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The re-enactment of a 1980’s surgical operation.
On the 15th August, Professor Roger Kneebone and his team from Imperial College London staged a surgical re-enactment at the Science Museum. Visitors were treated to an authentic series of operations, performed as they would have been in the 1980’s, by a surgical team that combined the experience of clinicians who practised in the Eighties with current trainees. Medical student Frances Butcher observed the proceedings.
The operating theatre was set up. The anaesthetist was ready and the surgeons were scrubbing in. And the patient? A highly realistic, contextualised hybrid model from prosthetics designer, and Director of the medical simulation company Health Cuts Ltd, Max Campbell. The models used consisted of a real pig’s liver and gallbladder, housed within a bespoke three-dimensional silicone environment to suggest the layers of skin, fat and muscle of an abdominal cavity.
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The hybrid model: the abdominal cavity is open, exposing the liver.
To conduct the operation, the legendary surgeon Professor Harold Ellis was joined by his equally distinguished surgical team, anaesthetist Professor Stanley Feldman and scrub nurse Sister Mary Neiland. Although now retired, this team had worked together for many years in London’s Westminster Hospital during the 1980’s and know each other well.
The team’s friendship highlighted an important change in surgical practice over the last thirty years, which is a focus of Kneebone’s research. Now, external factors such as the European Working Time Directive mean that the team doing an operation may never have met until the day of the procedure. In fact, some hospitals now have policies reminding staff to introduce themselves at the beginning of surgery – a (hopefully) unnecessary prompt to observe common courtesy and a reminder of working for the biggest employer in Europe. Strangers in the operating theatre can lead to communication problems: anyone who plays a team sport knows the team functions more successfully when rapport is established between players. The long-standing teamwork and friendship demonstrated by Ellis’ team is one aspect of this re-enactment that it is a shame to consider history.
The surgery performed in the 1980’s was very different too. This re-enactment demonstrated a cholecystectomy (removal of the gallbladder) and a hernia repair (mending a rupture of the muscles in the groin). These were, and continue to be extremely common operations. The difference is the re-enactment demonstrated the now largely outdated open technique. This involved large incisions with a direct visualisation of the organs. Although an open operation is perhaps more visually dramatic for those observing, both in real surgery and the re-enactment, the current laparoscopic, or keyhole, techniques, where miniature cameras and instruments can be passed in through tiny holes in the skin, are far less invasive. This means that patients make a much quicker recovery post-operatively.
This does not mean the skills used in open surgery are redundant. In fact, on the rare occasions that laparoscopic surgery goes wrong, an emergency conversion to open surgery may be necessary. This indicates that it is vital that surgical trainees are proficient in these skills. The opportunity to learn from Ellis in open techniques is a valuable chance the current surgical registrars at the re-enactment made the most of. Not daunted by Ellis’ announcement that he removed his first gallbladder in 1953 (“before your mother was born”), the operations were performed successfully by the Professor and current surgeons Jimmy Kyaw Tun and Alexander Harris.
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Professor Harold Ellis and Mr Jimmy Kyaw Tun during the surgery.
As well as a fascinating display, Professor Kneebone’s re-enactment demonstrates immersive simulation as an innovative method for capturing and documenting the history of twentieth century surgery. The operations showcased authentic instruments and equipment from the Science Museum’s medical collection alongside realistic training models designed specifically for medical simulation, and this has been captured on film. By having a real team participating in the practice of the surgery, rather than simply describing them, Kneebone hopes that simulation may be used as a tool to reanimate surgical practices or traditions that have fallen from the medical profession’s consciousness. The authenticity of this re-enactment was clear to see – perhaps too clear – as I noticed several visitors looking rather shocked. One had to be reassured that no, this is not real.
Frances Butcher
Frances Butcher is a summer intern at the Wellcome Trust.
Professor Roger Kneebone is the recipient of a Wellcome Trust Research Leave Award for Health Professionals and Scientists. The awards allow practising health professionals and scientists to be released from their duties to carry out a short period of uninterrupted research in an area of ethical and social science research.
Image credits:
Top: Clio Heslop
Middle and bottom: Max Campbell (www.healthcuts.com)
Filed under: Event, Public Engagement Tagged: Imperial College London, Professor Harold Ellis, Professor Roger Kneebone, Science Museum, Surgery Image may be NSFW.
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Image may be NSFW.Clik here to view.
