Tuesday, June 9, 2015

Lessons learned in soft tissue surgery: tips from top surgeons

Soft tissue surgery can be rewarding, but it can also present hard challenges.
What are the mantras that the profession’s best surgeons live by? I was recently able to pick the brains of three specialist veterinary surgeons about their top tips. The trio are converging in Melbourne from May15-18 to present a course on soft tissue and reconstructive surgery. Together they have over 100 years of surgical experience.

Bryden Stanley BVMS MACVSc MVetSc Dip ACVS is the section head of surgery at Michigan State University College of Veterinary Medicine.

Dr Stanley and colleagues perform a procedure.
Her tips are:
  • Halsted’s Principles – learn them and love them.
  • Know your anatomy – inside out.
  • Pay attention to detail - never think, “that’ll do”.

Dr Stanley performing surgery.

Above is a short video showing just how many people are involved in specialist small animal surgery. The video was made by Dr Kyle Snowdon. The surgeons are Dr Bryden Stanley and Chief Resident Lindsey Kurach. The patient had chylothorax.

Good surgeons love their loupes. Professor Hunt uses them in a procedure.
Geraldine Hunt BVSc MVetClinStud PhD is Professor of Surgical and Radiological Sciences at UC Davis. Professor Hunt was one of my teachers of surgery and I watched her perform many incredible procedures including correction of portosystemic shunts and open heart surgery. She was unflappable.

Her tips are:

  • Have a good decision making process
  • Ensure you are clear on the goals of your surgery
  • Don't be afraid to re-evaluate your plan in light of additional information
Professor Hunt with colleagues and students.
Arthur House BVSc PhD Cert SAS Dip ECVS is an Australian and European specialist small animal surgeon.

Dr House meets an elephant at the WSAVA conference.
Early on in my career when I thought that I would like to pursue specialist surgery a friend (and specialist in surgery) said to me that 'you can teach a monkey to do tricks but a good surgeon knows when to do tricks'. He is absolutely correct.  In addition, to be a good surgeon you have to
  • have the ability to always question your diagnosis and be prepared to be wrong and reconsider i.e. keep searching. This can be only achieved if you have a comprehensive knowledge base;
  • consider and fully understand all treatment options, be realistic with what you as an individual and collectively as a practice / hospital can achieve and do not be fixated with only surgical choices;  
  • be able to manage all complications and not accept euthanasia as an acceptable outcome;
  • accept only the optimal treatment - even at 11pm after a 16h day. 

Using a 3D printed porous titanium radius implant in a limb sparing surgery.
Behind every great surgeon...a candid image of Dr House's slightly plus-size moggy kipping
on the rug (and snoring!).
The three surgeons are getting together in Melbourne next week to teach a course on soft tissue surgery through the Centre for Veterinary Education. For more info about the course, click here.