Cutting Technology

Cutting was a term I first heard of when I became a resident doctor. All operative work was called cutting. I suppose it had to do with the use of scissors and knife in the operative work. Odd that the use of sutures and ligatures was not included in the nomenclature. Vocabulary of youngsters changes over time. What was cool once is awesome now. But this term – cutting – has persisted in its full glory. The term has not only persisted, but it has become the principal driving force in the lives of resident doctors in specialties with operative work. It is not enough to know what, it is more important to have a hands-on training of how to (operate). With residents not interested in the subject primarily, the what part of it is no more. It is only how to. When one gets into residency not for the love of the subject but because one can get it based on one’s score in the entrance test, the concepts are not clear. Only the desire to operate and master the technique remains. Then the operative steps go wrong, and one does not even realize that they have gone wrong. That resident was performing a vaginal hysterectomy. The uterosacral-cardinal ligaments and the uterine vessels had been clamped, cut and ligated. The cornual structures could not be accessed because the uterine corpus was enlarged. So the uterus was bisected. Now the cornual structures were accessible and she started to put a clamp on them. But the anatomical concepts were not clear, and only the habit of putting a clamp holding the hand so was the guiding force. So she placed the clamp held in that particular direction as usual, but across the bisected half of the uterus instead of lateral to it over the cornual structures. I wanted the thing documented, but none of the residents would oblige by taking a snap as I requested. Finally I had to threaten them that I would stop their further ‘cutting’, when they obliged. I can post that picture if I get requests for the same. I stopped the resident in her endeavours and got the clamp placed the right way in the patient’s interest. She further proved her lack of anatomical knowledge when she caught the bladder fascial plate between the anterior vagina and the divided uterovesical fold of peritoneum,and told me it was the uterovesical peritoneal fold itself. When I said it was not, she said it was paraurethral tissue. Though she is that bad, I am sure she will go through life operating on her patients, without she or the patients knowing that something is amiss. That reminded of another resident who was my Houseman when I was a Registrar. I was assisting him perform a vaginal hysterectomy. We had two operations going on on two adjacent tables, and I was supervising the other one too, because my bosses were too busy with their private practice to go to our OT in the general hospital. The fellow had clamped the cornual structures, when the resident on the other table asked me for some advice. I turned around and sorted out the problem in a minute or so. When I turned back to see what the fellow was doing, he had cut the cornual structures and showed me the result quite proudly. Unfortunately, he had cut them lateral to the clamp, leaving it attached to the uterus. I was aghast. Luckily the divided structures were not bleeding, nor had they receded beyond reach. I caught them with two Allis’ forceps and got them ligated. He was totally lost. He could just not understand what he had done wrong. He had entered residency without any love for the subject. He did not know that the clamp was to prevent bleeding when the pedicles were cut, and had to be on the vessels until they were ligated. He had become a technician to whom it did not matter much on which side of the clamp he cut. I hear that fellow is a consultant gynecologist in the USA now.