I’ve performed about ten pterygium excisions in the operating room so far, and the biggest challenge I’ve encountered is operating on the LEFT eye. I’d imagine that any experienced surgeon would scoff at this hurdle, but the patient’s nose seems to impede my suturing abilities significantly (I use my right hand for needling driving).  The suturing in pterygia operations involves the medial bulbar conjunctiva, which is adjacent to the nose.

On my first few cases, I used a traction suture on the cornea to help rotate the globe for access. To minimize trauma on the cornea, I now ask my assistant/attending to help rotate the globe with a muscle hook. This is impractical, since most surgeons operate solo in practice. To remedy this problem, I’ve come up with three solutions:

1. Practice more–the obvious solution, but not elegant.
2. Use my LEFT hand to drive the sutures when operating on the LEFT eye. Use my RIGHT hand to drive sutures when operating on the RIGHT eye. Switch hitters in baseball do it, right? While I am not completely ambidextrous, I’m sure that my triple-digit hours playing Quake III and other FPS‘s might have helped my dexterity.
3. Operate only on RIGHT eyes. After all, there are already too many subspecializations in ophthalmology. Why not specialize on just one eye?

Which one is your favorite?

medicine humor, ophthalmology