Some cases do not go as planned. This one did not go as planned twice.
The first attempt
I had a patient scheduled for percutaneous nephrolithotomy (PCNL, keyhole surgery through the back to remove kidney stones). The first attempt had to be abandoned because of clots in the kidney. We regrouped, rescheduled, and tried again.
The second attempt
On the second attempt the problems started before I even reached the stones. The nephrostomy tube (the drainage tube already in the kidney) would not release. Its balloon would not deflate the standard way, so I cut the external end to decompress it manually. Then the bladder had clots that needed to be washed out.
Then came the real problem. The collecting system of the kidney was packed with clot. Finding and extracting stones through a field hidden by organised haematoma is genuinely difficult.
In a case like this your instruments matter, and your team matters even more. The thulium fibre laser made my day. We got through it, and all the stones were cleared.
What a professor told me on day one
The part I keep thinking about is something a professor told me on my first day in general surgery: “You can do surgeries without any issues, but to become the best surgeon, you must know how to treat complications.”
That is the job: the case where you face three problems in a row in under ten minutes and have to stay sharp through all of them.