A patient's surgery experience

What to expect during surgery

Surgery involves a huge amount of trust in  a complete stranger (the surgeon), after meeting for only a brief period of time.  If I were to say to you "give me all your money, your car keys, and the deed to your house, and I'll give them back to you tomorrow, you would say "what are you, nuts?"  And yet, each day, a patient will trust a surgeon, who has spoken with them for literally minutes, to say that we will put them to sleep, make an incision, get down to nerves, take out a disk or fuse the spine, close them up, and then awaken them.  Can there be a greater level of trust bestowed upon one human by another?

Day of the operation:

Often, surgery will begin in the morning, unless the operation is "following" another.  A typical start time will be 7:30 AM or 8:00 AM.  The patient will have been instructed to not eat or drink anything for at least six hours before surgery.  This decreases the risk of aspiration during the intubation process (the placement of a breathing tube into the lungs, by the anesthesiologist). 

The patient will often be given a sedative just before going back to the operating room (OR).  In the OR, there will be a lot of activity, which might be disconcerting to the patient.  What the patient must remember is that all the activity in the room is for the benefit of the patient.  Everyone is focused on a particular task, in order to make sure the patient has a safe and successful surgery.  The room may seem cool, and the personnel might appear impersonal, but this is only because they are focused on a number of tasks. 

Various lines may be placed.  This means that the patient might have additional intravenous (IV) lines started, to supply fluid.  A central line, which is essentially a large IV placed either under the collar bone or into the jugular vein in the neck, might be inserted.  Although this sounds like a big deal, for an anesthesiologist this is a routine task.  A Foley catheter to drain the bladder may be placed if the procedure is anticipated to last several hours.  An arterial line, which is essentially a line to measure arterial blood pressure instantly, might be placed.  Some of these lines might be placed after the patient is put to sleep.

Next the patient will go to sleep.  The anesthesiologist will insert the endotracheal tube into the lungs (this will breathe for the patient while asleep).  The patient will then be positioned appropriately for the surgery.  For a posterior approach surgery, the patient will be turned over into the prone position (on the belly), with the knees, elbows, breasts and genitals carefully cushioned to decrease the risk of pressure sores. 

The surgeon will then usually mark the skin in the region of intended incision.  The circulating nurse will "prep" the skin with antibiotic solution and scrub, and the scrub nurse will "drape" the patient with towels and an iodine impregnated plastic "sticky" drape known as ioban.  The remainder of the body is now draped off. 

While the body is being prepped and draped, the surgeon will generally "scrub" his hands and forearms.  He will then enter the room, "don" his gown and gloves, step up to the field, and start operating. 

Seen here is a typical modern operating room.  The anesthesiologist is located behind the "ether screen."  The blue drape covers the patient.  An IV pole is seen, from which fluids are "hung."

The operating microscope has advanced the field of microneurosurgery.  It provides three advantages to the surgeon.

• magnification
• light
• stereoscopic vision

The ability to see in stereo is an important one.  The distance between one's pupils is roughly 55 mm, too large to see in stereo in a small hole.  The operating microscope evades this problem for the surgeon.

Many instrument are used during a typical neurosurgical operation.  For this reason, it is one of the more difficult specialties for scrub nurses to learn.

An extensive set of retractors is available to the neurosurgeon.  These help to keep the skin, fat and muscle retracted while the surgeon is operating.  As can be seen here, a variety of depths of blades are required, depending on the size of the patient.

A Shaw Scalpel (top device) provides the ability to cut with little blood loss.  The blade heats up and coagulates fine vessels when they are divided.  The bipolar coagulator (bottom device) allows the surgeon to coagulate between the tips of a fine instrument, preventing electrical current from traveling to the rest of the body.

The Bovie coagulator (also known as monopolar) allows coagulation, by sending electricity from the tip of the instrument to a grounding pad (usually on the leg).

A cell saver allows a good portion of the blood which is lost during the case, to be sucked up, processed, and given back to the patient.

Nerve monitoring, usually left up to the discretion of the surgeon, allows the evaluation of the integrity of the nerve roots, while the patient is asleep.

Bone graft is seen here.  This cancellous material provides a good framework or lattice for the patients own bone to grow through.

Although difficult to see, the lamina has been removed during this posterior lumbar laminectomy, and the dura covering the spinal nerves is visible.

Dr. Kraus is seen operating on a lumbar spine.  The operating microscope is seen on the right.  An extremely experienced team is assisting him.

Following closure of the wound, a dressing is applied, and the patient taken to the recovery room.  The surgeon will then evaluate the patient, write orders, dictate the operative procedure, and speak with the family.