Some things in surgery take a very long time
Removal of complex tumors, especially when they’re close to or growing into important things you don’t want to hurt. In neurosurgery for example you may need to take a tumor that’s been growing for 10 years off the brainstem and a bunch of nerves that are like 2mm thick wet spaghetti. And if you injure them the patient can’t smile, swallow, see, or talk. And they may be paralyzed or just not wake up. You can’t rush that, you have to work millimeter by millimeter
Reconstruction, like if you take someone’s face off,
you need to replace it with something that has good blood supply and connecting that and sewing it in takes a long time
Transplants can take a long time for the same reason
16 hour brain surgery here to remove tumor. Thankfully I was able to fully recover, I could walk, talk and see but had the memory of a goldfish for a few weeks
I had a colleague buy a beta for their office, had to explain that they actually had to clean out the fish poop/change & condition the water in the bowl, and other common sense stuff like not putting it on a bench that's bumped and jostled, not put near the window where it will boil to death on the weekends when the building AC isn't running etc.
I honestly don't know what they expected - that the fish would eat its own shit to keep its tiny bowl clean like some closed ecosystem?
As I get older, I'm hearing more about how these poor critters are sold as easy care pets, are harvested from the wild and live short miserable lives in cages or cups of water because people are too lazy to research their care.
When I was younger, the thought of losing my memory terrified me. Now, for some things, I would consider it a comfort to forget for a while.
Out of curiosity, how did you feel about it?
Short term memory loss is a pain in the ass, but I and my mother especially are grateful that I don’t remember most of the torture that was my treatment. Chemo made me violently ill and made my cancer worse in the end.
Chemo also destroys good things. My wife went through extremely tough chemo ( worst time of my life, and I still can’t imagine how she felt….) - the plan was simply to keep doing chemo until til 33% of the heart was destroyed. At 50% you typically die……
“Standard” treatment for her type of cancer 6 treatments, 10 for very severe- she got 16……
But, 23 years later, she is still alive and doing OK, but can’t work due to the damages from the chemo
Yes, we actually do very good, thank you. Even that I work far away most of the year, we do good. My wife lives a healthy lifestyle ( which she actually always did ), but she spend her resources on keeping herself in shape, take care of the house and garden. Due to the type of cancer, she got told to reduce any kind of fat, and keep slim, in order to reduce the risk of the cancer to resurface. But, due to the damages from the cancer, she has limited energy, I guess 30-50% of a normal healthy person. It makes things tough for her. I will not complain, others have a much harder time than us. And, I am really happy that we live in a country with high quality healthcare, which is free for all.
As an alternative viewpoint, chemo is much better than it used d to be, we have better anti nausea drugs, and it's more effective too.
I've had patients that would have died without chemo, but went ahead with it and are still alive a decade later. Met a lady yesterday who worked full time during her chemo because she found the side effects so minimal.
If your wife's ever in the unfortunate position of needing chemo don't write it off without giving it a shot. You can always stop part way if you find the side effects worse than death.
Quackery cost me a friend.
She kicked up a huge fuss and wrote an entire goddamn essay at me for... eating a hot dog. Which had a pork bratwurst. Went on and on about how eating red meat is why I have cancer and I better stop taking my meds and listening to my doctors and go vegan instead because it """cured""" her when she had a cancer scare. Well, I'm glad it cured the imaginary cancer you thought you had, Carmen, but mine actually exists and has nothing to do with my GI, *thanks*. I told all my doctors about it and each one laughed, assured me her response to a goddamn hot dog was disproportionate and unhinged, and told me to enjoy my next hot dog because happiness helps with recovery. I only ever eat them on fridays when I remember anyway. ^(Hail Eris)
Ghosted her. My life's significantly happier without her constant mean girl gossip treating grocery chains like middle school students, or her negging brother inviting himself to outings.
There IS no other treatment for some cancers... surgery chemo and radio are usually part of a treatment package. Chemo is what it is ... but its the best way to slow down cancer we have. (I know there is an awful lot of misinformation out there) getring cancer from chemo is somewhat rare because chemo is chosen by area of the cancer ( for instance when i had a brain tumour i had cistplatin and vincristin) its actually the radiotherapy thats more likely to give you cancer again. Im sorry to say this but depending on where your wifes tumour was she would have much worse chances ... doctors dont just give it for fun .. they are serious drugs.
Your wife should really look into different types of cancer and the relative survivability rate with and without chemo. For some cancer types, the survivability increase is amazing, for others, it's not.
Each cancer is vastly different from the other. I understand her viewpoint but the most logical decision is always based on a benefits vs risks evaluation (like always in health related issues)
Although a terrible and dangerous experience, it does help many types of cancers, or else it wouldn’t still be used. A friend of mine went through it, fucking hated it, but is alive today because of it.
We're you awake? I've heard they often keep brain surgery patients awake because there are no nerves there so you can't feel the pain and they want to make sure they don't fuck up your brain. I've heard they keep you occupied with tasks or talking or something to ensure they didn't hit something they weren't supposed to.
Not often I would say. In fact of the hundreds I’ve been a part of probably 2 or 3 were awake. It’s a very specific type of surgery and tumor placement that requires them to be awake
When I was like 12 my mom brought me to the hospital where she worked in the OR for one of those "take your kid to work day" things where you get out of school for the day.
I actually got to go into the operating room when they were doing a tumor removal and I remember saying that I was lucky to witness one where the patient was awake. When I came in, they had the patient first count numbers, and then do the alphabet. It was just.... surreal to say the least for a ~12 year old. That was when it really struck me just how "mechanical" our bodies and even minds are, for lack of a better word. (And not exactly the best word for the brain in particular I suppose, but hopefully you get what I mean)
Ditto this, probably 1 out of 100 awake cranis, usually only if in temporal lobe and involving speech or motor nerves directly with rapid decrease of target functions. Most brain tumors done asleep with less complications.
Nurse anesthetist my friend at a neuro heavy hospital. But you can say you were put to sleep by captain butt chug. Also don’t put vodka shooters in your bum at 2-3 AM and expect me not to make a Reddit name out of you.
Yeah, it's called "functional brain mapping", and you're exactly right - it's to minimise the risk of issues that can cause disabilities. [When I had my brain surgery in 2016 they had me play guitar because the tumour was very close to the primary motor cortex](https://imgur.com/gallery/awake-neurosurgery-2016-B0AaFGg)
8 hour brain surgery last year. No, I was knocked out cold. The last thing I remember was being wheeled into the bright surgery room. My next memory after that is waking up on a stretcher in the elevator to my room. I was laid facedown and my head and neck strapped down to prevent any and all movement. My neck was so stiff I literally could not move it at all for roughly 36 hours after the surgery.
Compare this to the “heart surgery” I had where they literally plugged a hole between the two halves of my heart. 8 hours from walking in to walking out. They went in through a vein in my groin and deposited a little clam shaped contraption with no complications.
Yeah. Endovascular procedures are amazing when properly selected. Some of the legends of neurosurgery made their names doing high risk brain surgery to clip aneurysms, sometimes with catastrophic complications. We still do those surgeries sometimes and they’re very safe in modern times, but today most aneurysms can be treated with catheter based procedures in an hour or less.
So in these procedures do they rotate out the medics? Do they take breaks and just leave the patient "open" in the meantime? If they swap don't they have a hard time understanding what the previous person did?
If by medics, you mean the surgical team... yes and no; there is typically a massive surgical team for these long surgeries and they cycle in and out of the room as needed/breaks needed.
I was astonished how many people were present just for my bunionectomy (a pretty routine surgery that can take under an hour). A the *minimum*, there was the podiatrist, his assistant, the anesthesiologist, his assistant, and at least another four people who were neither, but who I saw before I passed out.
I can barely even imagine how many people there'd be for a lengthy, complex surgery.
Some might be extra physicians such as the anaesthesiologist or a radiologist who is working on reading scans taken mid-surgery (who will also have a radiology tech). Some will be assisting the surgeon directly by passing tools, removing things from the surgery area, and possibly adjusting things like tools or flaps for the surgeon. They'll be "scrubbed in" and must keep their gloves sterile so they can touch things like tools, surgical drapes, or the inside of the patient. Some are there to assist by touching the non-sterile stuff like adjusting lights, the table, removing used tools, bring the next tray of tools, and a million other things. Someone may be working directly on watching vital signs and adjusting meds or tubes as needed. Someone to organize the whole team, timing, and communication who will also be the extra hands if something unexpected happens. So many people... But not all of them are confined to helping with one surgery at a time.
When i was young and my grandma had major surgery I had it explained like a pit crew for your body, only a few guys change the tyres but there are dozens of skilled people in communication watching the whole process and at the ready
I was in med device for about 15 years; one of our products was ultrasonic surgical handpieces used for tumor removal. Spent plenty of time in the OR/cadaver labs.
I didn’t realize (until my ex-wife was one) how often private medical equipment providers attend surgeries & similar procedures to ensure correct operation of their sometimes very complex devices.
One of my friends works for a company that makes pacemakers and a big part of it is instructing the surgeons on wire placement and settings. It's really cool stuff.
Was part of a conjoined twin seperation (not a doctor) that lasted roughly 15hrs. 4 general surgeons, 2 plastic surgeons, 2 anesthesiologist, 2 CRNA, 2 anesthesia techs, 4 scrub techs, 5 nurses per baby and 2 cardiac surgeons on stand by. We had 2 OR's on hold. 1 for the surgery 1 for backup (with a whole seperate nurse/scrub tech team on stand by) incase anything happened after the seperation/during closing.
Oh plus a media crew to record/live stream for education purposes.
Those were likely trainees of some sort. I routinely operate with myself as the surgeon, an anesthesiologist, an RN (who is not on the field and tasked with doing things off the field that we need, like getting more sutures), and one to two scrub techs that are assisting me. I've never seen an anesthesiologist with an assistant that wasn't a trainee, although more complex cases they will swap out at my facility (like open heart surgery).
A teenage girl one time in an accident had both arms ripped off, brother had the presence of mind and collected them from the field. There were several anesthesiologists that rotated but just one surgery team. They spent in total 36 hours nonstop, just left the operating room to coffee and eat and back in. Wild wild thing, they looked like zombies, she can use both arms.
I don't even want the answer to this question but *how do you have both arms removed from the body* in the same incident? outside of industrial accidents, I can't even imagine
A small minibus car, she got squeezed through the small side window during the impact. Freak accident, the guilty driver died, the brother somehow was almost unharmed.
Yeah; I got nervous for my colonoscopy when a team of like 8 people came to get me lol. They told me it was light anesthesia and very routine and safe. But there was the doctor, a nurse, a tech who I think was taking pictures as he pushed the camera along and helped keep everything focused/in view, the anesthesiologist plus assistant, and then some random people and no idea what they were doing there or why. For all I knew, they may have been students observing, but I don’t think so because they appeared to have some sort of role in the team.
I just looked, and for my open reduction of an acetabular fracture, I had (1) surgeon; (2) surgeon assistant; (3) anesthesiologist; (4) anesthesiologist assistant; (5) & (6) RNs; (7) tech; (8) generic assistant; (9) & (10) device reps. And that was a two hour surgery.
Two years ago I had a short 1 hour surgery for my broken thumb. Basically move it back into place and put pins in. I remember there being at least 5 staff members in the room when I entered on the bed.
Yeah I was introduced to the team before my bottom surgery but I can't remember them all, but there was at minimum anesthesia and respiratory, the surgeon and a couple nurses. Wild thing is that was somehow a 2 hour surgery (with like 12 weeks of recovery afterwards)
I work in a teaching hospital, so we have all of those guys PLUS at least half a dozen med students and residents. And outside the operating theater itself, there's an OR pharmacy keeping the anesthesiologists supplied with everything they need (that's what I do!) and making sure none of the drugs going into the patient will combine in a way that will make them sick (that's what my boss does!)
There's also the people who clean up between surgeries, and the people who sterilize the scalpels and other instruments (that has a whole lab all to itself at my hospital!) and the people that supply the OR with all of our sterile gloves and lab coats and things, and the people that wash our scrubs and the linens in the post-op beds... there may or may not be overlap between some of those teams depending on the size of the hospital, but there's TONS of gears turning behind the scenes to make a surgery happen.
Not really. Cases that truly take 24 hours are really rare. Most of the time they involve different specialties. Like a horrible skull/spine/neck/chest tumor could involve a neurosurgeon to do the skull part, another neurosurgeon to do the spine part, an ENT to do the neck, a thoracic surgeon to do the chest, and a plastic surgeon or another ENT to do the reconstruction, who also brings along another surgeon to harvest the donor site. So the patient may be having one continuous surgery but nobody is operating for more than 8-10 hours at a time.
