Fourth and Gall (Play by Play Coverage)

Good afternoon ladies and gentlemen, and welcome to today's Southwestern Conference matchup. We've got a dandy for you here. Dr. Floyd McKittrick, whom we've seen so many times before, will be going up against Lou Lister, a big strapping hulk of a guy with chronic biliary tract disease. We know you're going to like this one. I'm Keith Halstead, and doing the play-by-play is my good friend and colleague of so many American Surgical League broadcasts, the old Texan himself, coach Dave Billroth. David. Good morning, Keith, and good morning, everyone. It's a nippy November morning here in Boston. The room is in perfect condition, and the participants are ready.

You know, we've seen so many great matchups on this very field. I believe you and I covered a GI bleeder here many years ago. McKittrick was just a student then, probably all wide-eyed watching the big boys. Now here he is himself, the main event. He is halfway through his eighth season in the American Surgical League.

Most observers feel that he's just hitting his professional stride. He's got great hands. His greatest strength, though, is his innovative offense. He's not rigid. He adapts. That's been the key to his success in the league. Dave, how about this fellow, Lister? Keith, Lou Lister is a 52-year-old cost analyzer for an aeronautical research company.

He has a long history of right upper quadrant pain with two ER visits in the last month. Ultrasound shows stones and a contracted gallbladder with no other abnormalities. It's the general consensus of all players involved that cholecystectomy is indicated. He's a big man, 6 feet 2 inches, 195 pounds, and in good shape. He's eager and he's ready.

How about the field conditions which you mentioned at the top of the broadcast? The field is perfect, Keith. The lights are new. The table has recently been serviced. The floor is a bit slick, but otherwise playable.

The suction is in peak condition. Bovie has been rewired and inspected. Temperature in the high 60s. Perfect biliary weather. Thank you, David.

We'll be back with the start and lineups after this commercial message. Ladies and gentlemen, join us on the ASL Network, Thursday nights at 8, and prepare to witness history in the operating room. Join us for the premiere of Greatest Surgical Legends, a groundbreaking series that dives deep into the lives and legacies of the pioneers who changed surgery forever. Truly, their innovations laid the groundwork for everything we do today, from revolutionary techniques to miraculous recoveries explore the stories behind the scalpel with us in the lives transformed by those medical heroes. As many patients have said, I owe my life to the innovations these legends brought to the table. Don't miss greatest surgical legends coming this fall to the ASL network. Tune in to celebrate the courage, innovation, and and dedication that saved millions.

Hello again, folks. The old Texan Davey Billroth will go over the lineups. David. Thank you, my friend. Floyd McKittrick will be working with his longtime first assistant, Dr. Calvin Duffy.

They've been working together for years, although they are often viewed as unlikely teammates. How so? Well, Keith, as you know, McKittrick one of these Southwestern boys good-natured, low-key, but not afraid to innovate in tight situations. Duffy is a product of that disciplined Northeast conference, very conservative on offense, and unusually rigid on defense. Yet, when these two are on, when they really have it going, there is no finer duo in the league. How about anesthesia today? Anesthesia controversy has dogged this conference for years. McKittrick has chosen his own for today's match. He's gone over his game plan repeatedly with the special teams and feels that they're ready. Thank you, Dave. The patient is being induced. The prep is underway. The nursing staff is ready. We'll be back with the skin incision after these important messages. Folks, we know you're going to love Catgut Capers.

Get ready for a surgical sitcom like you've never seen before. It's time for Catgut Capers. Remember folks, if at first you don't succeed, just blame it on the catgut. Follow the misadventures of Dr. Charlie Catton and his eccentric team as they navigate the ups and downs of life in the OR, where laughter truly is the best medicine. The patients say I came for a surgery, but I'm getting a comedy show instead. As the sassy nurse says to the surgeon, who knew surgery could be so DIY?

