Home Surgery to Become a Reality

Dr Vernon Coleman

According to the Daily Telegraph (one of the UK Government’s official publications): `The NHS is to treat up to 25,000 patients at home in virtual wards to help clear the elective surgery backlog.’

`Patients will be offered acute clinical care at home, including remote monitoring and treatment, as an alternative to hospital stays.’

I’m delighted to say that I got there first (though I confess I was joking).

The piece following is an extract taken from my book The Complete Guide to Life, which was first published in 1984 and later published under the title: Why is Pubic Hair Curly?

Home Surgery Made Simple
Waiting lists for operations are often long and surgeons' fees can be very high. You can overcome both problems by learning how to perform surgery on yourself. Of course, you have to remember that some operations are far too complicated for the beginner. Even quite gifted amateurs will have difficulty in coping with delicate neurosurgical procedures. Amputations can be pretty tricky too.

Before you do anything at all you must plan your operation. You may have a cool nerve, steady hands and an incisive mind but you won't get far without a few instruments. Planning is all important in surgery. There is nothing worse than getting to the end of an operation and discovering that you don't have anything with which to close the wound. You'll find that a walk to the local surgical appliances shop is twice as long when you're having to hold the edges of a gaping wound together. Remember how it feels when there isn't any toilet paper left? Well, it'll be a lot worse than that!

The first decision you must make concerns the nature of the operation you intend to perform. Here are some of the operations you can choose from: tonsillectomy, hip replacement, orchidopexy, mammaplasty and hemicolectomy. There are lots of other operations; some of them difficult to pronounce and some of them quite impossible to spell. Don't allow yourself to drift into doing an operation just because you can pronounce it. Try to choose one that will be useful. I suggest that you try an exploratory laparotomy or a simple cholecystectomy to start with since the mortality rates associated with these two operations are relatively slight.

Having decided on an operation you must next collect together all the instruments and equipment you're likely to need. A good basic kit will include: foot operated suction pump, bi-active hyfrecator, platinum tipped cautery burner, heavy duty gynaecological transformer, proctosigmoid desiccation set, universal needle set, angle ball electrode, Babinski's percussor, diathermy scalpel handle, Halsted's `mosquito' artery forceps, Blackhaus' towel clips, Lister's sinus forceps, Forester's sponge holding forceps, Littauer stitch scissors, Wright's needle holder, Crile Murray's needle holder, aural syringe, McKay nail elevator, seamless aluminium ear trough, Jobson Horne probe, Formby cerumen scoop and hook, Thudichum's nasal specula, Higginson's rubber syringe, Rose's sinus douching cannula, post nasal and laryngeal atomizer, St Clair Thomson's rhinoscopic mirrors, Naunton Morgan's rectal speculum, universal lighting attachment, Barron haemorrhoidal ligator, dissecting forceps, uterine curette, Horrock's uterine sound, heavy duty cautery outfit, Macrae mucous extractor, umbilical dilator, Portex umbilical cannula, disposable surgical gloves, self-healing bisexual urinal.

You'll also need a large cardboard box filled with assorted syringes, needles, towels and paper tissues. You won't need to bother with a mask. Surgeons only wear masks so that they won't be recognised afterwards.

Most of the instruments I've described can be obtained from any surgical supply store but if you have difficulty in finding some of them try approaching your local hospital. Offer to buy or rent an armful of assorted instruments. You will need at least an armful for any useful operation.

Having chosen an operation and having collected a bundle of instruments, you must next decide on the best site. You can, of course, perform your operation just about anywhere but it might prove sensible to opt for the kitchen. For one thing there will probably be a large table there. What's more, the floor and walls will probably be fairly easy to clean. If your home is equipped with a specially furnished operating theatre then there will, of course, be no problem.

Next you must have a good shave. Not just the hair on your face; you must shave your entire body. Little germs and other nasty things can hide among the hairs – particularly the tightly packed curly ones – and so it is vitally important to remove every last millimetre of stubble.

Finally, before you start it's wise to take the telephone off the hook and put any animals in another room. You don't want people ringing up when you're half way through a liver transplant to ask you round for coffee; nor do you want your dog to hang about begging for scraps. It might be a good idea to lock and bolt the back door too. Neighbours and tradesmen who might wander in by mistake may bring fresh germs with them. They are very unlikely to have shaved off all their hair before coming to see you.

With everything ready you can now begin. Pull the table into a good position where the light is evenly distributed. Put a pillow or a pile of towels under your head so that you can see what you're doing. Unfasten your skirt or your trousers and part your clothing so that you can see the whole area involved. If you are going to perform brain surgery you can keep all your clothes on.

Before you cut through the skin you must give yourself an anaesthetic, of course. This is really quite important. I suggest that you turn on the television and watch for twenty minutes. Do not watch any programme for longer than this: you mustn't render yourself completely unconscious, or you'll have difficulty in continuing with the actual procedure. You can start cutting just as soon as you begin to feel woozy.

If, for example, you have decided to perform a gall bladder removal operation on yourself, you can now set to work in search of the gall bladder. The following outline will demonstrate how simple it all is.

You will, of course, have unfastened your trousers (or skirt) and pulled your shirt (or blouse) right up under your chin. You may even like to remove your clothing altogether. Do remember to draw the kitchen curtains if you do this. Your gall bladder is nestling somewhere under your right ribs and that is where you are going to be working.

The first cut must take you right to the site, so it is important to make it in the correct place. Don't make half a dozen cuts or you're going to find sewing up again afterwards a real nightmare. The cut should be precisely situated under those ribs of yours. Do make a good deep cut and don't be tempted to mess around with a lot of wimpish little nicks. A really sharp slash with your scalpel will take you straight through the skin, the subcutaneous fat, the fascia, the muscle layers and the peritoneum. Poke your hand through the hole you've made and feel around inside. Once you've found the gall bladder (and you can't fail to recognise it) you can use your scissors to cut it away from the other internal tissues. There may be a little bleeding but there shouldn't be anything that a styptic pencil won't stop. (A styptic pencil, by the way, is a very useful surgical item.)

With the gall bladder out of the way, all that remains is to sew up the wound again. That shouldn't take more than a minute or two. It really is an extremely simple business and it's astonishing to think that surgeons make so much of a fuss about it.

Give yourself five minutes to recover and then get up off the table and make yourself a nice cup of tea. (That is another advantage of operating in the kitchen – the kettle isn't far away.) Don't forget to throw your gall bladder away. Wrap it in a paper bag if you're going to put it into the dustbin. As you relax with your tea, you can reflect smugly on the huge amounts of time and money you've saved.’

NB: This was written as a joke. Do not try this at home. If the NHS wants you to perform an operation on yourself let them take the responsibility.

Copyright Vernon Coleman 1984 and 2022

Vernon Coleman’s latest novel (Dr Bullock’s Annals) is available as a paperback and an eBook. It’s a rather black comedy about a GP working in 19th century England.