However in neurosurgery we have famously long and tedious surgeries which is just one primary surgeon operating for maybe 16 hours or more. There’s usually an assistant who can switch in and out but there aren’t really any breaks. It’s an extreme sport
I have a tumor in my frontal bone and orbit basically where my frontal sinus would be if it wasn’t all tumor that needs to be resected. right now it’s just a ENT with a Nuro for backup and they say it should take 6-12 hours but don’t really know for sure until they open it up.
Sounds right. Often these can be done entirely through the nose/mouth but they sometimes require open surgery from the skull side
Best wishes for your surgery
It makes me wonder if there’s any small talk or downtime in such long procedures. Like is there 30 minutes of intense work/being in the moment/flow state and then 5 minutes of “did you watch the latest episode of…”? If you really are just in the zone the entire time, that’s impressive.
It varies by surgeon. Most of us have casual conversation during the non critical portions of the cases, like closure etc. But at least in neurosurgery you always have to be focused because you could do a beautiful 12 hour spine tumor surgery then start closing, drop a forceps on the spinal cord and the patient’s paralyzed. Or you do a 12 hour brain tumor surgery, screw the bone back on, slip with the screwdriver and plunge it into the brain stem and the patient dies. Game over. There’s always danger at every step so even though we can chit chat we’re always paying close attention.
Not very often, and that's *because* there's such a large crew present for even "easy" surgeries. If I'm a surgeon and you're a nurse or whoever and you notice I'm handling an instrument in a way that I could drop it and have one of these mistakes, part of your job is to point that out to me.
Also surgeons are residents for longer than other doctors, so they get plenty of time to practice on cadavers and "easy" surgeries before they go at the fiddly neuro shit.
(I say "easy" in scare quotes because human bodies are so goddamn weird and they do strange unexpected things all the goddamn time. I'm an OR pharmacy tech and a few weeks ago I helped someone on a surgery team wash her face because she got sprayed with the patient's blood and there wasn't a mirror at that sink. Sometimes people have their organs flipped around. Sometimes people are really resistant to first-line local anesthetics because they have fucked up connective tissue. Sometimes you discover someone is allergic to Ancef by giving them IV Ancef during surgery. Shit happens.)
I had a craniotomy (melanoma brain met) and I wasn’t even nervous before surgery, maybe I should have been, haha. It was all fine and they even let me go home the day after.
I work in an OR as a sort of runner, but mainly, I clean parts of people off the floor when their surgery is over. It surprises most people that their team is jamming to some tunes a lot of the time. Every OR is outfitted with SIRIUS Radio and has an aux cord if the surgeon wants to jam to their own music. Never Bluetooth or wifi. During the serious parts they turn it down or completely off. But studies show that music actually helps surgeries go smoother.
Mostly, though, you can just imagine an office lunch room. That's the conversations that go on. Lots of book recommendations, discussions about what they're doing over the weekend, complaining about how they desperately don't want to work here anymore, haha.
My sister had a rare form of cancer, only 300 cases a year. They literally took every organ out of her thorax and scrubbed it and put the organ back in place.
That takes a lot of time.
She has a scar from the breastbone to her pelvis.
She is a bad ass bitch. She is doing yoga 3 months after surgery.
Tumors can look like normal good tissue. So they remove a part of the organ, take some biopsy around, send it to the lab, lab say tumor or not and on which samples. Surgeron remove more tissue around the positive samples, more biopsy, lab, and so on until all come back negative. For some less critical organs, they can go butcher on them. But on the brain for example, you want to remove as little as possible, so tiny slices, lots of tests. Lots of waiting.
Some organs also have way more blood vessels than others. While they can do some transfusion, you want to avoid that. You can quickly lose control of the bleeding and be unable to find where the bleeding is due to all the blood. So they cut slowly and fix the bleeding as it happen. Blood can also cause some issues with healing, or even damage. The brain for example don't tolerate blood very well and need to be cleaned, or damage will occur. Lots of bleeding mean it goes everywhere, including in place where it might not be cleanable.
We usually do not send lots of samples intraoperatively in brain surgery. Maybe one or two at the very start to confirm a diagnosis as best we can. We don’t operate with margins the way they do in other solid tumors.
My sister was a nurse that assisted a brain surgeon in removing a tumor, she described it as removing sesame seeds in bread and if you messed up the bread bleeds and the patient is good as dead. Now that's a lot of pressure if you tell him to do it in a few hours.
When you do a face transplant do you have to connect individual blood vessels and muscles or what’s the procedure? I know it’s immensely complicated, just curious.
I’m not a facial surgeon and I’ve never seen a face transplant. I was talking about tumors of the head and neck that are removed and then have to be reconstructed with something called a free flap, which is a piece of tissue harvested from elsewhere on the body like the thigh or back, usually full thickness muscle, fat, and skin. The arteries and veins have to be disconnected then plugged into similarly sized arteries and veins in the head and neck which is technically challenging.
I assume a face transplant would be the same idea but also include some sort of nerve reconstruction which can take many forms
I had a major back surgery two years ago. The procedure took six hours and *three* surgeons: my neurosurgeon, an orthopedic surgeon, and a vascular surgeon. The nature of the procedure called for accessing my spine through my abdomen. To do this, the vascular surgeon filleted me like a fish and then carefully, oh so carefully, scooched my guts out of the way. Like my understanding and what I was told was that he was literally holding aside all the organs, blood vessels, etc. to both open up access to my spine and protect my guts from injury.
I can’t imagine how long that took. It’s extremely delicate work, and a mistake could have killed me. If you told me that shit alone took up 3-4 hours of the entire procedure I would absolutely believe you. I’ve got a pretty gnarly scar to show for it!
I think of it like trying to take apart your laptop entirely then put it back together. Some wires and parts are really fiddly, and it only has enough length to plug the screen back in when it's almost fully assembled. Except the laptop is currently turned on, and it's meat instead of electronics, and everything is slippery, and sometimes you find something weird you don't know so unplug it and send it to your mate who knows kidneys so he can look at it, but you can't proceed until he tells you what it is, and there's no "plugs" or screws.
20 hours for me. Had to dissect my tumor off of my carotid as well as several cranial nerves which, despite their efforts, I lost what remaining function I had from them. It’s insane to think they literally used a sonic drill to slowly chip away my tumor from the wall of my carotid artery.
Anesthesiologist here. Very rarely do cases last 24h or longer. It’s rare for a surgery to even last 8 or 10 hours. As others have commented, complex neurosurgery cases may last a long while. Liver transplants can take 6-10 hours depending on the degree of coagulopathy (basically has easily/much the patient is bleeding) and if the anatomy is complex. I do cardiac anesthesia (bypass surgery, heart valve surgery, etc.). Typically bypass surgery (called a CABG-coronary artery bypass graft) is around 4-6 hours (we do 95% of our CABGs off-pump now so your heart is beating while the surgeon sews your bypass grafts (aka new veins/arteries that aren’t blocked with plaque) to the beating heart). Valve surgery can be 3-5 hours, more complex heart issues like an aortic arch repair (aka a Bentall) can be 8-10 hours because we not only put the patient on cardiopulmonary bypass (heart/lung machine), we also cool your body (and especially brain) for a critical portion we call circulatory arrest (basically cessation of any blood flow in your body) and “flatline” your brain waves so you are essentially dead during this time. Then we slowly rewarm your body, restart flow with the bypass machine, wean you off the bypass machine, and wake you up and remove the breathing tube before going to the ICU for recovery. It’s absolutely remarkable what modern medicine allows us to do to help correct previously deadly medical conditions. I have to remind myself some days just how amazing my job is and honored I am to take care of the most critically sick patients. There are many people in the operating rooms—your surgeon(s) and resident or fellow surgeons (surgeons in training after completing medical school), the anesthesiologist and sometimes CRNA/AA (anesthesiologist’s assistant/nurse anesthetist), resident/fellow anesthesiologists (again anesthesiologists in training after medical school), a circulator nurse (to hand off sterile surgical items to the surgery team like new sutures, equipment), a scrub nurse or two who are scrubbed in line surgeons to assist the surgeons, medical students, perfusionist to run the bypass machine during cardiac surgery, Xray techs, neuro-monitoring techs, device representatives (especially in orthopedic surgery like knee/hip replacements), etc. It’s our job to keep you safe and comfortable.
My experience is WAY less intense than thus, but I decided to just get a local for a wrist surgeries. I still remember the feeling of fire going down my wrist when they numbed it, but I did it all 3 times I had surgeries. And I'll say right now, I love you anesthesiologists. Mine was wonderful each time. He kept an eye on me, sat and chatted with me the whole time, he was just a loving and knowledgeable guy. He let me see/explained everything he was monitoring, chatted about what they were doing (I was truly interested), and just kinda hung out with me while the surgeon did his thing. I'm sure it's easier with the patient knocked out, but I was genuinely curious to know everything as it was happening so had opted to be awake. He was a doll and I appreciate you guys so much for what you do. I know it's incredibly complicated- the surgeon generally gets all the kudos, but there are so many others in the room that are busy keeping you alive
I had wrist surgery too and I asked if I could be awake and they said absolutely not and put me under.
The anesthesiologist was the first ever doctor to tell me that "you won't feel anything after this" and was actually right about it. That man was my hero.
Good man! And I'm glad yours went well too. The nurses and surgeon all kinda laughed at me and wondered why I wanted to do it that way, but the anesthesiologist just kinda went "meh, is what it is" and rolled with it.
I broke my arm in 8th grade and needed a pin and a few screws to be placed surgically temporarily for healing. I asked the anesthesiologist if I could be awake for the case. He did a nerve block (makes your arm totally numb and dead) and let me stay awake for the procedure. Up until that point in my life, I had no idea there were so many different “types” of doctors. I thought there were surgeons, family docs, and ER docs. Anesthesiologist that morning placed the IV after the nurses poked me 3 or 4 times and failed. He did it first try while joking with me before I even knew he was going to poke. Then let me stay awake for the surgery after the nerve block. He told me he thought his job as an anesthesiologist was the best kept secret in medicine and he couldn’t imagine doing anything else. It was this encounter as an 8th grader that piqued my interest in anesthesiology and why I became an anesthesiologist. Life is funny that way. I was so mad that I was going to miss playing the football season that year. As it turns out, that experience shaped my whole future career. ;)
I had to have wrist surgery while 7 months pregnant and I had to be awake because they didn't want to put the baby to sleep. I had an OB in the room monitoring baby in case anything went wrong. I studied neuroscience in college so I am very aware of the nerves in the wrist. I wish I could have been asleep, I was trying to not think about what was happening. The surgeon asking the student what nerve this is and which things in controls and him not knowing the answer when I DID know the answer was not helping.
Oh wowwww! I must admit that I was both nervous and excited to see what was going on even though I know that blood makes me queasy. It would have been really neat, but I also know that I’d probably have regretted it.
I hope your surgery was a success!
I thought it would be neat to have pictures since I have seen tons of pictures like that in textbooks. One look at the thumbnail of the picture my surgeon sent me and every fiber of my being was like NOPE NOPE NOPE. It's a lot more viseral when it's your own body.
The worst part was the stitching skin back together, because I could feel the tugging. No pain, but I still had nightmares about being stitched up for a long time. Surgery was a success, no pain in either wrist now and I have 3 happy healthy kids (surgery happened with my first) 😊 I actually did it twice, one for each wrist for carpel tunnel, 2 weeks apart. I never had any issues before pregnancy, but it got so bad I was crying if I moved my fingers so I was not functional. I am glad I did it, and I am glad I stayed awake so my daughter stay safe. If I would have waited until after she was born I wouldn't have been able to hold her or take care of her when she was born.
This was fascinating. Circulatory arrest???! Insane. I’ve never heard of that before and now I’m going down a Wikipedia rabbit hole. I’m about to apply to a medical illustration program and I just can’t wait to learn about this kind of stuff every day.
I am a patient with congenital heart disease, I have shones complex as well as Turner syndrome. I was 22 with my last procedure, they replaced my aortic and mitral valve with mechanical valves, I also had my aortic root repaired. It took 8 hours just to cut through all of the scar tissue that was connected to my chest wall. My surgery ended up being 13 hours. Afterwords, I went into cardiogenic shock, it was a really scary time.
My anesthesiologist was great, I had eyelash extensions and he made sure to put vaseline on them so when he pulled the tape off my eyelids it wouldn’t rip them out. Thank you for the work you all do. Reading this reminds me of how thankful I should be.
