Inner sights

December 2, 2008 § 11 Comments

that-is-a-big-tool

A surgeon wielding a big tool (Endo GIA) on Grey's Anatomy. Note the bloody glove.

When you enter an operating room for the first time, you’re probably a bit worried about how you’re going to react to the visual impressions.The only reference most of us have is television. If it’s hospital drama or news footage, the surgery is always only hinted at. They show surgery without actually showing surgery. We get to see some bloody, gloved hands and some skin. The rest is left to Mr. Imagination, and as we know, he needs a reality check.

I was at a medical convention promoting www.oncolex.no. As a part of our stand we had a 40″ LCD screen demonstrating the website and showing some of my videos. A lot of people passed by our stand, and now and then some convention attendees would stop and watch a video, maybe ask some questions. In the afternoon a from the convention hotel started fixing some defect lights not long from where we were. He went to and fro for half an hour and passed our LCD several times without taking any notice. But when passing for the fifth time he glanced at the screen as he passed it and stopped dead in his footsteps.

On the screen, an inguinal lymph node dissection (LND) was in progress. He stood there watching, looking rather disgusted, for fifteens seconds or more before asking me: “what the hell is that?”. I said it was a video of an operation to remove cancerous lymph nodes from a man’s right thigh. “Oh,” he said, and continued watching, the look on his face slowly shifting from disgusted to intrigued.

The insides of our bodies is a hidden world to most of us. A world we often associate with death and carnage and would rather not think about. There’s blood in there, and guts. If there’s something wrong and we need an operation, most of us would not want the details, just get it over with. And the surgeon would most likely want to spare us the details. Implying, of course, that the details are horrible and you’d have to be a surgeon to find it interesting. Just like television tells us.

I believe more people would be interested in the inner sanctums of our bodies, given the chance. Like the hotel janitor. But like watching a 2D pattern to reveal a hidden 3D image, you have to see beyond initial (disgusting?) visual impression to see the real structures. Let’s take a look at a still image from the inguinal LND video.

The left groin after an inguinal lymph node dissection.

The left groin after an inguinal lymph node dissection.

This does not make much sense. If you don’t know what you’re looking at you’d probably say that Mr. Imagination was right, and look away. But what if we add some annotations to the still?

Femoral nerve.

Clockwise: IL: Inguinal ligament. FA: Femoral artery. FN: Femoral nerve. SM: Sartorius muscle. ALM: Adductor longus muscle. FV: Femoral vein.

Suddenly the different structures become visible. Looking closely you can see the length of the artery and vein passing along the thigh side by side. If we supplement this image with an anatomical illustration of the same area it becomes even more interesting. Watch the drawing and then watch the image. Intriguing, isn’t it?

Litograph plate from the 20th U.S. edition of "Gray's Anatomy of the Human Body", published in 1918 (public domain).

Litograph plate from the 20th U.S. edition of "Gray's Anatomy of the Human Body", published in 1918 (public domain). Click for a larger image.

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