“Confidence is contagious.
So is lack of confidence.” –Vince Lombardi
So, can you leave this here with us?”
I was part of a group of US surgeons traveling
to Eldoret, Kenya, seeing patients and helping the
Kenyans ENT surgeons learn surgical techniques. Our
two-week mission allowed us to work across the table
from Kenyan colleagues, discussing surgical approach-
es, demonstrating techniques, and reviewing all aspects
of surgical care.
“I have never seen such a thing!” my young Kenyan
colleague said. “Explain again how the device seals
blood vessels without the need to tie them.”
Because of differing practice patterns and a lack of experience
with larger surgical cases, the Kenyan ENT surgeons rarely perform
thyroid surgery. Thanks to the generosity of US surgical supply
companies, I was able to bring along some technology that I use
regularly at home.
I explained how one particular device seals and cuts the vessels.
"Here," I said. "Grab the vein carefully right here then squeeze the
blades tightly together and
pull the ring on the handle.
Let the device do all the
“That’s remarkable!” he
said. “And you don’t you have
to go back and tie all of the
vessels at the end?”
The device did its job, seal-
ing the large thyroid vein then
cutting it. The edges of the vein fell away without spilling a drop of
"There is no need to tie off all of the veins, although I still tie a
few of them. The vessels almost always seal permanently."
Over the next hour, we dissected out the massive goiter, one of
the largest I had seen, cutting some of the veins with the device,
tying some, dividing some with a bipolar cautery, and discussing the
advantages and disadvantages of each technique. We talked about
the high numbers of patients in Kenya with enormous goiters. My
young colleague gained confidence as we continued, finding all of
the important surgical landmarks and protecting
each one. I was impressed with his technique. Soon
we were done.
"This device is wonderful!" he said again as we
placed the skin sutures.
"Yes, it helps," I told him, "but you certainly
could have done the case the old-fashioned way just
as easily. You did just fine."
"Yes, but the surgery went so much more quickly
this way! We cut many vessels with the device. If we
had tied off each of the veins, it would have taken a
long time and would have slowed us down." He was
correct and I sensed that he was enamored with the
technology. He was smiling behind his surgical mask.
"So, you will leave the machine here with us, right?"
"Unfortunately, no," I told him. "Not this time. I only borrowed
it. I can’t leave it here."
“Maybe next time? You will leave it then?”
While preparing to visit Africa, I knew we would face more
cases than we could possibly complete during our stay and that
the more efficient we were, the more patients we would be able to
see. Despite this, I had been hesitant to bring along the technology
because the surgeons there
do not have access. Would
using the devices make them
less confident in performing
the procedures after we were
gone? On the other hand,
would the devices increase
their confidence levels by
allowing them to concentrate
on the procedures rather than
the process of tying off dozens of engorged veins common in a large
My Kenyan colleague pulled off his gloves and gown, then helped
settle the patient on the transport cart. “Next time? When you come
back next year, you will leave it then, right?” he asked again, smiling.
“Sure,” I said. "I'll try." Honestly, I had made no plans before I
left home to acquire one of the devices permanently for the Kenyans
but his enthusiasm and newly-formed confidence were impressive.
I shook my head and grinned. “Absolutely I will try. Next time, you
will have one of your own.”
Building Confidence Through Surgery
Reflections on time spent teaching Kenyan ENT surgeons a variety of surgical techniques.
Bruce Campbell, MD,
My young colleague gained confidence as
we continued, finding all of the important
surgical landmarks and protecting each
one. I was impressed with his technique.