So please join us for laughter, mishaps, and a whole lot of heart in Catgut Capers, premiering this fall on your ASL networks. 10 o'clock central, midnight, eastern time. You won't want to miss a single stitch. Now back to the game. Hello again everybody. Keith Halstead and Davey Billroth bringing you a barn burner here from the rugged southwestern conference of the American Surgical League. McKittrick and company are going up against a tough rock-em-sock-em bag of stones, and we're gonna stick with it all the way. Davey! Here we go, old buddy. He's going straight for a laparotomy. He's starting with a right subcostal.

Yes, he's done this routinely for years. No reason to change with his record. Excellent choice going directly to an open technique given the patient's previously ruptured colon. Pesky bleeder at midfield. Nicely handled with the cautery. Okay, he's in. The abdomen is open. Now watch McKittrick on routine exploration. Cool, methodical, updating the team at every move. Great, no abnormalities on routine exam.

Remember the unexpected pancreatic head mass from last season? Yes, indeedy. The boys in programming really caught heat from our viewers when they elected to pull away from the broadcast after the cholangiogram. And here we go. He's begun dissection at the porta. Let's watch Duffy, the assistant. He's short, but what strong hands. He can hold that position for a long time. Wait, wait, fumble! The duodenum has slipped up and covered the field. Hold on a moment, who recovered? It's Duffy. Somehow he replaced his hand on the duodenum. He definitely has possession. The porta is visible again. Okay, folks. McKittrick has identified the cystic duct. He's looking for the artery.

Hold on to your tickets. Wait a minute. Yes, I thought so. Bleeding during cystic duct dissection. This could result in a delay of case call. Watch Duffy with the suction. Very few players use it so well. Gentle. There's the vessel. He's quick-clipping. Here it is on the replay. Vessel bleeding freely. freely. Duffy comes down, slight curving motion, he's around it. Gently, firmly clipped. What a player. McKittrick has the cystic artery now, he'll doubly clip it but not divide it, as is his usual move. He'll go up top. If our overhead camera can get a view of the fundus, we'll see him dissect out the gall bladder from the liver bed. But first, a word from our sponsors. Are you tired of ordinary wine that just lies there in your glass? Introducing Cavernosa. When your evening needs a little lift, our master vintners have crafted the perfect blend of premium California grapes and pure passion. It's the first wine that stands up to any occasion. Finally, a wine that rises to meet life's greatest moments.

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Welcome back, folks. While we were away, McKittrick began his posterior dissection. What do you think, Dave? He's beginning to . . . wait a minute . . . Norma Jean! Looky here!

He's passing. He's passing the dissector to the chief resident. Not like him at all to do this at this time in the case. He definitely passed. The nurse is nodding in agreement.

It's complete. That was no lollipop pass either, buddy. No siree. It was a straight-down-the-middle, head-on, Thank you, Susie.

Meet me in the lounge. Don't take no for an answer pass.

What's his passing percentage? Last season, as the graphic on our screen shows, McKittrick was 48 of 63 from the field for a passing percentage of 0.762. Not bad for a 41-year-old who's a bit overweight and who has been accused of wearing a rug. Be kind, Keith. Don't forget the long bomb he threw earlier this season. New nurse, early in the case. He passes from way downtown. Bingo. Complete. He's made his peritoneal incision. It's as thick as cowhide, buddy. Here he goes. Hold on. He's in the liver bed. Not unusual in a match like this. Let's watch him work. Staying on the gallbladder as best he can. He's really in and out of it. Very dense inflammation. Yes, and We know how the men in the striped shirts can interpret that. Oh, oh, there's a flag on the play. Watch McKittrick's face. He knows he must continue without arguing the call at this time. There he goes. The gallbladder is almost free.

The vessel he clipped earlier is definitely the cystic artery. He's dividing it. What was the call? Unnecessary roughness. Let's replay that on the monitor.

There's the fundus. He dips behind. Well, the inflammation really obscured our angle. Let's just say it was close. Unnecessary roughness is subject to a lot of interpretation.

