Waiting lists for operations are often long and surgeons' fees can be very high. You can overcome both problems by learning how to perform surgery on yourself. Of course, you have to remember that some operations are far too complicated for the beginner. Even quite gifted amateurs will have difficulty in coping with delicate neurosugical procedures. Amputations can be pretty tricky too.

Before you do anything at all you must plan your operation. You may have a cool nerve, steady hands and an incisive mind but you wont get far without a few instruments. Planning is all important in surgery. There is nothing worse than getting to the end of an operation and discovering that you dont have anything with which to close the wound. You'll find that walk to the local sudery appliances shop twice as long when your having to hold the edges of a gaping wound together. Remember how it feels when there isn't any toilet paper left ? Well, it'll be a lot worse than that!

The first decision you must make concerns the nature of the operation you intend to perform. Here are some of the operations you can choose from: tonsillectomy, hip replacement, orchidoplexy, mammaplasty and hemicolectomy. There are lots of other operations; some of them quite impossible to spell. Dont allow yourself to drift into doing a operation just because you can pronounce it. Try to choose one that will be useful. I suggest that you try an exploratory laparotomy or a simple cholecystectomy to start with since the mortality rates associated with these operations are relatively slight.

Having decided on an operation you must next collect together all the instruments and equipment you're likely to need. A good basic kit will include :foot operated suction pump, bi-active hyfrecator, platinum tipped cautery burner, heavy duty gynaecological transformer, proctosigmoid dessection set, universal needle set, angle ball electrode, Babinski's percussor, diathermy scalpel handle, Halsted's `mosquito' artery forceps, Backhaus' towel clips, Lister's sinus forceps. Foerster's sponge holding forceps, Littauer stitch sissors, Wright's needle holder, Crile Murray's needle holder, aural syringe, McKay nail elevator, seamless aliminium ear trough, Thudichum's nasal specula, Higginson's rubber syringe, Rose's sinus douching cannula, post nasal and laryngeal atomizer, St Clair Thomson's rhionoscope mirrors, Naunton Morgan's rectal speculum, universal lighting attachment, Barron haemorrhoidal ligator, dissecting forceps, uterine curette, Horrocks uterine sound, heavy duty cautery outfit, Macrae mucous extractor, umbilical dilator, Portex umbilical cannula, disposable sugical gloves, self sealing bisexual urinal.

You'll also need a large cardboard box filled with assorted syringes, needles, towels and paper tissues. You wont need to bother with a mask. Sugeons only wear those so that they wont be recognised afterwards.

Most of the instruments I've described can be obtained from any surgical supply store, but if you have any difficulty in finding some of them try approaching your local hospital. Offer to bye or rent an armful of assorted instruments. You will need at least an armful for any useful operation.

Having chosen an operation and having collected a bundle of instruments, you must then decide on the best site. You can, of course, perform your operation just about anywhere but it might prove sensible to opt for the kitchen. For one thing there will probably be a large table there. What's more, the floor and walls will probably be fairly easy to clean. If your home is equipped with a specially furnished operating theatre then there will, of course, be no problem.

Next you must have a good shave. Not just the hair on your face; you must shave your entire body. Little germs and other nasty things can hide among the hairs - particularly the tightly packed curly ones - and so it is vitally important to remove every last millimetre of stubble.

Finally, before you start it's wise to take the telephone off the hook and put any animals in another room. You dont want people ringing up when your half way through a liver transplant to ask you round for coffee; nor do you want your dog to hang about begging for scraps. It might be a good idea to lock and bolt the back door too. Neighbours and tradesmen who might wander in by mistake may bring fresh germs with them. They are very unlikely to have shaved off all their hair before coming to see you.

With everything ready you can now begin. Pull the table into a good position where the light is evenly distributed. Put a pillow or a pile of towels under your head so that you can see what you are doing. Unfasten your skirt or your trousers and part your clothing so that you can see the whole area involved. If you are going to perform brain surgery you can keep all your clothes on.

Before you cut through the skin you must give yourself an anaesthetic, of course. This is really quite important. I suggest you give yourself an intravenous injection of Valium - using perhaps 20 mg. You mustn't render yourself completely unconscious, or you'll have difficultly in continuing with the procedure. You can start cutting as soon as you begin to feel woozy.

If, for example you have decided to perform a gall bladder removal operation on yourself, you can now set to work in search of the gall bladder. The following outline will demonstrate how simple it all is.

You will, of course, have unfastened your trousers (or skirt) and pulled your shirt (or blouse) right up under your chin. You may even like to remove your clothing altogether. Do remember to draw the kitchen curtains if you do this. Your gall bladder is nestling somewhere under your right rib and that is where you will be working.

The first cut must take you right to the site, so it is important to make it in the correct place. Dont make half a dozen cuts or you're going to find sewing up afterwards a real nightmare. The cut should be precisely situated underneath that rib. Do make a good deep cut and dont be tempted to mess around with a lot of wimpish little nicks. A really sharp slash with your scalpel will take you straight through the skin, the subcutanous fat, the fascia, the muscle layers and the peritoneum. Poke your hand through the hole you've made and feel around inside. Once you've found the gall bladder (you cant fail to recognise it) you can use your scissors to cut it away from the other internal tissues. There may be a little bleeding but there shouldn't be anything that a styptic pencil won't stop. (A styptic pencil, by the way is a very useful item.)

With the gall bladder out of the way, all that remains is to sew up the wound again. That shouldn't take more than a minute or two. It really is an extremely simple business and it's astonishing to think that surgeons make so much fuss about it.

Give yourself five minutes to recover and then get up off the table and make yourself a nice cup of tea. (That's another advantage of using the kitchen - the kettle isn't far away.) Dont forget to throw the gall bladder away. Wrap it in a paper bag if your going to put it in the dustbin. As you relax with your tea, you can reflect smugly on the huge amounts of time and money you've saved.

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