Surgery Without Wires

Surgery is messy... and I don't mean in terms of blood and guts...

What I mean are wires, cables, tubing, etc.

Let's take a routine tonsillectomy and adenoidectomy for example...

1. Electric cord for the operating table
2. Electric cord for the anesthesia machine
3. Electric cord for the surgeon's headlight
4. Light cord from the surgeon's headlight to the lightbox
5. Breathing circuit tube from the patient to the anesthesia machine
6. Carbon dioxide outflow tube from the patient to the anesthesia machine
7. Suction tubing from the surgical table to the vacuum canister
8. Vacuum cable from the vacuum canister to the wall socket
9. Electrocautery cable (along with electric cord to power the machine)
10. Coblation cable (along with electric cord to power the machine)
11. IV fluids lines from patient to IV bags
12. EKG lines
13. Grounding pad cable
14. All the wires and cables that go with running a computer
15. etc etc etc

It's an "organized" chaos of cords, tubes, electric wires, etc all emanating away from the patient like a Man-of-Wars jellyfish.

Pictures shown on the internet as well as movies are "staged" and appear to be neat and orderly, but believe me (as someone who has had pictures taken), surgeons and nurses take the time to "tidy" things up before the picture or video is recorded giving a false impression of neatness.

99% of the time, everyone knows where everything is, so it's not a problem. However, when an unanticipated emergency happens, things get confusing and in fact dangerous to not only the patient, but the staff (I recall one incidence of a nurse running to get a surgical tray, tripping on one of the numerous cords mentioned above, falling, and breaking her hand).

When something stops working... we literally have to trace the cord from source to origin to figure out why something stopped working. With all the cords present, this tracing needs to be done by hand and eye (analogous to an entertainment system with all the wires in the back, one would trace out the cords by hand and eye).

IS there a better way???

Of course the operating room staff takes the time to bundle and organize the various cords, but the fact remains that the cords are there.

What about wireless technology to power instruments or relay information?

Well, NPR reported on August 23, a young 22 year-old entrepreneur Meredith Perry, who has invented and patented a way to transmit power over the air without the need for wires using ultrasound. Yup... the same ultrasound used to look at a human fetus in the womb.

Her ingenious idea is to use ultrasound to "vibrate" the air which than vibrates a piezoelectric transducer contained within nearby devices. The vibration of the piezoelectric transducer will than generate an electric current which can be stored in a battery and used to power anything that requires energy.

I acknowledge that it may take time before such wireless power is available to power large surgical devices, but one can always hope!

Read the NPR story here.

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New Video on Endoscopic Vocal Cord Mass Injection & Bronchoscopy Without Sedation

We have produced a new video demonstrating how vocal cord masses can be injected with medications (like steroids) under endoscopic guidance without the need for any sedation. This video also includes bronchoscopy that was performed at the same time (also without any sedation).

Check out the video here!

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Rapid Strep Test Positive But No Sore Throat

Occasionally, I see patients who have received throat swabs for strep that have come back positive... even if they have no signs or symptoms of pharyngitis.

In this situation, there are 2 main actions a physician may take (I am biased towards one):

1) Prescribe antibiotics until throat cultures are normal
2) Do nothing

Personally, if a patient is without throat symptoms and has no history of rheumatic fever or kidney damage, I would not have even bothered obtaining a strep test. What for???

Also, a person can be a carrier for strep without suffering any health problems. As such, even if the strep test is positive, but if the patient has no symptoms, I do not recommend treatment. (Which again begs the question of why bother getting a strep test if no treatment will be recommended regardless of the test result.)

I would go so far even to say follow-up cultures are NOT necessary after antibiotic treatment for strep throat if a patient does not have any more symptoms and exam is normal.

Which is why I find it surprising when children and adolescent patients receive multiple courses of antibiotics when they feel perfectly fine, but have received treatment just because a strep test came back positive.

Of course... that's just my opinion as I do acknowledge that there's another school of thought which supports antibiotic treatment of all strep positive cultures with follow-up cultures to ensure eradication.

However, according to the 2012 clinical practice guidelines published by the Infectious Diseases Society of America (statement 12),

"We recommend that GAS carriers do not ordinarily justify efforts to identify them nor do they generally require antimicrobial therapy because GAS carriers are unlikely to spread GAS pharyngitis to their close contacts and are at little or no risk for developing suppurative or nonsuppurative complications (eg, acute rheumatic fever; strong, moderate)."

Depending on the doctor you see, you will get different opinions. But it is good for patients to be aware of the varying views on this topic given how common sore throats are.

Reference:
Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clin Infect Dis. (2012) 55 (10): e86-e102. doi: 10.1093/cid/cis629

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Boy With Missing Cerebellum & Pons Learning to Walk!

First off... the cerebellum and pons are part of the brain that is responsible for some very important things like balance, breathing, regulating blood pressure, heartbeat, etc.

So one would think that without a cerebellum or pons, life would not be possible.

Well... it seems that may not be quite true.

You see, there's a young boy missing those parts of the brain who not only is living without mechanical assistance, but eventually managed to sit up on his own, something he shouldn't have been able to do without a cerebellum to provide balance. Next he learned to crawl, first dragging himself military-style, then pushing himself upright. Now, he's learning to walk.

A true medical mystery.

Read more here.

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