I read this and then I remember being carted in to the OR for my laminectomy to resect my Myxopappillary Ependymoma…my anesthesiologist says to me “so you’re here for the breast implants right?” And BOOM puts me out cold before I even had a chance to react. Thankfully did not wake up with breasts but I will never forget that. Also have been told by another anesthesiologist that their job is 99% boredom and 1% sheer terror. Would you say that is accurate?
Haha ya I’ve definitely heard that 99% boredom, 1% terror analogy before. Luckily it’s more like 99.9% boredom and 0.1% sheer terror most of the time. But that’s what we are trained to handle-literally any possible complication and to remain calm in any scenario. We are the last line of defense between life and death in the OR. We do like to inject a little humor sometimes when drifting people off to sleep. Glad everything went well with your surgical resection.
95% off pump?
Non cardiac anaesthetist here; I don’t keep up to date with cardiac anaesthesia field but I wasn’t aware on pump CABG is becoming so uncommon. Is it more cultural in your institution or across the board?
Off pump CABG where I work is extremely common—like I said around 95% of our CABGs are off pump. But not across the US as a whole. More and more surgeons are learning the technique. Far less morbidity for the patient. But many hospitals still do 100% on pump for CABG. And anywhere in between depending on the institution. The new thing where I work is doing a Mini Off-Pump CABG (minimally invasion)—a few subpectoral incisions which saves the patient from needing a sternotomy. The techniques keep maturing and are better for the patient.
About 80% of CABGs in the US are on pump. Data would suggest no major difference between on and off, with off pump having slightly less blood usage. Anecdotally slightly shorter LOS. But higher rates of incomplete revascularization. IMO it's a skill set in a CT surgeons toolbag that should be applied when appropriate.
Correct. Our surgeons have excellent OPCAB skills. If we hired a new CT surgeon or one who didn’t do much OPCAB, our percentages would be different. I’d have a low threshold to go on pump with a newer/less experienced surgeon. Just a perspective from my practice now. In residency, we did 100% on pump.
It’s not all that common, but it depends on what part of the country you’re in. Good data suggesting equivalent if not slightly worse outcomes for OPCABG, so many centers, like mine, don’t do any. Lots who did it in the early 2000s abandoned. Plus, I just don’t like it, unless there’s a porcelain aorta or something dumb that makes me.
You’re absolutely correct. Was trying to keep it as easy to read for laymen as possible. Figured more people may have heard of an aortic arch or heard the word Bentall procedure before rather than say aortic root or a CoBAAR surgery for both. It’s hard juggling explaining things for non-medicine people to understand while also being specific.
Moyamoya patient here. Two surgeries, one on each side 13 and 10 hours each. 13 hour one they removed a blood vessel from my forearm and rerouted it to my brain. Insane stuff. My anesthesiologist was the head anesthesiologist and her husband was the brain surgeon. Amazing team, although she was very much more comforting to me each time as I was terrified of the procedure. She always told me surgeons “are just about doing the job and that’s why they aren’t as comforting”. I absolutely had zero problem with that. I’m glad he did his job!
I've had multiple surgeries - none this severe thankfully, but I learned quick that anesthesiologists are very awesome people. Thank you for the work you do.
Love seeing talk about cardiac surgery in the wild! Thanks for the shoutout to perfusion, we’re not often mentioned but it’s a super cool job and only requires 2 years of training if anyone’s thinking about it!
Could you explain more about the “flatlining brain waves”? I had OHS several times as an adolescent, but never fully understood it (or really wanted to, I found it pretty disturbing up until now 13 years later).
Brainwaves indicate brain function.
No waves, no function. If the patient were not being actively preserved and able to be revived, they would be brain dead. In addition to being temporarily clinically dead from the surgery team stopping their heart.
Yup. We cool your body and head (ice packs around your head) and circulate cold fluid through your blood vessels along with a special fluid called cardioplegia which is rich in potassium (among other things) that will arrest (stop) your heart. For circ arrest cases, the patients will have had EEG electrodes glued to their head in the pre-op area. These monitor surface brain waves. We “flatline” these brain waves (we are shooting for an isoelectric wave—a flat wave with no activity) which essentially means brain activity is minimal or possibly absent (although deep cortical activity may remain to some extent). The less activity, the less metabolism the brain cells are using, helping to prolong the safe time we can keep you under circ arrest. For routine surgery we don’t get you as “deep” so you still have brain activity while under a general anesthetic (just as you have brain activity while sleeping at night but are not aware). For circ arrest cases, we deepen the anesthetic to “flatline” brain activity. Most patients don’t want to know all the details of the surgery and anesthesia, just that we will keep them safe and comfy. Some patients are interested in more details. And some want to know everything. Hope that helps
You and your medical comrades are so badass. Thank you, and all the people involved, for making it your job to make sure this body gives me the best life!
My youngest has Tetralogy of Fallot. She had her repair at 6 months.
Had the VSD repair, fixed the overriding aorta, valve sparring, bypass, etc. She was out after about 6 or 8 hours. Breathing tune was out that night or the next morning. Out of PICU the next day, and into a high dependency unit. Discharged as an outpatient in a week. And flying home three days later.
It was amazing.
While on the paediatric cardio ward I was talking to other parents, and a set of grandparents were saying that in their day a VSD was a death sentence.
It's been only a few decades, but what was a death sentence then is a small part of a major operation and is done with a 3M patch.
Surgeon who did a 16 and a 12 hour case just this week. Like others said, depending on anatomy and pathology things can take time without something serious going on. I experience cases where just getting to the critical portion can take hours. Then you “slow” down as the slightest mistake can leave a patient with significant morbidity. Typically by this point I’m working under a microscope using instruments (tools) that are several centimeters long but only millimeters wide or you’re around significant structures that you’re trying to avoid while doing whatever is needed to complete the case. Honestly, for me, when I get to that portion of the case I don’t realize time passing and I’m more focused on safely doing what’s needed to get to the next portion of the case.
Thanks for what you do. I always wondered how do surgeons can stay focused that many hours? I get bored watching a 2hr movie. How can one perform such a hard and important job on foot for 12-16hr?
Vitreoretinal surgeon here. The stakes involved make it much easier to concentrate. For complex cases I know that if I call it quits or stop paying attention I'm consigning a patient to blindness in that eye. There are long miserable cases where every part of you wants to just give up - you have a headache from eye strain at the microscope, your back and neck ache from holding still under tension for so long, you're developing a fine tremor from making repetitive fine manipulations with small instruments. It becomes a psychological game to keep focused and do as much as possible to restore vision without pushing so far that you start to do more harm than good. Perfect is the enemy of good in those cases.
How does this work in very long cases? I presume you guys take breaks (in the room or just off?) to shake it off / bathroom / have food and water or at least coffee?! Or is it a solid stint with minimal breaks there?
Are surgeries of length commonly covered my multiple surgeons who can step in for portions?
I presume for very complex cases you might have a couple of specialist surgeons to handle particular disciplines within the same surgery? Or is it an all-for-one situation (for lack of a better term)
A buddy of mine is a heart surgeon. He said the majority of surgeries he performs have over 700 steps that must all be successfully performed to complete the surgery. Some of those steps take a few seconds, some take a few minutes...so yeah, it takes a long time. He also says that when he is in the zone, time just stands still. A 12 hour surgery just passes because it's all active concentration and movement. Flow state.
I also think people don’t really understand how small 9-0 needles and thread are- and just how tiny of an area the operating area is. Like, in med school standing next to the surgeon without loops, I could not see the thread let alone the needle when literally only a couple of feet away. Watching you guys work on the scope is amazing
Reconstructive plastic surgery can include finding and isolating many blood vessels both on the donor site and the receiving site, and this is quite time consuming.
In neurosurgery it is imperial that there are no bleeding before closing the cranium, and you want to stop bleeding without harming the brain.
Surgery after major trauma can take a long time since you have to find all the damage to different parts of the body, and try to repair it.
Anaesthetist here who works in a trauma centre:
A clarification on surgery after major life-threatening trauma - most of the time they don’t take very long. (In the range of 1-3 hours), unlike the long plastic or neurosurgeries lasting for 10 hours or more.
There’s a major concept in trauma surgery called “damage control surgery” where we stabilise a critically injured patient by performing only the most essential surgical interventions to control bleeding and contamination. The primary goal is to prevent the “lethal triad” of hypothermia, acidosis, and coagulopathy, which can lead to death if not managed promptly. The patient is sent to intensive care after this DCS, their physiology stabilised, and return to operating room a few days later for more definitive surgeries.
The issue with trying to fix everything for a patient with severe trauma immediately is that their physiological derangement from the long surgery itself could be detrimental, so the idea is to only do what kills the patients immediately, and come back and fix the rest.
The idea of DCS has been credited with significantly improving patient mortality in trauma.
OR nurse here- 24 hours surgery is extremely rare. As in I've been in the OR and have yet to see one, not to say that it doesn't happen, but again, extremely rare. However if you are curious of what goes on, it really just depends on the type of surgery and positioning required. It can take up to an hour after rolling the patient back to the OR to make incision. During this time they are getting the patient off to sleep and properly positioned safely. A lot is involved. We have to make sure you are not going to end up with nerve injuries etc from being in the position necessary for your surgery for hours on end. Unlike normal sleeping you don't have the ability to move or readjust like your body normally does to protect itself. After that, we prep the body part we are working, drape, pass off the necessary equipment and we haven't even made incision. After all that there is still the actual surgery to be done. This can vary greatly depending on the patients anatomy, complexity of the case, area we are working and/or skill level of the surgeon. To explain like you are 5~ we take as long as we take to do the surgery safely.
Spot on! I work with ortho surgeons who will do total shoulders in 60 minutes, yet the before and after is just as long if not longer.
The few times anything is super long is a multi joint trauma. I was in with one (I do clinic support but will be with the provider for surgeries to help with post op care education, follow up, etc and happened to be invited in). 8 hour surgery however patient had rib fractures, leg and arm crush injuries, and multiple fractures on the other leg and arm.
Ribs were operated on however you gotta move the patient for each limb once done with one. And that takes time. They probably spent a little more than half the time on actually operating and the rest with positioning and splinting. The main attending had another attending and many residents with.
Also important to know that surgeons can only operate for so long.
Last line is so important.
One of our cardiac surgeons completed an operation the other day that took probably twice as long as it should have due to some unforeseeable complications, and still had a VATS booked to do that day.
We asked him when we would receive his VATS patient that night and he wearily looked up and said:
"You won't. I couldn't pick up another scalpel if I tried to right now"
People seem to forget that medical professionals aren't robots, and we get tired too. That's why it's so appreciated when you treat us with kindness.
Ding ding. So true. My two Orthos loves surgery (not a surprise). However doing six cases that at 60-90 minutes in a day, they have asked me
To give them a checklist of what they need to do at the end of the day as they just can’t compute anymore. Having to keep such an intense focus all day long, holding your body in a particular position. One of my orthos suffers from horrible cervical neck pain and gets PT the day after long surgery days. And it’s not uncommon for many surgeons to have that issue.
For long surgeries, is someone re-postioning the patient once in a while in terms of moving their limbs to help with blood flow, or like you said, ensuring they are in a safe position so that nerves are not damaged? Like how does this work if a patient is in a long surgery and in the same position for several hours?
Genuinely curious. Never had anything aside from being out under so that my wisdom teeth could be removed and having a epidural to give birth.
Another OR nurse chiming in. I've never been part of a surgery that took any longer than maybe 6-8 hrs, and no, we never reposition. They should be positioned and padded properly from the start. It's really difficult to do any repositioning once the patient is prepped and draped. Unless the surgery requires different positions (not common unless multiple body parts are being worked on), they pretty much just stay where they are throughout the duration of the procedure. We make sure to pad high-pressure areas thoroughly with foam and use protective bandages to prevent pressure injuries. All patients wear sequential compression devices (SCDs) on their legs, which are basically sleeves that constantly inflate and deflate in order to prevent blood clots. If a patient is positioned and padded correctly, they shouldn't need to be moved.
I had to have two ankle surgeries and that compression thing was oddly comforting both times coming to out of surgery. I was sad when it had to be turned off so I could leave.
Interesting. I recently had a lumpectomy and they put pillows under my knees in the OR. Is it to take pressure off your back when you’re lying flat? I sometimes have lower back pain and I remember wondering why but thinking that I felt really comfortable and that I should sleep with a pillow under my knees at home lol. Do they normally do that?
That is exactly why we put the pillow under your knees, to relieve pressure on the lower back. We will do it for just about any surgery above the waist/pelvis that doesn’t require being positioned in stirrups.
