Quick guide to sketching in the operating room

Who benefits from sketching in the operating room?

It can be useful for med students scrubbing in for the first time, residents/fellows learning the procedure, all the way up to seasoned staff (see below). It is something that I will continue to do throughout my career.

How do you benefit as a trainee?

There is so much attention in the literature paid to simulation-based training. Lo-fidelity, high-fidelity, you name it. Sketching before the surgery forced me to walk through the steps in my head, much like a simulation or a football player going through the plays before the game. Sketching after surgery gave me an opportunity to reflect on what was done, in what order and how it was done. By doing this immediately afterwards, I could recall the steps more precisely. It also serves as a reference for next time.

Along with knowing the steps is knowing the tissue planes and anatomic relationships. Drawing has made me more observant of these details and artists talk about developing an “eye”. Truly, the more you look, the more you see. I didn’t truly appreciate this until I started sketching regularly.

How do you benefit as an experienced staff surgeon?

While I am not one myself, I see staff surgeons use drawings to figure things out. It’s the equivalent of a back-of-the-envelope sketch. In particularly unique or difficult cases, it helps to walk-through the case with your assistants and trainees. It can be an informal discussion beforehand but you can use drawing to illustrate what the plan might be.

It also helps for operative notes to communicate with those not in the OR, especially non-surgeons. After a long case with multiple tubes and/or anastomoses, a simple sketch is so helpful especially if the patient is not going to your surgical service (e.g. ICU).

What do I bring to sketch with?

• Pencils (2H, HB, 3B)
• Black pen
• Eraser (generally, I don’t use this in the OR as the eraser bits get everywhere but handy when refining my sketches afterwards)
• Sharpener (one that is entirely self-contained)
• Hand-held sketchbook
• Camera (with photography consent from the patient, of course)

This will fit in most large scrub pant pockets. If it gets cumbersome, I just take the sketchbook and an HB pencil.

What details are important to take note of?

• Draw not only the site that you’re operating on but adjacent structures. This shows anatomic relationships and orientation.
• Traction sutures
• Retractors
• Instruments – while it may seem unnecessary, it comes in handy for future reference. This gives you something to refer to the next time you say, “What was the clamp thingy-majiggy that we used on the aorta?” In the drawing, I like to show how it was used.
• Label your drawings – it is nearly impossible to draw a 7-0 PDS suture (I’ve tried). A few key labels (sutures, instruments, organs, etc.) go a long way. It doesn’t have to be 100% visual.

How do you sketch in the operating room?

When I first learn a procedure, I want to sketch every step. As I see and do more of a particular case, I sketch key details that I may not have noted before. Now, I tend to sketch more rare cases or even routine cases with unique anatomic variations and approaches.

At the end of the case after I’ve scrubbed out, transferred the patient to recovery, finished the paperwork (yes, we still have paper and computer-based orders!), dictated, gone to the bathroom, checked in the next patient, I usually have a few minutes for a few very rough thumbnail sketches. These are refined later but I get down the most important details that I want to remember.

-LCTL

If you have a question or have a tip to share, please leave a comment below!