Open appy video?

[Cheisu]

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I was wondering if anyone knew where there are any open appy videos anywhere on the internet? I've seen TONS of lap appy videos, but I'm really interested in seeing an open appy.

Any ideas?

 

[tussy]

Having done more than a hundred open appys i can tell you there isn't much to see, therefore you won't find any useful videos.

Basically the operations goes like this:

Make a small incision in the RLQ, split the muscle then open the peritoneum. Get you finger in there and find the appendix and try to flip it up into the wound - usually involves taking down some inflammatory adhesions and sometimes even a little blunt mobilization of the cecum. The appendix then pokes out the wound. Once you see the base then you divide and tie off the mesoappendix and then clamp the appendix, tie off the base, divide with a knife, close and you're done.

Easy operation, but on video it would mostly consist of the surgeons hand in the wound jiggling about until the appendix pops up!

 

[Anka]

Cheisu, you're back!!! Where have you been?

Anka

 

[Cheisu]

Cheisu, you're back!!! Where have you been?

Anka

Was that sarcastic? lol

I hope I haven't ruined my name on here because I'm opinionated...

 

[Anka]

Not sarcastic. You just disappeared. I was worried!

 

[Castro Viejo]

So how did that shadowing thing with the "cardio surgeon" go?

 

[RajMahal]

So how did that shadowing thing with the "cardio surgeon" go?

teeeeee heeeeeeeeeee. castro, i'll bet you're really mean to your medical students. in fact, I wouldn't doubt if you make them cry on a regular basis. either that, or you completely ignore them.

Cheisu
I think your interest in surgery is excellent, but remember, grasshopper; a journey of a thousand miles begins with a single step--there is no surgical video that will help you get into medical school. spend more time hitting the books and less time on YouTube.

 

[Blade28]

I was wondering if anyone knew where there are any open appy videos anywhere on the internet? I've seen TONS of lap appy videos, but I'm really interested in seeing an open appy.

You've really got a fascination with the open appy, don't you? I think you've mentioned this procedure more than any other operation - including all of the CT Surg ones that you love. 🙂

 

[Castro Viejo]

teeeeee heeeeeeeeeee. castro, i'll bet you're really mean to your medical students. in fact, I wouldn't doubt if you make them cry on a regular basis. either that, or you completely ignore them.

Not in general, but I have been known to give a beat down every now and then to medical students who qualify for the Hall of Fame in Slackerdom.

If they suck, I generally ignore them now. If they show initiative and show some interest, then as I wrote in another post, I'll let them help out during a case (e.g., stitch something, fire a GIA, try running the bowel, etc.).

 

[Cheisu]

So how did that shadowing thing with the "cardio surgeon" go?

It didn't. The stupid nurse in charge of the OR said I was too young (16 years old) or some crap like that.

 

[Cheisu]

You've really got a fascination with the open appy, don't you? I think you've mentioned this procedure more than any other operation - including all of the CT Surg ones that you love. 🙂

Probably because the open appy is so symbolic of the art of surgery. It's apparently one of the most simple procedures, and one of the most common surgeries performed. It just seems really surgery-y.

But still, no one's given me a link to a video 🙁

 

[Blade28]

Probably because the open appy is so symbolic of the art of surgery. It's apparently one of the most simple procedures, and one of the most common surgeries performed. It just seems really surgery-y.

But still, no one's given me a link to a video 🙁

Really? More common than the hernia repair? 😕

 

[smq123]

But still, no one's given me a link to a video 🙁

Because there isn't a video available online. Open appys can be messy and difficult to visualize, so videotaping them is kind of hard.

Probably because the open appy is so symbolic of the art of surgery. It's apparently one of the most simple procedures, and one of the most common surgeries performed. It just seems really surgery-y.

Hmm. Interesting. I don't think that I ever considered appys to be symbolic of surgery. They're okay to watch, I guess, but I don't think that they demonstrate the true "art" of surgery very well. I'd rather watch an aortic valve replacement, a Whipple, or a liver transplant over an appendectomy any day.

