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One of the major selling points of most of the new consumer technological
devices out there-stereos, VCRs, computers-is ease of use. The companies
that make these devices spend as much time making them"dummy proof" and
worthy of the invitation to "plug and play" as they do improving the sound
and picture and computing quality. Unfortunately, all that great consumer
technology and consumer marketing has lulled some of us into believing
that new surgical technology is also always easier to use. It's not. Surgery
remains a hands-on art and so far, the most dazzling technology has not
managed to replace sound surgical judgement. And if we fail to remember
this, we may end up hurting patients.
I'm reminded of a story that I think illustrates this point very well.
Several years ago, I helped develop CR Bard's mesh PerFix hernia plug.
In my hands and in the hands of many colleagues, the device proved a wonderful
tool, shortening case time to 20 minutes and allowing the patient to resume
full normal activities within 24 hours.
One year ago, at the Clinical Congress of the American College of Surgeons,
a surgeon approached me to discuss his less-than-satisfactory experience
with the plug. This surgeon told me that he had performed his first plug
repair the week before. Unfortunately, the hernia had recurred the following
day, and the plug had uncomfortably lodged in the patient's scrotum. It
didn't matter to this surgeon that more than a million of the PerFix plugs
had been successfully implanted worldwide. His patient was living proof,
he said, that the technology just didn't work.
After listening to the surgeon's critique, I questioned him about his
knowledge of the device. Finally, he sheepishly admitted that he had never
actually obtained instructions on how to properly use the plug. But, since
it represented cutting-edge hernia technology and seemed so easy to use,
he had jumped into his first case figuring that there was no way he could
go wrong. Of course, he couldn't have been more mistaken. After questioning
him thoroughly on his technique, I discovered that he had actually placed
the device upside down in the patient's inguinal canal and had never sutured
it into position, as is required. That the plug ended up in the patient's
scrotum was inevitable.
As this story shows, it's easy to be beguiled by surgical technology.
Unfamiliar with the proper use of the latest and greatest surgical device
but bedazzled by its promise, we go ahead and employ the technology anyway.
The end result is an unhappy patient with a complication that could have
been avoided if the surgeon had just taken the time to learn how to use
the equipment.
An exciting time awaits all of us involved in surgery. In the next 10
years, we are almost guaranteed to see technological advances that we
cannot even imagine today. But we all must understand that slick instrumentation
and innovative devices can never replace sound surgical judgment. To achieve
the excellent outcomes we all desire, we must combine one with the other.
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