Three out of ten hospitals offering keyhole surgery are operating with obsolete equipment, the first ever audit of laparoscopic operating theatres reveals.
It had been a busy morning, and the last case was a laparoscopic cholecystectomy. The harsh glare of the overhead lights reflected off the prematurely bald head of JT Sanderford, the recently-appointed surgical consultant. It would be his first opportunity to demonstrate his keyhole surgery skills to his new colleagues.
“Trocar please, sister…I hope it’s not too sharp - we don’t want any of that dangerous old-fashioned rubbish,” he said, with what he hoped was a winning and ironic smile.
“No, it’s not sharp. Not any more,” replied Sylvia Devenish, the scrub nurse. Sanderford viewed with distaste the discoloured metallic tube she slapped into his outstretched hand. It wasn’t what he had been used to during his minimally invasive surgery fellowship at Johns Hopkins.
“What’s this on the end of it?” he asked. “It looks like dried blood.”
“It certainly is not!” rejoined Devenish, clearly affronted by the accusation. “All our instruments are properly cleaned and sterilised. It’s rust.”
Sanderford sighed. Not a good start, and it was becoming clear that, as the most recent recent appointee to the staff, he wasn’t going to be allowed to use the trust’s best keyhole surgery equipment - the set that had just scraped into the ‘bronze’ category in the recent national audit. Glancing across the table, he idly wondered what descriptive category could ever adequately circumscribe the appalling assortment of kit laid out on the trolley at sister’s elbow - it looked like the type of thing you might come across in a slightly macabre car-boot sale.
Resignedly, he thrust at the patient’s abdomen with the jagged end of the trocar. Eventually, there was a sudden give, and with a faint tearing sound, an irregular hole appeared in the right upper quadrant. Five minutes later, he had managed to insert the laparoscope itself into the first hole, and had made a couple of others, each looking like a rather ragged, very low velocity gunshot wound, elsewhere on the abdomen. The light source, apparently assembled from a car battery, some old electric flex, the light bulb from a fridge and a stick, was inserted into one of these. To his amazement, Sanderford saw that an operating department assistant had his lips closely applied to the third hole, gently inflating the abdomen.
“Ready to go?” asked Sanderford.
“Urrrghh,” replied the ODA.
“I’ll take that as a yes,” said the surgeon. “Come on Hamish,” he said, beckoning to his SpR, “you’re supposed to be learning from this - get the teaching attachment set up.”
The junior surgeon, grunting under the weight of the wood and chrome contraption, attached the connecting tube, with its complicated system of mirrors and prisms, to the main scope.
Sanderford peered through the misted lens, and glimpsed what might have been the gallbladder, lunging at it with the corroded and recalcitrant dissecting forceps. Eventually, he managed to tease out the cystic duct, or at least, some sort of tubular structure. Hamish raised his head: “OK if I get a picture of that for my logbook?”
“OK, but don’t take all day,” replied Sanderford. He saw his junior bend over the tripod, pull the black cloth over his head and squeeze the rubber bulb. The startled ODA pulled his lips away from the insufflation aperture with a faint pop, and a wisp of smoke emerged.
Sanderford sighed.
