SURGERY UNDER AIR PRESSURE

 

INTRODUCTION

Surgery has been used throughout history, up to the present time. In some cases there is no way out except surgery and generally it is the last attempt to save a life. Sometimes, a patient who is already too weak due to the existing disease cannot get through an operation for want of blood. In some major operations the patient has to get blood of other persons, and in some cases it becomes very difficult to get enough blood of a proper group. 

Also, the doctors have to perform the operation in a minimum time to avoid unnecessary loss of blood by the patient. Generally during operation veins or arteries also get cut and to stop bleeding from the exposed ends, the ends are closed with different forceps. Some times the forceps are not enough to stop the bleeding which hinders the operation work as it fills the wound giving poor visibility . The blood is to be removed frequently by suction tubes. Also, in case of some malformation atop the spinal cord or deep in the brain, the surgeon cannot avoid cutting some of the blood-bearing vessels, and haemorrhages will not give clear vision of the area to be operated. The surgeon cannot use suction tube in such areas as it can destroy some important nerve cells. In such cases some perilous technique is adopted in which blood is drained out from the body and stored so that it can be pumped back into the arteries after the necessary surgery. The surgeon gets a blood-free field for surgery, but for a very limited time as the heart can survive without oxygen for nor more than an hour.

A new method of surgery is being explained here in which there will be no bleeding from the opened part of the body. There will be no need to attach forceps at the exposed veins or arteries. It will help the patient to save his strength and the doctors will be able to perform some serious operations more efficiently. Some delicate parts of the body like brain which are hardly attempted for surgery can be opened for longer time without any risk to the patient.

CAUSE OF BLEEDING

Liquid flows in three directions only. The one, from upper level to lower level, the second from higher pressure to lower pressure and the third from a more diluted to a concentrated solution through semi-permeable membrane.

In case of bleeding the blood is coming out of the body because it is at higher pressure within the body than the atmospheric pressure. The blood pressure is the pressure of blood, within the body, exceeding the atmospheric pressure and is due to pumping of blood by the heart. Also, the bleeding will be excessive if the effected part is brought lowest from rest of the body.

BLEEDING CAN BE STOPPED BY APPLYING PRESSURE

It is a well known fact that when the body gets some cut the blood starts oozing from the wound. the force with which the blood will come out of the body will depend on the blood pressure of the body and location of the effected part with respect to the location of the heart. In any case the force of out coming blood will be just near to blood pressure of the body.

In Fig. 1, let a b is the portion of the body where a cut is formed and the blood is oozing out of the cut. A pump with piston P is placed on the exposed location of the body. The pump is placed in such a way that its open mouth C covers the wounded portion. Now, if the piston is moved upward it will create some vacuum over the wound and the blood will start coming out more violently. Again, if the piston P is moved downward gradually, the pressure over the wound will start increasing and the blooding will start decreasing. The blood will stop leaking out at a critical pressure over the wound.  In this way a blood free field can be prepared at any exposed portion of the body.

The blood pressure within the heart will be a little more than the blood pressure observed by the sphygmometer. Similarly, the blood pressure will be different at different parts of a body depending on the distance of that part from the heart.

Now, if the pump is enlarged in such a way that the surgeons can also enter the area of critical pressure, they can perform surgery in a blood free field.

SURGERY UNDER PRESSURE

If any part of the body is cut opened in a space having pressure just equal to the sum of atmospheric pressure and blood pressure of that part of the body, while keeping rest of the body in atmospheric pressure with opened part upward, there will be no bleeding from the exposed portion.

Or, in order to stop bleeding the difference of two pressures, the one in which the body is kept and the other in which any part of the body is cut opened, should be just equal to the blood pressure of that part of the body. 

In Fig. 2, the doctors and the exposed part of the patient is placed in a space having pressure equal to the sum of atmospheric pressure and blood pressure of the exposed part of the patient while the patient is lying under normal atmospheric pressure. 

