Standing on the Shoulders of Physicists in the Operating Room

Welcome friends to Medics Musings, The Physics of Laparoscopic Surgery, a dissertation on the contributions of famous physicists to laparoscopic surgery, written and read by Leo A. Gordon, MD. At this time in the development of laparoscopic surgery, it is appropriate to undertake a review of the basic principles of physics which govern its performance. Laparoscopic surgery is dependent on technology that uses principles of physics for its implementation. Over the years, significant contributions have been made by famous physicists. Each has elucidated a basic principle of physics, which has direct bearing on the conduct of laparoscopic surgeries.

For most of us, those principles of physics were learned many years ago, either in college or in medical school. Most of us have forgotten them, and rightfully so. Why, after studying so hard, should one ever be forced to read, never mind comprehend? Such statements as, as the thermal energy of the lattice is proportional to the temperature when sufficiently high above absolute zero, a point is reached where the mean free path is proportional to the temperature, and hence where, in accordance with Sommerfeld's the conductivity is inversely proportional to the absolute temperature. Yet, despite its complexity, an understanding of physics is essential to the discipline of laparoscopic surgery. We, as endoscopic surgeons, must understand these principles as we seek to effectively perform operations, design new instruments and technology, and contribute to this growing field.

A new generation of endoscopic leaders is emerging, but they truly stand on the shoulders of the giants of physics. And if those giants of physics looked up to see who was standing on their shoulders, they would notice two things. That they have entrusted their discipline to honorable physicians, and that there is gender equality in laparoscopic surgery today. These men of science never realized that one day their principles would be used to remove gall bladders and appendices or to repair hernias. They never dreamed that they would have a hand in removing common duck stones, resecting colon lesions, or creating trocar controversies.

But such is science. Ten basic principles and laws of physics form the technological basis of laparoscopic surgery today. 1. Heisenberg's Principle of Indeterminacy While still in his twenties, Werner Karl Heisenberg, one of the great nuclear physicists of the day, completed important work in quantum theory and atomic structure. In 1932, he was awarded the Nobel Prize for Physics. Heisenberg defined methods of detection and observation, contributing greatly to the tools of the nuclear physicist. Using the scintillation method, the cloud chamber, and the Geiger counter, Heisenberg formulated his Principle of Indeterminacy.

After formulating this principle, the German Rentgenologic Society requested that he apply his principles to the study of operating room delays. He studied delays using his principle, which he later refined to the principle of operating room support indeterminacy. This formulation gives a physical and mathematical explanation for the delays in operating theaters, particularly during high gamma-ray dispersal during the performance of intraoperative of calangiography. Heisenberg's principle of indeterminacy states, the location of the radiology technician at the time of calangiography is indeterminate. Second Thompson's principle of negatively charged particles.

Sir Joseph John Thompson received the Nobel Prize in physics in 1906, mainly for his discovery of the electron. He worked with magnetic deflection of cathode rays in different gases. He formulated his principle of negatively charged particles using a cathode tube in a bell jar and applied his principle during an outbreak of blank films in the early phases of the introduction of intraoperative cholangiography. Mystified by the number of UN-exposed films, he formulated his on-off theory of of retkinologic devices. His principle of negatively charged particles gave a formulaic explanation for the frustration many surgeons experienced during cholangiography for laparoscopic cholecystectomy.

Thompson's principle of negatively charged particles states, the passage of an x-ray through an empty cassette generates no data. Third Schrodinger's theory of wave mechanics. Erwin Schrödinger made great contributions in the fields of color theory and the study of radium. He won the Nobel Prize for Physics in 1933. In his Nobel Prize address, he stated, The way out of the difficulty was actually, though unexpectedly, found in the possibility I have already mentioned, namely, that in the Hamiltonian principle, we might also assume the manifestation of a wave mechanism, which we suppose to lie at the basis of events in point mechanics, just as we have been long accustomed to acknowledge it in the phenomena of light and in the governing principle by Fermat. This statement alone explains the blank look on many of the faces in attendance the evening of the award ceremony.

Schrodinger was later credited with the first determination of the specific gravity of the Saccator. In explaining the physics of wave dynamics, he showed that a fluid passing through media of varying densities will follow the path which will allow it to arrive at the end in the shortest possible time, provided that fluid is not a low-calorie soft drink. Thinking such as this led him to formulate his fundamental law of wave mechanics, a physical which has direct implications to the conduct of laparoscopic procedures. Schrodinger's theory of wave mechanics states a clamped irrigation system will not allow irrigation fluid to flow. 1. Descartes' Vortex Theory Rene Descartes, mathematician and philosopher, contributed greatly to to laparoscopic surgery. His theory of vortices accounts for many explanations in today's operating rooms. His rational basis for hypothesis of creation of the solar system explains many light source problems. But it is for his vortex theory that he is remembered most by surgeons. Studying the logic theory of tube placement, he became fascinated by the evolving randomness of a concerted, non-random action.

He initially studied the placement of tubes in the laboratory. Eventually, he became hospital-based and geographically full-time. Subsequently, he became operating room-based. Reducing tube and wire placement to a mathematical equation occupied his later years. Just prior to his death, he wrote his vortex theory in German, Die Tüben Verschimmelt, in which he states his theory.