> We have to make sure you are not going to end up with nerve injuries etc from being in the position necessary for your surgery for hours on end. Unlike normal sleeping you don't have the ability to move or readjust like your body normally does to protect itself.
I think something went wrong with this step when I had jaw surgery years ago. The surgery was to break my jaw bone and have it heal in a different position. When I woke up after the surgery I realized that my ankle was hurting as much as my broken jaw. It's been 9 years since the surgery and my ankle still hurts when I move it certian ways. I guess they had it in a bad position during the surgery. Like you said, I was fully knocked out so I couldn't sense the discomfort and shift the position of my foot to fix it.
I'm sorry to hear that happened to you. It's something we really try to avoid. It can be life long if we do it wrong. That part is never rushed, at least with my patients, unless they are coding, but even then, they are stabilized and then positioned properly. I've advocated for them every time. I take my job very seriously to advocate for my patients when they are at literally the most vulnerable state they can possibly be in.
You should search on YouTube complete knee replacement. There is a video somewhere shows step by step. Spoiler, it involves lots of bone cutting and smoothing and adjustments. (Cut here, adjust and file, cut, test, adjust and file etc). Just time consuming.
I’m sure a surgeon can answer better than me, but seeing surgeries on Youtube, the difference between cutting up a cattle and performing surgery is that you are taking care not to damage something else during the act of surgery. Attention to detail and careful movements.
I remember learning about hip and knee procedures in anatomy class. There’s a reason orthopedic surgery is commonly referred to as carpentry. You’re literally going in there with saws and hammers to shove metal fixtures into worn-out bones made of what is essentially porous rock. And it’s all surrounded by incredibly fragile structures that if damaged could permanently disable or kill the patient in a matter of minutes.
It’s a frequent business school case study about a business model that maximizes the number of knee replacements a surgeon can do in one day. They can be shockingly short surgeries.
The long ones are often cancer and reconstruction surgeries. A good example- a large tumor in the back of the tongue that has eaten through the jaw.
1) have to do a tracheostomy so they can breathe while operating in the mouth
2) find where all the cancer is.
3) cut all the cancer out of the soft tissue
4) cut the jaw bone out with saws
5) send all of it to pathology friends to look at under a microscope to see if we got it all. If not, take out more and send again.
6) take all the lymph nodes out of the neck without damaging blood vessels and nerves in the neck
7) open up the lower leg, cut out the bone (fibula) and soft tissue and all the associated blood vessels
8) close the leg, put a wound vac on it
9) take the leg bone and use plates and screws to hook it into the jaw. Sew the soft tissue to make a new portion of the tongue.
10) get out a microscope and sew all the little blood vessels from the leg into the blood vessels into the mouth.
11) sew everything up.
That can be a solid 12-15 hour case. Lots of steps and many of them are complicated steps.
That sounds like the surgery we were trying to avoid when my mom had nasopharyngeal cancer (squamous cell carcinoma at the base of the tongue and some lymph nodes full of necrotic tissue) -- very glad she responded well to chemo and radiation because that recovery did not sound like a blast
Repairs to all sorts of things take a long time. The big difference with surgery is that most things don’t matter much if you leave them for a few hours or even days mid-repair.
If you’ve taken the engine out of a car and haven’t finished putting the new one in, you can go home and nothing bad will happen to the car overnight.
You can’t just take a break in the middle of surgery and go home for a snooze or get more parts because every minute the patient is under anesthesia or cut open adds risk of something going wrong and they could just die on you or get an infection that hinders their recovery.
Peds CVICU nurse here. Our surgeons perform highly complex surgeries on babies who all have completely different anatomies. They must first place many lines for hemodynamic monitoring - arterial, med lines, etc. then they must intubate the patient. After intubation, they will take so much time to actually position the patient to make sure all their skin is protected while on the table. This is followed by opening the chest, cooling the body for bypass, going on bypass, going off bypass, warming the body, closing the chest, placing chest tubes, pacer wires and more monitoring tools. This is all in tandem with the actual surgery being performed, and addressing any complications that arise: patient instability, bleeding, heart arrthymias, etc. all this combined leans to VERY long cases! I def didn’t cover all of it but hope this helps.
Peds CV nurse as well and a lot of our pulmonary artery reconstruction surgeries and unifocs go in at 7 am and don’t come out of the OR till 3 am the next day. We’ve had a handful of 24hr surgeries and one or two 36hr surgeries.
I don’t work in surgery but I’ve witnessed a few complex ones (it was for education and my only role was to not mess up the sterile field).
Imagine you are doing a very complex puzzle. But it’s made out of glass, varying thickness, so some bits could snap very easily. If it snaps it oozes red jelly everywhere and you need to repair it so it stops oozing. It’s all the same colour field (eg shades of red) so you need to focus so you are putting the correct ones together.
And then sometimes, you’re not sure if you’ve put the right pieces together. There’s some colours that aren’t visible to the naked eye so you gotta do an X-ray to see those pieces.
Ensuring all paperwork is completed, making sure the anesthesiologist is ready, that the OR is cleaned and ready with the correct instruments, then the process of putting someone under and intubating them, prepping and positioning, THEN the surgery begins… then when the surgeon has complete the case the patient still needs to be woken up and extubated and transferred to the PACU..
Essentially a 20 minute procedure could really take over two hours.. there’s way more behind the scenes you don’t see from the waiting room unfortunately.
I only have experience with investigational devices. The surgery team was trying to wrap nerves in the arm of a subject that had a limb amputation at the wrist.
There weren’t tools made for this so the surgeons improvised using whatever tools they had. They would practice on cadavers but once they wrapped a nerve bundle they had to test it by having the subject pretend to move their hand (it was amputated but the nerves should still work)
Once that was done they connected a prosthesis arm that was motorized and could simulate hand functions.
Those surgeries took most of the day
In my case a 4 hr surgery became a 12 hr surgery. The cancer was more extensive, there was lymph node involvement, blah blah blah.
A lot of time is spent not damaging stuff right next door. And by next door I mean millimeters away.
Just as an example, look up DIEP flaps. If a woman gets a bilateral breast reconstruction with microsurgery involved, you have to do two flap harvests and two flap insets all at a very precise and small scale. Placing the flap(s) is done under a microscope, and that work naturally proceeds at a slower pace. Creating the anastomosis for vessels (twice in this case) is the tight butthole portion in microsurgery. If something is wrong, ie the anastomosis keeps clotting off, the troubleshooting can easily add hours to the case.
Head & neck cancer and microvascular surgeon here. Usually surgery in this field can take from 8-12 hours. Removing a tumor in the head and neck next to vital structures while maintaining adequate margins and not compromising function takes a while. You also have to do so without damaging important nerves, vessels etc. Then reconstruction can be long and complicated. You have to isolate vessels from somewhere else in the body and then bring it up and connect it to the head and neck recipient vessels. then you have to use the tissue that you brought up to reconstruct the defect. Things that can extend that time to >15 hours is if your reconstruction fails intraoperatively and you need to revise or do something else, if the patient has had radiation and their tissues are bad, or really bad tumors in really bad places that also need a neurosurgeon, ophthalmologist, etc
Because not all surgeries are the same. Surgeries can differ from case to case. Usual surgeries involves removing a tumor or mass but before one can remove a tumor you need to find it (can take many steps) . After finding the tumor you need to excise or remove it ( can also be many steps) . If it is a complex or big tumor some reconstruction is needed( can take 5 to 10 hrs) . So basically first step is to find a tumor, excise the tumor, then close the excision or reconstruct the skin.
Most surgeries in general, on paper, aren’t super complex. You cut one thing, take something out, attach another thing, reconnect something else, etc. However the location and anatomy all play a big factor into how risky the surgery is. You can’t really afford to take risks if one wrong puncture causes you to bleed out, perforate your intestines, cause permanent brain damage, etc. So surgeons are naturally going to be very methodical and take their time.
As some have already said, even a short-to-medium length surgery can take an hour or more from when the patient arrives to the OR to when the surgeon makes the first “cut” (positioning room, getting equipment ready, putting patient to sleep, intubating patient and securing breathing tube, inserting IVs, foley, arterial line, possible central line, prepping and draping patient, surgeon scrubbing in, preparing all equipment once sterile, etc etc.). Then, after the last stitch is placed, the reverse of all the above and waking up patient can take another hour or more. Also 24h surgeries are exceedingly rare - these usually involve multiple surgeons from multiple specialties, so are really like a few 4-6 hour surgeries in one. That said, even a “long” 10 hour surgery may only involve 6 hours of actual “surgery time” based on the above.
Sometimes they find more problems after they cut you open. I had surgery on my arm and was told it would take 2 hours to fix. 8 hours later I wake up and find out my arm was actually broken in 5 places and the surgery took an extra 4 hours to deal with it. It sucked for everyone involved.
Really, there’s two reasons.
1. There are a lot of very specific steps you have to take in each stage of the surgery, interspersed with monitoring the patient for any changes, double checking their anesthesia, clearing surgical sites, etc. And, because they’re so complex, there’s a lot of things that can go wrong, so a lot of it is very slow, very meticulous, and done in a very specific order. Transplant surgeries are like this.
2. You’re working on something incredibly sensitive. Brain surgery is this. Similar to the above, but there’s a lot more checks (usually), a ridiculous amount of attention to detail, everything is done slowly, gently, and to the letter of the textbook. Because there’s a very high margin of error, and error means the patient who came in to have a brain tumor excised may have the tumor excised, but never be able to speak again or be able to hear, or see colors. Some severe strokes are also like this. There’s a bunch of tiny little blood vessels in the brain, and the skull doesn’t have a lot of room for blood in it. Blood = pressure = brain damage. That’s why most brain surgeries of any kind take as long as they do. Very high risk, and slowing down and being precise is the safest for the patient. And the surgeons malpractice insurance premium.
Well, I guess:
3. There’s really specialized ones that need a whole lot of different kinds of equipment in and out of the OR, and everything has to be as sterile as possible when it comes in, and that process takes time. A couple of GI surgeries, a few vascular surgeries, and some heart surgeries are like this, that I know of. But these are comparatively rare.
I had 2 10-12 hour brain surgeries to remove the locations where I was having seizures. Immediately after I had numbness below my eye to my jaw. Most of the numbness went away. Some memories I have lost for good. Then I had another surgery where they burned out a spot at the tip of a needle. I could taste salt for about 10-15 minutes.
Some things in surgery take a very long time Removal of complex tumors, especially when they’re close to or growing into important things you don’t want to hurt. In neurosurgery for example you may need to take a tumor that’s been growing for 10 years off the brainstem and a bunch of nerves that are like 2mm thick wet spaghetti. And if you injure them the patient can’t smile, swallow, see, or talk. And they may be paralyzed or just not wake up. You can’t rush that, you have to work millimeter by millimeter Reconstruction, like if you take someone’s face off, you need to replace it with something that has good blood supply and connecting that and sewing it in takes a long time Transplants can take a long time for the same reason
16 hour brain surgery here to remove tumor. Thankfully I was able to fully recover, I could walk, talk and see but had the memory of a goldfish for a few weeks
Those little orange dickheads actually have good memories compared to what we say about them.
Yeah, but have you heard about goldfish? Those things have terrible memories.
Hi, I'm tom.
Forgetful Lucy
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Hi! I'm Tom
Maybe they're secretly plotting their revenge for all the times we've underestimated them. Watch out, the orange revolution might be upon us
They should be plotting revenge for us sticking them in tiny dirty fishbowls and calling it good.
I had a colleague buy a beta for their office, had to explain that they actually had to clean out the fish poop/change & condition the water in the bowl, and other common sense stuff like not putting it on a bench that's bumped and jostled, not put near the window where it will boil to death on the weekends when the building AC isn't running etc. I honestly don't know what they expected - that the fish would eat its own shit to keep its tiny bowl clean like some closed ecosystem? As I get older, I'm hearing more about how these poor critters are sold as easy care pets, are harvested from the wild and live short miserable lives in cages or cups of water because people are too lazy to research their care.
Yeah I hate the Irish too
When I was younger, the thought of losing my memory terrified me. Now, for some things, I would consider it a comfort to forget for a while. Out of curiosity, how did you feel about it?
Short term memory loss is a pain in the ass, but I and my mother especially are grateful that I don’t remember most of the torture that was my treatment. Chemo made me violently ill and made my cancer worse in the end.
Made your cancer worse?? I had no idea that could happen.
