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Published: March 21st 2007
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Dr. Pete
It appears that green is my colour! The down side of Scot’s invitation to observe in Theatre was the fact that the surgeon’s working day starts at 7am! So after an early breakfast and calming down a very concerned Mary who thought I must be ill to be up so early, it was off to the hospital.
I assumed there would be some degree of process or rigmarole involved in gaining entry, at least somebody who would need to be notified but no, none of that. Scot advised me that so long as I changed into hospital sandals and the green scrubs I would have free reign to come and go as I pleased between the various operating rooms and patient pre-opp areas. He did suggest I would be best not touching anything though!
It turned out to be a god morning to visit, Dr Aravind was operating in the main theatre and although he isn’t the Chief Medical Officer he is acknowledged as the most expert cataract surgeon and one of the world’s best. Dr Aravind seemed more than happy to see me arrive in Theatre and much to my concern even started asking me how my project was progressing - all I could
Dr. Aravind
Some things are best left to the professionals. think of was the poor man lying in front of him, fully conscious with a rather viscious looking sharp implement inserted into his eye whilst his surgeon was asking me about an MIS project!
I quickly realised that although I could get reasonably close to the procedure, it really isn’t easy to see what’s going on in detail and I was always in danger of getting in the way of a sister or even worse, stumbling over something and posing the patient a real risk. I decided it was safest for all if I studied the TV screen instead which relayed the image that the surgeon sees through his scope.
Scot provided a running commentary as Dr Aravind made various incisions through the Cornea to gain entry for his instruments and then proceeded to break down the Cataract affected Lens with an ultrasonic device known as the Phaco machine. The Lens once broken into small pieces is then sucked out by the same Phaco device and then a new folded artificial Lens is inserted and manipulated into place behind the Iris.
The whole procedure took Dr Aravind 7 minutes, as evidenced by my photographs. That’s 7 minutes
The OR
I counted 18 people in this OR at one point, not including 4 patients.
Notice the patient notes don't even leave the patient in the OR, they simply leave them on their chests. from this gentleman having zero vision in this eye to probably 20:20 vision! It’s 7:30 in the morning and he’ll probably be at home by the end of the day!
As soon as he finished the procedure Dr. Aravind swung his chair round to a second operating table where the next patient had been prepared by the sisters and without more than 45 second delay he was conducting exactly the same procedure. Apparently Dr. Aravind will work like this for 4 or 5 hours straight and in a session can carry out 40 or 50 procedures. Also in the same operating theatre was another surgeon operating in the same mode on another pair of tables.
To my amazement also, as soon as the procedure was finished, a hospital porter appeared and helped the patient of the table. The patient, showing no signs whatsoever that he had just undergone surgery simply walked out of the theatre, passing the next incoming patient at the door. It really is a one-out, one-in scenario as the sisters have as long as it takes Dr.Aravind to finish his current procedure to prep the next next patient, it would be unacceptable for Dr.Aravind to
The Problem
The lens is completely opaque as a result of this quite thick cataract. It is too thick to use the ultrasonic Phaco device to break up so it will be removed whole. have a delay between patients!
Production line surgery if ever there was. Fast, efficient and crucially, clinically effective. Complication rates at Aravind are on the whole superior to those in the US or UK. This is largely due to the surgical competence of the Doctors and also the incredibly expert and knowledgeable Sisters. As Scot advised me, Dr Aravind probably conducts as many procedures in a couple of weeks as most western surgeons might conduct in a year and in this trade, practise really does make perfect.
To help put this into context for me, as a training Ophthalmic Surgeon in the US, Scot will carry out on average 1 operation per week, the rest of the time he is observing. In Aravind he is carrying out 2 a day so every week he spends here is equivalent to 3 months training in the US.
Scot also explained to me that the Sisters here are incredibly knowledgeable and were more than capable of providing clinical advice to the surgeons when complications were encountered mid-procedure. In the US these staff would be highly sought after and would be able to command significant salaries.
In all, spent 2
The Solution
Same eye, 7 minutes later - check out the times on the pictures!
This cataract was removed using the more invasive ECCE procedure hence the amount of blood. Phaco rarely seemed to lead to bleeding. hours wandering from one OR to another. There were 5 rooms operating this morning. 2 Cataract theatres, both with 4 tables and 2 surgeons. There was a retina theatre, a cornea theatre and also a paediatric theatre all single bed theatres in operation. The procedures being carried out in these theatres are significantly more complex and unfortunately not screened so it was hard to gain any real insight.
There is also a theatre for Orbit work and Oculoplasty. The expert in this field is Dr Usha who is world-renowned. The procedures carried out in this field are extremely serious reconstructions with some cases making it into the world press. One example being the successful extraction of a Swordfish sword and subsequent orbit reconstruction for a very fortunate Indian fisherman. Apparently Dr Usha maintains a collection of bizarre objects that she has retrieved from eyes. This theatre is also where any new medical staff are initially sent if they are in any way squeamish - apparently after 3 days witnessing this sort of hard-core surgery nothing will ever phase you again.
Having thanked Dr. Aravind for what really did feel like a privilege, allowing me to watch him work,
Dr ??
I never did find out the name of Dr. Aravind's OR colleague. I headed back to my office. A unique way to start your day’s work but a fantastic opportunity to witness the genuine purpose of Aravind.
In a mere 2 hours I witnessed at least 20 individual procedures, in each case an elderly, partially or totally blind patient walked into a room and 20 minutes later they walked out with restored vision, no longer a burden on their families, no longer potentially facing starvation. It’s hard to imagine the level of job satisfaction the staff here must experience daily.
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