How is Microsurgery like a Symphony?

When I leave the operating room after vasectomy reversal microsurgery, I thank the staff for all their help and often compliment them on a “great performance.” Because that’s what complex microsurgery really is, a performance. Like that on any other of life’s stages.

A complex musical score
Sorabji’s Opus Clavicembalisticum: the harmony “bites like nitric acid.” (Courtesy:

 A Team Sport

Surgery is like a symphony. As the surgeon, I am both the conductor and first violin, directing and performing in the event. But there are others in the room, the orchestra, who are so essential to the go and flow of things. Think about it: If the surgical scrub across from me does not know what I need, time is wasted. If it takes 10 more seconds than usual to provide my instrument or suture, and I ask for something 100 times a case, that adds almost 20 minutes of largo (slow cadence) to the symphony. But with preparation, things move along beautifully, a tempo (on time) to the benefit of all. Would you really want to walk in blind to your performance of Bach’s “Well Tempered Clavier?”

Captain’s Call

But there’s more. How about the conductor? Surgeons like to go fast, maybe because it’s perceived as a sign of being “good.” Sure, fast-and-good is better than fast-and-bad. But honestly how many symphonies are performed entirely allegro (fast) or pretissimo (superfast)? If the patient is the score and each musical movement represents their biology, you can see how being sensitive to the nuances of each piece will lead to a better performance. So much of the poetry of life, music and surgical precision are missed by speeding through things.

God of Small Things

The philosophy that “life is in the details” is so utterly applicable to both surgery and symphonies. Complex musical or surgical movements require deliberate attention to detail, homage to pace and cadence, and appreciation of a medley of moods. First observing and then respecting those small biological differences among patients are similar to divining the nuanced work of a brilliant composer. Take for example Mozart’s study on “Twinkle, Twinkle, Little Star” in his Twelve Variations in C major on “Ah vous dirai-je, Maman” K. 265/300e. A delightful frolicking around and about a simple nursery rhyme. In surgery too, a single moment can make all the difference, like waiting for that small, momentary stillness that occurs after a deep exhalation and before air is drawn again to place that difficult microscopic suture. Can’t rush perfection.

For surgery, like music, is a craft and one of the highest order. The innumerable details that characterize surgery or a sheet of music are more than just unrelated points or sounds in space. When taken all in and performed just right, they represent the best of art, beauty and design. So hats off to the small stuff in life as many great big things result from lots of small little ones.

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