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They say that bilateral symmetry is an indicator of attractiveness and freedom from disease^{1, 2}.

But in today’s world, bilateral symmetry comes with a unique set of potential problems. If you have two legs, then it’s critical that your surgeon knows which foot not to amputate.

Wrong-sided surgery happens, and although it might not happen a lot (relatively speaking), the consequences can be devastating. And when it’s a craniotomy (opening up the skull to get at the brain) on the wrong side, the implications are scary. The authors of a paper evaluated three times at F1000 (making it one of our Top 7 in Medicine), Wrong-site craniotomy: analysis of 35 cases and systems for prevention, estimate that in 2002, 32 wrong-site craniotomies (out of ~145,000 total) were performed in the US alone³.

The authors identify a number of reasons for the instances of wrong-site surgery they studied: communication breakdown, inadequate preoperative checks, technical factors and imaging, and finally, human error. In four cases, the wrong side had been prepared for surgery by someone other than the surgeon, who (quite reasonably, perhaps) assumed the correct side had been prepared. Human error, not surprisingly, appears to be more prevalent in late night and emergency situations.

Fortunately, most of the 35 cases examined did not result in major neurological trauma, but there is obviously something rotten in the state of Denmark when any surgical intervention carries a non-zero risk of being in the wrong place (or even performed on the wrong patient). The authors state,

many WSCs that have occurred in the past could have been prevented with strict, comprehensive, and thorough protocols and procedures.

They make some recommendations, including noting the correct site on the consent form; better (and automated) imaging procedures (such as placing some sort of imaging-opaque pill or marker on the site); an operating room ‘time out’ that includes double-checking the imaging; and mandatory reporting of errors.

They also compare medical procedure with flight (brain surgery and rocket science?), saying

In dealing with individual human lives, we should be at least as vigilant and proactive as the airline industry in terms of reporting, investigation, analysis, and remediation.

Yes, please.