Spoiled for choice

Let us take a random body part of which there is only one in the body.

Such as the appendix.

The removal of the appendix is called an appendectomy.

I talk about appendixes a lot because they are the largest percentage of afternoon and night cases.

The goal is to remove the appendix.

It is up to your body type and makeup and the surgeon’s skill level to determine which way to remove it.

There are lots of ways; or rather, there are two ways with lots of approaches.

The decision tree looks like

APPENDICITIS

REMOVE?

YES NO

OPEN LAPAROSCOPIC ANTIBIOTICS

If open is chosen, you make an incision, tie off the appendix and cut it out and close.

If laparoscopic is chosen, there are many other options. Which scope? Which stapler? Which trocars? Which sizes of trocars? Which suture? Which electrocautery device?

The combinations are endless. In my hospital, there are 2 and a half trocar types. Of which there are at least 6 sizes from which to choose. There are 3 types of scopes and 2 types of degrees of bend to the scope, and three sizes of scopes. There is an upteen number of suture combinations. There are 2 types of staplers, but the second type has at least 2 different sizes of staplers and about 8 stapler heads. There are three different types of electrocautery devices, with the third with 4 different options in this hospital.

The point is, there are lots of decisions to be made.

And the circulator in the room is required to remember the surgeon’s on call’s preferences.

Higher math for OR nerds.

Or the surgeons are spoiled for choice.

But woe betides the circulator who does not remember what the particular call surgeon uses.

And please believe us when we tell you that something is on backorder.

And just imagine all the options in all the surgery specialties we have.

Mindboggling, isn’t it?