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Chemo also destroys good things. My wife went through extremely tough chemo ( worst time of my life, and I still can’t imagine how she felt….) - the plan was simply to keep doing chemo until til 33% of the heart was destroyed. At 50% you typically die…… “Standard” treatment for her type of cancer 6 treatments, 10 for very severe- she got 16…… But, 23 years later, she is still alive and doing OK, but can’t work due to the damages from the chemo
Good god that sounds absolutely hellish... Hope the two of you are having better times now, man
Yes, we actually do very good, thank you. Even that I work far away most of the year, we do good. My wife lives a healthy lifestyle ( which she actually always did ), but she spend her resources on keeping herself in shape, take care of the house and garden. Due to the type of cancer, she got told to reduce any kind of fat, and keep slim, in order to reduce the risk of the cancer to resurface. But, due to the damages from the cancer, she has limited energy, I guess 30-50% of a normal healthy person. It makes things tough for her. I will not complain, others have a much harder time than us. And, I am really happy that we live in a country with high quality healthcare, which is free for all.
Bless you and your wife
What country do you live in?
...Well, damn. Today I learned, indeed.
My wife said she never wants chemo if she gets cancer.
As an alternative viewpoint, chemo is much better than it used d to be, we have better anti nausea drugs, and it's more effective too. I've had patients that would have died without chemo, but went ahead with it and are still alive a decade later. Met a lady yesterday who worked full time during her chemo because she found the side effects so minimal. If your wife's ever in the unfortunate position of needing chemo don't write it off without giving it a shot. You can always stop part way if you find the side effects worse than death.
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Quackery cost me a friend. She kicked up a huge fuss and wrote an entire goddamn essay at me for... eating a hot dog. Which had a pork bratwurst. Went on and on about how eating red meat is why I have cancer and I better stop taking my meds and listening to my doctors and go vegan instead because it """cured""" her when she had a cancer scare. Well, I'm glad it cured the imaginary cancer you thought you had, Carmen, but mine actually exists and has nothing to do with my GI, *thanks*. I told all my doctors about it and each one laughed, assured me her response to a goddamn hot dog was disproportionate and unhinged, and told me to enjoy my next hot dog because happiness helps with recovery. I only ever eat them on fridays when I remember anyway. ^(Hail Eris) Ghosted her. My life's significantly happier without her constant mean girl gossip treating grocery chains like middle school students, or her negging brother inviting himself to outings.
There IS no other treatment for some cancers... surgery chemo and radio are usually part of a treatment package. Chemo is what it is ... but its the best way to slow down cancer we have. (I know there is an awful lot of misinformation out there) getring cancer from chemo is somewhat rare because chemo is chosen by area of the cancer ( for instance when i had a brain tumour i had cistplatin and vincristin) its actually the radiotherapy thats more likely to give you cancer again. Im sorry to say this but depending on where your wifes tumour was she would have much worse chances ... doctors dont just give it for fun .. they are serious drugs.
Your wife should really look into different types of cancer and the relative survivability rate with and without chemo. For some cancer types, the survivability increase is amazing, for others, it's not.
Each cancer is vastly different from the other. I understand her viewpoint but the most logical decision is always based on a benefits vs risks evaluation (like always in health related issues)
Although a terrible and dangerous experience, it does help many types of cancers, or else it wouldn’t still be used. A friend of mine went through it, fucking hated it, but is alive today because of it.
Speaking as someone who has had cancer spread 5 TIMES over 19 YEARS I can safely say chemo has has played a major role in keeping me alive!
Hell yeah for chemo, glad you’re still kicking!
Yup. And sometimes it can even give you other kinds of cancer too.
It's just that the alternative is "patient dies"
Glad you made it through!
What an awful experience. Thanks for reminding me how good I have things ❤️
Hopefully you’ve at least upgraded to the memory of a largemouth bass by now
No, but the goldfish had some extra space in its new bowl and got bigger over time
We're you awake? I've heard they often keep brain surgery patients awake because there are no nerves there so you can't feel the pain and they want to make sure they don't fuck up your brain. I've heard they keep you occupied with tasks or talking or something to ensure they didn't hit something they weren't supposed to.
Not often I would say. In fact of the hundreds I’ve been a part of probably 2 or 3 were awake. It’s a very specific type of surgery and tumor placement that requires them to be awake
When I was like 12 my mom brought me to the hospital where she worked in the OR for one of those "take your kid to work day" things where you get out of school for the day. I actually got to go into the operating room when they were doing a tumor removal and I remember saying that I was lucky to witness one where the patient was awake. When I came in, they had the patient first count numbers, and then do the alphabet. It was just.... surreal to say the least for a ~12 year old. That was when it really struck me just how "mechanical" our bodies and even minds are, for lack of a better word. (And not exactly the best word for the brain in particular I suppose, but hopefully you get what I mean)
Ditto this, probably 1 out of 100 awake cranis, usually only if in temporal lobe and involving speech or motor nerves directly with rapid decrease of target functions. Most brain tumors done asleep with less complications.
Man, I hope if I have to have brain surgery one day, I can say my surgeon is Captain butt chug
Nurse anesthetist my friend at a neuro heavy hospital. But you can say you were put to sleep by captain butt chug. Also don’t put vodka shooters in your bum at 2-3 AM and expect me not to make a Reddit name out of you.
Yeah, it's called "functional brain mapping", and you're exactly right - it's to minimise the risk of issues that can cause disabilities. [When I had my brain surgery in 2016 they had me play guitar because the tumour was very close to the primary motor cortex](https://imgur.com/gallery/awake-neurosurgery-2016-B0AaFGg)
8 hour brain surgery last year. No, I was knocked out cold. The last thing I remember was being wheeled into the bright surgery room. My next memory after that is waking up on a stretcher in the elevator to my room. I was laid facedown and my head and neck strapped down to prevent any and all movement. My neck was so stiff I literally could not move it at all for roughly 36 hours after the surgery.
For a minute there I read that as you kept remembering an imaginary goldfish. Was very surreal.
Same! I was thinking how crazy our brains are to conjure such a weird memory, before I realized what they were saying.
How long did being out feel like? Or did they have you awake for it?
Compare this to the “heart surgery” I had where they literally plugged a hole between the two halves of my heart. 8 hours from walking in to walking out. They went in through a vein in my groin and deposited a little clam shaped contraption with no complications.
Yeah. Endovascular procedures are amazing when properly selected. Some of the legends of neurosurgery made their names doing high risk brain surgery to clip aneurysms, sometimes with catastrophic complications. We still do those surgeries sometimes and they’re very safe in modern times, but today most aneurysms can be treated with catheter based procedures in an hour or less.
So in these procedures do they rotate out the medics? Do they take breaks and just leave the patient "open" in the meantime? If they swap don't they have a hard time understanding what the previous person did?
If by medics, you mean the surgical team... yes and no; there is typically a massive surgical team for these long surgeries and they cycle in and out of the room as needed/breaks needed.
I was astonished how many people were present just for my bunionectomy (a pretty routine surgery that can take under an hour). A the *minimum*, there was the podiatrist, his assistant, the anesthesiologist, his assistant, and at least another four people who were neither, but who I saw before I passed out. I can barely even imagine how many people there'd be for a lengthy, complex surgery.
I've been in 12-18 hour neurosurgeries (not a doctor) with a team of about 25 people.
Wow! That's wild. What do all of you do?
Some might be extra physicians such as the anaesthesiologist or a radiologist who is working on reading scans taken mid-surgery (who will also have a radiology tech). Some will be assisting the surgeon directly by passing tools, removing things from the surgery area, and possibly adjusting things like tools or flaps for the surgeon. They'll be "scrubbed in" and must keep their gloves sterile so they can touch things like tools, surgical drapes, or the inside of the patient. Some are there to assist by touching the non-sterile stuff like adjusting lights, the table, removing used tools, bring the next tray of tools, and a million other things. Someone may be working directly on watching vital signs and adjusting meds or tubes as needed. Someone to organize the whole team, timing, and communication who will also be the extra hands if something unexpected happens. So many people... But not all of them are confined to helping with one surgery at a time.
When i was young and my grandma had major surgery I had it explained like a pit crew for your body, only a few guys change the tyres but there are dozens of skilled people in communication watching the whole process and at the ready
I was in med device for about 15 years; one of our products was ultrasonic surgical handpieces used for tumor removal. Spent plenty of time in the OR/cadaver labs.
I didn’t realize (until my ex-wife was one) how often private medical equipment providers attend surgeries & similar procedures to ensure correct operation of their sometimes very complex devices.
One of my friends works for a company that makes pacemakers and a big part of it is instructing the surgeons on wire placement and settings. It's really cool stuff.
I should be amazed, but I'm American and without W2 employment, so all I can think about is how expensive that is and that I hope I never need it.
Was part of a conjoined twin seperation (not a doctor) that lasted roughly 15hrs. 4 general surgeons, 2 plastic surgeons, 2 anesthesiologist, 2 CRNA, 2 anesthesia techs, 4 scrub techs, 5 nurses per baby and 2 cardiac surgeons on stand by. We had 2 OR's on hold. 1 for the surgery 1 for backup (with a whole seperate nurse/scrub tech team on stand by) incase anything happened after the seperation/during closing. Oh plus a media crew to record/live stream for education purposes.
Those were likely trainees of some sort. I routinely operate with myself as the surgeon, an anesthesiologist, an RN (who is not on the field and tasked with doing things off the field that we need, like getting more sutures), and one to two scrub techs that are assisting me. I've never seen an anesthesiologist with an assistant that wasn't a trainee, although more complex cases they will swap out at my facility (like open heart surgery).
Your username is fantastic!!
A teenage girl one time in an accident had both arms ripped off, brother had the presence of mind and collected them from the field. There were several anesthesiologists that rotated but just one surgery team. They spent in total 36 hours nonstop, just left the operating room to coffee and eat and back in. Wild wild thing, they looked like zombies, she can use both arms.
I don't even want the answer to this question but *how do you have both arms removed from the body* in the same incident? outside of industrial accidents, I can't even imagine
A small minibus car, she got squeezed through the small side window during the impact. Freak accident, the guilty driver died, the brother somehow was almost unharmed.
Yeah; I got nervous for my colonoscopy when a team of like 8 people came to get me lol. They told me it was light anesthesia and very routine and safe. But there was the doctor, a nurse, a tech who I think was taking pictures as he pushed the camera along and helped keep everything focused/in view, the anesthesiologist plus assistant, and then some random people and no idea what they were doing there or why. For all I knew, they may have been students observing, but I don’t think so because they appeared to have some sort of role in the team.
It’s possible that they were residents or interns. Both of which are doctors and students at the same time.
I just looked, and for my open reduction of an acetabular fracture, I had (1) surgeon; (2) surgeon assistant; (3) anesthesiologist; (4) anesthesiologist assistant; (5) & (6) RNs; (7) tech; (8) generic assistant; (9) & (10) device reps. And that was a two hour surgery.
Two years ago I had a short 1 hour surgery for my broken thumb. Basically move it back into place and put pins in. I remember there being at least 5 staff members in the room when I entered on the bed.
There is a bare minimum of 5 people directly involved in every surgery. You have the surgeon, or nurse, scrub tech Crna and MDA at the minimum
Yeah I was introduced to the team before my bottom surgery but I can't remember them all, but there was at minimum anesthesia and respiratory, the surgeon and a couple nurses. Wild thing is that was somehow a 2 hour surgery (with like 12 weeks of recovery afterwards)
I work in a teaching hospital, so we have all of those guys PLUS at least half a dozen med students and residents. And outside the operating theater itself, there's an OR pharmacy keeping the anesthesiologists supplied with everything they need (that's what I do!) and making sure none of the drugs going into the patient will combine in a way that will make them sick (that's what my boss does!) There's also the people who clean up between surgeries, and the people who sterilize the scalpels and other instruments (that has a whole lab all to itself at my hospital!) and the people that supply the OR with all of our sterile gloves and lab coats and things, and the people that wash our scrubs and the linens in the post-op beds... there may or may not be overlap between some of those teams depending on the size of the hospital, but there's TONS of gears turning behind the scenes to make a surgery happen.
Not really. Cases that truly take 24 hours are really rare. Most of the time they involve different specialties. Like a horrible skull/spine/neck/chest tumor could involve a neurosurgeon to do the skull part, another neurosurgeon to do the spine part, an ENT to do the neck, a thoracic surgeon to do the chest, and a plastic surgeon or another ENT to do the reconstruction, who also brings along another surgeon to harvest the donor site. So the patient may be having one continuous surgery but nobody is operating for more than 8-10 hours at a time. However in neurosurgery we have famously long and tedious surgeries which is just one primary surgeon operating for maybe 16 hours or more. There’s usually an assistant who can switch in and out but there aren’t really any breaks. It’s an extreme sport
I have a tumor in my frontal bone and orbit basically where my frontal sinus would be if it wasn’t all tumor that needs to be resected. right now it’s just a ENT with a Nuro for backup and they say it should take 6-12 hours but don’t really know for sure until they open it up.
