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Wednesday, June 20, 2007

DOC, YOU FORGOT SOMETHING?

You have, like me, all seen at some time or the other, some movie or heard some joke about a surgeon's watch left in a patient's tummy during surgery. I don't know of too many doctors who can afford to leave their Breitlings and Rolexes in such secure vaults as the bellies of patients, but I do know of a few who have left pieces of cotton, called gauzes and mops (the latter being bigger and bulkier) inside, blissfully unaware that the patient was really not dying for the unwelcome implant!

In the days when I (as a resident) used to pick up patients from Government hospital OPDs and push them into surgeries because I wanted to do them (as opposed to their needing them at that moment), I once operated on a patient for a recurrent thyroid tumor. He had been operated a few years back and soon felt the same tumor, for which he came to me. No scans, those days. 'See and cut, cut and see' was the mantra. In the OR, the tumor turned out to be a piece of leftover gauze surrounded by a dense capsule of tissue reaction. Patient cured. Much later, I learnt that this was an example of a Gossypiboma. Doctors always try to mask this disaster as a 'Foreign Body', though not all foregn bodies are our creations (like thorns, fish-bones, etc).
It is every surgeon's nightmare when a mop goes missing during surgery. The theater nurse has to reconcile the count of mops she came in with before surgery, and she has to leave with the same numbers seen and counted outside the patient's abdomen. Else, an xray has to be got, though it is not a sure shot answer in the third world, and the patient may need to be re-opened, and...it is best avoided like an airplane co-passenger with XDR-TB!
Now, technology is here to make such silly things as obsolete as writing letters. SmartSponge System is a product that seems so simple you wonder why no one thought of it. It has a small Radio-frequency Identification Device (RFID) chip implanted in each sponge (an American name for a mop) with its own serial number. A device just detects the sponges at the end of surgery and counts them, with each number being listed. The FDA has just approved the device, and hopefully, it will become a standard gadget in our ORs.
As a laparoscopic surgeon, I have less worries with sponges, as it hard to imagine pushing in a six inch sponge through a 10 mm cannula. But I can push in small gauze pieces to soak up stuff, and this technology would be one way to prevent becoming too (in)famous!

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