All cables and tubing become intertwined despite logical arrangement. 2. Bradley's Aberration of Light Theory James Bradley made many observations on the position and location of the stars. This major discovery, however, was his discovery of the aberration of light. In this paper, he states, the great regularity of the observations left no room to doubt that there was some regular cause that produced this unexpected motion, which did not depend on the uncertainty or variety of the seasons of the year.

The British Science Academy at first took him literally, not allowing operations during the winter months. Later, they relaxed their restrictions and followed up with Saturday laparoscopic booking hours. Light aberrations fascinated Bradley. This fascination eventually led him to study brownouts in the Frampton section of London. From those seminal studies arose his aberration theory, which states, a laparoscopic light source is ineffective if not plugged in. Third Boltzmann's Theory of Entropy and Probability Ludwig Boltzmann, who spent most of his life as a professor in Austrian and German universities, spent a lot of time studying heat. He was the father of the heat-seeking cluster schnitzel, the basic unit of nutrition of the German army. His studies eventually focused on the the second law of thermodynamics and its relationship to the theory of probability.

After studying the effect of prolonged heat on German criminals, he began applying his theories to German surgical activity. He applied his theories to optics and surgical efficiency at the Allgemeine Krankenhaus. As he stated in his classic study, the initial state will in most cases be a very improbable one. This improbable conclusion led him to formulate his theory of entropy and probability. The laparoscopic case preceding your case will be 20% longer than originally scheduled, or C equals P plus T plus .2 T plus L, where C equals the time of onset of your case. P equals present time. T equals scheduled duration of preceding case. L equals turnover time. 4. Lavoisier's law of gas insufflation.

Antoine Laurent Lavoisier was French. Because of the French rural diet at the time, he became interested in gas, its distribution, quantification, and its flow rate through rigid tubes. In the great tradition of French academics, his grand scientific achievement was organizing and interpreting data already collected by others and then publishing them with multiple authors. He was also interested in human respiration. This led to a study of gases and their flow rates. He researched the process of combustion which led him to study oxygen. His interest in flow rates of gases led to the formulation of a law of critical importance to the field of operative laparoscopy.

Professors at the Hotel Dieu, M.A.P., $125 per night single, $145 per night double with continental breakfast, requested that he study flow rates in their operating rooms. He became fascinated with the differences between booking time and the actual time it took to perform a laparoscopic case. Studying these times and flow rates and observing the organization of the operating theaters led him to the formulation of his law. The rate of insufflation of a laparoscopic gas is inversely proportional to the number of laparoscopic cases following in that room, or R equals TL per T squared plus N, where R equals rate of insufflation in liters per minute.

TL equals scheduled time of the case, T2 equals room turnover time, N equals number of laparoscopic cases following in that room. 5. The Reciprocity Law of Bunsen Robert Wilhelm Bunsen, a professor of chemistry at Heidelberg, was the father of many inventions. The charcoal pile, the ice calorimeter, the filter pump, the styptic pencil, and, of course, the Bunsen burner. His Law of Reciprocity was formulated after studying the volcanic composition of two extremities of a trachitic rock in Iceland. This will tell you what kind of a life this guy was leading.

Bunsen's Law of Reciprocity deals with different rock types in volcanic areas. As he wrote, On examining this dike closely, it is easy to see it has melted the surrounding rock at all the points where it has touched it. Using the law, he was able to calculate the amount of time it took one type of rock to aid in the development of another type. For example, if igneous rock helped cretaceous rock for 5 million years, then cretaceous rock would help igneous rock for 10 million years. This principle, when applied to laparoscopic surgery states, if you tie your assistant up on a lengthy laparoscopic case, he will do the same to you at the most inconvenient time.

Sixth Cavendish's Law of Condensation Henry Cavendish studied gas and therefore is an intimate contributor to the discipline of laparoscopic surgery. He also discovered hydrogen. He was much in demand as an after dinner speaker in the mid-L 700s when he would regale professors with his Cavendish's top ten gas list. He was the first to synthetically make water. He became fascinated by condensation problems, leading him to write that hydrogen, when kept under the inverted bottles, contains near one-ninth its weight of moisture. Cavendish was constantly annoyed by condensation on his beaker. He formulated his law of condensation shortly before he was committed to the Shropshire House for the laparoscopically insane. Cavendish's law of condensation states, despite drying, warming, deening, smearing, and white balancing, the laparoscope lens will be obscured by condensation.

7. Einstein's Theory of Laparoscopic Relativity Albert Einstein brought about a revolution both in scientific theory and in hairstyling. His theory of relativity revolved around a new theory of gravitation. He won the Nobel Prize in 1921 for his Unified Field theory, which reduced electromagnetism to a series of equations that no one could understand. His ties to medicine and the surgical world are well known. By uniting time, space, and motion, he successfully analyzed the lunch schedule of the circulating nurse. At the time of his death, he was the special consultant to the Society of American gastroenterologic and endoscopic surgeons to study the most vexing problem facing laparoscopic surgeons.

That problem, the suspension of the time-space continuum following the second hour of any laparoscopic case, is the underpinning of his theory of laparoscopic relativity. Motion, space, and time cease to exist after the second hour of any laparoscopic case. laparoscopists owe a great debt to these pioneering physicists. Each in his own way has contributed to the art and science of laproendoscopic surgery. These principles are utilized daily for the development of the science and for the direct benefit of our patients. We must never forget the great debt we owe these pioneering physicists. Until next time, friends, goodbye from Dan and Leo at Medics Musings.