Wednesday, February 22, 2012

Medical Question: Surgical Timeline

I'm pleased to have Amitha Knight back who will be hosting a medical question today and tomorrow about surgeries. Today, she covers the general surgical timeline and what the patient's process is through the OR. On Friday, she'll cover more in depth about brain surgeries.

RB asks:

In the book my one lead character, a Brain surgeon, will be performing two major surgeries during the life of the book, one on (an animal), and the other she will be performing a radical operation on the male lead.

Could you, in as short as possible, give me an overview of what happens during such a surgery. The big picture and any suggestions you could give me that would make the scenes believable.
Even if you can point me at a website where I can read up about brain surgery – any videos would help as well, I am not squeamish about blood etc… so don’t worry about that side (more fascinated by the whole process).

Any help would seriously be appreciated.

Amitha says:

While I saw lots of surgeries during my 12-week surgery rotation in medical school, ranging from cholecystectomies (gall bladder removal) to liver transplants to cardiac surgeries to breast implants, I didn't see any brain surgeries. I especially didn't see any veterinary surgeries so I can't comment on that part of your question.

The reason I didn't see the brain surgeries was that the surgeons wanted you to be there for the entire surgery and brain surgeries can take a long time. For example, I heard of one brain tumor removal taking 6 hours. A quick search of the web reveals people who report their brain surgeries having taken more than 12 hours--not sure if they're counting recovery time. Performing and assisting surgeries for long periods of time requires stamina, dedication, and patience. Alas, our hospital didn't have a surgical theatre like on Grey's Anatomy where people could eat lunch, gossip, and come and go as they please while watching surgeries.

While I haven't seen a brain surgery, the very basic timeline of surgeries are generally the same:

  • The patient is wheeled into the sterile operating room (OR) and transferred to the operating table. Everyone in the room (besides the patient) is required to wear a face mask, a hair covering of some kind, scrubs, and shoe covers.

  • The anesthesiologist sedates the patient (sometimes this is started in the pre-op area). During some brain surgeries, the patient is kept awake for portions of the surgery (so they can monitor the patient's brain functions by having the patient do different things during surgery) while in others, the patient is intubated and kept under general anesthesia the entire time.

  • The patient is positioned appropriately for the surgery. Parts of the body that aren't being operated on are covered up. The patient's head is shaved (or at the very least the part that they are operating on I should think).

  • Meanwhile the surgical team "scrubs in" (i.e. they go to a separate room attached to the OR to thoroughly clean their hands/arms up to the elbows and then return to the OR where they are helped by surgical technicians and nurses into sterile gowns and gloves, all the while making sure not to touch anything that isn't sterile). Sterile coverings (which are usually all blue) are draped everywhere so that people who are "scrubbed in" don't accidentally touch non-sterile things. People who aren't "scrubbed in" aren't allowed to touch anything in the sterile field. Keeping things sterile and clean is key.

  • The surgical area is "prepped" (i.e. cleaned).

  • Surgeons and surgical techs do a "time out" and double check the patient's name and the procedure being done and the area being operated on.

  • The first incision is made.

  • The surgery is performed. Tools are all counted by the surgical tech. (During long surgeries, this may happen several times throughout.)

  • The surgical site is "closed" i.e. stitches are put in, the wound is dressed.

  • The patient is wheeled to the post-operative area ("post-op").
Have you ever written a scene that involved the operating room?


Amitha Knight is a former pediatric resident turned writer of middle grade and young adult fiction. She’s also a blogger, a book lover, an identical twin, and a mom. Follow her on twitter @amithaknight or check out her website:


  1. Fascinating insight into this procedure! Of course, it all sounds like common sense. Everything WOULD have to be kept sterile and you'd really need to keep track of the instruments. I think this is going to be a very useful web site for me. :-)

  2. I'm amazed at the level of detail and admire you for the level of care so easily seen in your descriptions. Since I never would sit ringside for any kind of surgery, this glimpse provided great insight. Thanks!

  3. Thanks, Sue! Amitha did a great job and I'm very grateful for her posting this information.

    Donna-- I know! Don't you feel like you're sitting next to the OR table?