Wow, I would love to watch that procedure. However, I'm thinking the operation alone would kill the fish. I would think that manually removing the parasites would open the fish up to a variety of infections. But if the ich is so bad, enough to kill the fish anyway, then I suppose there's no harm in trying. From my limited experience and what I've read, rams aren't the most healthy fish to begin with. The trauma should do the fish in long before the ich would.