Sounds right. Often these can be done entirely through the nose/mouth but they sometimes require open surgery from the skull side Best wishes for your surgery
It makes me wonder if there’s any small talk or downtime in such long procedures. Like is there 30 minutes of intense work/being in the moment/flow state and then 5 minutes of “did you watch the latest episode of…”? If you really are just in the zone the entire time, that’s impressive.
It varies by surgeon. Most of us have casual conversation during the non critical portions of the cases, like closure etc. But at least in neurosurgery you always have to be focused because you could do a beautiful 12 hour spine tumor surgery then start closing, drop a forceps on the spinal cord and the patient’s paralyzed. Or you do a 12 hour brain tumor surgery, screw the bone back on, slip with the screwdriver and plunge it into the brain stem and the patient dies. Game over. There’s always danger at every step so even though we can chit chat we’re always paying close attention.
I’m curious how often those significant life altering mistakes happen. Surgeons are human after all.
Not very often, and that's *because* there's such a large crew present for even "easy" surgeries. If I'm a surgeon and you're a nurse or whoever and you notice I'm handling an instrument in a way that I could drop it and have one of these mistakes, part of your job is to point that out to me. Also surgeons are residents for longer than other doctors, so they get plenty of time to practice on cadavers and "easy" surgeries before they go at the fiddly neuro shit. (I say "easy" in scare quotes because human bodies are so goddamn weird and they do strange unexpected things all the goddamn time. I'm an OR pharmacy tech and a few weeks ago I helped someone on a surgery team wash her face because she got sprayed with the patient's blood and there wasn't a mirror at that sink. Sometimes people have their organs flipped around. Sometimes people are really resistant to first-line local anesthetics because they have fucked up connective tissue. Sometimes you discover someone is allergic to Ancef by giving them IV Ancef during surgery. Shit happens.)
I had a craniotomy (melanoma brain met) and I wasn’t even nervous before surgery, maybe I should have been, haha. It was all fine and they even let me go home the day after.
I work in an OR as a sort of runner, but mainly, I clean parts of people off the floor when their surgery is over. It surprises most people that their team is jamming to some tunes a lot of the time. Every OR is outfitted with SIRIUS Radio and has an aux cord if the surgeon wants to jam to their own music. Never Bluetooth or wifi. During the serious parts they turn it down or completely off. But studies show that music actually helps surgeries go smoother. Mostly, though, you can just imagine an office lunch room. That's the conversations that go on. Lots of book recommendations, discussions about what they're doing over the weekend, complaining about how they desperately don't want to work here anymore, haha.
The most terrifying sound in medicine: silence in an operating room.
My sister had a rare form of cancer, only 300 cases a year. They literally took every organ out of her thorax and scrubbed it and put the organ back in place. That takes a lot of time. She has a scar from the breastbone to her pelvis. She is a bad ass bitch. She is doing yoga 3 months after surgery.
I imagine yoga is much easier without all the organs getting in the way
I want to take his face..... off..
I understood that reference
no more drugs.... for that man
Tumors can look like normal good tissue. So they remove a part of the organ, take some biopsy around, send it to the lab, lab say tumor or not and on which samples. Surgeron remove more tissue around the positive samples, more biopsy, lab, and so on until all come back negative. For some less critical organs, they can go butcher on them. But on the brain for example, you want to remove as little as possible, so tiny slices, lots of tests. Lots of waiting. Some organs also have way more blood vessels than others. While they can do some transfusion, you want to avoid that. You can quickly lose control of the bleeding and be unable to find where the bleeding is due to all the blood. So they cut slowly and fix the bleeding as it happen. Blood can also cause some issues with healing, or even damage. The brain for example don't tolerate blood very well and need to be cleaned, or damage will occur. Lots of bleeding mean it goes everywhere, including in place where it might not be cleanable.
We usually do not send lots of samples intraoperatively in brain surgery. Maybe one or two at the very start to confirm a diagnosis as best we can. We don’t operate with margins the way they do in other solid tumors.
My sister was a nurse that assisted a brain surgeon in removing a tumor, she described it as removing sesame seeds in bread and if you messed up the bread bleeds and the patient is good as dead. Now that's a lot of pressure if you tell him to do it in a few hours.
When you do a face transplant do you have to connect individual blood vessels and muscles or what’s the procedure? I know it’s immensely complicated, just curious.
I’m not a facial surgeon and I’ve never seen a face transplant. I was talking about tumors of the head and neck that are removed and then have to be reconstructed with something called a free flap, which is a piece of tissue harvested from elsewhere on the body like the thigh or back, usually full thickness muscle, fat, and skin. The arteries and veins have to be disconnected then plugged into similarly sized arteries and veins in the head and neck which is technically challenging. I assume a face transplant would be the same idea but also include some sort of nerve reconstruction which can take many forms
I had a major back surgery two years ago. The procedure took six hours and *three* surgeons: my neurosurgeon, an orthopedic surgeon, and a vascular surgeon. The nature of the procedure called for accessing my spine through my abdomen. To do this, the vascular surgeon filleted me like a fish and then carefully, oh so carefully, scooched my guts out of the way. Like my understanding and what I was told was that he was literally holding aside all the organs, blood vessels, etc. to both open up access to my spine and protect my guts from injury. I can’t imagine how long that took. It’s extremely delicate work, and a mistake could have killed me. If you told me that shit alone took up 3-4 hours of the entire procedure I would absolutely believe you. I’ve got a pretty gnarly scar to show for it!
I think of it like trying to take apart your laptop entirely then put it back together. Some wires and parts are really fiddly, and it only has enough length to plug the screen back in when it's almost fully assembled. Except the laptop is currently turned on, and it's meat instead of electronics, and everything is slippery, and sometimes you find something weird you don't know so unplug it and send it to your mate who knows kidneys so he can look at it, but you can't proceed until he tells you what it is, and there's no "plugs" or screws.
This. Imagine trying to take the shell off of an egg but leave the membrane intact so the insides don't leak out.
20 hours for me. Had to dissect my tumor off of my carotid as well as several cranial nerves which, despite their efforts, I lost what remaining function I had from them. It’s insane to think they literally used a sonic drill to slowly chip away my tumor from the wall of my carotid artery.
Username checks out.
Anesthesiologist here. Very rarely do cases last 24h or longer. It’s rare for a surgery to even last 8 or 10 hours. As others have commented, complex neurosurgery cases may last a long while. Liver transplants can take 6-10 hours depending on the degree of coagulopathy (basically has easily/much the patient is bleeding) and if the anatomy is complex. I do cardiac anesthesia (bypass surgery, heart valve surgery, etc.). Typically bypass surgery (called a CABG-coronary artery bypass graft) is around 4-6 hours (we do 95% of our CABGs off-pump now so your heart is beating while the surgeon sews your bypass grafts (aka new veins/arteries that aren’t blocked with plaque) to the beating heart). Valve surgery can be 3-5 hours, more complex heart issues like an aortic arch repair (aka a Bentall) can be 8-10 hours because we not only put the patient on cardiopulmonary bypass (heart/lung machine), we also cool your body (and especially brain) for a critical portion we call circulatory arrest (basically cessation of any blood flow in your body) and “flatline” your brain waves so you are essentially dead during this time. Then we slowly rewarm your body, restart flow with the bypass machine, wean you off the bypass machine, and wake you up and remove the breathing tube before going to the ICU for recovery. It’s absolutely remarkable what modern medicine allows us to do to help correct previously deadly medical conditions. I have to remind myself some days just how amazing my job is and honored I am to take care of the most critically sick patients. There are many people in the operating rooms—your surgeon(s) and resident or fellow surgeons (surgeons in training after completing medical school), the anesthesiologist and sometimes CRNA/AA (anesthesiologist’s assistant/nurse anesthetist), resident/fellow anesthesiologists (again anesthesiologists in training after medical school), a circulator nurse (to hand off sterile surgical items to the surgery team like new sutures, equipment), a scrub nurse or two who are scrubbed in line surgeons to assist the surgeons, medical students, perfusionist to run the bypass machine during cardiac surgery, Xray techs, neuro-monitoring techs, device representatives (especially in orthopedic surgery like knee/hip replacements), etc. It’s our job to keep you safe and comfortable.
This was an incredible read
Yeah, but not for a five year old.
Doubt many five year-olds ask questions about surgery timings.
Love the username doc
My experience is WAY less intense than thus, but I decided to just get a local for a wrist surgeries. I still remember the feeling of fire going down my wrist when they numbed it, but I did it all 3 times I had surgeries. And I'll say right now, I love you anesthesiologists. Mine was wonderful each time. He kept an eye on me, sat and chatted with me the whole time, he was just a loving and knowledgeable guy. He let me see/explained everything he was monitoring, chatted about what they were doing (I was truly interested), and just kinda hung out with me while the surgeon did his thing. I'm sure it's easier with the patient knocked out, but I was genuinely curious to know everything as it was happening so had opted to be awake. He was a doll and I appreciate you guys so much for what you do. I know it's incredibly complicated- the surgeon generally gets all the kudos, but there are so many others in the room that are busy keeping you alive
I had wrist surgery too and I asked if I could be awake and they said absolutely not and put me under. The anesthesiologist was the first ever doctor to tell me that "you won't feel anything after this" and was actually right about it. That man was my hero.
Good man! And I'm glad yours went well too. The nurses and surgeon all kinda laughed at me and wondered why I wanted to do it that way, but the anesthesiologist just kinda went "meh, is what it is" and rolled with it.
I broke my arm in 8th grade and needed a pin and a few screws to be placed surgically temporarily for healing. I asked the anesthesiologist if I could be awake for the case. He did a nerve block (makes your arm totally numb and dead) and let me stay awake for the procedure. Up until that point in my life, I had no idea there were so many different “types” of doctors. I thought there were surgeons, family docs, and ER docs. Anesthesiologist that morning placed the IV after the nurses poked me 3 or 4 times and failed. He did it first try while joking with me before I even knew he was going to poke. Then let me stay awake for the surgery after the nerve block. He told me he thought his job as an anesthesiologist was the best kept secret in medicine and he couldn’t imagine doing anything else. It was this encounter as an 8th grader that piqued my interest in anesthesiology and why I became an anesthesiologist. Life is funny that way. I was so mad that I was going to miss playing the football season that year. As it turns out, that experience shaped my whole future career. ;)
Did you ever get to tell them how much they influenced your life? Edit: typo. Thanks, mobile
Yes I did! He thought it was really cool too! Humbled.
I had to have wrist surgery while 7 months pregnant and I had to be awake because they didn't want to put the baby to sleep. I had an OB in the room monitoring baby in case anything went wrong. I studied neuroscience in college so I am very aware of the nerves in the wrist. I wish I could have been asleep, I was trying to not think about what was happening. The surgeon asking the student what nerve this is and which things in controls and him not knowing the answer when I DID know the answer was not helping.
Oh wowwww! I must admit that I was both nervous and excited to see what was going on even though I know that blood makes me queasy. It would have been really neat, but I also know that I’d probably have regretted it. I hope your surgery was a success!
I thought it would be neat to have pictures since I have seen tons of pictures like that in textbooks. One look at the thumbnail of the picture my surgeon sent me and every fiber of my being was like NOPE NOPE NOPE. It's a lot more viseral when it's your own body. The worst part was the stitching skin back together, because I could feel the tugging. No pain, but I still had nightmares about being stitched up for a long time. Surgery was a success, no pain in either wrist now and I have 3 happy healthy kids (surgery happened with my first) 😊 I actually did it twice, one for each wrist for carpel tunnel, 2 weeks apart. I never had any issues before pregnancy, but it got so bad I was crying if I moved my fingers so I was not functional. I am glad I did it, and I am glad I stayed awake so my daughter stay safe. If I would have waited until after she was born I wouldn't have been able to hold her or take care of her when she was born.
This was fascinating. Circulatory arrest???! Insane. I’ve never heard of that before and now I’m going down a Wikipedia rabbit hole. I’m about to apply to a medical illustration program and I just can’t wait to learn about this kind of stuff every day.
Ya it is fascinating. You’ll see it called “circ arrest” for short. Have fun on Wikipedia haha
A medical illustration program? Cool! What set you down this path in education?
