Revision syndrome

It tends to only be in operations that last more than about 90 minutes. Hand surgeons rarely suffer from it. Acetabular revision and primary joint replacement are usually OK. But be warned, if you're going to start chipping out the femoral cement, do a tumour prosthesis or something a bit challenging/demanding/stressful, then you may well be exposed to this pernicious syndrome.

I understand it. The only person actually having any fun at this point is you, as the main operator. The assistant is in a trance, the anaesthetist has probably 'just popped out', according to the abandoned anaesthetic nurse, but you need, right now, that particular instrument from supplementaries, so you ask for it. The scrub nurse looks shifty and utters the dread words: "you may have to wait a minute, I'm on my own right now".  Many surgeons will be familiar with this. You look around, the circulating nurse has disappeared, the auxiliary is mysteriously absent. Nobody knows where they are.

It was all so different at the start of the operation, the theatre was crowded, a herd of students grazed quietly outside the laminar flow, there was a subtle sense of anticipation at doing 'a big case'. Now, all gone. You're alone. Ten minutes is added to the procedure by the time the instrument has been located and staff have drifted back.

It's revision syndrome. True, it is eventually self-limiting, but boy, is it annoying.

My theatre