Global warming: an inoperable truth

Here it is: It came to me yesterday, in the operating room. Surgeons are the cause of global warming.

My practice now consists entirely of helping with laparoscopic surgery, in which operations are carried out via very small incisions in the abdomen, through which long thin instruments are inserted, along with a camera with a tiny lens. In order to see what we do, the abomen is inflated with gas, which separates the abominal wall from the organs it covers. And the gas we use? Carbon dioxide, released into the air during and after the operation.

Is it coincidence that global warming is accelerating at exactly the time that such surgery is growing at expodential rates? I don't think so. In fact, I might just publish a paper on it. As Orac has shown us, there are medical journals out there that'll print it up for me.

Amazingly enough, I had the solution during the peak years of my practice, but no one listened. If I were a better marketer (buy my book, by the way) I could have saved the world.

Cholecystectomy ("chole" = bile; "cyst" = bag; "ectomy" means removal. So we're talking removal of the gallbladder) is among the -- if not at the top of the list of -- most common operations. Must be at least a million a year done on the planet. During my years in training, cholecystectomy was done through very large incisions. Over the years in practice, I began making smaller and smaller incisions, until I was able to remove most gallbladders through a single one-inch (ok, occasionally one and a half; rarely two) incision. It was around the time I got that small (surgically speaking) that laparoscopic surgery came around, and revolutionized the operating room. I'm the first (well, the fify-thousandth) to admit it's been a good thing and that many operations are much better when done laparoscopically. Cholecystectomy, in my less than humble opinion, ain't one of them. Assuming all the surgeons doing it could be equally well taught to do it "mini" instead. In brief, mini-cholecystectomy, the way I did it, achieves the same results in terms of pain, time of discharge, and return to work. I did the extreme majority as outpatient procedures. The main difference: cost. To the tune of a couple of grand per.

There was a great study done a few years back in England. Natch. In it, neither the patient nor the surgeon knew ahead of time whether the operation would be a "lap chole" or a "mini chole." After the patient was asleep, he/she was randomized to get one or the other; a large bandage was slapped on everyone, hiding whether there was one mini-incision, or the four or five port-holes of laparoscopy. Not the patient, the recovery room nurses, or the floor nurses knew which had been done. The patient was given ad-lib pain medication, and ad-lib discharge, ad-lib return to work. No difference. Except in cost, signigicantly favoring mini-surgery. And get this: the typical "mini" incision over there, for the study, was 5-7 centimeters (2-3 inches), as opposed to my smaller ones. (Actually I'm pretty sure it was 7-10 cm, but I'm too lazy to look it up. In any case, the incisions were bigger than mine, which means if my patients had been in the study, maybe [can't say] the pain scores would have actually favored the mini.)

For a variety of reasons, I lost the war. Surgeons don't want to learn the mini-operation (it's harder than lap-chole). Outside of my area and a couple of others, patients don't hear about it, while lots of companies make wonderfully engineered equipment and make lots of bucks selling it for laparoscopy. It's beautiful stuff, no doubt about it, even if it costs a bucketload and gets to the landfill after use. So of the half-million or more gallbladder operations done every year in the US, nearly all are done with the scope. And carbon dioxide. Leaking into the atmosphere.

The list of abdominal operations done laparoscopically grows: hernias, appendectomy, colon resection, pancreas surgery, etc, etc. The jury, as it were, is still out on whether it's actually an improvement in many of those instances. My opinion: it's clearly better for hiatal hernia repair and for gastric banding for weight-loss. For the others, it depends on whom you read, and on how skillful the surgeons are at the non-laparoscopic alternatives. Don't quote me, but I'd say many operations are done laparoscopically for the same reason a dog licks his privates. But do it they do; more and more and more....

Meanwhile, gas escapes, in nearly every hospital, round the clock, round the world. The planet warms. And it's clearly the fault of me and my fellow surgeons. Sorry about that.