This certainly wasn't the most obvious case, particularly when the critical view had been established. McKittrick kept his cool. He's fourth and gall. What do you think he'll call now? No question in my mind.

Cholangiogram? Definitely. Cystic duct cholangiogram. The graphic shows McKittrick's record from last season. 30 cholangiograms out of 39 cases for a cholangiogram rate of .769. Not bad. How about the positives for occult stones?

Ten true positives last season. A great record. Here we go. Now watch Duffy duck out. He ducked out early, seeking the protection of the x-ray barrier. He's shown us just about his only fault as an assistant leaving the field before the play is finished. That cost him last week. Okay, the gram is underway. No, he's hesitating. Oh, oh, baby. Another flag, no question, Keith: delay of case, no x-ray tech. Oh, that hurts. Here he is. The contrast is in, it's filling the ducts. It's good. Let's cut to the films for our viewers. There is the cystic duct entry, there's the distal duct with good emptying, there is the proximal duct, there's the right hepatic, there's... oh, oh, oh, oh, mama, what a big stone in the left hepatic duct! Great, we'll get a chance to see McKittrick shift from a one-on-one offense to a one-two with resident or nurse during the bile duct exploration. A real treat for our viewers: a common bile duct exploration. We'll be back after these important messages.

Thank you, Keith and Dave. Folks, it's the moment we've all been waiting for. It's finally here. Get ready for the high-stakes finals of the American Surgical League. Watch as the best surgeons in America compete head-to-head in an electrifying display of skill, ingenuity, and nerves of steel.

This is not just about technique, folks. It's about artistry and surgery. Who will take home the coveted title and be crowned the ultimate surgical champion? As last year's finalists said, quote, I've trained my whole life for this moment. Let's make it count.

And it did. So, folks, join us for the nail biting conclusion of the finals of the American Surgical League this fall, 10 o'clock Central, midnight Eastern Time. Be there as surgical history is made. OK, we are back. Watch this, folks, and watch it well.

McKittrick routinely performs a Kocher. He Kochers as well as anyone in the league during bile duct exploration. There he goes. He'll get that distal duct and pancreatic head-up lickety-split. Watch Duffy.

Oh, Sally Jean, Duffy is out of bounds. He's over by the cava. Okay, he's recovering nicely. You think they'll call it? It's close.

They'll let it go. McKittrick is opening the duct. He'll be using a biliary Fogarty. Here he goes. It's up.

It's long enough. It's straight enough. Here it comes. It's good. He's got the stone.

How about a completion gram, Keith? Floyd McKittrick is a wily old fox of a player. He knows the value of a disciplined completion gram both for filling defects and equally as important for precise tube placement. Okay, folks. In case you just joined us, we had a lulu of a hepatic stone extraction. Here's the replay of the stone extraction and completion gram. How about it, Davey?

Here's the tape, Keith. The catheter is up. It looked to me as if it veered to the right initially, but not so. Stone is out, the gram is perfect, great placement, and no other defects. Thank you, Davey. We're back live. Oh, oh, oh, Nellie. Just hold on. The field is really unsteady.

McKittrick feared this in a pregame interview. It's the anesthesia problem again, Keith. Another flag. He's getting a ten-minute major misconduct for improper abdominal relaxation. This could definitely shift the momentum.

Oh, oh, oh, he's hot. McKittrick is arguing. Very unusual for him to do this. He could wind up in the well-being committee. He prides himself on good communication with the entire team. He's settled down now. The field is stable. He's using a round Silastic drain. Any comments?

Well, Davey, what can you say about a league that's spent the last 100 years arguing about a piece of rubber? Right, you are partner. He'll use it and use it well. Lister is drained. Let's watch the closure. Oh, oh, wait a minute. McKittrick is stopping.

He's motioning for the room to quiet down. Crowd noise can be a problem late in the match. He's still motioning. There he goes. His assistant can rely on audibles now.

