“As we know, there are known knowns; there are things we know we know. We also know there are known unknowns; that is to say we know there are some things we do not know. But there are also unknown unknowns—the ones we don’t know we don’t know…”
Donald Rumsfeld
During my surgical lifetime probably the most common operation in General Surgery was the cholecystectomy. I may have been considered a Breast Endocrine specialist, but I sure did a lot of cholecystectomies. In fact during my training was the era of transition from open surgery to laparoscopy. There were a lot of long, difficult and humiliating procedures, and that was just the consultants. Bile duct injuries soared for a few years. At the core was the anatomy of the biliary tree. To remove the gallbladder you have to safely divide the cystic artery and cystic duct, and nothing else. Above we can see the classification of cystic artery and cystic duct anatomy that we were required to memorise before our Fellowship Exam. The trouble is that surgeons don’t know which category of anatomy any given patient has before starting the operation. You can know the diagrams and still be in a world of pain. #beentheredonethat #letsmakelemonade
Pen Paint and Scalpel 