Dave’s turning point in VVF surgery

Two weeks spent in Liberia on the new ‘Africa Mercy’ Mercy ship with a renowned teacher (and urologist), Steve Arrowsmith has been a surgical turning point for me. My previous trainers have shown me the problems and challenges of VVF surgery, but haven’t given me the confidence to dissect and repair the terrible pelvic injuries that face me. But the 25 cases I have done here with Steve at my shoulder he has given me that confidence. Challenges include:

• Thick rubbery scar tissue that faces you like a wall, hiding those delicate tissues within that have to be gently displayed so the repair can be performed.
• Fear that your finger or scissors will plunge in error through a delicate layer enclosing one body fluid or another.
• Fear you can’t reach the dark tight corner with scissors or small curved needle
• Fear that you cannot find the tiny opening of the ureter which must receive your 1 mm diameter catheter before the operation can proceed
• Fatigue in neck and shoulders & arms, knowing that there are another two cases to do
• Knowledge that the last suture you placed was your best effort, but it wasn’t really tight and secure
• A trickle of blue liquid through your repair at the end of the procedure when you perform the dye test, indicating that it is not water-tight and must be repeated.
• Failure of the repair days later, meaning disappointment for the surgeon and anguishing distress for the patient.

I am thankful for the help I have received for these challenges.