The awake surgeon is a method in which the patient is awake and conscious, which has the advantage of minimizing neurological damage. However, the emotional anxiety that patients feel during surgery and the commitment they need to make beforehand means that it’s not for everyone.
A South Korean drama once aired a scene in which a patient underwent brain surgery while still conscious and shot a bow. Immediately after the episode aired, many social media sites criticized the show, saying, “It’s a drama, but isn’t it too much?” and “Isn’t it unreasonable?” However, the criticism gradually diminished after the episode aired, as American violinist Roger Frisch played the violin to see if his hand tremors were relieved during the 2009 episode.
So what is awake surgery? The word “awake” has a dictionary definition of “wakefulness,” meaning to be awake and alert. Therefore, awake surgery refers to the practice of giving a patient a sleeping anesthetic and then reawakening them during surgery.
So, when is awake surgeries performed? There are two main reasons why awake surgeries are needed. First, it’s used for patient safety when surgery is required in a very dangerous area and it’s difficult to obtain pre-operative images even with modern imaging equipment. Second, wake surgeries are chosen when a surgeon needs to decide whether to remove or preserve a certain part of the body during surgery. This is because it is difficult to get an accurate picture of the patient’s condition while under general anesthesia. The advantage of this method is that the surgeon can check on the patient’s condition throughout the surgery.
The idea of performing surgery while the patient is awake raises questions such as “Isn’t it dangerous?” or “Won’t the patient feel pain?”. If awake surgery is safe, would I choose awake surgeries every time? To answer these questions, you need to have a basic understanding of the surgery.
Patients undergo surgery in a normal, awake state, able to hear, see, speak, and feel everything except pain. While the scalp is opened and incisions are made in the muscles and skull, the patient is given a partial nerve anesthesia beforehand. During this process, you will feel all the sensations of pins being driven into your head and tissue being cut. In the case of tumor removal, once the tumor is exposed, the surgery is performed in a near-pain-free state, as there are no nerves to cause pain. To minimize damage to the areas responsible for speech and movement while removing the tumor, the patient is constantly asked to speak, lift their leg, or fold their fingers during the surgery. More complex questions or exercises may be asked. This real-time monitoring of the patient’s condition reduces the likelihood of postoperative disability due to neurological changes that may have gone undetected during general anesthesia surgery.
The surgery is performed by inserting electrodes into the affected area to stimulate it. The stimulated area may recover normally or worsen, so the surgeon checks the patient’s condition from time to time. However, since normal brain circuits are stimulated during the stimulation, side effects may occur, so the patient’s determination is required before surgery. The surgery takes about an hour and a half to implant the electrodes on one side of the brain, and about three hours to implant the electrodes on both sides. This is followed by the insertion of the battery into the electrodes under general anesthesia.
Since awake surgeries require patients to be awake and conscious for a long period of time, there is a significant amount of emotional anxiety for patients, including being able to hear any emergencies or doctor’s conversations during surgery. However, this surgery has the advantage of minimizing the possibility of postoperative disorders. Therefore, it is recommended that you consult with your doctor in depth before deciding whether or not to have the surgery.
So, if you want an awake surgeon, can you always get one? Not always. It“s mainly limited to brain-related conditions that are closely related to muscles or speech. Therefore, it”s not always possible to have it.
Due to the high burden on both patient and doctor, few doctors specialize in this procedure and it is not as widely known as other surgeries, so the number of surgeries is very low. In South Korea, awakening surgeries are usually performed by doctors or professors with many years of experience and are not yet well developed. However, given the benefits of awake surgeries, more research and investment could lead to more patients with less postoperative damage. More research and capital investment in awake surgeries is needed.
