Twenty-Six Hours in Surgery?

How long operations work.

Richard Holbrooke, the president’s envoy to Pakistan and Afghanistan, underwent more than 20 hours of surgery to repair a torn aorta over the weekend. In an “Explainer” column reprinted below, Daniel Engber told how surgeons keep at it for such long periods of time.

A pair of conjoined 4-year-olds who were separated in mid-August have moved out of the intensive-care unit. It took a team of surgeons in Utah more than a day to divide the twins, who shared a body up to the mid-torso. How can surgeons work for so many hours in a row?

They work in teams. A conjoined-twin operation can be broken down into many stages, like the initial incision, the work around the bones, separation of the blood vessels, and reconstructive plastic surgery. A different team of surgeons scrubs into the operating room for each stage, most of which take only a few hours to complete. That way, most of the surgeons don’t end up working for more than four or five hours in a row.

The lead surgeons try to stay involved for the duration. They’ll stay in the operating room for as long as they can, with a couple of breaks for snacks and rest. A surgeon who specializes in long-haul surgeries told the Denver Post that he stops for food and drink every seven hours or so. “It really is like a marathon,” he said. “You’ve got to keep hydrated.”

When surgeons at the Johns Hopkins Children’s Center separated a pair of twins who were conjoined at the head, they had a live feed of the procedure on a video display in a room upstairs. That way doctors who weren’t involved in a particular stage could scrub out for a while and watch the operation on TV.

For the Hopkins conjoined-twin procedure, four surgeons operated at any one time, with one pair assigned to each twin. Nurses shifted into the procedure every few hours, with two assigned to each pair of surgeons. Having so many people at the table could get a little confusing, so nurses and surgeons who worked together wore the same color stripe on their surgical caps.

Got a question about today’s news? Ask the Explainer.

Explainer thanks George Jallo of the Johns Hopkins Children’s Center.