Here's the closure. Remember last season when several players were deemed ineligible because of closure problems? I surely do. The famous cheap bite controversy in the Midwest Conference really cut into the credibility of a lot of the players. Can't fault McKittrick here, monofilament, running lock and two-layer. Skin clips, great match.

He's done. He's leaving the table quietly. Quite a change from last season. Yes, the rule against post-match celebrations within three feet of the playing field has really stopped a lot of the hoopla. Remember that anterior resection in the Big Eight we covered two years ago? Who was it, Slawson? That's right. Big Daddy Slawson had the lesion licked and lost it all on a high five that contaminated his left glove. What a mistake. This has been a great match. Before we break, let's update our viewers on other action around the league today. Interesting development in the Southeast Conference where Don Randall had to forfeit the first two cases of the season on an ineligibility. The hospital's review committee called back two cases because of lack of proper credentials. A tough call for Randall, but I got to hand it to Commissioner Semmelweis. He's done a lot to clean up this game we love. Drama, controversy, success, failure. We've got it all in the American Surgical League broadcasts. Stay tuned, folks. We'll be back with our post-game interviews and wrap-up after these messages. Welcome back folks, we've been covering a real shoot-em-up for you here today. Things have gone well. We have Amal Gupta in the recovery area who'll be doing the post-match interviews for us.

Amal? Amal, can you hear us? Keith? Amal? Keith?

Keith, I'm here in recovery with Lou Lister who appears to be doing very well after the match. Vital signs are great, good respiratory effort, clear bile in the bile bag. Lou, how do you feel? I'm, I... where? The nurse.

Well, Keith, Lou is a bit excited about the match. Perhaps we should come back to him. Is there okay, buddy? Maybe you could get over for a locker room interview with Dr. McKittrick. Floyd, you had problems early in the case.

The bleeding around the porta, the poor relaxation, the unexpected hepatic duct stone. You came through. Things went well and the patient is fine. How do you feel? I'm all, it was tough.

I had a great team in there today. We all worked together to get the job done and emerge with a win. Your assistant, Cal Duffy. What can you say about him? Cal was great.

He protected me when he had to. He knew where I was during the entire match. His coverage was excellent, particularly last weekend. His retraction was superb during the exploration of the duct. We have that on tape.

Watch the monitor. Here he is positioning the duct. Yes, he had just the right amount of tension. Real steady. The fumble during the duodenal retraction had me concerned, but after Cal recovered, I knew we would be all right. You know, Amal, everyone maligns the assistants, but they are key. Everyone in the league knows they can take a poor player and make him respectable, and take a mediocre player and make him a star. How about anesthesia?

We've had our problems with anesthesia all season. We shifted the line up, brought some rookies early in the year and I know we've been suspect. Dr. Stanton came through today.

What about the delay of case call during the cholangiogram? Look, I know the refs have a tough job. I thought it was unnecessary at that time. It's a judgment call. The x-ray tech was at lunch following her second break. You know how those things can happen. You looked real down after the unnecessary roughness call during the gallbladder dissection.

The patient had a lot of inflammation posteriorly, the gallbladder was partially intrahepatic, the line judge called it, I'm sure, because of the bleeding. You and the viewers realized that after years of inflammation, that plane can be hard to find, and bleeding can result. I thought it was over-calling it, myself, particularly at the 150cc line. What now, Floyd? Where does Floyd McKittrick go now? now. Amal, we did a great case today. I'll be stopping by recovery to review the orders and talk to Lou Lister. Then I'll review everything with the family. After that, I'll go to the office to line up the rest of the schedule. We look forward to covering your cases in the future. Thanks Amal. Can I say one thing? Sure. Hi mom. Back to you Keith and Dave. Okay friends, there you have it. A beautiful cholecystectomy with bile duct exploration and extraction of a left hepatic duct stone. A beautiful match with an early good result.

Thanks for being with us. Please remember next week we'll be covering a big pancreatic tail lesion in the Tough Western Conference. This is Keith Halstead and the old Texan Davey Billroth saying goodbye for now.