 

[Castro Viejo]

Really? More common than the hernia repair? 😕

Hmmm... Methink so too that appendectomies are the most commonly performed operations in the United States. Unless that was the most commonly performed URGENT operation in the United States.

Damn. Back to the Schwartz...

 

[Castro Viejo]

Probably because the open appy is so symbolic of the art of surgery.

My left or right index finger basically does most of the operation. There's not really much of an "art" to performing an appendectomy.

As smq noted, there are far more complex operations that are much more symbolic of surgery. Hell, many people in these parts refer to the Whipple as the Holy Grail of General Surgery. You should probably see one of those.

 

[DoctorMunchkin]

I'd rather watch paint dry then watch an open appy. Doing one is pretty fun, especially when there is some pus that comes rolling out of the belly, accompanied by that feculant odor! MMM, good! I love it when you get the appendix out and its all green and rotten and falling apart! Then I love finding those little pockets of pus that are sometimes still stuck in the loops of bowel or in the pelvis!! I do enjoy a good, ruptured appy.

Watching one is boring. There is a lot of grunting and a confused look on the attendings face, and maybe some choice words. And just the index finger poking around in some dark hole... Not much fun to watch in the OR.

 

[beastmaster]

There's a video on youtube for !@#$ sake. But it shows an umbilical incision. There's a video of the classic RLQ incision on Accesssurgery, provided you have access to the site.

 

[Cheisu]

There's a video on youtube for !@#$ sake. But it shows an umbilical incision. There's a video of the classic RLQ incision on Accesssurgery, provided you have access to the site.

Could you provide the links to them, please?

 

[Winged Scapula]

Could you provide the links to them, please?

Do you not have Google? This took me 0.0000004546 seconds to find:

http://www.accesssurgery.com/ and

[youtube]http://www.youtube.com/watch?v=CUwa84h2_eE[/youtube]

as others have noted above, this is unusual. Open appys are not generally done through an umbilical incision.

 

[SocialistMD]

Do you not have Google? This took me 0.0000004546 seconds to find

Don't feed into it!

 

[Winged Scapula]

Don't feed into it!

I know...but its in my kind and gentle nature to try and help.

(and having talked to him on AIM, he seems like a normal kid).

 

[SocialistMD]

I know...but its in my kind and gentle nature to try and help.

You are being an enabler. He came here initially asking what he could do at this point in time to prepare himself for being a physician. How about self-reliance? Before you know it, he is going to be 650lbs, bedridden, and you are going to be bringing him 3 buckets of KFC for his mid-afternoon snack.

 

[Winged Scapula]

You are being an enabler. He came here initially asking what he could do at this point in time to prepare himself for being a physician. How about self-reliance? Before you know it, he is going to be 650lbs, bedridden, and you are going to be bringing him 3 buckets of KFC for his mid-afternoon snack.

You can thank me then because then he won't be a surgeon and asking questions here!

 

[SocialistMD]

You can thank me then because then he won't be a surgeon and asking questions here!

Whatever! It will be 10x worse, as the only thing he will have to do all day is sit on this website, asking what he can do now to prepare to be a surgeon after his gastric bypass.😱

 

[Winged Scapula]

Whatever! It will be 10x worse, as the only thing he will have to do all day is sit on this website.😱

True...nothing worse than a thwarted surgeon!

Ok I'll try and stop enabling.😀

 

[Winged Scapula]

Whatever! It will be 10x worse, as the only thing he will have to do all day is sit on this website, asking what he can do now to prepare to be a surgeon after his gastric bypass.😱

That's better than the first one...funnier.

BTW, what are YOU doing on here...don't you have some resident type stuff to be doing?

 

[SocialistMD]

That's better than the first one...funnier.

BTW, what are YOU doing on here...don't you have some resident type stuff to be doing?

Lab time. Cells and tumors grow themselves.

 

[Cheisu]

You are being an enabler. He came here initially asking what he could do at this point in time to prepare himself for being a physician. How about self-reliance? Before you know it, he is going to be 650lbs, bedridden, and you are going to be bringing him 3 buckets of KFC for his mid-afternoon snack.

