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Comment by oneoff786 | Hacker News Reader

Question: is surgery hard?

I’m aware you need to be steady. I’m aware it can take a great deal of time and focus and endurance. But how hard is it to figure out a surgery, and execute it?

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I think it depends on the surgery. Farmers neuter their own pigs and cattle all the time which is a type of surgery.

My daughter had brain surgery and we found the actual medical paper describing how to perform the procedure. It’s basically 6 sentences long. Cut here, make an incision, use a tool there. All while being sure not to accidentally sever an infant’s spine and make them a quadriplegic. The actual instructions were simple enough that I could understand perfectly well how to do the procedure based on the document. However, I’m sure if I actually attempted the surgery I’d be a nervous wreck. I’d guess confidence is probably another part. But maybe a doctor will chime in.

I just tried to find the paper but am not sure where we dug it up or I’d just post it here.

barber chirurgeons

I imagine the trained surgeon knows what to do when anything goes wrong following those 6 simple instructions, and from thence flows confidence.

Exactly. Wife is a neurosurgeon, and somewhere towards the end of her sixth year of residency, she had the gradual realization that she could handle anything that might happen in the course of an even semi-normal case. That fluency has continued to build since then, of course.

I think a lot of it is the knowledge of the rest of the body and the ability to adapt when something doesn't go exactly according to plan.

My fiance does a lot of abdominal surgeries, including robotic. There are a handful that are "difficult" in the traditional sense - lots of complicated steps, indications and contraindications for different methods to complete the same task, etc - but by-and-large most of them are following a set of prescribed steps. For her, because the surgeries are abdominal, a lot of the difficulty comes in when dealing with patients of larger weight and/or who have had lots of previous procedures. A surgery that takes 45 minutes on a 110-pound 17 year old with no major medical history can easily take 4 hours or more for a 400-pound woman with multiple c-sections and multiple other surgeries. Scar tissue distorts the anatomy, it's just physically more difficult to move past outer layers, etc.

Any beginning woodworker quickly learns how much of the job is not just making a straight cut but juggling a whole ton of shit you didn't think about.

And that's all without getting into things like how much of a grace period you have between the first cut and the last fastener, which you don't have with a living organism.

The difficulty of a task transcends mere mechanics.

A common analogy used in neurosurgery training: "Imagine a wooden plank on the driveway and walk its length -- no problem. Suspend that same board ten stories in the air and try again." The hard part is not the "figuring out" or "execution" but knowing the irreversibility and making the correct decision. Your patient expects you to be correct 10 times out of 10, yet you know that's not possible. Squaring our fallibility with the irreversibility of our missteps is the hard part, and what keeps surgeons up at night. The fly struggles in the web.

There are a lot of difficult non-obvieous things to watch for and know. It's like an old cardiac surgeon told me, he can walk into a room and know from across the room if the patient has high blood pressure, is this, is that, just by their coloring etc. It's the same way watching the experienced surgeons do their work, they know so much about a patient just by looking around inside, this means that, etc. Wisdom.

To answer your question, basic surgury isn't (difficult). Good medicine is. The more complex the issue, the better medicine you need.

I can't speak to how hard surgery is to perform but I will say, from talking to surgeons, it sounds like deciding when to operate (and to what extent) is more difficult than actually performing the surgery in a lot of circumstances.

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