Three tips that help vets improve their confidence in surgery
Surgery Skills Series
Alright, going into theatre for the first times on your own can be very daunting... When you have someone there, you have an extra layer of support that does make a big difference, but at some point you will be flying solo! And when that happens, all your doubts tend to creep up and you ask yourself if you can do it. Sometimes, though, you end up with less cases than you want, but now you're expected to get on and do it on your own... except you don't feel as confident as you did before... First, you had extra backup and support and were doing the procedures more regularly. And second, you now have the weight of expectation that you should be able to do this alone...
"And it's been so long since I've done it..."
Let me tell you a story. Once upon a time, there was a vet that learned how to do surgery and realised she didn't really like surgery that much. So she decided she was going to do consulting-only jobs that she loved, and she was quite happy with that. One day, though, she was in sunny Portugal consulting when she scanned an unwell cat that had given birth and clearly had something in her uterus. She was alone at the practice. Sole charge. She thought "Well [not the word she used in her mind], this is an emergency surgery. I don't remember the last surgery I did. It must have been 3 years ago".
...
Wow... What would YOU have thought?
I will tell you what this vet thought. She thought "Pretty sure I can still do a spay. Let's prep!"
So - I explained what I was going to do, I got consent, I pre-medicated the cat and off we went for surgery. Cat happily back home and with a pretty good looking skin suture too (if I may say so myself...). Non-vet boss very impressed this cat went home without a bandage and a vest.
"OMG how did she do it?"
If you're wondering how I was able to tell myself I still got it and didn't question my entire existence (p.s. I did question it a bit xD), keep reading, because I would like to share that with you.
Before we keep going though, let me make this clear: I am competent at surgery (realistically). I'm not Supervet, I'm not super fast, pretty sure many of my techniques are wrong, but I know I have the following level of competency (for certain procedures!) - I can do the procedure effectively and safely from start to finish, reducing complications where I can. I don't enjoy surgery, but hey, if it saves a life and I can do it, I'm not going to chicken out. How is that fair for the animal??? However, I do know my limits and I'm real with them. So here's how I was able to do a spay/potential c-section after spending 2 years (going on 3) away from theatre confidently.
1. Know your anatomy
Yeah, first year of Uni, but that's what helps you find your way. Know where to look for things, know where your blood vessels are, know the structures in front of you and the ones you want to stay away from. Your uterus is always between the bladder and the colon. Your suspensory ligaments are always near the kidneys. You don't want to tie the ureters. Don't leave any leftover ovaries in. Remember when you do an enucleation, you can cause blindness of the contralateral eye if you're too rough. Know where to do you cat flank incision so you immediately find the uterus. Remember how many layers of muscle you have to go through.
2. Know your procedure
And I mean not just how to do it, but what you're trying to do and why. In essence, why do you clamp the ovaries? Why do you do an inverted pattern when stitching the uterus after a c-section? How do you close the muscle layer? Why do you use certain suture material but not other? What are the different steps to complete the procedure in the quickest, safest and least-likely way to cause complications? If it helps you, before you go into surgery, close your eyes and play the surgery in your head. And while you're at it, do a little training with your hands.
3. Be prepared for what can go wrong
And be prepared to ask for help! But for me personally, it helps me to review the procedure and potential complications so I can pay attention to them. I'm fine doing this mentally, but some people may need to actually write down our speak up their list. Bleeder? Ok, follow the blood trail and find it. MASSIVE bleeder/artery snip? PUT YOUR FINGER ON IT (I would have another interesting story to tell you about that one if you want to hear it... It involves a horse and a melon). Pinched the bladder by accident? Oops, how do I close it? Open the abdomen and find out free fluid? Remember, it can be normal in cats to have a small amount of free fluid. See something weird I don't know about? Call someone that knows about this stuff!
BONUS TIP: The Big Secret
There is one secret to every skill you want to master in life. Here it is: KNOW the principles and APPLY them. Yes. That is it.
If you know the principles and don't apply them, you're a lecturer.
If you happen to apply the principles but don't know them, you got lucky.
If you know the principles and how to apply them, you're a professional.
With surgery, you want to know the principles of surgery and the principles behind the procedure you need to do, but also be able to apply them. And this is the same with medicine - you need to know the principles behind the diseases and presentations and how to apply them to fix the problem your patient has. Actually - this works for anything you want to master in life. Want a happy love relationship? It's not enough to read how to do it in the books, you have to have the skills to put your heart where your mouth is!
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