WIRED Science put up an article with “10 Gory Surgical Triumphs on YouTube”. Last week I posted a review of the first five of those videos. Here are my reviews of the last five. Enjoy!

6. Autopsy

This can be rather difficult to watch, due to its graphic nature. The video is uploaded on the user account of an individual and it says nothing about where it originates from. It’s cut short at the end of this clip, which indicates that it’s an outtake from a longer video of an autopsy.

A thing worth noticing in this video is the problem of on-site commentary. The voice over seems to have been recorded at the time of the autopsy, resulting in the slightly surprised comment on the discovery of breast implants. Adding comments as you go can be a  convenient way to get the doctors (who generally have little time) involved, but in my opinion a well written voice over added in post-production tends to leave a more professional impression.

7. A Trip through the Digestive Tract

This is a straight-forward edited recording from a gastroscope, uploaded by and Indian doctor. The videos shows the removal of several large polyps in the stomach and duodenum. The doctor applies electric current to a metallic snare to cut the polyps from their stalks. When I edit videos like this, I like to include some shots from the room, showing the doctor manipulating the scope, the setup etc. I think this makes a video that is easier on the eye. A video with only endoscopic images tends to feel a little “claustrophobic”, and you want to take a step back and take a look at the bigger picture.

8. The Brain Surgery You Stay Awake For

This is a video (which originates from the website of the Pittsburgh Post-Gazette) of an awake craniotomy to remove a brain tumor. Patient’s are kept awake during parts of a brain operation in cases where the tumor is situated in areas where there’s a risk of damaging vital functions. The surgeons probe the areas around the lesion while asking the patient to do simple tasks, as a hand squeeze or a smile. The relevant functions, of course, depends of the area of the brain being operated on. I shot an operation like this once. In that case the patient was asked to state the days of the week. It was quite nerve-racking to listen to him, hoping he’ll get them right. I can’t imagine how it must be for the patient.

Although very interesting, this video is also not very good shot or edited. The sound have been recorded using only the built-in camera mic, which results in lots of background noise and unwanted sound. This is especially annoying in the short patient interview at the start. This, together with the somewhat erratic editing, also makes the OR come across as a rather chaotic and noisy place. The exact opposite of what it usually is, at least with elective surgery. There is also a lot of comments made by the surgeons as to what is being done, but we never see any actual surgery. This makes the comments a bit hard to relate to, I think.

9. Robotic-Assisted Prostate Surgery

This is one of many videos of robot-assisted laparoscopic radical prostatectomies on YouTube. With the robot and bloodless surgery this is appealing to a lot of people, I guess. This video has a lot of shots from the OR, in addition to the high quality footage from the surgical robot. As I said above, I think this makes for a better viewing experience. The OR shots do, however, contain a lot of unmotivated zooming and slow-motion. Zooming is an effect, and should be used accordingly (I’ll write a post on that soon).

The captions makes the video quite easy to understand, and although I generally hate background music in videos like this, I have to admit it doesn’t do too much harm when there’s no voice over.

10. Liposuction

A liposuction video put up by a plastic surgeon called Foley in Olympia, USA. In almost every way I think this is a good and informative video. The voice over relates directly to the video, the footage is steady (no zooming) and the editing is smooth (no jump cuts) and effective. There’s close ups of important equipment and the before/after shots and containers with fat helps to conclude the story.

This is, however, an example of how I think background music should not be used. It starts very nice, but when the classical music kicks in with the surgery, I can’t help but laugh. There’s such a contrast between the somewhat cheesy classical music and the visual roughness of the liposuction. I keep thinking they’re trying to sweeten the pill so to speak. Do you feel the same?

This concludes my WIRED review. Watch out for more videos next week!

A few weeks back they did.

I was scheduled to make a video of a craniotomy. The patient had a neoplasm in the brain, believed to be causing his epilepsy. Because the neoplasm was located deep in the patient’s frontal lobe, he had to be woken several times during the procedure, so the surgeons could probe the areas around the lesion and avoid the eloquent regions. He was only administered local anesthetics and sedative drugs.

As always I arrived at the OR after the patient had been brought down from the surgical ward. Looking in through the window I saw the anesthesiologist was still working, and I went to disinfect my video equipment. I always prefer to stay out of the OR until the patient is sleeping. He should not have to think about me a few minutes before they’re going under the knife. To be honest, I probably find it easier not having to relate to the patient as a person too.

Although not in general anesthesia, the patient would be sleeping for most of the operation. Finishing the disinfection I entered the OR to connect a hard disk recorder to the surgical microscope. I noticed the neurosurgeonwas fixing the patient’s head in a three-point headrest. When I was done the surgeon had left and the nurses had resumed with covering the patient in sterile drapes. Everything seemed to proceed as normal and I left the room to get a cup of coffee thinking the operation would start in 30 minutes or so.

With the OR door ten steps behind me I suddenly heard shouting and running feet. What was going on? I turned an entered the OR again to find the two nurses just managing to keep the patient from falling off the table. Blood everywhere.

The sterile nurse ordered me to get her out of her bloody gown. While the other nurse ran to get the surgeon, I had to do her job. That meant getting out new sterile gloves and gown for the nurse, handling bloody drapes, pouring warm saline solution and finding the right kind of suture until the non-sterile nurse arrived with the surgeon.

What had happened? The patient had a violent epileptic seizure. So violent that his head was pulled loose from the pins fixing it to the headrest, the pins tearing into the skin around the points of fixation. The nurses later told me it was just luck that kept him on the operating table. They were furious with the surgeon who didn’t warn them that this could happen and make sure there was enough hands in the room to keep the patient down.

After stopping the bleeding in the patient’s scalp and cleaning the floor, the patient suddenly woke. Heavily sedated, he had slept through it all.

In stead of the three-point headrest the patient’s head was now placed on a vacuum fixation pillow. The operation proceeded without any more incidents. Two times during the operation the patient was woken and asked to loudly state the days of the week.

A bit shaken by the emergency I tried to concentrate on my job. But suddenly being more involved in the events, the person who was being operated on became more real to me. I found it hard to stay focused when the days of the week was cited from beneath the drapes. Worrying that he might get them wrong. Wondering what he must be thinking, having been unconscious during an emergency and conscious during brain surgery.

I guess this incident was a reminder to me of the dramatic events I’m documenting in my work. Although most operations proceed calmly and without any physical drama, they’re none the less milestones for the patients, determining the course of their lives.

The patient got the days right both times, by the way. Hopefully he was cured of his epilepsy.

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Here is a video I’ve made of a craniotomy to remove a tumor. Not from the case described here. Commentary in Norwegian.

Check out this interesting patient’s account of an awake craniotomy.

Here’s a good feature article on the subject from St. Petersburg Times.

The photos in this post are not from the described case. Photo credits: photo 1, photo 2.