Tunnel vision in surgery: looking for anatomy



Tunnel vision is a cognitive bias associated to radiology when a finding preclude a total observation of the visual field missing an important piece of information. A similar situation could happen when a surgeon focused his or her intervention over a segment without a complete physical or functional review of the anatomical area involved.

Two narrative examples will help to understand this concept..

EXAMPLE 1: a patient with a tumor on his hand was treated with surgical excision. Days later a lump was discovered on his axilla on the same side of the initial tumor.

Comments: surgeons are used to see patients inside the operating room without previous general examination. They trust on previous medical records and physical examination made for other doctors usually internists.

Analysis: this could be seen as a “system failure” related to a wrong diagnosis. At least the anatomical compartiment must be examined at the operating room.

EXAMPLE 2: a male patient started with ictericia, acolia and coluria. A sonogram showed a big stone close to the gallblader. He had a surgical intervention and the stone was removed. Eight months later the patient started again with obstructive ictericia in relation to a tumor on the Vater ampulla.

Comments: normally one disease explained the symptoms of a patient, but all possibilities around the anatomical area must be excluded.