A chance of life
BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a2958 (Published 10 December 2008) Cite this as: BMJ 2008;337:a2958
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We congratulate David Knott and Meirion Thomas, the two surgeons,
who, 7000km apart, collaborated by text leading to the successful
performance of a forequarter amputation.
Their work highlights two important issues.
First, the provision of detailed expert operative information.
Second, transmitting such information to any part of the world.
Since 2001, one author (MHE) has been writing and developing
operation scripts. The scripts aim to provide all the information that an
expert uses when operating 1. This means 10 or more times the information
in an operative
textbook or manual.
At Wikisurgery, the free online surgical encyclopaedia, over 50 such
scripts have been available to any visitor to the website since 2006 2.
The scripts can also be sent as text messages.
Three amputation operations are included among the 50 scripts.
http://www.wikisurgery.com/index.php?title=Amputation-above-knee-
Operationscript
http://www.wikisurgery.com/index.php?title=Amputation-below-knee-
Operationscript
http://www.wikisurgery.com/index.php?title=Amputation-toe-Operationscript
The scripts are open to comment, discussion, addition and editing by
approved users.
The site also contains online training programs in basic
surgical skills and basic laparoscopic operations.
Wikisurgery is sponsored by the International Journal of Surgery 2.
We provide operative information via links to websites including the Royal
College of Surgeons of Edinburgh, Wikidoc.org and Wikipedia.org.
The worldwide provision of free expert information, covering all
surgical procedures, is an easily achievable goal. Wikisurgery already
forms the centre of such a resource.
New authors are welcome.
Michael Edwards FRCS Web consultant Wikisurgery
Riaz Agha MB BS Administrative Editor Wikisurgery
References
1 Edwards M H. From protocol to pantogen and pantino: customisable
surgical scripts with all the expert information. Hospital Medicine 2001;
62: 4:
2 Agha R. Introducing Wikisurgery.com: The blueprint for a surgical
architecture of participation. Int J Surg 2006; 4:140-143. 2-234.
Competing interests:
Are these interests in competition?
MHE is unpaid Web consultant of Wikisurgery.
RA is founder of the International Journal of Surgery and Wikisurgery. He is Managing and Executive Editor of the International Journal of Surgery and is Administrating Editor of Wikisurgery.
Competing interests: No competing interests
Dear Editor
re BMJ 2008; 337:a2958
Thank you for publishing David Nott's account of the upper limb amputation
in the Democratic Republic of Congo. This is the first mention I have seen
of the anaesthetist, who is named as Paul, and rightly praised for his
part in the operation. As an anaesthetist (albeit retired), I would find
it fascinating and instructive to read a report in similar detail of
Paul's management of what can only have been a challenging case.
Janet Trythall, MB, BS, FFA
(BMA 6468912)
Competing interests:
None declared
Competing interests: No competing interests
Should orthopaedics be returned to general surgery?
This case demonstrates that surgical skills are largely generic and
can be applied from one part of the body to another by surgeons who knows
their anatomy. What is more the opportunity to do an operation of this
magnitude outside of one's own subspecialty is a learning experience that
has the potential to extend one's ability to push the frontiers in one's
own subspecialty. In this case, for example, Mr Nott's practical knowledge
of vascular exposure in the axilla and his potential to perform novel
vascular operations in the region might have been greatly increased. More
importantly thuis case demonstrates that orthopaedic operations can be
carried out very competently by those without subspecilaty training in
orthopaedics.
The danger in subspecialization is that some subspecialties could be
made disappear ever night by advances in medical care. A striking example
in my professional life has been the effect of H2 receptor antagonists and
proton pump inhibitors on upper gastrointestinal surgery. Subspecialty
board certification, such as that practiced in the US, is a largely a
means of job protection. What is more general surgeons are, in my
experience, often better able to perform subspecialty operations than the
subspecialists themselves.
Competing interests:
None declared
Competing interests: No competing interests