1. Stop being an ***
2. Stop assuming things about me
3. I'm a vegetarian
4. You sound like the people at the Westboro Baptist Church.

 

[Cheisu]

True...nothing worse than a thwarted surgeon!

Ok I'll try and stop enabling.😀

Why are you agreeing with this **** of a human?

Obviously, he likes to put others down because it makes him feel better. I wonder if he does it with his "sick, captive audience"?

People like him are the reason people think all doctors are dicks.

 

[smq123]

1. Stop being an ***
2. Stop assuming things about me
3. I'm a vegetarian
4. You sound like the people at the Westboro Baptist Church.

Rule #1 of a good surgery student? Look things up for yourself. (As demonstrated in this thread, you have some work to do in that area.)

Rule #2 of a good surgery student? Respect your elders. SocialistMD is an actual surgery resident - he's already accomplished 90% of what you spend your copious free time dreaming about. He may also be your attending one day. Think about it.

If you can't do learn a little respect, then the strict hierarchy of surgery (or ob/gyn for that matter) will not appeal to you. Maybe peds or psych will be more your speed.

People like him are the reason people think all doctors are dicks.

And clearly hyper-eager high school students who already think that they're surgeons (but are still in high school) have NOTHING to do with why people think that all doctors are jerks. 🙄

Dude. Learn how to be polite. It'll get you a lot more.

 

[BlackSails]

Dude. Learn how to be polite. It'll get you a lot more.

 

[SocialistMD]

1. Stop being an ***
Why are you agreeing with this **** of a human?

Is there a smiley that I can use that can shed the tear I feel is necessary here? She agrees with me because she knows I'm right. I've known her since before she was a physician, and she has known me since before I was a medical student. She has seen all 1900 of my posts and knows that the advice I offer is generally spot-on and I have nothing but the best intentions for those who have legitimate questions and are respectful to those from whom they seek advice.

Also, where is my moderator to come in and save me from the viscious name-calling? Its my recollection of the rules (that I agreed to some seven years ago) that name-calling isn't allowed. 🙄

2. Stop assuming things about me

What did I assume? That you would rather someone else do your work for you than to do it yourself? With the evidence presented on this forum, what other conclusion could I draw?

4. You sound like the people at the Westboro Baptist Church.

If it is because they, too, say you should be self-reliant, then by God, organized religion has finally done something right.

Obviously, he likes to put others down because it makes him feel better. I wonder if he does it with his "sick, captive audience"?

What did I do to put you down? Say you were wanting others to do your work for you? Is that not true? Do we live in a society today that doesn't allow the truth to be said when it hurts the feelings of others?

People like him are the reason people think all doctors are dicks.

Look, you come here extolling your vast knowledge of surgery and how it should be (without ever having been a surgeon or gone through a surgery training program), preaching to medical students how they need to be completely dedicated and work hard, things about which you have no knowledge (not to say you don't work hard, but that you don't know what they are doing and how hard they are working). You equate the complaints and sarcasm on this forum to how we are with our patients, which again is a product of just how naive you are about people in general and surgeons in particular. Every person on this forum can tell you how they have been completely pissed about a consult or an action a patient has taken, yet when talking to the patient not five seconds later have been very calm and collected, because the frustration has nothing to do with the patient but the system. You come asking questions, but then criticize those offering answers when they aren't the answers you want to hear. If you want to play with the big boys and girls, you need to grow up.

We have been very patient in answering your questions and tolerating your constant know-it-all attitude and insults you spew to those of us who you feel are inferior and are terrible clinicians. You need to learn to take criticism, as we all do it on a daily basis. You need to learn there are many different truths, and that in order to be the best you can be, you must accept all of these truths and navigate your own way through them to do what is best, be it for some future patient you have or life in general. You need to learn to be respectful of those to whom you address your questions, even if you don't agree with what they have to say. All of these lessons are more important than becoming and EMT or starting a pre-med club in high school or watching an open appy video when it comes to getting into medical school.

