diathermy safely in the peritoneum.

With a well-organised timetable, breakfast, lunch and refreshments provided at suitable times, it was a great experience to behold. The instructors have my utmost respect, as after this course, I have realised so many things. I came to this course with the aim of gaining an introduction to surgery, as well as learning about the different types of knots and getting a feel of whether it would be too technical a field for me to go into.

I came out of the course, learning more about myself than I expected. I learnt that I prefer technicality. I love handling the drill and knowing what to do with screws and plates. I can be ambidextrous, especially with knot-tying, and it is not at all difficult, and I do not have to practice extra hard for that! I demand perfection from all that I do. Not only does my sutures need to be perfect, it also has to be done fast as well. I know that I am competitive, but with myself. I know that I am impatient, for wanting results, for wanting perfection, but I know it is good in a way, as it helps to better myself, and ultimately, it is good for the patient. But I’m not going to kill myself for it if it doesn’t go as planned.

I was very pleased with my anastomoses – no leaks, neatly done and one of the fastest, surprisingly. My vein patch graft wasn’t as pretty, but it was functional. I must say, however, that vascular surgery is so very delicate. Scary. Had a chat with Mr Paul Thomas, who was my instructor for 2 out of the 3 days (and who incidentally works as a vascular surgeon at my hospital, so imagine my surprise and cringing when I saw him there at the course!), and he said that he was quite impressed with my skills. My dexterity with knots and the anastomoses was ‘impressive’, and that amongst all the participants at the course, ‘you were quite exceptional’. In terms of knots/sutures/veins, but not as fantastic as he expected with the laparoscopic stuff. I agree, but I still think I’m quite good (as compared to the others), in terms of handling the laparoscopic instrumentation and getting orientated in the field.

All in all, this course has reinforced my belief that I actually am cut out for surgery, have the technical ability for it, and ultimately, I thrill in the enjoyment of it!



On anothe note, I have finished all my orthopedic on-calls, as of last tuesday! Have finally done my dues (especially after doing 3 weekends in a row in September, going for a 2 week break, then coming back to a 3-weekend simultaenous oncall in October - it can kill. Trust me. But... I've survived it all, and done all my on-calls at manic Heliers (now that all the trauma is diverted to from Epsom to Heliers). I've survived!

Now, bliss for 3 weeks before swapping jobs in December and being on call for General Surgery (which I know nothing about) on the first day, as well as the first weekend. It's gonna be bad....