Crashing into the middle

Occasionally in surgery, we have quite long wounds to close. Sometimes “to save time” we’ll have two operatators (surgeons or trainees) suture half each. More often than not, without instruction, they’ll start at the two ends. Great to start with. But as they get closer to the middle of the wound they clash and interfere with each other; one will often “give way”, and any time savings evaporate.

The idea of sharing the work is good, but it needs to be executed properly. One person starts at one end, the other starts in the middle. In this way, there is always distance between them, and it usually gets larger. Also, the slower person starts at the end, and to their natural forearm movement. The more experienced (and likely faster) operator should position themselves at an ergonomic disadvantage if one exists. Finally, it usually means the more experienced surgeon usually finishes earlier and can supervise the final few sutures or knots of their colleague, and provide feedback if needed.

How does this relate in real life? I was fortunate enough to attend a Champagne tasting event at a renowned maison in Reims, France. After an incredibly accomplished bilingual tour, we ended in the tasting room where a line of flutes were carefully lined up. And two Gallic bartenders proceeded to pour from the edges into the middle. Guess what happened?

#efficiency