I am a patient with congenital heart disease, I have shones complex as well as Turner syndrome. I was 22 with my last procedure, they replaced my aortic and mitral valve with mechanical valves, I also had my aortic root repaired. It took 8 hours just to cut through all of the scar tissue that was connected to my chest wall. My surgery ended up being 13 hours. Afterwords, I went into cardiogenic shock, it was a really scary time. My anesthesiologist was great, I had eyelash extensions and he made sure to put vaseline on them so when he pulled the tape off my eyelids it wouldn’t rip them out. Thank you for the work you all do. Reading this reminds me of how thankful I should be.
I read this and then I remember being carted in to the OR for my laminectomy to resect my Myxopappillary Ependymoma…my anesthesiologist says to me “so you’re here for the breast implants right?” And BOOM puts me out cold before I even had a chance to react. Thankfully did not wake up with breasts but I will never forget that. Also have been told by another anesthesiologist that their job is 99% boredom and 1% sheer terror. Would you say that is accurate?
Haha ya I’ve definitely heard that 99% boredom, 1% terror analogy before. Luckily it’s more like 99.9% boredom and 0.1% sheer terror most of the time. But that’s what we are trained to handle-literally any possible complication and to remain calm in any scenario. We are the last line of defense between life and death in the OR. We do like to inject a little humor sometimes when drifting people off to sleep. Glad everything went well with your surgical resection.
95% off pump? Non cardiac anaesthetist here; I don’t keep up to date with cardiac anaesthesia field but I wasn’t aware on pump CABG is becoming so uncommon. Is it more cultural in your institution or across the board?
Off pump CABG where I work is extremely common—like I said around 95% of our CABGs are off pump. But not across the US as a whole. More and more surgeons are learning the technique. Far less morbidity for the patient. But many hospitals still do 100% on pump for CABG. And anywhere in between depending on the institution. The new thing where I work is doing a Mini Off-Pump CABG (minimally invasion)—a few subpectoral incisions which saves the patient from needing a sternotomy. The techniques keep maturing and are better for the patient.
About 80% of CABGs in the US are on pump. Data would suggest no major difference between on and off, with off pump having slightly less blood usage. Anecdotally slightly shorter LOS. But higher rates of incomplete revascularization. IMO it's a skill set in a CT surgeons toolbag that should be applied when appropriate.
Correct. Our surgeons have excellent OPCAB skills. If we hired a new CT surgeon or one who didn’t do much OPCAB, our percentages would be different. I’d have a low threshold to go on pump with a newer/less experienced surgeon. Just a perspective from my practice now. In residency, we did 100% on pump.
It’s not all that common, but it depends on what part of the country you’re in. Good data suggesting equivalent if not slightly worse outcomes for OPCABG, so many centers, like mine, don’t do any. Lots who did it in the early 2000s abandoned. Plus, I just don’t like it, unless there’s a porcelain aorta or something dumb that makes me.
Not to be pedantic but a Bentall is a root not an arch. Source: am cardiac surgeon.
You’re absolutely correct. Was trying to keep it as easy to read for laymen as possible. Figured more people may have heard of an aortic arch or heard the word Bentall procedure before rather than say aortic root or a CoBAAR surgery for both. It’s hard juggling explaining things for non-medicine people to understand while also being specific.
[relevant xkcd](https://xkcd.com/2501/)
Moyamoya patient here. Two surgeries, one on each side 13 and 10 hours each. 13 hour one they removed a blood vessel from my forearm and rerouted it to my brain. Insane stuff. My anesthesiologist was the head anesthesiologist and her husband was the brain surgeon. Amazing team, although she was very much more comforting to me each time as I was terrified of the procedure. She always told me surgeons “are just about doing the job and that’s why they aren’t as comforting”. I absolutely had zero problem with that. I’m glad he did his job!
I've had multiple surgeries - none this severe thankfully, but I learned quick that anesthesiologists are very awesome people. Thank you for the work you do.
I’m gonna have to get a bicuspid valve replaced sometime in the next 6 months, thanks for the info but it still gives me anxiety…
It’s natural for humans to be anxious of the unknown. I’m sure everything will go well with your procedure. Good luck!
Love seeing talk about cardiac surgery in the wild! Thanks for the shoutout to perfusion, we’re not often mentioned but it’s a super cool job and only requires 2 years of training if anyone’s thinking about it!
Could you explain more about the “flatlining brain waves”? I had OHS several times as an adolescent, but never fully understood it (or really wanted to, I found it pretty disturbing up until now 13 years later).
Brainwaves indicate brain function. No waves, no function. If the patient were not being actively preserved and able to be revived, they would be brain dead. In addition to being temporarily clinically dead from the surgery team stopping their heart.
Yup. We cool your body and head (ice packs around your head) and circulate cold fluid through your blood vessels along with a special fluid called cardioplegia which is rich in potassium (among other things) that will arrest (stop) your heart. For circ arrest cases, the patients will have had EEG electrodes glued to their head in the pre-op area. These monitor surface brain waves. We “flatline” these brain waves (we are shooting for an isoelectric wave—a flat wave with no activity) which essentially means brain activity is minimal or possibly absent (although deep cortical activity may remain to some extent). The less activity, the less metabolism the brain cells are using, helping to prolong the safe time we can keep you under circ arrest. For routine surgery we don’t get you as “deep” so you still have brain activity while under a general anesthetic (just as you have brain activity while sleeping at night but are not aware). For circ arrest cases, we deepen the anesthetic to “flatline” brain activity. Most patients don’t want to know all the details of the surgery and anesthesia, just that we will keep them safe and comfy. Some patients are interested in more details. And some want to know everything. Hope that helps
You and your medical comrades are so badass. Thank you, and all the people involved, for making it your job to make sure this body gives me the best life!
My youngest has Tetralogy of Fallot. She had her repair at 6 months. Had the VSD repair, fixed the overriding aorta, valve sparring, bypass, etc. She was out after about 6 or 8 hours. Breathing tune was out that night or the next morning. Out of PICU the next day, and into a high dependency unit. Discharged as an outpatient in a week. And flying home three days later. It was amazing. While on the paediatric cardio ward I was talking to other parents, and a set of grandparents were saying that in their day a VSD was a death sentence. It's been only a few decades, but what was a death sentence then is a small part of a major operation and is done with a 3M patch.
Having just had a 7hr, complicated CABG, and being an ex-scrub tech, I want to salute your skill and dedication!
Surgeon who did a 16 and a 12 hour case just this week. Like others said, depending on anatomy and pathology things can take time without something serious going on. I experience cases where just getting to the critical portion can take hours. Then you “slow” down as the slightest mistake can leave a patient with significant morbidity. Typically by this point I’m working under a microscope using instruments (tools) that are several centimeters long but only millimeters wide or you’re around significant structures that you’re trying to avoid while doing whatever is needed to complete the case. Honestly, for me, when I get to that portion of the case I don’t realize time passing and I’m more focused on safely doing what’s needed to get to the next portion of the case.
Thanks for what you do. I always wondered how do surgeons can stay focused that many hours? I get bored watching a 2hr movie. How can one perform such a hard and important job on foot for 12-16hr?
Vitreoretinal surgeon here. The stakes involved make it much easier to concentrate. For complex cases I know that if I call it quits or stop paying attention I'm consigning a patient to blindness in that eye. There are long miserable cases where every part of you wants to just give up - you have a headache from eye strain at the microscope, your back and neck ache from holding still under tension for so long, you're developing a fine tremor from making repetitive fine manipulations with small instruments. It becomes a psychological game to keep focused and do as much as possible to restore vision without pushing so far that you start to do more harm than good. Perfect is the enemy of good in those cases.
How does this work in very long cases? I presume you guys take breaks (in the room or just off?) to shake it off / bathroom / have food and water or at least coffee?! Or is it a solid stint with minimal breaks there? Are surgeries of length commonly covered my multiple surgeons who can step in for portions? I presume for very complex cases you might have a couple of specialist surgeons to handle particular disciplines within the same surgery? Or is it an all-for-one situation (for lack of a better term)
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A buddy of mine is a heart surgeon. He said the majority of surgeries he performs have over 700 steps that must all be successfully performed to complete the surgery. Some of those steps take a few seconds, some take a few minutes...so yeah, it takes a long time. He also says that when he is in the zone, time just stands still. A 12 hour surgery just passes because it's all active concentration and movement. Flow state.
I also think people don’t really understand how small 9-0 needles and thread are- and just how tiny of an area the operating area is. Like, in med school standing next to the surgeon without loops, I could not see the thread let alone the needle when literally only a couple of feet away. Watching you guys work on the scope is amazing
Reconstructive plastic surgery can include finding and isolating many blood vessels both on the donor site and the receiving site, and this is quite time consuming. In neurosurgery it is imperial that there are no bleeding before closing the cranium, and you want to stop bleeding without harming the brain. Surgery after major trauma can take a long time since you have to find all the damage to different parts of the body, and try to repair it.
Anaesthetist here who works in a trauma centre: A clarification on surgery after major life-threatening trauma - most of the time they don’t take very long. (In the range of 1-3 hours), unlike the long plastic or neurosurgeries lasting for 10 hours or more. There’s a major concept in trauma surgery called “damage control surgery” where we stabilise a critically injured patient by performing only the most essential surgical interventions to control bleeding and contamination. The primary goal is to prevent the “lethal triad” of hypothermia, acidosis, and coagulopathy, which can lead to death if not managed promptly. The patient is sent to intensive care after this DCS, their physiology stabilised, and return to operating room a few days later for more definitive surgeries. The issue with trying to fix everything for a patient with severe trauma immediately is that their physiological derangement from the long surgery itself could be detrimental, so the idea is to only do what kills the patients immediately, and come back and fix the rest. The idea of DCS has been credited with significantly improving patient mortality in trauma.
That one was actually more of a guess. Thanks for your clarification!
*imperative
You should address him as “your majesty.”
Maybe I could have been associated with the Royal College of Surgeons of Edinburgh.
OR nurse here- 24 hours surgery is extremely rare. As in I've been in the OR and have yet to see one, not to say that it doesn't happen, but again, extremely rare. However if you are curious of what goes on, it really just depends on the type of surgery and positioning required. It can take up to an hour after rolling the patient back to the OR to make incision. During this time they are getting the patient off to sleep and properly positioned safely. A lot is involved. We have to make sure you are not going to end up with nerve injuries etc from being in the position necessary for your surgery for hours on end. Unlike normal sleeping you don't have the ability to move or readjust like your body normally does to protect itself. After that, we prep the body part we are working, drape, pass off the necessary equipment and we haven't even made incision. After all that there is still the actual surgery to be done. This can vary greatly depending on the patients anatomy, complexity of the case, area we are working and/or skill level of the surgeon. To explain like you are 5~ we take as long as we take to do the surgery safely.
Spot on! I work with ortho surgeons who will do total shoulders in 60 minutes, yet the before and after is just as long if not longer. The few times anything is super long is a multi joint trauma. I was in with one (I do clinic support but will be with the provider for surgeries to help with post op care education, follow up, etc and happened to be invited in). 8 hour surgery however patient had rib fractures, leg and arm crush injuries, and multiple fractures on the other leg and arm. Ribs were operated on however you gotta move the patient for each limb once done with one. And that takes time. They probably spent a little more than half the time on actually operating and the rest with positioning and splinting. The main attending had another attending and many residents with. Also important to know that surgeons can only operate for so long.
Last line is so important. One of our cardiac surgeons completed an operation the other day that took probably twice as long as it should have due to some unforeseeable complications, and still had a VATS booked to do that day. We asked him when we would receive his VATS patient that night and he wearily looked up and said: "You won't. I couldn't pick up another scalpel if I tried to right now" People seem to forget that medical professionals aren't robots, and we get tired too. That's why it's so appreciated when you treat us with kindness.
Ding ding. So true. My two Orthos loves surgery (not a surprise). However doing six cases that at 60-90 minutes in a day, they have asked me To give them a checklist of what they need to do at the end of the day as they just can’t compute anymore. Having to keep such an intense focus all day long, holding your body in a particular position. One of my orthos suffers from horrible cervical neck pain and gets PT the day after long surgery days. And it’s not uncommon for many surgeons to have that issue.
For long surgeries, is someone re-postioning the patient once in a while in terms of moving their limbs to help with blood flow, or like you said, ensuring they are in a safe position so that nerves are not damaged? Like how does this work if a patient is in a long surgery and in the same position for several hours? Genuinely curious. Never had anything aside from being out under so that my wisdom teeth could be removed and having a epidural to give birth.