I am very tolerant and very open-minded to most people on this forum, and will play devil's advocate to any side when I think people are losing the forest for the trees. What I do not tolerate, though, are arrogantly presumptive people who come in thinking they know more about things than they actually do, who speak as a voice of authority and who argue their theory with people who have actually experienced something. In my view, real world experience trumps theory and disrespecting people who have that experience when it disagrees with your theory, especially when you have come to them for help, is something I find unacceptable and unimaginable. Yet here you are, doing it almost every day you grace this site and make a post.

If you don't agree with something someone says, but find yourself in the situation where they have experienced it in real life and you have only experienced it on television or in whatever fantasyworld you live, don't snap back; you discredit yourself and make it such that no one wants to help you. If it continues, I guarantee you will find all of your questions ignored and that no one will offer to help you anymore.

 

[Blade28]

Also, where is my moderator to come in and save me from the viscious name-calling? Its my recollection of the rules (that I agreed to some seven years ago) that name-calling isn't allowed. 🙄

The post has already been reported. Action will be taken shortly.

 

[Cheisu]

The post has already been reported. Action will be taken shortly.

Oh, okay. So he's allowed to call me a fat, lazy troll, but I'm not allowed to call him something that is masked by asterisks?

 

[SocialistMD]

1. Why aren't you in school?
2.

Inappropriate Language

The use of inappropriate or offensive language is not permitted in these forums. Inappropriate or offensive language includes, but is not limited to, any language or content that is sexually oriented, sexually suggestive or abusive, harassing, defamatory, vulgar, obscene, profane, hateful, or that contains racially, ethnically or otherwise objectionable material of any kind. We ask that you please be considerate to other members in the forums when posting your messages.

I didn't call you a fat, lazy troll. I have called you a troll before, because many of your posts have that troll-like quality. The comment about your becoming a chicken-eating 650lb person was related to WS being an enabler, not to your body habitus or work ethic.

In order to avoid getting in further trouble, I suggest you direct your comments to me in a PM.

 

[Carissa]

Hmm. Interesting. I don't think that I ever considered appys to be symbolic of surgery. They're okay to watch, I guess, but I don't think that they demonstrate the true "art" of surgery very well. I'd rather watch an aortic valve replacement, a Whipple, or a liver transplant over an appendectomy any day.

I'm surprised no one has mentioned a heart transplant. Maybe I'm being cliche, but that, in my opinion, has got to be the ultimate surgery.

 

[Carissa]

1. Why aren't you in school?

Maybe he has a snow day? If he lives anywhere near me, he probably does.

 

[smq123]

I'm surprised no one has mentioned a heart transplant. Maybe I'm being cliche, but that, in my opinion, has got to be the ultimate surgery.

Haven't seen one yet. But I think that the theory behind liver transplantation is more interesting than the theory behind heart transplants. The physiology behind the liver and the pancreas is AMAZING, which is why I think that transplanting the hepatobiliary system is so interesting. It's also why I like Whipples.

I really like cardiology, and find it to be fascinating. Valve replacements are great - fun to watch, and the technical challenges behind valve replacements is so interesting. Plus I liked the interplay between anatomy and physio when it came to valve replacements. So it's not that I don't like the heart. (You can stop being so tachycardic, Blade - and I know that you are right now! 😛) But it's the interplay between very complicated physiology and anatomy (which I find in liver transplants) which I loved.

[P.S. If it helps your heartrate return to baseline, Blade, I will add that I think that lung transplants are incredibly cool and fascinating, for the same reasons that liver transplants fascinate me. 😀]

 

[SocialistMD]

I'm surprised no one has mentioned a heart transplant. Maybe I'm being cliche, but that, in my opinion, has got to be the ultimate surgery.

That is something up to interpretation.

But it's the interplay between very complicated physiology and anatomy (which I find in liver transplants) which I loved.

