Impact of Procedure Type, Case Duration, and Adjunctive Equipment on Surgeon Intraoperative Musculoskeletal Discomfort.

BACKGROUND: Surgeons are at high risk of developing musculoskeletal disorders. STUDY DESIGN: This study was designed to identify risk factors and assess intraoperative physical stressors using subjective and objective measures, including type of procedure and equipment used. Wearable sensors and pre- and postoperation surveys were analyzed. RESULTS: Data from 116 cases (34 male and 19 female surgeons) were collected across surgical specialties. Surgeons reported increased pain in the neck, upper, and lower back both during and after operations. High-stress intraoperative postures were also revealed by the real-time measurement in the neck and back. Surgical duration also impacted physical pain and fatigue. Open procedures had more stressful physical postures than laparoscopic procedures. Loupe usage negatively impacted neck postures. CONCLUSIONS: This study highlights the fact that musculoskeletal disorders are common in surgeons and characterizes surgeons' intraoperative posture as well as surgeon pain and fatigue across specialties. Defining intraoperative ergonomic risk factors is of paramount importance to protect the well-being of the surgical workforce.

Pediatric medical device development by surgeons via capstone engineering design programs.

BACKGROUND: There is a need for pediatric medical devices that accommodate the unique physiology and anatomy of pediatric patients that is increasingly receiving more attention. However, there is limited literature on the programs within children's hospitals and academia that can support pediatric device development. We describe our experience with pediatric device design utilizing collaborations between a children's hospital and two engineering schools. METHODS: Utilizing the academic year as a timeline, unmet pediatric device needs were identified by surgical faculty and matched with an engineering mentor and a team of students within the Capstone Engineering Design programs at two universities. The final prototypes were showcased at the end of the academic year and if appropriate, provisional patent applications were filed. RESULTS: All twelve teams successfully developed device prototypes, and five teams obtained provisional patents. The prototypes that obtained provisional patents included a non-operative ureteral stent removal system, an evacuation device for small kidney stone fragments, a mechanical leech, an anchoring system of the chorio-amniotic membranes during fetal surgery, and a fetal oxygenation monitor during fetoscopic procedures. CONCLUSIONS: Capstone Engineering Design programs in partnership with surgical faculty at children's hospitals can play an effective role in the prototype development of novel pediatric medical devices. LEVELS OF EVIDENCE: N/A - No clinical subjects or human testing was performed.

Theatre of paediatric surgery.

In the 50 years since the first edition of this journal, operative paediatric surgery has undergone radical change. Many of the most common instruments are unchanged, both as a testament to their utility and in recognition of past surgeons remembered eponymously. Surrounding that basic core of instruments, theatre has changed radically as new tools and techniques have arisen. Surgeons have come down from their pedestals, recognising surgery as a team sport rather than a solo performance. More than half of the current paediatric surgical trainees are women, a higher proportion than in any other craft group of the Royal Australasian College of Surgeons. The appearance, and rapid development, of laparoscopy is to many observers the most notable change in surgery over the last 50 years. Placed in its context though, it is simply the most prominent example of a frameshift in surgical thinking. The patient as a whole is now the focus, rather than just the disease. Recent developments are as much about minimising harm to normal tissues as they are about extirpating pathology. As a surgical maxim, 'Primum non nocere' is even more in evidence in 2015 than it was in 1965.

Health technology assessment in surgery.

This review focuses on how surgical methods should be assessed from a health technology perspective. The use of randomized controlled trials, population based registries, systematic literature research and the recently published IDEAL method are briefly discussed.

Specialist surgery in the developing world: luxury or necessity?

Patients suffering from conditions requiring specialist intervention cannot obtain treatment when facilities do not exist locally. Specialist visiting teams in a number of surgical disciplines have attempted to address these issues in collaboration with local clinicians. These interventions require careful planning and communication to achieve optimum results. Several teams have been successful in building long-term relationships that have lead to important clinical developments in the local country.

Telemedicine's adolescent angst.

Ten years after telemedicine hit the mainstream, growing pains are evident, robotic surgery and other "wows" relatively rare. But home-based care is set to explode.

Specialized staff and equipment for weight loss surgery patients: best practice guidelines.

OBJECTIVE: To provide evidence-based guidelines on the specialized personnel, equipment, and physical plant required for safe and effective care of severely obese weight loss surgery (WLS) patients. RESEARCH METHODS AND PROCEDURES: We examined MEDLINE (Ovid and PubMed) and the Cumulative Index of Nursing and Allied Health Literature for articles on facilities resources for care of WLS patients published in English between January 1980 and March 2004. We queried several web sites for appropriate references; these included the Agency for Healthcare Research and Quality and the American College of Surgeons. The majority of reference material was descriptive and not specific to facilities resources for WLS patients. We identified a substantial body of literature on the general subject of patient safety; three of these articles were used to develop recommendations on the use of technology for medical error reduction. All other recommendations are based on 11 expert opinion reports. RESULTS: We recommended adequate training and credentialing for all medical staff; dedicated support and administrative personnel; and specialized interventional, diagnostic, operating room, and transport equipment. We specified needed adaptations to the physical plant and developed evidence-based guidelines for medical error reduction and systems improvements. DISCUSSION: Specialized resources and dedicated staff are needed to protect the health of WLS surgery patients and staff. Adaptations include preoperative preparation for safe means of patient transport; techniques of anesthesia and intraoperative exposure; provisions for postoperative recovery; and measures to assure postoperative patient safety, hygiene, and comfort.

Técnica cirúrgica / Surgical technique

O texto busca apresentar os princípios essenciais da técnica cirúrgica aplicando-os em procedimentos básicos, procurando adequá-los à realidade da disciplina de Técnica Cirúrgica da Faculdade de Medicina da PUCRS (FAMED-PUCRS). Trata dos princípios fundamentais da técnica cirúrgica, descreve de forma prática os tempos operatórios e os passos para a montagem de uma mesa cirúrgica básica com seus instrumentos essenciais, o preparo do animal, passando pela anestesia e chegando aos procedimentos propriamente ditos. São descritas também as técnicas consagradas de laparotomia, flebotomia, traqueostomia, gastrostomia, anastomoses intestinais e colocação de dreno de tórax, com modificações que visam otimizar o aprendizado

Intraoperative magnification: Who uses it?

Surgeons over recent decades have made increasing use of intraoperative magnification to enhance the outcome of surgical procedures, yet no published information exists regarding the extent of magnification use within surgical specialties. A sample of surgeons consisting of 148 specialists and senior surgical trainees in the west of Scotland was surveyed by postal questionnaire regarding their frequency and types of magnification use. Patterns of use were similar within each specialty, but varied markedly between specialties. Otolaryngologists and plastic, maxillofacial, and ophthalmic surgeons use both loupes and microscopes frequently. Cardiothoracic and pediatric surgeons tend only to utilize loupes, whereas neurosurgeons tend only to use microscopes. General surgeons, urologists, orthopedic surgeons, and gynecologists are infrequent users or nonusers of magnification, and when required will utilize loupes rather than microscopes. As a clear pattern of magnification use exists, it should be possible to anticipate the equipment needs of surgeons when providing theater services.

Can using emergent technology incur liability?

There are numerous areas of potential liability for the practicing surgeon attempting to upgrade skills and introduce emergent technology into his or her practice. The College understands that graduate medical education in a teaching institution, continuing medical education at our College-sponsored venues, and all other sponsored or co-sponsored educational activities each carry risks and benefits. Current College activities are directed toward enhancing translation of emergent surgical technology into clinical practice as effectively, productively, safely, and as free of risk as possible.