New Frontiers in Wide-Awake Surgery.

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Explain the most important benefits of wide-awake surgery to patients. 2. Tumesce large parts of the body with minimal pain local anesthesia injection technique to eliminate the need for sedation for many operations. 3. Apply tourniquet-free surgery to upper and lower limb operations to avoid the sedation required to tolerate tourniquet pain. 4. Move many procedures out of the main operating room to minor procedure rooms with no increase in infection rates to decrease unnecessary cost and solid waste in surgery. SUMMARY: Three disruptive innovations are changing the landscape of surgery: (1) minimally painful injection of large-volume, low-concentration tumescent local anesthesia eliminates the need for sedation for many procedures over the entire body; (2) epinephrine vasoconstriction in tumescent local anesthesia is a good alternative to the tourniquet and proximal nerve blocks in extremity surgery (sedation for tourniquet pain is no longer required for many procedures); and (3) evidence-based sterility and the elimination of sedation enable many larger procedures to move out of the main operating room into minor procedure rooms with no increase in infection rates. This continuing medical education article explores some of the new frontiers in which these changes affect surgery all over the body.

Design, Development, and Validation of a High-Fidelity "Ganglion Cyst" Model for Cadaveric Hand Surgery Training.

Introduction This study presents a design and developmental model with prospective validation. This study was aimed to design, develop, and validate a cadaveric model simulator of a ganglion cyst to train surgeons in its surgical excision. Materials and Methods A novel "ganglion cyst" was designed using a latex powder-free glove and water-based, water-soluble lubricant (K-Y jelly). This "ganglion cyst" was then inserted subcutaneously into a cadaveric hand, positioned over the dorsum of the wrist to simulate a ganglion lesion. This simulation model was prospectively validated using postsimulation surveys conducted on novices and experts in hand surgery. The simulation was conducted during a basic hand surgery cadaveric workshop that included a practical station on ganglion excision. Results Both the novices and experts had a concurrent agreement that the simulator provided relevance, realism, and value as a simulator for the teaching, excision and procedural assessment of ganglions in the hand. Conclusion The role of high-fidelity simulation has been documented in the literature for surgical procedures. This simple and affordable model that we have developed and validated allows for the creation of a high-fidelity ganglion simulator in the cadaveric hand for teaching, excision, and procedural assessment among trainees.