Averting surgical crises: Steps you can take

April 1, 2016

A recent Urology Times article highlights some provocative work that suggests there might be a difference in the ability of the surgeon to respond to a surgical crisis depending on the surgical approach being used-standard laparoscopy or robot-assisted laparoscopy.

J. Stuart Wolf, Jr., MDDr. Wolf,

 

A recent Urology Timesarticle highlights some provocative work that suggests there might be a difference in the ability of the surgeon to respond to a surgical crisis depending on the surgical approach being used-standard laparoscopy or robot-assisted laparoscopy.

Read: Robot may negatively impact surgical crisis outcomes

The concern is that having the surgeon removed from the operative site, at the console rather than at the bedside, could reduce effectiveness at addressing a surgical catastrophe. This may or may not be true, but it brings up the larger issue of what should be done to improve our ability to resolve a surgical crisis. The literature suggests that using simulators (Surg Endosc 2008; 22:885-900), team training (World J Surg 2007; 31:1843-53), and checklists (N Engl J Med 2013; 368:246-53) are all strategies to enhance surgical team performance.

Although our generally unstructured “apprenticeship” model of urology training is effective for many aspects of urology practice, for surgical crisis management it might not work well since the duration of training is such that some urologists enter practice without ever having experienced a surgical crisis. As such, some type of simulation-based training should be considered.

Even without such training, however, there are small but important steps that you can bring to your surgical practice right now that can help. The pre-incision time-out is a great time to orient the surgical team to what surgical catastrophes might be encountered with this particular case. What instruments, sutures, blood products, etc. should we be thinking about? Doing a right-sided retroperitoneal procedure? Maybe get that preloaded 4-0 Prolene ready. Up high under the diaphragm? Tell the anesthesiologist to watch for pneumothorax.

It is the surgeon’s responsibility to lead this part of the discussion during the pre-incision time-out, and engaging thoughtfully in this process will improve your team’s ability to help you address a surgical crisis.

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