Tonsillectomy!

Tonsillectomy!
Every ENT surgeon or resident or PG is either pleased, scared or terrified of this!
When we start our ENT residency, one of the first surgeries we do is the tonsil! We are grilled on the blood supply and the complications and the types of tonsillectomy!

Every OT, the tonsil is the most coveted and anticipated surgery especially for the junior ENT! The deal is to convince the patient and get him or her ready for the surgery and then you get to do the case! Most of the time, you get to dissect the case at least on one side and then the senior takes over and controls the bleeding. The dissection is very important but the more essential part is the control of the bleeding. If your dissection is too deep on not in the proper plane then the bleeding is more especially if it is too deep! If the  dissection is too superficial then you have the risk of recurrence which can happen even in two weeks!

So you have a risk of immediate bleeding or recurrence in two weeks! The choice is yours! Then you have the infiltration which you are allowed to give! If you give proper infiltration then the tonsil will not bleed during the dissection but when the effect of infiltration and especially the adrenaline wears of the bleeding will happen in the recovery or the ward when you or the duty surgeon is alone! Again a fine balance!

One of the first surgeries when your start your residency and your practice was the tonsillectomy!

One of the most simplest surgeries but one of the surgeries which can cause dangerous complications at any stage of your career!
So during my training in the Government Medical College at Bangalore, I had the fortune of doing more than 70 or so tonsil surgeries! The first one of course was the best and without any complications! It was so routine that I have done tonsillectomy on a patient in local anesthesia who was aged 11 years!
With that confidence when I moved on to a private hospital, I was given the charge to do an straight forward adult tonsillectomy. It was a good case but I was not given any time for
infiltration. The instruments were all new and the whole set up was new! With that stress and pressure, I botched up the dissection and plane and the final result was a badly taken tonsil with injury to the pillars which are the front limits and usually preserved! Now these injuries have no long term sequalae but in a private hospital all these things
matter! In addition to this, the tonsil would not stop bleeding! After trying in vain for some time, I had no choice but to call my senior who was not very
happy to help! He took the cautery and burnt all over the tonsil cavity carelessly and also the lip! He finally threw the cautery to one side and announced, it is mucosal bleed and will stop on its own!

My chief who saw the patient in the ward later on, gave me the dressing down of my life when he saw the bloody fossa and the burnt lip!
That is when I understood some facts of a surgeon's life and what a tonsil can teach you!

Now after done more than a thousand or so tonsil surgeries in the most difficult of situations where sometimes we did not have a cautery, I have done a good job!
Once there was no vacuum suction for surgery but we still managed to do it! One of the most memorable days was when I was doing surgery on a child of around 5 years
in a peripheral center and just at the middle of dissection, the electricity went off! I remembered my mantra! Do not panic!
We finished the surgery with lots of gauze and a torch!

So the entry surgery or one of the most common talked about organ in ENT which actually does not have much function in the body can actually give you so many valuable lessons!
The lessons are-

  • The success of a surgery is shared by everyone in the team but the failure is yours alone!
  • In spite of doing many cases, every case is a new case and unique! So be prepared!
  • Every surgery can go for complication, but being calm is the only way to tackle it.
  • Remember that, a good set of instrument is always the best, but a good set of calm confident and skillful hands is better than any instrument!
  • Tonsil may not be useful to the body but it is responsible for teaching thousands of surgeons the skill of pain management, infection management and bleeding control!

In the days of Google patients, all these experiences are limited but still they are permanent!

So for any doubts on Tonsils do get in touch with your ENT surgeon while you can contact Sundar Pichai for any doubts on Google!  

Dr. Sriram Nathan