AOPA Pilot Magazine - May 2024 - 94

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would involve surgery-open or laproscopic
CBD exploration. Fortunately
for me, there is now a minimally
invasive interventional endoscopic procedure
for removing gallstones from
the CBD. Its medical term is unpronounceable-endoscopic
retrograde
cholangiopancreatography-which is
why it's always referred to by the acronym
ERCP. I was scheduled for an ERCP
two days after the MRI diagnosis.
The ERCP is a complex and technically
challenging procedure. It involves
a side-viewing duodenoscope-basically
a specialized borescope equipped
with more tools than a Swiss army knife.
The procedure is done with the patient
under general anesthesia and is X-ray
directed, so it requires a four-member
team consisting of the gastroenterologist
who specializes in endoscopy,
an assistant (since it requires four
hands), a radiology technician, and an
anesthesiologist.
An article from the National Institutes
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94
AOPA PILOT / May 2024
of Health that I found with Google stated
that ERCP complications such as acute
pancreatitis are significantly lower if
the endoscopist has done the procedure
at least 180 times before. Naturally, I
checked on this and learned that my gastroenterologist
had performed thousands
of ERCPs, so I was satisfied I'd be in competent
hands.
Once I was put to sleep with propofol,
the scope was inserted through my
mouth, esophagus, stomach, and pyloric
valve into my duodenum (top of the
small intestine). The ampulla-where
the CBD discharges into the duodenum-was
located visually through
the scope. A guide wire was inserted
through the ampulla and threaded into
the CBD using X-ray guidance to ensure
it was in the right place. A small incision
was made to open the ampulla. This permitted
the stones to be extracted using
various types of baskets or snares or-
in my case-an inflatable balloon used
to trawl the CBD and drag the stones
through the ampulla into the duodenum.
Two stones were found and
extracted from my CBD. Then the scope
was removed, the propofol was stopped,
and I woke up 30 minutes later with a
mild sore throat. I was discharged about
an hour after that with instructions not
to eat until the next morning.
By now you're probably thinking,
" What the heck does any of this have to
do with aviation? "
MIS in aircraft maintenance
A&P mechanics are the surgeons of aviation.
But unlike M.D.s, they have been
slow to adopt minimally invasive procedures,
particularly when it comes to
piston aircraft engines. Cylinder removal
still seems to be the " standard of care " for
most engine maladies. Many A&Ps are
spring-loaded to call for an engine teardown
whenever they change the oil and
find metal in the oil filter.
Splitting the case of an aircraft
engine is the aviation equivalent of
open-heart surgery-it's the most invasive
thing you can do to an engine. Right
behind it on the invasiveness scale is
cylinder removal-a highly invasive
and risky procedure that's the aviation
analog to the open gallbladder removal
surgery (cholecystectomy) involving a
six-inch abdominal incision. (This surgery
very nearly killed my dad in the
1990s, which explains why I've been
reluctant to have my own stone-filled
gallbladder removed.)
For more than a decade, I've been
on a campaign to sensitize A&Ps and
aircraft owners to the risks of invasive
maintenance and the importance
of using minimally invasive procedures
wherever possible in order to minimize
that risk. I've evangelized the use
of borescopes and other noninvasive
methods to figure out what's going on
inside cylinders, crankcases, fuel tanks,
and aerodynamic structures without
having to take them apart. I've also promoted
minimally invasive therapy such
as lapping valves in place and performing
solvent ring flushes to solve the most
common cylinder issues without the
need for cylinder removal.
At first, my sermons from the pulpit
of the Church of Minimal Invasiveness
were not well received by A&Ps. " Show
me where this procedure is described
in the maintenance manual, " they'd ask.
" I'm not allowed to do something that
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AOPA Pilot Magazine - May 2024

Table of Contents for the Digital Edition of AOPA Pilot Magazine - May 2024