This is what she enjoys, and I can understand it. However, to me, the ultimate operation is the one that saves or changes a life and allows one to return to the baseline level of health and activity with the minimal risk to the patient. Heart transplant patients have to take immunosuppression and will still likely die from complications related to their heart or to infection from the medication. Breast cancer operations are nice because you can cure someone of their cancer; many other cancer operations are not so. Many trauma laparotomies are very complex and require vascular anastamoses, bowel anastamoses, etc..., but they often have frustrating postop courses. To me, the ultimate operation is the pyloromyotomy. Technically, it is not that difficult or dramatic, but you take a baby who can't keep anything down and could ultimately die from dehydration or malnutrition and turn him (usually) back into a normal, healthy baby who is tolerating feeds about four hours after the procedure. It is highly rewarding.

 

[Winged Scapula]

I'm surprised no one has mentioned a heart transplant. Maybe I'm being cliche, but that, in my opinion, has got to be the ultimate surgery.

Like others have noted, the concept of "ultimate" in surgery is dependent on the person.

I frankly have little interest in CT surgery but will readily admit it was because the CT surgeons during my residency treated us like dogs who shouldn't be even allowed in the OR. Transplants are cool - regardless of the organ, but the work doesn't fascinate me, only the theory.

Pancreatic surgery is cool...I loved Whipples, largely because they were mostly done by my residency director (and he and I got along really well), so they were fun, but also because I found the pathology interesting and the work enjoyable. But I don't like doing something which such a high rate of failure and death.

Vascular? Eh...not on your life. I hate drippy ulcers, crusty cold feet, the non-compliant patients and all the enjoyment of a vascular anastomosis cannot make up for that (and the middle of the night, cold leg consults).

But I find Breast Surgery very rewarding...as SocMD notes, its a chance to cure and its an opportunity to play a very important role in someone's life and to follow-up with them long-term. The patients can be high maintenance but they are, for the most part, compliant and very grateful. However, I know lots of surgeons who despise breast surgery - the procedures are not technically challenging, or they don't care for the level of emotion or follow-up that I enjoy. I get a lot of derogation from fellow surgeons who feel that I have "wasted" my general surgery training; yet these are the guys who don't know current standards of care in my field and whose patients come to see me.

Bottom line is that there is no 1 surgery that defines surgery as a field, IMHO or is the "ultimate"; there will be as many opinions as there are surgeons.

 

[Blade28]

So it's not that I don't like the heart. (You can stop being so tachycardic, Blade - and I know that you are right now! 😛)

😱

[P.S. If it helps your heartrate return to baseline, Blade, I will add that I think that lung transplants are incredibly cool and fascinating, for the same reasons that liver transplants fascinate me. 😀]

Ah nice. 🙂 👍

 

[Carissa]

This is what she enjoys, and I can understand it. However, to me, the ultimate operation is the one that saves or changes a life and allows one to return to the baseline level of health and activity with the minimal risk to the patient. Heart transplant patients have to take immunosuppression and will still likely die from complications related to their heart or to infection from the medication. Breast cancer operations are nice because you can cure someone of their cancer; many other cancer operations are not so. Many trauma laparotomies are very complex and require vascular anastamoses, bowel anastamoses, etc..., but they often have frustrating postop courses. To me, the ultimate operation is the pyloromyotomy. Technically, it is not that difficult or dramatic, but you take a baby who can't keep anything down and could ultimately die from dehydration or malnutrition and turn him (usually) back into a normal, healthy baby who is tolerating feeds about four hours after the procedure. It is highly rewarding.

That makes a lot of sense. I guess I can't say a heart transplant is the "best" surgery if it isn't necessaryily the most beneficial to the patient (not that it isn't beneficial, but complications can render it pointless).

 

[Blade28]

That makes a lot of sense. I guess I can't say a heart transplant is the "best" surgery if it isn't necessaryily the most beneficial to the patient (not that it isn't beneficial, but complications can render it pointless).

Well that all depends on how you define "beneficial."

 

[SocialistMD]

That makes a lot of sense. I guess I can't say a heart transplant is the "best" surgery if it isn't necessaryily the most beneficial to the patient (not that it isn't beneficial, but complications can render it pointless).

Well, it is probably the most beneficial to that particular patient, but I prefer to stay away from that patient population all together. 😉