The normal blood pressure of a human body goes to about 150 mm of mercury i.e., equal to 200 milibars of atmospheric pressure. The average atmospheric pressure, which is about 1000 millibars at the sea level, goes on decreasing as we go higher and higher. The annual mean pressure at Darjiling, which is about 7432 feet from the sea level, is about 775 milibars. It shows the man can live in such a variable pressures. Therefore, the addition of blood pressure in the atmospheric pressure will not harm the surgeons working in it.

Ground floor is the control room and first floor is operation room. The two are separated by a glass cabin G. D3 is the entrance for control room and D2 is the entrance for operation room. The operation room is having two air tight doors D1 and D2. A1 and A2 are two air pumps. Pump A1 pushes the air in the operation room from inlet M. The only exit for air from operation room is from N. A desirable pressure is maintained in the operation room by controlling the out going air from P1.

In order to make it possible for surgeons to move in and out of the operation room without disturbing the pressure in the room, two air tight doors D1 and D2 are provided. The pressure between D1 and D2 is kept equal to the pressure of the operation room by a air pump A2 and outlet P2.

During exit from operation room the doctor will open the door D1 and enter the space between D1 and D2. He will open the door D2 after closing the door D1.

During entrance in the operation room the doctor will enter from door D2 and open the door D1 after allowing the pressure between D1 and D2 to reach the pressure of the operation room. A pressure gauge is attached at door D1 ( not shown in Fig. ) to help doctor, standing in between D1 and D2 to see the pressure difference between the operation room and the space of D1 and D2. The complete system can be automated by computer technology, The computers will be able to control all pressures by directly sensing the blood pressure of the patient and the atmospheric pressure. The computers will also lock and unlock doors after sensing different pressures.

The patient is brought in the glass cabin G by lifting him from the control room by the L.

In Fig. 3, E is the open part of the glass cabin G. F is a funnel type arrangement made up of rubber. The upper edge of the funnel F is attached to rectangular metallic frame and the lower edge is tied with the patient.

Fig. 4, shows cross-section of the funnel F with its lower edge in contact with the body. The lower edge of the funnel is designed in such a way to make it leakage proof for air under pressure. The compressed air will press the thin leaf K with the skin making the contact air tight. Before attaching the funnel F with the body, some thick oil is applied at the place of its contact with the body to make it completely air-tight. The upper edge of the funnel F is brought in contact with the frame E by net bolts and the contact is made air tight. B is the body of the patient and S is the portion of the body to be operated. 

The design of the glass cabin G, funnel F and resting position of the patient will be unique for different type of operations. During the surgery of the brain, the best position of the patient will be vertical. The complete patient will be clamped with soft pads to hold him vertically.

To make the process more effective the atmosphere of the operation room is to be controlled by those gases which will prevent clotting of the blood. The design of the system will be a little different as each surgeon will have their own breathing masks to protect chemical composition of the gases and humidity of the operation room. Their breathing masks will receive and expel air through special tubes that will be connected to special system outside the operation room. The pressure of the operation  room will be made to fluctuate slightly in harmony with heart beat of the patient, so that the pressure will be always exactly equal to the exposed portion. The complete system will be controlled by electronic devices.

In this way the surgery can be further refined. The surgeons will get sufficient time to operate some delicate parts like brain without extra risk to the patient. It will also help real time study of the working of deeper regions of the brain by letting scientists watch open regions of the brain for a longer period.

In the end I suggest that we should give a try to this procedure even if it is a little better form the existing system. Some people have died during surgery just because they could not wait a few minutes more due to the loss of their precious blood.

We could have saved them

Wednesday, July 9, 2003 -Singapore: Neurosurgeons separated the 29-year old Iranian twins born joined at the head, after two days of delicate surgery, but both sisters died Tuesday, shortly after their parting. Laden Bijani died 90 minutes ahead of her sister Lelah with both death occurring because of blood loss, said hospital officials. 

Let no more such deaths.