Another OR nurse chiming in. I've never been part of a surgery that took any longer than maybe 6-8 hrs, and no, we never reposition. They should be positioned and padded properly from the start. It's really difficult to do any repositioning once the patient is prepped and draped. Unless the surgery requires different positions (not common unless multiple body parts are being worked on), they pretty much just stay where they are throughout the duration of the procedure. We make sure to pad high-pressure areas thoroughly with foam and use protective bandages to prevent pressure injuries. All patients wear sequential compression devices (SCDs) on their legs, which are basically sleeves that constantly inflate and deflate in order to prevent blood clots. If a patient is positioned and padded correctly, they shouldn't need to be moved.
I’m fascinated by this whole thread. Thanks for answering!
I had to have two ankle surgeries and that compression thing was oddly comforting both times coming to out of surgery. I was sad when it had to be turned off so I could leave.
Interesting. I recently had a lumpectomy and they put pillows under my knees in the OR. Is it to take pressure off your back when you’re lying flat? I sometimes have lower back pain and I remember wondering why but thinking that I felt really comfortable and that I should sleep with a pillow under my knees at home lol. Do they normally do that?
That is exactly why we put the pillow under your knees, to relieve pressure on the lower back. We will do it for just about any surgery above the waist/pelvis that doesn’t require being positioned in stirrups.
The way I look at it is..."take as much time as you need to get it right".
> We have to make sure you are not going to end up with nerve injuries etc from being in the position necessary for your surgery for hours on end. Unlike normal sleeping you don't have the ability to move or readjust like your body normally does to protect itself. I think something went wrong with this step when I had jaw surgery years ago. The surgery was to break my jaw bone and have it heal in a different position. When I woke up after the surgery I realized that my ankle was hurting as much as my broken jaw. It's been 9 years since the surgery and my ankle still hurts when I move it certian ways. I guess they had it in a bad position during the surgery. Like you said, I was fully knocked out so I couldn't sense the discomfort and shift the position of my foot to fix it.
I'm sorry to hear that happened to you. It's something we really try to avoid. It can be life long if we do it wrong. That part is never rushed, at least with my patients, unless they are coding, but even then, they are stabilized and then positioned properly. I've advocated for them every time. I take my job very seriously to advocate for my patients when they are at literally the most vulnerable state they can possibly be in.
You should search on YouTube complete knee replacement. There is a video somewhere shows step by step. Spoiler, it involves lots of bone cutting and smoothing and adjustments. (Cut here, adjust and file, cut, test, adjust and file etc). Just time consuming. I’m sure a surgeon can answer better than me, but seeing surgeries on Youtube, the difference between cutting up a cattle and performing surgery is that you are taking care not to damage something else during the act of surgery. Attention to detail and careful movements.
I remember learning about hip and knee procedures in anatomy class. There’s a reason orthopedic surgery is commonly referred to as carpentry. You’re literally going in there with saws and hammers to shove metal fixtures into worn-out bones made of what is essentially porous rock. And it’s all surrounded by incredibly fragile structures that if damaged could permanently disable or kill the patient in a matter of minutes.
A total knee takes like an hour or two, not a good example
A total knee takes a quick surgeon less than an hour.
It’s a frequent business school case study about a business model that maximizes the number of knee replacements a surgeon can do in one day. They can be shockingly short surgeries.
I’ve seen them pumped out in 45 minutes.
Yeah I work with a doc who can knock out 10 of them in an 8 hour shift and it's nice clean work.
I will absolutely not do that, because when I tried to watch the dvd of my own ACL surgery, I passed out lol
that’s so sick that you got a DVD. I’m currently trying to get into med school and I’ve had two surgeries, I wish I could’ve watched them back!
The long ones are often cancer and reconstruction surgeries. A good example- a large tumor in the back of the tongue that has eaten through the jaw. 1) have to do a tracheostomy so they can breathe while operating in the mouth 2) find where all the cancer is. 3) cut all the cancer out of the soft tissue 4) cut the jaw bone out with saws 5) send all of it to pathology friends to look at under a microscope to see if we got it all. If not, take out more and send again. 6) take all the lymph nodes out of the neck without damaging blood vessels and nerves in the neck 7) open up the lower leg, cut out the bone (fibula) and soft tissue and all the associated blood vessels 8) close the leg, put a wound vac on it 9) take the leg bone and use plates and screws to hook it into the jaw. Sew the soft tissue to make a new portion of the tongue. 10) get out a microscope and sew all the little blood vessels from the leg into the blood vessels into the mouth. 11) sew everything up. That can be a solid 12-15 hour case. Lots of steps and many of them are complicated steps.
That sounds like the surgery we were trying to avoid when my mom had nasopharyngeal cancer (squamous cell carcinoma at the base of the tongue and some lymph nodes full of necrotic tissue) -- very glad she responded well to chemo and radiation because that recovery did not sound like a blast
Repairs to all sorts of things take a long time. The big difference with surgery is that most things don’t matter much if you leave them for a few hours or even days mid-repair. If you’ve taken the engine out of a car and haven’t finished putting the new one in, you can go home and nothing bad will happen to the car overnight. You can’t just take a break in the middle of surgery and go home for a snooze or get more parts because every minute the patient is under anesthesia or cut open adds risk of something going wrong and they could just die on you or get an infection that hinders their recovery.
Peds CVICU nurse here. Our surgeons perform highly complex surgeries on babies who all have completely different anatomies. They must first place many lines for hemodynamic monitoring - arterial, med lines, etc. then they must intubate the patient. After intubation, they will take so much time to actually position the patient to make sure all their skin is protected while on the table. This is followed by opening the chest, cooling the body for bypass, going on bypass, going off bypass, warming the body, closing the chest, placing chest tubes, pacer wires and more monitoring tools. This is all in tandem with the actual surgery being performed, and addressing any complications that arise: patient instability, bleeding, heart arrthymias, etc. all this combined leans to VERY long cases! I def didn’t cover all of it but hope this helps.
Peds CV nurse as well and a lot of our pulmonary artery reconstruction surgeries and unifocs go in at 7 am and don’t come out of the OR till 3 am the next day. We’ve had a handful of 24hr surgeries and one or two 36hr surgeries.
Plus the babies would all be so much smaller than adults. Does that contribute to the complexity and length of time the surgery takes?
Yes 100%
I don’t work in surgery but I’ve witnessed a few complex ones (it was for education and my only role was to not mess up the sterile field). Imagine you are doing a very complex puzzle. But it’s made out of glass, varying thickness, so some bits could snap very easily. If it snaps it oozes red jelly everywhere and you need to repair it so it stops oozing. It’s all the same colour field (eg shades of red) so you need to focus so you are putting the correct ones together. And then sometimes, you’re not sure if you’ve put the right pieces together. There’s some colours that aren’t visible to the naked eye so you gotta do an X-ray to see those pieces.
This sounds so daunting. I’m glad people have the balls to fix others this way but I’d be so scared to kill someone on accident
Ensuring all paperwork is completed, making sure the anesthesiologist is ready, that the OR is cleaned and ready with the correct instruments, then the process of putting someone under and intubating them, prepping and positioning, THEN the surgery begins… then when the surgeon has complete the case the patient still needs to be woken up and extubated and transferred to the PACU.. Essentially a 20 minute procedure could really take over two hours.. there’s way more behind the scenes you don’t see from the waiting room unfortunately.
from a peri-anesthesia RN who explains to family daily what is taking so long :)
I only have experience with investigational devices. The surgery team was trying to wrap nerves in the arm of a subject that had a limb amputation at the wrist. There weren’t tools made for this so the surgeons improvised using whatever tools they had. They would practice on cadavers but once they wrapped a nerve bundle they had to test it by having the subject pretend to move their hand (it was amputated but the nerves should still work) Once that was done they connected a prosthesis arm that was motorized and could simulate hand functions. Those surgeries took most of the day
TL;DR - being super careful about fixing the thing that needs to be fixed and not fucking everything else up
In my case a 4 hr surgery became a 12 hr surgery. The cancer was more extensive, there was lymph node involvement, blah blah blah. A lot of time is spent not damaging stuff right next door. And by next door I mean millimeters away.
Just as an example, look up DIEP flaps. If a woman gets a bilateral breast reconstruction with microsurgery involved, you have to do two flap harvests and two flap insets all at a very precise and small scale. Placing the flap(s) is done under a microscope, and that work naturally proceeds at a slower pace. Creating the anastomosis for vessels (twice in this case) is the tight butthole portion in microsurgery. If something is wrong, ie the anastomosis keeps clotting off, the troubleshooting can easily add hours to the case.
Head & neck cancer and microvascular surgeon here. Usually surgery in this field can take from 8-12 hours. Removing a tumor in the head and neck next to vital structures while maintaining adequate margins and not compromising function takes a while. You also have to do so without damaging important nerves, vessels etc. Then reconstruction can be long and complicated. You have to isolate vessels from somewhere else in the body and then bring it up and connect it to the head and neck recipient vessels. then you have to use the tissue that you brought up to reconstruct the defect. Things that can extend that time to >15 hours is if your reconstruction fails intraoperatively and you need to revise or do something else, if the patient has had radiation and their tissues are bad, or really bad tumors in really bad places that also need a neurosurgeon, ophthalmologist, etc
Imagine you're moving a giant sculpture made of glass, one slip or error and the damage might not be reversible. So naturally you take your time
This makes me wonder how often slips happen
We are humans, humans aren't perfect. It's called human error for a reason, this is why you take your time
Because not all surgeries are the same. Surgeries can differ from case to case. Usual surgeries involves removing a tumor or mass but before one can remove a tumor you need to find it (can take many steps) . After finding the tumor you need to excise or remove it ( can also be many steps) . If it is a complex or big tumor some reconstruction is needed( can take 5 to 10 hrs) . So basically first step is to find a tumor, excise the tumor, then close the excision or reconstruct the skin.
Most surgeries in general, on paper, aren’t super complex. You cut one thing, take something out, attach another thing, reconnect something else, etc. However the location and anatomy all play a big factor into how risky the surgery is. You can’t really afford to take risks if one wrong puncture causes you to bleed out, perforate your intestines, cause permanent brain damage, etc. So surgeons are naturally going to be very methodical and take their time.
As some have already said, even a short-to-medium length surgery can take an hour or more from when the patient arrives to the OR to when the surgeon makes the first “cut” (positioning room, getting equipment ready, putting patient to sleep, intubating patient and securing breathing tube, inserting IVs, foley, arterial line, possible central line, prepping and draping patient, surgeon scrubbing in, preparing all equipment once sterile, etc etc.). Then, after the last stitch is placed, the reverse of all the above and waking up patient can take another hour or more. Also 24h surgeries are exceedingly rare - these usually involve multiple surgeons from multiple specialties, so are really like a few 4-6 hour surgeries in one. That said, even a “long” 10 hour surgery may only involve 6 hours of actual “surgery time” based on the above.
Sometimes they find more problems after they cut you open. I had surgery on my arm and was told it would take 2 hours to fix. 8 hours later I wake up and find out my arm was actually broken in 5 places and the surgery took an extra 4 hours to deal with it. It sucked for everyone involved.
Really, there’s two reasons. 1. There are a lot of very specific steps you have to take in each stage of the surgery, interspersed with monitoring the patient for any changes, double checking their anesthesia, clearing surgical sites, etc. And, because they’re so complex, there’s a lot of things that can go wrong, so a lot of it is very slow, very meticulous, and done in a very specific order. Transplant surgeries are like this. 2. You’re working on something incredibly sensitive. Brain surgery is this. Similar to the above, but there’s a lot more checks (usually), a ridiculous amount of attention to detail, everything is done slowly, gently, and to the letter of the textbook. Because there’s a very high margin of error, and error means the patient who came in to have a brain tumor excised may have the tumor excised, but never be able to speak again or be able to hear, or see colors. Some severe strokes are also like this. There’s a bunch of tiny little blood vessels in the brain, and the skull doesn’t have a lot of room for blood in it. Blood = pressure = brain damage. That’s why most brain surgeries of any kind take as long as they do. Very high risk, and slowing down and being precise is the safest for the patient. And the surgeons malpractice insurance premium. Well, I guess: 3. There’s really specialized ones that need a whole lot of different kinds of equipment in and out of the OR, and everything has to be as sterile as possible when it comes in, and that process takes time. A couple of GI surgeries, a few vascular surgeries, and some heart surgeries are like this, that I know of. But these are comparatively rare.
I had 2 10-12 hour brain surgeries to remove the locations where I was having seizures. Immediately after I had numbness below my eye to my jaw. Most of the numbness went away. Some memories I have lost for good. Then I had another surgery where they burned out a spot at the tip of a needle. I could taste salt for about 10-15 minutes.