March 6, 2009 § 4 Comments
The pebbed glass door panel is lettered in flaked black paint: “Øystein Horgmo…Anatomical Investigations”. It is a reasonably shabby door at the end of a shabby corridor in the sort of building that was new about the year all-tile bathroom became the basis of civilization. The door is locked, but next to it is another door with the same legend which is not locked. Come on in – there’s nobody in here but me and a few volumes of Sobotta and Gray’s.
I do a lot of anatomical investigations, and I love it. Working with surgical videos I often do not understand what I’m looking at when I’m editing. It could be that the surgeon didn’t point all the anatomical landmarks during the video shoot or I’ve simply forgotten. But the surgeons have so much work on their hands, I can’t go asking them about every little detail. Besides, it’s much more fun finding it out myself. Especially when I’m right. Nothing impresses a surgeon like anatomical knowledge from a “layman”.
Case 4711: The Whipple Mystery
It was a dark and rainy night. I was editing some footage of a Whipple procedure and I hadn’t had the time to talk to the surgeon who handled the operation. I knew the basics, but I didn’t know what blood vessels where being cut and tied. Investigation needed.
First I checked the Internet. I found several descriptions of the Whipple procedure, but none of them so detailed as to reveal the mysterious vessels to me. I did however find out that one of the reasons the duodenum is removed together with the head of the pancreas, is that they share the same arterial blood supply. Sobotta down from the shelf. Yes, there was indeed both a superior and inferior pancreaticodudenal artery. A roll of thunder in the distance.
So the inferior one has to be cut from its source, the superior mesenteric artery. Intriguing. But wait a minute. Isn’t the distal part of the stomach removed as well? What arteries supplies that with blood? Leaf through Sobotta again. The right gastric and right gastro-omental arteries. And hey! The right gastro-omental is a branch of the gastroduodenal artery, and the superior pancreaticoduodenal is as well. They must be cutting the gastroduodenal then! And the right gastric! That must be it! I’ll be damned.
All these long words are making me dizzy. I head over to the editing station and try to pinpoint the vessels and check if the map fits the terrain. It does! Gottcha, you dirty shared blood supply!
Suddenly a greenish thug reveals himself and I have to dive for cover. I didn’t see that coming! I jump over to my copy of Gray’s and quickly whip out the cystic artery. Cut and tied. Gall bladder dealt with.
What the hell happened? Feels like I’ve been hit by a train. I need a bourbon.
I contact the surgeon and show him the edited video with voice overs. He can not understand how I managed to reveal his entire operation. “This is nothing,” I tell him. “You should have seen me when I got all the muscles right in a humerus resection.” He opens his mouth, but I’m too quick for him. “Hold your flattery,” I tell him. “It’s all in a days work for an Anatomy Detective.”